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Version Control:

Date Version Comments sought from

Comments Changes

27th May 2015

5.1 AD’s Quality Improvement & Safety

i)Review contents Content change

1st June 2015

5.2 Phillip Young (Chair Ealing CCG QPS) and Trish Longdon (Chair Hammersmith & Fulham CCG QPS)

i)Review content ii) Review layout of the Strategy & Appendices

Layout and content change

4th June 2015

5.2 Whole Team (CCG Quality, Safeguarding & Medicines Management) Away Afternoon

Critique & discussion None

5th June 2015

5.3 Quality team discussion & review

i) Key component to delivery is our own capability & expertise. ii) Values reviewed.

Additional enabler added Learning & development. Team values updated.

21st July 2015

5.4 Whole team discussion & review

Requested more detail and easier read version

Changes to structure, grammar and inclusion of appendices

19th August 2015

Central London Quality & Patient Safety

None Approved

1st September 2015

West London Quality & Patient Safety

None Approved subject to further discussion by WL CCG senior team

25th August 2015

Hammersmith & Fulham Quality & Patient Safety

To include: i)Resource implications (p4) ii) Ongoing monitoring (p7).

Approved

25th August 2015

Hounslow Quality & Patient Safety

To include: i)The role of system Leadership (p3, 4). ii) Patient empowerment and engagement (p2). iii) Cultures that enable learning (p6). iv) Importance of mandatory training (p6).

Approved

Ealing Quality & Patient Safety (QPS Chairs Action)

None received

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Introduction

The CWHHE Collaborative Clinical Commissioning Groups (CCGs) are committed to working in partnership with patients, carers, the wider public and local statutory and non statutory partners to ensure that the services that are commissioned are high quality and responsive. More specifically, the CCGs are committed to ensuring both the continuous improvement in patient experience and the overall quality of care that is provided locally. Our established governance structures (appendix 1) support us to deliver this ambition.

Quality in healthcare is a multifaceted concept and is not amenable to a single performance measure or simple metric. In the past two decades there has been a concerted international effort to improve measurement and reporting, and a growing consensus about the key domains of quality in healthcare and relevant measures and indicators for these domains.

The CCGs have been working with lay members, clinical leaders, providers of NHS services and wider stakeholders to develop a shared definition of our quality priorities to inform decisions for commissioning person-centred care that is safe, effective and where people have as positive an experience as is possible of treatment and care.

The focus of this strategy (which should be viewed alongside and is intrinsically linked to the CWHHE CCGs Patient Experience Strategy) is both in the ‘here and now’ but also the future, the aim being that delivery will be driven forward irrespective of personnel or organisational changes.

Strategic Context

The NHS Outcomes Framework sets out key requirements for CCGs to: • Commission high quality services • Identify the improvements they wish to secure in the quality of services they commission • Use the commissioning process to drive up continuous quality improvements. The term ‘quality’ in this paper draws on the definition set out in ‘High Quality Care for All’

(Department of Health, 2008) which highlights the 3 dimensions of quality as outlined below:

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Developing the Quality Strategy:

An initial ‘Quality Strategy discussion document’ was written as Clinical Commissioning

Groups (CCGs) became legal bodies. The discussion document outlined the general direction

of travel during the transition period from Primary Care Trusts (PCTs) and over the initial

setup of the CCGs. In 2014 the document was reviewed and it was agreed that CCGs needed

a more robust strategy to move the quality agenda forward.

As a result, a series of stakeholder workshops took place late 2014 and early 2015. The

workshops were attended by over 50 participants including lay members, Healthwatch

representatives, CWHHE Quality Committees Chairs, GPs, NHS Provider Quality leads and

Directors of Nursing, Medical Directors and commissioners.

The themes and outcomes emerging from the workshops as well as those identified in

developing the patient experience strategy were used to develop the ‘Ambition’, ‘Values’’

and ‘Outcomes’ outlined below.

‘Our Ambition for Improving Quality across CWHHE CCGs’

We will work together with patients, carers and our partners collaboratively as system leaders to

achieve the best quality healthcare outcomes by using the best clinical evidence and patient

feedback to commission care that is:

effective

Safeguards patients and prevents all avoidable harm

consistently shows improvements in positive experience and satisfaction of all patients and

carers and staff

‘Values That Will Drive Our Ambition Forward’

Patient experience

Clinically effective

Safety

Care which provides as positive an

experience as possible of treatment and

care, including being treated according to

what an individual wants and needs and

with compassion, dignity and respect

Care delivered according to

best evidence as to what is

clinically effective in

improving an individual’s

health outcomes

Care which is

delivered to

prevent all

avoidable harm

and risks to the

individual’s safety

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We will:

Act with compassion, honesty and integrity, and be accountable for our decisions and actions

Engage and work with with our partners providing both robust challenge and high support

Promote creativity and innovation

Work together with teams, organisations and across systems to provide the best available outcomes for patients and carers

Ensure that public money is used effectively and efficiently to promote and improve healthcare equitably.

Identify and escalate implications for resource allocation.

‘Expected Outcomes’

No never events.

No NWL patient is harmed by abuse or neglect or failure by our services.

There is an effective process for organisations to learn from their experience (and from each other) to make sure that they don’t repeat mistakes

People using services and staff have confidence that they are in a safe environment.

The is a culture of openness, learning and transparency in how we work as CCGs which is reflected in our expectations of how our commissioned providers work with our patients, their supporters and us.

The CWHHE Collaborative is in the top quartile for all clinical outcomes.

Patients rate their care as best in the country with CWHHE commissioned providers.

Patients are at the centre of their care and have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals.

All organisations have adopted the recommendations of ‘Freedom to speak up’ the Frances review on whistleblowing.

‘Current Challenges and New Opportunities’ The engagement to develop the Quality Strategy also identified key challenges as well as new opportunities to consider. These include:

System Leadership to ensure that we more away from:

o The provider commissioner relationship which largely based upon a contract to a

more collaborative approach to improve quality within and across organisations

o A zero tolerance contract management process can limit a culture of open reporting

for fear of penalties to a culture that demonstrates learning, openness and

transparency

o Quality being at the periphery of the new and emerging transformation programmes

to being embedded and key driver for change across health and social care

o Developing a workforce trained to deliver traditional activities to driving change to

working in collaboration with health and care providers and commissioners to

ensure that current and emerging workforce is equiped and supported to deliver

care which reflects the new ambition for integrated, whole systems person-centred

care.

Address the disparity in focus relating to quality, finance and performance where :

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o Contracts monitoring focusses equally on costs, volume and quality of care

o Data gathering and collation is based on a clear purpose and is used systematically

to improve the quality of care commissioned by CWHHE CCGS

Emerging NHS financial position and implications on investment in the workforce:

o Ensuring that the workforce recruitment, development and training needs are not

disproportionally impacted on given NHS cost pressures. Evidence suggests that

there is a direct correlation between workforce development / development /

recruitment / retention and the quality of care and support that patients and carers

receive.

o London’s unique positions in terms of:

A young, mobile workforce creating a higher turnover of staff.

Higher than average spend on agency staff: London NHS Trusts spend

approximately £500 million on agency staff per year.

Key Enablers: What may help us deliver these outcomes?

Partnership working: a number of strategic partnerships work to improve the quality of care across

North West London. These include:

1. Imperial College Health Partners (NWL Patient Safety Collaborative): main aim is to deliver

demonstrable improvements in health and prosperity for the people of North West London and

beyond through collaboration and innovation. It does this by spreading best practice research

across a range of health and social care areas.

2. Health Education North West London (HENWL), the Local Education and Training Board (LETB)

for the North West London area: As part of Health Education England they are responsible for

planning the availability of all NHS healthcare staff in the area and ensuring high quality

education and training is provided to them.

3. Strategic Clinical Networks: Strategic Clinical Networks work in partnership with commissioners

(including local government), supporting their decision making and strategic planning, by

working across the boundaries of commissioner, provider and voluntary organizations as a

vehicle for improvement for people, carers and the public.

4. NWL Quality Surveillance Group: A Quality Surveillance Groups (QSG) has been established in

North West London which brings together NHS England, TDA, the CQC, Monitor, HealthWatch,

LA and CCGs to routinely share information and intelligence to safeguard the quality of care

people receive.

5. HealthWatch: the independent consumer champion for health and social care provides us with a

critical challenge and completes its own reviews on health and social care providers across our

sector.

6. The CWHHE Collaborative: Information flows across various parts of the system to build a richer

picture of issues and challenges in the Health and Social Care economy. Working collaboratively

frees up capacity and decreases duplication. It is key to delivery on a number of key enabling

projects, for example:

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o WHYSE: an online tool that can be used to manipulate huge amounts of centrally

stored data and convert into usable analytics.

Business planning processes: Improving the links between the Quality team and the Project

Management Office will help align quality with the wider business processes of the CCGs.

o Greater alignment in the annual processes of QIPP, CQUINs and development of the

Quality Schedule.

System culture: All organisations within the health system work together and with people openly and honestly to achieve high quality seamless care and services. This is achieved by:

o There is a collaborative partnership approach to quality between and among people who use services, providers and commissioners.

o Senior leaders work together to remove organisational obstacles to deliver better value for the populations they serve.

o There is an honest conversation with the public and with staff about what can and cannot be provided.

o Positive leadership behaviour and good clinical practice is routinely celebrated and rewarded.

Learning and development: We invest in our own staff development, there is a culture that enables

learning and people want to work here. This is achieved by:

o There is a meaningful appraisal system in place; requirements for mandatory training are met; there are clear objectives relevant to the person and to the role and a systematic approach to identifying learning needs across the directorate.

o Staff have access to programmes of development that enable them to fulfil their roles and enable professional growth through capitalising on their ideas; enabling ‘good’ morale; fostering positive attitudes, motivation and behaviour.

o Specialist skills are maintained ‘we sustain our experts’. o Our staff have access to relevant training ‘we grow our own’. o Positive leadership behaviour and good clinical practice is routinely celebrated and

rewarded. o Personal and professional development is a ‘core task’.

Implementation of the Quality Strategy: How do we do we get there?

Our focus is primarily on system leadership, promoting a shared understanding of what good is and

to improve how we work together across multiple organisations. We will promote dialogue among

system leaders and develop system ownership of key goals.

There are a number of work streams that will need to contribute to achieving our outcomes. The

exact areas and desired output will be based upon a thorough assessment of our baseline position.

The immediate next steps are detailed below in table 1.

Once our baseline position is established we will have a quarterly review of progress and an annual

review against the baseline. This will ensure we have time to see an impact, will help keep the work

focussed, will identify issues that may impact our plans and will ensure that we continue to align

quality with the annual business planning cycle.

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The action plan outlined below provides an overview of CWHHE Quality priorities over the next 5

years. These priorities will be developed, owned and monitored at both a CCG and CCG Collaborative

level via the Quality and Patient Safety Committees which will report (as Sub Committees) to the

Governing Body.

QUALITY PRIORITY ACTION OUTCOME OUTCOME METRICS

No NWL patient is harmed by abuse or neglect or failure by our services and there are mechanisms to investigate and learn from omissions in care

Actions to be devised following baseline and RCA.

People using services and staff have confidence that they are in a safe environment.

The CWHHE Collaborative is in the top quartile for all clinical outcomes including Friends and family test.

Patients are at the centre of their care and have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals

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Appendix 1: Quality Governance

Structure:

Quality Inputs:

1. Provider Clincal Quality Group

2. CCG Quality Patient Safety & Risk

3. CCG Governing Body

•Constructive challenge

•Expert opinion

•SI managment & assurance

•Clinical advice/input

•Locally allocated tasks

•Agreed core agenda

Provider CQG

•CQG report

•Monthly Integrated performance & Quality Report

•Monthly Serious Incident report

•Quarterly Safeguarding report

•Quarterly Infection control report

•Quarterly complaints report

•Provider concerns briefing

CCG QPSR

• Bi monthly QPSR report

• Bi-monthly Integrated performance & Quality Report

• Annual safeguarding

• Annual Infection control

• Annual patient experience

• Annual complaints report

• Annual EPPR report

CCG GB

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Appendix 2

Notes of Quality Strategy Meeting: Friday 16th January, 2015

To what extent does this Framework set out our ambition for quality?

What suggestions do you have for refining & focussing the strategy?

Status of Strategy

This is a Commissioning Strategy, but we want to fully engage providers.

Framework is Must Do: necessary but not sufficient.

Make strategy sustainable and politically robust – promote consistency and use common language.

Promote sustainability and resilience.

Simple picture

Agree 4-5 real key smart goals, e.g. o Clinical effectiveness – top quartile performance o People’s goals met (is this realistic?) o Patients not harmed and feel safe o Staff feel able to deliver patient goals (is this realistic?)

Scope

Self review – look across whole system.

Focus on primary care as well as acute.

Working with providers

Decide how Commissioners get assurance of quality.

Be consistent across Directorate in Commissioning in relation to providers (finance/contracts).

Immediate provider focus is on CQC assessment of quality. How do they achieve meaningful improvement vs knee jerk reaction? Need to engage in dialogue with CQC.

Develop different levers for different sectors.

Working with other partners

More focus on integration with Adult Social Care and Public Health.

Share with LAs and HWB.

Involve private and voluntary sector.

Guidance for implementation

Focus on leadership, values, culture – how we work. Promote dialogue among system leaders – shared message.

Achieve quick wins – demonstrate achievements e.g. residential care, cancer care.

Keep in mind patient pathways.

Work out how to embed for all staff.

Develop standardised methodology to get improvement.

Work out how to share learning from incidents more effectively.

Include continuity of care and shared decision-making.

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Appendix 3

CWHHE Quality Statement : Detail of Activity and quality functions

(Drafted and approved by Quality Committees in 2014)

Introduction

This document is designed to provide a succinct overview of the Collaborative’ s commitment and

numerous mechanisms in place to monitor, measure and improve the quality of services provided

for patients in North West London.

This document set out the CCGs commitment to embed quality into every part of the commissioning

cycle, reinforcing the collaborations commitment to assure the development of services within and

between care settings.

CWHHE responsibilities are for the quality assurance of provider organisations ensuring they are

held to account for delivery of quality standards and contractual obligations.

‘Quality’ cannot easily be subtracted from day to day business or viewed in isolation, within CWHHE

it forms the golden thread running through each of the organisations objectives, and is supported by

the robust reporting, escalation and governance frameworks. This ethos is supported by the

learning and recommendations made following the Francis / Berwick reports and the Collaborative

aim to ensure quality remains at the heart of their activity.

This overview document therefore is supported by and references a number of other key

documents, strategies and work streams which operationally deliver the ambitions and objectives of

the CCGS as a Collaborative.

Shaping a Healthier Future brings together the commissioning of acute hospital providers,

community services providers, CCGs across West London alongside Local Authorities and patient

representative groups to decide on the future shape of services provided, their location and address

quality.

Quality Driven Partnership Working

Patient and public engagement are fundamental to the pursuit of high quality care and the CCGs are

committed to consult and engage with others to help influence their decision making and their

overarching commissioning intentions. The Collaborative of CCGs have made a commitment to work

together and in partnership with patients, the public and local providers, local authority and the

clinicians that deliver care.

The CWHHE collaborative has also committed to work closely with other regulatory and authorities

responsible for monitoring the performance of NHS funded services. We work closely with NHS

England, the Trust Development Agency and Monitor, as well as the CQC to ensure that Trusts and

provider organisations receive consistent messages from external monitoring organisations, and to

ensure knowledge and intelligence available about a provider is shared appropriately to maximise

the accuracy of the knowledge we have about a provider.

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Healthwatch

Healthwatch is the independent consumer champion for health and social care in England created to

ensure that the voices of the public and those who use services reach the ears of the decision

makers. We are linked to the key Healthwatch committees who oversee the activity in Central

London, West London, Hammersmith, Fulham, Hounslow and Ealing. Healthwatch are a unique and

independent resource, and play a key role a local level in ensuring the views of the local population

and people who use commissioned services are taken into account.

Meetings with Healthwatch representatives are held Quarterly to ensure we engage with

Healthwatch as one of our key stakeholders.

Health and social care providers that the Collaborative work with include:

Member GP practices across the 5 CCGs

Imperial College Healthcare NHS Trust

Central London Community Healthcare NHS Trust

West Middlesex NHS Healthcare Trust

Chelsea and Westminster NHS Foundation Trust

Central North West London (Mental Health) NHS Foundation Trust

West London Mental Health NHS Trust

North West London Hospitals

Hounslow and Richmond Community Healthcare Trust

Local Authorities

Macmillan

Also a range of independent and voluntary sector providers, such as residential and nursing homes –

continuing care providers.

Quality Accounts:

Quality Account Process: Quality Accounts demonstrate commissioned services’ commitment to

achieve and improve outcomes for patients. All commissioned NHS services are required to provide

an annual quality account for the public to read about the quality of their services. The CWHHE

Collaborative has established a transparent and consistent approach to how they work with provider

organisations on the development of their Quality Accounts. This process includes review and

presentation of Provider Quality Accounts at the Quality and Safety Committees within the lead

Commissioning CCG meeting.

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Risk Summits:

Concerns may escalate to the establishment of the risk summit process involving the CQC. This could

be led and/or undertaken by the Quality Surveillance Groups and NHSE.

Quality Schedules

A process of alignment will unify the Key Performance Indicators and benchmark Trusts against each

other in order that we are measuring quality ‘like for like’ between our organisations.

Purpose of the Quality monitoring

This document sets out how CWHHE will embed and integrate quality within its commissioning

principles, processes and governance arrangements.

Quality within healthcare can be defined as care that is safe, effective and provides as positive an

experience as possible. These domains will be used to evaluate and monitor quality of care and

services, ensuring the domains are embedded within our governance processes.

By reducing the variance and creating alignment and consistency in how we measure and monitor

quality from our providers will allow for greater scrutiny and earlier identification of quality

concerns.

Patient Safety

Commissioning high quality care which is safe

Reducing and preventing avoidable harm

Ensuring systems are in place to protect patients

Safe / Clean environment

Clinical Effectiveness

Increasing mortality / survival

Commissioning high quality care according to the best evidence

Developing clear outcome indicators

Ensuring interventions achieve their expected outcomes

Reducing the level of complications from interventions

Improving patients health status / quality of life

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Patient Experience

Ensuring compassion

Promoting dignity and respect

Demonstrating satisfaction with their own experiences

Promoting treatment in accordance to what the individual wants or needs

The core drivers for improving quality are to:

Increase accountability for the quality of care provided.

Improve quality of care.

Reduce health inequalities.

Improve accessibility.

Improve performance across all providers of care for the local population.

Drive up service quality and reduce variation.

This ambition will be delivered by developing ourselves by becoming an outward facing and

proactive clinical commissioning organisations. This commitment will be demonstrated and

reflected throughout the commissioning cycle, from the development and revision of the quality

schedules within the contracting framework through to the development of newly commissioned

services.

As the clinical commissioner and local leader of the NHS, on behalf of our population we will

continue to develop a clear focus on quality within all our contracts and throughout our reporting

and monitoring arrangement. This will serve to drive quality improvement on behalf of the

population we serve.

CWHHE Values based Commissioning

Values:

Working together for patients;

Respect and dignity;

Commitment to quality of care;

Compassion;

Improving lives;

Everyone counts.

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Enablers for Improving Quality / Governance Arrangements

As Clinical Commissioners who seek to do the best for our local population on whose behalf we

commission services , we recognise that there needs to be an effective framework for how quality

assurance will be obtained. The robust governance arrangements within the CWHHE collaborative

allow for escalation of concern and assurance quickly and easily. The basis of this was developed as

a result of the four stage methodology referenced in Sir Bruce Keogh’s report.

The different steps have been considered as part of the development of all the Quality and Safety

Committee Terms of Reference and the other supporting networks and committees feeding into the

Governing Bodies.

We believe this methodology is transparent, comprehensive and systematic. The four stages are as

follows:

Stage 1: Quality Data Analysis

Stage 2: Triangulation

Stage 3: Multi-disciplinary Reviews

Stage 4: Support Improvement

The following committees and Groups support the quality agenda or hold the remit for monitoring

quality and for influencing quality improvement initiatives:

Committees

Clinical Quality Groups (for each provider organisation)

Central London CCG Quality and Patient Safety Committee

West London CCG Quality and Patient Safety Committee

Hammersmith and Fulham CCG Quality and Patient Safety Committee

Hounslow CCG Quality and Patient Safety Committee

Ealing CCG Quality and Patient Safety Committee

CWHHE collaborative CCG Quality and Patient Safety Committee

Equalities reference Group

Clinical Quality Improvement Groups

CWHHE Quality Assurance Group for continuing Healthcare

CWHHE Pressure Ulcer working Group

CWHHE Primary Care Nurse Lead Network meeting

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CWHHE Clinical Quality Network

CWHHE Patient Experience Network

CWHHE Infection Prevention and Control Network

North West London Maternity Network

Safeguarding Boards

CQG CCG Quality Committee CWHHE Collaborative

committee

Governing Body

All CQG meetings within

CWHHE have aligned

Terms of Reference.

Ensuring complete

transparency and

consistency regarding

what is being monitored

at provider organisations.

Issue and concerns

escalated from the CQG

to the CCG quality

Committees.

Updates are received

from the CSU on provider

quality and performance

issues.

Minutes and papers from

the Provider CQG

meetings are also

available.

Exception reporting

escalated from each CCG

and shared decision

making regarding quality

of services at provider

organisations where more

than 1 CCG has an

interest in the

organisation although

they may not be the lead

provider.

As per authorisation.

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Overview of Key Quality Committees and Clinical Networks

Clinical Quality Group (CQG): these are formal dedicated monthly meetings held with all

commissioned services where one of the CWHHE CCGs is the lead commissioner. The meetings

provide opportunity and a forum to monitor and discuss all aspects of quality of care provided and

the quality element of the contract.

The CWHHE collaborative has created an aligned set of Terms of Reference for these CCG committee

meetings, which provides additional assurance and scrutiny across the collaborative that quality and

safety are viewed in exactly the same way across all provider organisations.

CCG Quality and Patient Safety Committees: these meetings are a subcommittee of each of the

Governing Bodies; each discusses local quality issues, to oversee and gain assurance on provider

quality and performance issues. The committee will escalate to the governing body or take action

where concern is identified.

CWHHE Collaborative Quality Committee provides a clear line of sight from provider organisation to

board, with membership from each of the CCGs and from the CQG meetings. The committee

provides opportunity to escalate and share potential areas of quality concern that are raised locally

by CCG Quality and patient safety Committees.

The committee promotes the consistency of reporting systems across the CWHHE collaboration in

order to simplify their production, highlight common and specific issues, and facilitate sharing of

good practice. Through this ability to share concern between the CCGs, and to escalate concern as

soon as a potential issue is identified, the CWHHE collaborative is better able to identify the key risks

or themes in terms of quality, to take action, and monitor and report progress on these themes to

the governing body, or advise on quality information to be available to support the cases for change

across the collaboration.

Clinical Quality Improvement Networks have been established with the following focuses.

CWHHE Pressure Ulcer working Group

CWHHE Primary Care Nurse Lead Network meeting

CWHHE Clinical Quality and Patient Safety Network

CWHHE Patient Experience Network

CWHHE Infection Prevention and Control Network

North West London Maternity Network

Safeguarding Networks

The shared purpose of these network improvement groups is to host a forum with representatives

from commissioners and provider organisations in order to share good practice, learning, concern

and innovation. The networks facilitate alignment of reporting and expectations across the patch

and ensure a collaborative approach across the health economy. To better enable constructive

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challenge, peer review and benchmarking. Although the Network has no powers of delegated

authority it may, through a process of consensus, develop recommendations as clinical experts

which will be shared across providers and commissioners for consideration.

Soft Intelligence – Collection Monitoring and Escalation of Information and concern.

Provider quality information and data trends and themes are monitored using information

triangulated with data from regular announced and unannounced inspection, visits to inform Key

Lines of Enquiry to follow up at Clinical Quality Group meetings with the provider. Where necessary

any immediate or emergent issues and concerns are escalated.

Information from social media – Twitter and Facebook accounts, particular communication

campaigns and key stakeholder feedback such as Healtwatch and primary care is part of the soft

intelligence utilised.

Contractual levers

Commissioning and Contracting Levers: contract monitoring is akin to quality assurance by holding

commissioned services to account for delivery of contractual obligations and quality standards.

CWHHE is committed to using its commissioning levers through multi-disciplinary review to drive up

quality of care for the population who use local health services.

In order to realise the full potential of the quality strategy, CWHHE ensures that quality is embedded

throughout the commissioning and contracting cycle. Improved commissioning specifications for

commissioned services add clarity to quality outcomes.

Rewarding Improvement and ‘Stretch’ targets for providers.

Commissioning for Quality and Innovation Framework (CQUIN):

CQUINs enable commissioners to reward excellence and improvement by linking a proportion of

healthcare provider’s income to the achievement of local quality improvement goals. CQUINs

schemes form part of the contract between the CCGs and its main providers of healthcare.

Demonstrating achievement against these targets is monitored by the NWL CSU with updates and

formal review provided quarterly at the Clinical Quality Groups (CQG) and contracting meetings.

The negotiation of CQUINs is led by the NWL CSU, through discussion with the Trusts. Consideration

is given to NHS England’s national ambitions for quality improvement and to the CCGs local plans

and priorities. Development of a local CQUIN may also be aligned to the specific needs of a provider

if there is a particular area where scope for improvement has been identified.

QIPP

Quality, Innovation, Productivity and Prevention (QIPP): is a large scale transformational programme

for the NHS.

QIPP involves and requires engagement from staff, clinicians, patients and the voluntary sectors to

improve the quality of care delivered whilst making efficiency savings, leading and supporting

change and addressing local quality challenges.

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QIPP is a well-established programme and the CCG works with its local health partners in developing

integrated QIPP plans that address local quality challenges. Each CCG within the collaborative has a

local QIPP plan, and each plan is aligned to the overarching Shaping a Healthier Future Strategy.

Furthermore QIPP plans are and will continue to be reviewed to ensure that that proposed Cost

Improvement Plans (CIP) that provider organisations are intending to implement are assessed

alongside the CWHHE QIPP plans in order to identify all potential adverse impacts on quality from

across the whole health economy.

Reviewing Trusts intentions and highlights potential conflict with local CCG QIPP programmes.

The aim of this work has been

1. To ensure that Trusts have been assessed in terms of the robustness of their internal processes for

developing, approving and monitoring the impact on CIP schemes.

2. To ensure that Trusts had undertaken a Quality Impact Assessment against each of the CIP plans

and to assess the robustness of this assessment.

3. To assess the Trusts CIP plans alongside the local CCG QIPP plans to identify risk to service delivery

and quality of care as a result of their combined impact.

4. Where potential adverse impacts have been highlighted to notify the Trust and to seek greater

assurance about the impact of their CIPs and to then identify a mechanism for extra monitoring or

mitigation of the risks.

Commissioning leverage for all providers of NHS Health care

The Collaboration continues to improve the robustness of its monitoring mechanisms for third sector

and other continuing healthcare providers. It will continue to strengthen joint working with Local

Authorities and Continuing Healthcare providers.

The on-going development of the Quality Assurance Group, as well as greater refinement and clarity

on the national contract quality schedules and further development of metrics for use on third

sector and non NHS providers will enable CWHHE to drive improvement in quality across the whole

health economy.

Clinical Leadership

The collaborative appreciates the significance of clinical leadership within the commissioning

organisations. Driving quality improvements within provider organisation will be supported by the

implementation and development of Clinical Networks with representation from both

commissioning and provider organisations to share innovation and initiatives and share lessons and

learning from each other’s local experiences, as well as by linking into national and regional work /

networks.

Board Assurance Framework

The Board Assurance Framework considers the top strategic risks facing CWHHE as an organisation –

the CCGs within the collaborative have worked together to identify a common set of risks and to

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develop a common approach to their management. The risks identified span patient safety and

quality, performance improvement, integrating health and social care and establishing and

developing clinical commissioning.

In relation to quality - seven of the twenty top priority risks relate to improving patient safety and

quality and these are used to assess each CCGs relative risk, its mitigation and whether the CCG

perceives that mitigating factors are addressing the risks identified. This is then escalated to the

respective CCG board and CWHHE collaborative Quality and Patient Safety Committee for discussion

across the collaborative and action.

Supporting Quality Improvement in General Practices

Practice Nurse Workforce development

CWHHE collaborative takes its responsibility for supporting quality improvement outcomes and a

positive patient experience in general practice very seriously. Supporting improvement within

general practice will contribute to making the care received by the population much more

sustainable. We recognise that it is important to support general practice to gain the right skills,

capacity and capability to deliver high quality services. A training strategy and dedicated resource to

support nurses working in primary care has been identified.

Next Steps

Following the recent publication of a number of high profile National Reviews there is an increased

public focus on quality. The collaborative welcomes this increased focus and is open and honest with

the public regarding the quality of service being delivered by the organisations from whom it

commissions care. The CWHHE collaborative is also transparent with both providers and the public

regarding how they make those commissioning decisions.

The recommendations and lessons learned from the following reviews have been considered

Mid Staffordshire NHS Foundation Trust (Francis Report);

Sir Bruce Keogh review;

Winterbourne View Hospital;

Professor Don Berwick’s Review into Patient Safety;

As described in the ‘Shaping a Healthier Future’ Strategy, services will be commissioned in

accordance with the following principles:

Improving outcomes for patients with long term conditions (LTC), their carers and families.

Supporting residents to achieve a good end to life.

Ensuring we deliver the Quality, Innovation, Productivity and Prevention (QIPP) Plan.

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Using an understanding of patient needs to shape services and their experiences to drive

performance improvement.

Developing integrated primary, secondary, community, mental health and social care

through sustainable partnerships.

Making, Better Healthcare Closer to Home real for delivering local population health

outcomes.

Support its residents to lead healthy lives and offer safe, high quality care to all

Help patients to make informed choices about their care and help ensure they do not go into

hospital unnecessarily

Provide more specialist hospitals on fewer sites to treat patients with the most complex

illnesses, with round-the-clock professional expertise on call

Encourage co-operation between those delivering care and support – GPs, community

services, hospitals, local councils and social care

Make it easier for more patients to be treated in their community and focus future

investment more in these services

Get the best value from all NHS spending

Whole systems integration

Improve the quality of NHS buildings to bring them up to standards set by the Care Quality

Commission