Quality and Safety of Patient CareElaine Thompson – Deputy Chief Nurse and Quality Officer

Purpose of the session• To provide an oversight the key national and local concerns and

challenges in respect to quality and safety of patient care

• To identify the current structures and processes Birmingham CrossCity Clinical Commissioning Group utilises to monitor and improve quality and safety of patient care

• To consider and discuss the draft priority areas for the Quality and Safety Strategy for Birmingham CrossCity Clinical Commissioning Group

Quality and Safety of Patient Care – National Concerns and Challenges

• Shock stories of failed patient care o Mid Staffordshire NHS Foundation Trusto Winterbourne View

• Delayed or cancelled treatments • Ambulance waits• Winter Pressures• Hospital mortality rates (The Keogh Review) • Increased public expectation • Increased demand on services• MAJOR reorganisation within both the NHS

and Partner Organisations

Quality and Safety of Patient Care – National Concerns and Challenges

• Creating the right culture that puts the patient first• Ensuring respect, dignity and compassion for all• Duty of candour• Robust commitment to quality of care• Staff who feel able to raise issues and concerns• Early recognition of warning signs • Triangulation of hard and soft intelligence to

understand quality• Development of nationally agreed and locally owned

measures of success, focussed on what matters most to patients that are effectively monitored

• Minimising bureaucracy, enabling time to care and time to lead

• Taking time to listen – and when we have heard what is said, to ensure that we act

• To never again allow targets or finance to come before the quality of care

Quality and Safety of Patient Care – National Concerns and Challenges

Ensuring that ALL patients receive the care and treatment they need, and that this care and treatment is delivered by a caring workforce

Quality and Safety of Patient Care – National Concerns and Challenges

Recurrent Themes• Promoting patient safety and reducing harm• Ensuring effective early warning systems and appropriate

escalation procedures for deteriorating, high-risk patients, in particular at weekends and out of hours

• Ensuring that lessons are learnt, changes are embedded• Ensuring that all services effectively use and learn from

hard and soft data to understand quality, maximising opportunities for Benchmarking

• Promoting and learning from “real-time” patient feedback• Ensuring that the most vulnerable are protected from harm• Workforce development - sharing skills, knowledge and

expertise, ensuring strong clinical leadership• Supporting the growth of Clinical supervision• Ensuring that all services have a shared understanding and

vision of what “good” looks like, and how to achieve this

Quality and Safety of Patient Care – Local Concerns and Challenges

General Issues for all Serviceso Increasing public expectations in respect to healthcare

oWorking within a tight financial envelope

o Busy services, busy staff

o Complex systems of healthcare

o Increased multi-agency and multi-professional working

o Competing demands for services

o Maintaining the Quality Agenda

o Ensuring systems oversight

o Ensuring care for the most vulnerable

Quality and Safety of Patient Care – Local Concerns and Challenges

Birmingham is a diverse city.

Birmingham is a growing city. Since 2001 the population has increased by almost 100,000 (10.2%). This is an average rate of 0.9% per year.

Whilst we have some world renowned healthcare services, we also have significant problems:

o Serious Case Review - Keanu Williams

o Birmingham City Council's Children Services

o Homeless epidemic

o Highest rate of diabetes in the UK

Quality and Safety of Patient Care – Local Concerns and Challenges

As a Clinical Commissioning Group

We are a new organisation with a massive and ever-changing agenda

We serve a large, complex and diverse population often with a variety of health and social care needs

We currently have over 50 Provider contracts including:University Hospital Birmingham Foundation TrustRoyal Orthopaedic Hospital Foundation TrustBirmingham and Solihull Mental Health Foundation TrustHeart of England Foundation Trust (Good Hope Hospital) Hospices, Primary Care, Urgent Care

We have a difficult role, achieving a balance in the relationship we have in respect to “support and scrutiny” of our providers.

Quality and Safety of Patient Care

CCG Oversight

Providers

Hard Intelligence• Incident data• Complaint data• Mortality rates• Readmission rates• Length of stay• Delivery against

contract standards• National

benchmarking• Survey data• CQC reviews

Soft Intelligence• Feedback from

patients• Themes from

complaints• Experiences of care• GP feedback• Informal staff

feedback• Assurance

spotchecks

CCG Structures and Processes to Monitor Quality and Safety

Quality and Safety of Patient Care

AssuranceClinical Quality Review Meetings

Assurance Visits to Providers

Monitoring Safety DataContract Review Meetings

External Assurances (CQC, Monitor)

GP Feedback

Themed Reviews

CCG Structures and Processes to Monitor Quality and Safety

Quality and Safety of Patient Care Driving change forwards

Birmingham CrossCity Clinical Commissioning Group is currently in the process of developing a Quality and Safety Strategy which will help us to continue to drive forwards the Quality and Safety agenda. It is suggested that the draft Quality and Safety Strategy has 5 Key Quality Priority Areas:

Primary Care

Safeguarding

vulnerable patients

Patient Experien

ce

Workforcedevelopm

ent

Patient Safety

Quality and Safety of Patient Care Driving change forwards

Primary Care

Safeguarding

vulnerable patients

Patient Experien

ce

Workforcedevelopm

ent

Patient Safety

Question 1: Are these the right 5 Key Quality Priority Areas for the CCG to focus on?

Quality and Safety of Patient Care Driving change forwards

Primary Care

Safeguarding

vulnerable patients

Patient Experien

ce

Workforcedevelopm

ent

Patient Safety

Question 2: If they are, what specific actions should we focus on within these 5 Key Quality Priority Areas?