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Research, Service Evaluation & Clinical Audit Strategy

2013-16

Evidence informed community healthcare improving patient outcomes

Date: January 2013 Author: Sarah Williams Version: v8

Research, Service Evaluation & Clinical Audit Strategy v8.1 2

Version Date Author Amendments Distribution

Version 1 April 2011 S Williams J Hillier

Version 2 May 2011 S Williams Add in deliverables

R&D Committee

Version 3 June S Williams Edit following comments at committee meeting

J Hillier

Version 4 19thJune S Williams J Hillier

Version 5 28 Nov S Williams Add in IP statement

Version 6 4th Feb 2012 S Williams Stronger emphasis on evaluation/ audit/ outcomes

Tony Snell

Version 6.1 16th Feb 2012 S Williams Proposed team structure and KPIs

Tony Snell & Directors

Version 6.2 23rd Feb 2012 S Williams Change in order of priorities

NEDs

Version 7.0 11th March 2012

S Williams Incorporate justification for centralised team. Incorporate paper on Clinical Audit

Assurance Committee

Version 7.1 16th March 2012

S Williams Comments from Judy Hillier

Assurance Committee, Trust Board

Version 8 Jan 2013 S Williams Update to incorporate service evaluation and clinical audit; add in key deliverables

R&D sub-committee, Clinical Audit and Service Evaluation sub-committee; research active staff, PPI

Version 8.1 March 2013 S Williams Update with comments from consultation


1. Executive statement

Solent NHS Trust is committed to the promotion of evidence informed practice, continuous improvement to quality and patient outcomes, and to the delivery of effective research, service evaluation and clinical audit across all clinical services. Research is essential to the development of new knowledge and to innovation; evaluation ensures learning from innovation is captured and that the patient view is included; and clinical audit is the cornerstone of ensuring that we consistently deliver high quality patient centred services and sustained improvement.

The evidence from research, service evaluation and clinical audit lies on a continuum from the measurement of service based achievements against defined standards through to the sourcing of new knowledge with opportunities for generalization across the health economy. Each source of evidence overlaps and feeds the other, and it is the collation of these difference types of information that together form a powerful platform from which to plan and deliver service delivery and improvement. This document sets out a four year strategy which aligns to Trust and clinical strategies and aims to embedding evidence informed practice, via research, clinical audit and service evaluation across the Trust. Within this it is committed to involving patients and the public in the whole spectrum of activity. It aims to place Solent NHS Trust as a leader in community healthcare research, and to lead the way in using evidence from clinical audit and evaluation to continuously improve services and patient health outcomes.

The strategy will embrace five core strategic goals:

1. To provide an organisational hub for the collation of best evidence via research, evaluation and clinical audit activity and to ensure clinicians are enabled to deliver evidence based quality improvements into service delivery and improve patient outcomes

2. To prioritise research, evaluation and clinical audit projects that will

provide a strong evidence base for continuous improvement in community based health care and support national priorities around transformation. To develop auditable evidence based clinical outcome measures across all services.

3. To increase the scope of research activity and the number of patients and

staff who are engaged with research projects.

4. To engage in a programme of clinical audit and service evaluation across all clinical services which reflects key national and local drivers for quality improvement, as well as divisional/ service line priorities and the interest of service users, carers and clinicians. Every service will be able to demonstrate how evidence informs its practice and leads to quality improvement.

5. To embrace and lead the way in an embedded culture of patient and

public involvement in research, service evaluation and clinical audit.


2. National Context

Both research and clinical audit are core activities for the NHS, and act as the foundation for ensuring quality improvement and better patient health outcomes. Participation in clinical audit is a mandatory activity, laid out in the NSH standard contract, and the NHS Constitution (2012), places research at the centre of the guiding principles for the NHS “through its commitment to innovation and to the promotion and conduct of research to improve the current and future health and care of the population.” Current changes to the NHS landscape are resulting in an increased shift towards community-based health care, greater efficiencies, a need to evidence innovation and continuous improvement and a focus on patient centered clinical outcomes. The document ‘NHS 2010-15: From Good to Great’ sets out a vision of the NHS with quality at the centre, and the NHS Operating Framework for 2012/13 asserts that “The promotion and conduct of research continues to be a core NHS function and continued commitment to research is vital if we are to address future challenges. Further action is needed to embed a culture that encourages and values research throughout the NHS” . The draft report ‘Quality in the New Health System (National Quality Board 2012) reiterates evidence around clinical effectiveness as a core dimension in ensuring quality. The Health and Social Care Act places a duty on the Secretary of State for Health, the NHS Commissioning Board, the Clinical Commissioning Groups and Monitor to ensure (evidenced) continuous improvement in the quality of services and the outcomes that are achieved from the provision of services. Clinical audit is cited as a key tool for the measurement of quality and improvement. The 2010 White paper, "Equity and excellence: Liberating the NHS", reaffirms the commitment of the government to the promotion and conduct of research and evidence based practice as a core NHS role’. The outlines a vision for the NHS in which there is an increase in clinical audit activity to inform quality and clinical outcomes (including linking measures in national audits to payments) and a focus on ‘implementing best practice to achieve improvements in outcomes supported by … continued research’, and an emphasis on ‘evidence based medicine and policy making’, within a culture of ’evaluation and learning’. NHS Organisations are now required to include statements and summaries on research and clinical audit activity in their Quality Account Statements, and the use of clinical audit in particular is a priority concern of the Care Quality Commission (CQC), the NHS Litigation Authority (NHSLA), commissioning authorities and other regulatory agencies. 3. The local context

On April 01st 2011, Solent NHS Trust became an independent provider of community and specialist mental health service provider for Southampton, Portsmouth and parts of Hampshire. Solent NHS Trust supports the Department of Health’s objective, within the ‘Transforming Community Services’ Agenda to create: “ .modern, innovative community and mental health services that have direct benefits for patients, are responsive to local need, and promote seamless care through increased opportunities for integration of health and social care services “ Solent NHS Trust is an aspirant Foundation Trust. Its stated mission is to ‘work in partnership to deliver health and local care’ and its vision is to ‘lead the way in local

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_117353


care.’ Three core strategic objectives (to enable improved healthcare outcomes, to deliver care pathways that are integrated with partner organizations, and to offer best value alternatives to acute hospital admissions) are supported by seven core values - Nurturing, Striving for Excellence, Passionate, Innovative, Empowered and Respectful. Research, Service Evaluation and Clinical Audit activity are integral to each of these values and objectives. Evidence, via research, service evaluation and clinical audit (and the triangulation with other sources) underpins and facilitates each of the strategic aims and values of the Trust. Moreover, successful transformation will require a strong evidence base to support the bid for Foundation Trust Status, and meet the requirements of local commissioners and national reporting requirements, particularly around quality and clinical outcome measures. A strong evidence base will also afford: the delivery of successful cost improvement programs; the meeting of contractual requirements; a driver for continual service improvement; and success in national programmes such as the revalidation of doctors and in future, nurses and Allied Health Professionals. In 2011/12 Solent NHS Trust was the second most active research ‘Care’ Trust nationally which is testament to the increasing value placed on research activity in recent years. Furthermore, the ambition to be recognised as a leading community and mental health research Trust is a core quality Improvement objective for the Trust. Nonetheless, there is considerable room for growth, and increase in activity. As a healthcare provider that spans acute, community and primary care services, the Trust is in a unique position to host research in priority areas, such as integrated care pathways, hospital avoidance and community based care. It faces significant challenges however, as a result of the funding models currently employed by the National Institute for Health Research, and as a result of a dramatically changing health research landscape, including the introduction of Academic Health Science Networks (AHSNs). The Wessex AHSN outlines a programme of work which will draw on research and innovation to improve clinical outcomes and commits itself to translating evidence into the improvement of the local healthcare system. It is critical that Solent becomes a central part of this programme, and exploits it in the promotion and delivery of a culture whereby evidence is used to inform practice and continuously improve clinical outcomes.

In May 2012, a new team was created in Solent NHS Trust, to oversee all Research, Service Evaluation and Clinical Audit activity. The creation of this team was born out of a desire to provide a centralised source of evidence to satisfy local and national reporting requirements, contractual obligations and to support continuous improvement in service delivery. It will also create efficiencies in terms of the skills and expertise around evidence based approaches, and will ensure clarity for staff.

A recent review of the clinical audit systems and processes in the Trust highlighted a lack of clarity around priorities and process in some clinical areas. Furthermore, it noted that a need to better assure clinical audit and evaluation activity, to increase the engagement of and oversight by the Trust Board and better celebrate the impact of audit in terms of outcomes.

Solent NHS Trust has the potential to be a leader in community based care, and in promoting the use of research, service evaluation and clinical audit to provide a firm evidence base for this care and for continuous improvement in service delivery and patient outcomes. This strategy outlines details around the five core priorities and plans for their delivery over the next four years.


4. Key Strategic Goal 1:

To provide an organisational hub for the collation of best evidence via research, evaluation and clinical audit activity and to ensure clinicians are enabled to deliver evidence based quality improvements into service delivery and improve patient outcomes

It is proposed that a central, co-ordinated approach to these areas of activity will provide an invaluable resource for the Trust embracing a culture of evidence informed practice. It is also critical that staff feel empowered and enabled to draw upon and use evidence in their everyday practice to ensure safety and improve patient outcomes.

Specific Objectives

1. Motivate staff to be involved in evidence informed practice: ensure all staff and services understand how research, evaluation & clinical audit fit into their clinical practice; processes around governance of these activities, and ways of sourcing support.

i. Celebrate success

ii. Regular communications via team brief and the intranet

iii. Attendance at clinical team meetings and divisional governance meetings

iv. Production of reports for each clinical division/ service line highlighting open and outstanding projects, key findings, actions and improvements

v. Production of an Evidence Based Practice Pack, available to staff and services with guidelines on governance processes

vi. Continuous information via a website

vii. Regular auditing of adherence to clinical audit policy

2. Offering regular and accessible training for staff on evidence based practice, research, evaluation and clinical audit

i. Deliver a series of face to face training workshops which focus on applied skills

ii. Link to programmes for medical trainees and preceptorship

iii. Provide access to training via University, research network or HQIP schemes

iv. Provide online training modules in evidence informed practice

v. Invest in clinical academic posts

3. Ensure that there is adequate expertise for support with data collection and analysis and associated training for staff

i. Ensure the correct skill mix in the Research, Service Evaluation & Clinical Audit team to provide expertise in methodology, data analysis and in the translation of evidence into actions/ service and cost improvement.


ii. Create supporting posts to work across clinical divisions in respect to evaluation and clinical audit planning, implementation and action planning. This will afford the necessary support for the revalidation of doctors, nurses and allied health professionals and for the identification of appropriate clinical outcome measures.

4. Ensure that evidence from research and innovation is fed back into services

i. Consolidating partnerships between services and academic institutions. It is important that there are tangible links between academic leads and relevant innovation. In particular link with Wessex AHSN

ii. Ensure access to research publications and findings (as per condition of research approval) in the Trust is achieved

iii. Ensuring these publications and evaluation/ clinical audit findings are available on the intranet

iv. Hosting an annual Solent NHS Trust Research, Evaluation and Clinical Audit Conference. Trust staff and students will be encouraged to present at this conference.

v. Setting up evidence based practice forums for staff involved in research, service evaluation and clinical audit to share learning

5. Ensure that this evidence is linked to outcomes and feeds into service improvement plans

i. As part of the evaluation registration and governance process, ensure a system is in place for translating evaluation and clinical audit findings into service improvement plans, cost improvement plans or refined outcome measures.

ii. Develop forward plans for service evaluations and clinical audits to provide the evidence base needed and to support the cycle of continuous improvement through PDSA (Plan, Do, Study, Act) cycles.

iii. Engage with Trust Board via the monitoring of research, service evaluation and clinical audit findings and subsequent implementation of innovation and improvement.


5. Key Strategic Goal 2

To prioritise research, evaluation and clinical audit projects that will provide a strong evidence base for continuous improvement in community based health care and support national priorities around transformation and to develop auditable evidence based clinical outcome measures across all services. The national agenda for patient care is to promote more community based health care and patient choice. Solent NHS Trust offers a huge range of specialist and often innovative services. To support and further promote these services and interventions, and to underpin the national agenda, there is a need for a better evidence base around the impact and outcomes of these interventions and the whole system benefits of the transformed community services. Solent NHS Trust will therefore prioritise research, service evaluation and clinical audit projects that can support the provision of this evidence base (and by implication, support profitable transformation schemes) and the individual Divisional Clinical Strategies. They will also prioritise research, evaluation and clinical audit projects that can offer value added evidence to priority improvement areas identified by the Trust, for instance in its annual Quality Account. These can be reviewed and identified annually, but examples include:

Avoidance of hospital admission, via initiatives such as Virtual wards

Community services for the older patient and end of life care

Community services for children and young people

Outcomes and impacts of substantial service delivery areas within the Trust such as sexual health, substance misuse and offender health

Management of long term conditions

Outcomes associated with patient centred integrated pathways of community based healthcare

The use of telehealth

Specific DH initiatives such as the “Dementia Challenge” Specific Objectives

1. Secure funding to invest in research staff posts within clinical divisions/ service lines to support National and Trust objectives (for example the Dementia Challenge)

i. Meet annual CLRN business objectives to secure activity based funding and negotiate support for posts in priority areas

ii. Utilise Research Capability Funding to invest in posts

iii. Maximise commercial income from research for investment in research capability

iv. Seek joint funded posts across the Trust and Universities and the Health Sector


2. Produce an annual programme of Clinical Audit and Evaluation in consultation with the Board and Clinical Divisions/ Service lines to align to local and national priorities

3. Establish a clear link between the Business and Marketing team and the Research, Service Evaluation and Clinical Audit team

i. To ensure that research, service evaluation and clinical audit objectives each year feed into and support Trust business objectives

ii. To ensure that products generated as a result of research are supported in terms of commercial activity and possible income generation, via marketing, licensing etc.

4. Increase the number of research projects hosted in priority areas

i. Investing in staff to identify relevant studies on the NIHR portfolio

ii. Enhancing partnerships with HEIs to consolidate understanding of Solent NHS Trust services. In particular establish clear partnerships with the Wessex Academic Health Science Network, link with education and ensure website is current.

iii. Proactively engage with Industry with an information pack about research capacity and opportunities at Solent NHS Trust.

iv. Working in partnership with other Trusts to secure projects across integrated care pathways

5. Engage with commissioning groups to incorporate the collection of best evidence into contractual arrangements and to adopt identified clinical outcomes measures as key performance indicators.

6. Key Strategic Goal 3:

Facilitate and increase the scope of research activity and the number of patients and staff that are engaged with research projects.

There is considerable scope for extending the number of services involved in research studies, and the number of studies that Solent NHS Trust hosts. There is also considerable scope for increasing access to clinical trials for our patients. Access to clinical trials is an NHS constitutional right of patients and allows them the chance to benefit from new treatments, interventions and medicines. Evidence suggests that patients who receive care in research active institutions have better health outcomes. The opportunity to engage in research also attracts high quality staff and productive external stakeholder relationships.

Specific Objectives


1. Increase the number of patients recruited to research studies& the number of studies open to recruitment by:

i. Horizon scanning and proactively approaching study managers to increase numbers of studies opened by 100% over four years.

ii. Ensuring processes for gaining consent maximise access to patients for invitation to participate in trials

iii. Improve awareness of research opportunities for patients via improved communications in all clinical areas.

iv. Increasing the number of services involved in research by 20% over four years

v. Increasing the numbers of patients involved in studies to meet annual targets set by the NIHR

vi. Establishing agreements with research networks and other NHS Trusts for sharing accruals equitably

2. Focus on commercial studies

In line with a national drive to increase research associated with the life sciences industry, and new targets to increase commercial trials in NHS Trusts, this will be a priority for Solent NHS Trust. This is vital to meet local performance management targets, and to provide income for research within the Trust.

To attract commercial trials to the Trust, Solent NHS Trust will:

i. Ensure there is clinical engagement and willingness to carry out commercial trials.

ii. Work with the CLRN and other research networks to identify suitable trials for Solent NHS Trust.

iii. Engage directly with pharmaceutical and medical device companies and CROs working on their behalf to promote Solent as a preferred research site.

iv. Facilitate trials with support and resource in terms of admin support, protected time and research staff (for instance research nurses).

v. Incentivise staff via the development of an income distribution policy to enable investigators to reinvest earnings from research –back into the development of further research capability. Ensure that investigators are aware of the policy

vi. Ensure there are adequate patient numbers to meet delivery targets set by commercial companies via partnerships with neighbouring NHS Trusts.


vii. Ensure governance processes are streamlined to guarantee approvals do not cause unnecessary delay. Where suitable, adopt co-ordinated and consistent approaches to approval (such as single point of negotiation) with partner Trusts.

3. Invest in protected research time for staff

Of prime importance is the need to focus on the research strengths of staff employed by Solent NHS Trust and identify potential areas of growth. There is a particular need to engage with clinical leads to encourage research activity within their service area. It is also essential that Solent NHS trust increases the capacity to support research by focusing on training and development across its staff base. Support for staff to undertake research or research training can serve as a key driver to develop capacity, encourage activity and foster a culture of research in the Trust. It can also help to improve retention of staff and attract high caliber applicants to the Trust. Specifically, we will:

i. Invest in a network of research nurses/ therapists who work in a clinical and an academic capacity from within clinical divisions/ service lines

ii. Invest in clinical academic posts (medical, nursing and AHP) at doctoral and post doctoral level to work within services and identify studies open in their service area. As a Trust demonstrate a clear commitment to supporting staff on a clinical academic career pathway.

iii. Engage with medics, medical trainees, nurses, AHPs and other clinicians to encourage and facilitate research activity in their service area.

iv. Provide training in clinical research and in the use of evidence in practice for new and developing investigators.

v. Include research in the appraisal and objective setting process.

vi. Improve financial incentives for staff and services to participate in research

vii. Celebrate and promote achievement.

4. Increase research income for the Trust

Research income can be maximized by achieving the above, and by meeting performance metrics set by the NIHR, and monitored by the Hampshire and IOW CLRN. Specifically:

i. The annual target for numbers of patients recruited into studies must be realistically negotiated and then achieved.

ii. The numbers of studies approved must increase and must be approved within national metric timeframes. In addition attracting NIHR funded grants as an NHS host organisation will increase our Research Capability


Funding Allocation (previously Flexibility and Sustainability Funding).

iii. Studies must be monitored to ensure they are recruiting to time and to target.

iv. The number of commercial trials opened in Solent NHS Trust must increase to maximize direct earnings and indirect performance management associated funding from the CLRN.

v. The costing of studies must ensure that all direct costs incurred are covered, and that there is some allocation for overhead and research development costs.

vi. Exploit opportunities for innovation in its research partnerships. In this regard protect Intellectual Property Rights of the Trust were relevant, and seek to encourage and support staff to participate in the generation of Intellectual Property (IP) as part of its commitment to encourage innovative practice and to deliver excellent healthcare

These measures will be monitored by a set of Key Performance Indicators, which will be presented to the Board. These are outlined in Appendix 4.

Key strategic goal 4: To engage in a programme of clinical audit and service evaluation across all clinical services which reflects key national and local drivers for quality improvement, as well as divisional/ service line priorities and the interest of service users, carers and clinicians.

The aim of this strategy is to use clinical audit (and where appropriate service evaluation) as a process to embed clinical quality at all levels in the organisation over the next four years, and deliver demonstrable improvements in patient care through the development and measurement of evidence based practice.

1. Develop an annual clinical audit and service evaluation plan to fit with corporate objectives, national priorities and clinical need

i. Engage with Trust board, Clinical Leads, Divisional Governance Leads and clinicians to identify and approve an annual programme of Clinical Audit and Service Evaluation

ii. Prioritise the activity within this programme into

Priority 1: National Audits that are mandatory

Priority 2: Clinical Audits and Service Evaluations outlined in commissioning and quality contracts; and audits around compliance with NICE guidelines. Clinical Audits that are required in response to incidents or complaints.

Priority 3: Trust priorities such as audits and evaluations on Integrated Care Pathways, Record Keeping, Consent, Discharge and Infection Control

Priority 4: Service identified audits, and those forming part of educational qualifications.


2. Meet statutory and mandatory obligations with respect to clinical audit

It is critical that the Trust complies with statutory and mandatory requirements for clinical audit, and can evidence this. This must be achieved in full by March 2014. relevant Acts and Policies are:

a. The Health and Social Care Act 2008

b. Care Quality Commission (Essential Standards of Quality and Safety)

c. Department of Health Standard Contract (from 2012)

d. Department of Health Act 2009 (Duty to provide information in Quality Accounts)

e. Monitor – Compliance Framework

f. NHSLA Risk Management Standards (and support for progression through Levels two and three)

g. General Medical Council – revalidation of doctors

3. Support the Trust Board to meet the standards of an ‘Exemplar’ Trust according to the Framework outlined by the Good Governance Institute in all ten dimensions. The full framework with an action plan can be found in Appendix 4 but specifically this will include:

i. Ensuring that clinical audit is used as a tool in strategic management, led by the Board which is supported by an appropriate committee structure, The Medical Director and the Director of Nursing and Quality

ii. Ensuring that the Board has sight of progress against the annual programme of clinical audit and evaluation, and reviews action plans and improvements via the completion of audit cycles (re-audit)

iii. That the Board has the ability to use clinical audit as a tool for identifying and addressing areas of concern via a network of clinical audit champions within clinical divisions/ service lines.

iv. Maintain a local and national profile in improvements in quality and patient outcomes via clinical audit and service evaluation for the organisational lead, the Medical Director (with support from the Director of Nursing and Quality)

v. Engage with our patients and the public, our members and governors to inform clinical audit prioritisation and monitoring. Use the Healthwatch to inform priorities

vi. Ensure that clinical audit is an integral part of planning, performance management and the operating process of the organisation, providing assurance to the Board.

vii. Facilitate a whole systems approach across patient pathways


viii. Provide evidence that clinical audit and evaluation is leading to improved outcomes.

4. Institute streamlined policies for clinical audit and registration

i. Update the clinical audit policy to reflect new governance arrangements and to incorporate service evaluation

ii. Develop a registration process that combines clinical audit and service evaluation for clarity to support front line staff

iii. Develop a reporting system for tracking completion of audits, implementation of actions and completion of the cycle via re-audit.

iv. Link the policy around mandatory registration and monitoring to appraisal, revalidation and training programmes (for medics, nurses and AHPs)

v. Ensure clarity around the policy for all staff and audit against adherence to the policy

5. Ensure governance and tracking of action plans identified from clinical audit and service evaluation

i. Ensure that each clinical division/ service line is tracking its audit programme in terms of timely completion of audits, and completion of the audit cycle via a programme of re-audit

ii. Ensure that governance structures within clinical divisions/ service lines support and can evidence the monitoring of action plans

iii. Ensure that the governance structures within clinical divisions/ service lines can support training and communication to clinical staff around processes for clinical audit and service evaluation.

6. Ensure clinical audit is linked to incident reporting, complaints etc and findings triangulated with other evidence such as from outcome measures (to include PROMS) and patient feedback

i. Institute systems for identifying audit need as a result of incidents and complaints, and quality priorities.

ii. Assure triangulation of information from incident reporting, patient experience and other quality indicators to inform programmes of clinical audit and service evaluation

7. Ensure adequate training for clinical audit for all staff, in terms of methods, reporting and translation into quality improvement

i. Insure that all staff are empowered to undertake clinical audit and service evaluation via training. This will take the form of

A series of face to face workshops which have demonstrable translation into clinical audit activity and quality improvement. At least three workshops each year


Access to online training packages for clinicians, the Board and members of the public

Delivery of training for students via the medical trainee and preceptorship programmes

Specialist training arranged as part of the Learning and Development portfolio of training courses

8. Link audit to medical revalidation and the appraisal process

To support their revalidation, doctors have to have systems and the skills to enable them to provide evidence of quality improvement initiatives and success. Processes and priorities around the registration and completion of clinical audit and service evaluation/ quality improvement can both provide a framework for this and be consolidated through it.

i. Systems will be put in place to ensure that doctors have the tools and recording systems to support their quality improvement portfolio

ii. Software will be rolled out to support this process, as well as patient feedback for revalidation

iii. Service Evaluation and Clinical Audit which is not registered with the Clinical Audit and Evaluation team will not be accepted as evidence for appraisals or revalidation.

iv. Ensure these processes and systems can be extended to nurses and AHPs when their programme of revalidation is launched in 2014.

Key strategic goal 5: Embrace and lead the way with a culture of patient and the public involvement in research, evaluation and clinical audit

Patient and public involvement is a vital part of research, evaluation, clinical audit and service improvement and will be a key tenet of the evidence based practice culture at Solent NHS Trust. User involvement ensures that work is: useful, relevant and of high quality; it helps us to ensure equality and diversity in participant recruitment, particularly in accessing ‘harder to reach’ communities; it helps to ensure that findings are published and communicated in ways that are appropriate and accessible for the participants and target audiences. User and public involvement is now a necessity for the granting of many funding opportunities and for approval by Research Ethics Committees. Increased involvement will be delivered via:

a. A dedicated post to promote patient and public involvement in research, service evaluation and clinical audit

b. Formalised partnerships with the Research Design Service, INVOLVE, HQIP and networks to promote PPI

c. Lay membership in all significant or strategic events such as


i. Membership on the R&D Committee

ii. Membership in evidence informed practice forums

iii. Representation at the annual conference

iv. Membership on panels for awarding funding/ prizes etc

v. Input into changes to strategy

vi. Active contribution to the website

d. Revisions to the R&D approval process to:

i. ensure support for staff and external researchers to increase patient involvement in projects

ii. Monitoring of public involvement across all studies

iii. Monitoring of appropriateness of materials and methods for the dissemination of findings

e. Revisions to the Clinical Audit and Service Evaluation registration and monitoring process to increase public and patient involvement in quality improvement.

f. Guidance on the website and support for lay members and researchers in the form of regular and appropriate training

g. Appropriate literature and marketing material in clinical areas to promote research and patient and public involvement.

h. Establishment of a network of PPI representatives/ service users who can support evidence informed practice

i. Support for PPI representatives to have access to local and national networks and forums in which they can share and disseminate best practice and success.

j. Identification of funds to support PPI activity as per national guidance,

k. Production and agreement of a policy to facilitate the appropriate renumeration of lay members as per national guidance.


References Academy of Medical Sciences (2011) A New Pathway for the Regulation and Governance of Health Research Audit Commission/ Monitor (2012) Delivering Sustainable Cost Improvement Programmes http://www.monitor-nhsft.gov.uk/home/news-events-and-publications/our-publications/browse-category/developing-foundation-trusts/deli DH (2012) NHS Standard Contract 2012/13 http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_131988 DH (2010) Equity and Excellence, Liberating the NHS (White Paper) http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_117353 DH/ NHS Finance, Performance and Operations (2010) The Operating Framework for the NHS in England 2011/12 http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_122738 DH (2010) The NHS Constitution for England (2009 Edition) http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_113613 DH/ NHS Finance, Performance and Operations (2010) Revision to the Operating Framework for the NHS in England 2010/11http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_110107 DH (2009) Transforming Community Services: Enabling New Patterns of Provision http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_093197 DH (2009) NHS 2010-15: From Good to Great. Preventative, People-Centred, Productive http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_109876 DH/ NHS Finance, Performance and Operations (2008) The Operating Framework for 2009/10 for the NHS in Englandhttp://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_091446 DH (2006) Best Research for Best Health: A New National Health Research Strategy http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4127127 DH (2005) Research Governance Framework for Health and Social Care, 2

nd Edition

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4108962 HM Treasury (2010) Spending Review 2010 http://cdn.hm-treasury.gov.uk/sr2010_completereport.pdf General Medical Council (2011) The Good Medical Practice Framework for Appraisal and Revalidation http://www.gmc-uk.org/static/documents/content/GMC_Revalidation_A4_Guidance_GMP_Framework_04.pdf

http://www.monitor-nhsft.gov.uk/home/news-events-and-publications/our-publications/browse-category/developing-foundation-trusts/deli

http://www.monitor-nhsft.gov.uk/home/news-events-and-publications/our-publications/browse-category/developing-foundation-trusts/deli





















http://cdn.hm-treasury.gov.uk/sr2010_completereport.pdf

http://cdn.hm-treasury.gov.uk/sr2010_completereport.pdf

http://www.gmc-uk.org/static/documents/content/GMC_Revalidation_A4_Guidance_GMP_Framework_04.pdf

http://www.gmc-uk.org/static/documents/content/GMC_Revalidation_A4_Guidance_GMP_Framework_04.pdf


General Medical Council (2011) Supporting Information for Appraisal and Revalidation http://www.gmc-uk.org/static/documents/content/Supporting_information_for_appraisal_and_revalidation.pdf NHS Commissioning Board (2013) Everyone Counts: Planning for Patients 2013/14 http://www.commissioningboard.nhs.uk/files/2012/12/everyonecounts-planning.pdf NHS Commissioning Board (2013) NHS Standard Contract 2013/14 http://www.commissioningboard.nhs.uk/files/2013/03/contract-particular.doc NHS Portsmouth, Clinical Commissioning Group (2012) Portsmouth Clinical Commissioning Group: Principles of Business and Provider Management Solent NHS Trust (2012) A report of a review of Solent NHS Trust’s clinical audit systems and processes (internal report written by Carol Bailey) Solent NHS Trust (2011) Strategy for Quality Improvement 2011-16 Solent NHS Trust (2012) Clinical Strategies: Adult Services; Adult Mental Health; Child and Family Services; Sexual Health Services

http://www.gmc-uk.org/static/documents/content/Supporting_information_for_appraisal_and_revalidation.pdf

http://www.gmc-uk.org/static/documents/content/Supporting_information_for_appraisal_and_revalidation.pdf

http://www.commissioningboard.nhs.uk/files/2012/12/everyonecounts-planning.pdf

http://www.commissioningboard.nhs.uk/files/2013/03/contract-particular.doc


Appendix 1:

Glossary

CIP Cost Improvement Plan

CLRN Comprehensive Local Research Network

CQC Care Quality Commission

CRN Clinical Research Network

CRO Clinical Research Organisation

DH Department of Health

e-dge Online database system for research management

ETCs Excess Treatment Costs

GMC General Medical Council

H&IOW CLRN Hampshire and IOW Comprehensive Local Research Network

IG Information Governance

IP Intellectual Property

IRAS Integrated Research Application System

NIHR National Institute for Health Research

Non-PF Non-portfolio

NRES National Research Ethics Service

PCRN Primary Care Research Network

PF Portfolio

PIC Participant Identification Centre

PPI Patient and Public Involvement

R&D Research and Development

RDS Research Design Service

RM&G Research Management and Governance

SLA Service Level Agreement

SOP Standard Operating Procedure

SSCs Service Support Costs


Appendix 2: Defining Research, Service Evaluation & Clinical Audit

Research

Service Evaluation Clinical Audit

The attempt to derive generalizable new knowledge including studies that aim to generate hypotheses as well as studies that aim to test them.

Designed and conducted solely to define or judge current care

Designed and conducted to produce information to inform delivery of best care

Quantitative research – designed to test a hypothesis Qualitative research – identifies/ explores themes following established methodology

Designed to answer: “What standard does this service achieve?”

Designed to answer: “Does this service reach a predetermined standard?”

Addresses clearly defined questions, aims and objectives

Measures current service without reference to a standard

Measures against a standard

Quantitative research – may involve evaluating or comparing interventions, particularly new ones Qualitative research – usually involves studying how interventions and relationships are experienced

Involves an intervention in use only. The choice of treatment is that of the clinician and patient according to guidance, professional standards and/or patient preference

Involves an intervention in use only. The choice of treatment is that of the clinician and patient according to guidance, professional standards and/or patient preference

Usually involves collecting data that are additional to those for routine care but may include data collected routinely. May involve treatments, samples or investigations additional to routine care.

Usually involves analysis of existing data but may include administration of interview or questionnaire.

Usually involves analysis of existing data but may include administration of interview or questionnaire.

Source: National Patient Safety Agency Research Ethics Service: Defining Research leaflet


Appendix 3: Key Performance Indicators, Research

Accountable to

Measure Assessment Criteria (to be used at year-end)

Supporting information

& source

1 Increase in patients participating in all studies

Trust Board Patients recruited to all studies against target : 10% increase p.a

Meet or exceed target

90-99% of target

<90% of target

Monthly performance report; Quarterly reports

Via e-dge, tracker and CLRN reports

2 To increase the number of recruiting studies

Trust Board Number of studies active against target by 20% pa


75-99% of target

<75% of target



3 To increase the number of commercial studies

Trust Board Number of new contracts against target (2 studies pa)


80-99% of target

<80% of target

Quarterly reports

Via tracker

4 Proportion of sites recruiting to target

Trust Board

% of study sites recruiting to target

80% 70-87% <70% of target

Monthly monitoring

Quarterly reports

Via tracker

5 % studies receiving NHS permission letter within 30 days of receipt of valid document pack

Trust Board

H&IOW CLRN

% studies receiving NHS permission letter within 30 days of receipt of valid document pack

90% 80-99% <80% of target




Appendix 4: HQIP Clinical Audit Maturity Matrix for Trust Boards – Position statement and action plan

Key Elements Basic Principle accepted Developing Working Well Exemplar

1. Use clinical audit as a tool in strategic management;

Measure Clinical audit is integral to the core strategy the Board is seeking to address

Clinical Audit programme is resourced to provide assurance against risks to strategic objectives

There is a capable and confident team leading and delivering audit

The Audit committee oversee the clinical audit programme focussing on topic selection, gaps, completeness & supporting the skills of NEDS to seek assurance of service compliance to standards

The Board directors lead as part of a unified board supported by appropriate sub- Committees, Commissioners and the Nursing or Medical Director

Current position

Core to strategic objectives – particularly evidence around improving health outcomes and integrated care pathways; and evidence that non-acute care is effective and safe

Audit team in post to support services; audit leads identified in each clinical division/ service line

Experienced team in place

Assurance Committee supported by Divisional Governance and Clinical Audit and Effectiveness sub committee oversee audit programme and monitor completion, adherence to standards. NEDS provided with training in clinical audit.

Medical Director has lead, supported by Director of Nursing and Quality. Trust Board supported by committee & governance structure

Actions to improve

Clinical audit objectives included in Trust Annual Business Plan; Clinical Audit Strategy to align to Trust and Clinical strategies; evidence from audit to inform progress against strategy

Deliver training across services; ensure audit is fully resourced and prioritized in transition to SLM

Recruit to remaining facilitator posts; support skills development across services

2. Develop an annual programme of work

Measure There is a confirmed direction and focus for clinical audit

There is clarity on how / which clinical audit activity will be supported?

An annual programme is prioritised and resourced

Resources and correct skill-base have been identified for each audit

There is an expectation and commitment from Board to see action plans arising from clinical audit implemented. .

Current position

In place Audit programme is banded according to

Annual audit programme in place, clinical audit

Resources and skill mix checked as part of

Action plans are a requirement following all


priority and this is agreed by Assurance Committee, Trust Board, Divisional Governance

strategy is in place (both currently under consideration by services)

governance and registration process

audits, and resultant improvements (evidenced by re-audit) recorded. Tracked by Divisional Governance and in turn, Assurance Committee

Actions to improve

Both to be ratified by Board

Additional training for staff to increase skill base across Trust

Evidence around implementation and improvement assured via re-audit in all cases

3. Instigate clinical audit as a direct result of mortality ratios, adverse clinical events, critical incidents & breaches in patient safety.

Measure Appropriate processes in place to respond to incidents, complaints and SMR trends Board is able to identify and anticipate priority areas of concern.

Audit process linked with clinical leaders who initiate data collection and report on the findings.

Audits are designed to check alignment to complaints and incident recording with resources in place for prompt response to adverse events

Agreed structure of audit champions in place who have received appropriate training to promote and initiate audit and ensure actions are followed through

Board is able to identify and anticipate priority areas of concern.

Current position

Processes in place for audit to be undertaken where there are a series of incidents

Clinical leads chair Divisional Governance groups; overview of incidents etc

Resources in place, process for responding promptly

Audit leads identified in SHS, Dental & Pharmacy. Non medical governance leads in all Divisions. Research nurses/ therapists across Trust to act as audit champions

Board has identified areas of concern (eg prison healthcare, Section 17 leave) in current year. Audit requested for future assurance. Concerns fed into annual audit programme

Actions to improve

Strategy outlines plans to improve triangulation of evidence. Governance leads and Quality & Risk team to work with CA team to improve links between incidents and audit activity

Formal process to instigate audit/ data collection required across all clinical divisions

Needs Development as in previous box

Audit leads/ champions to be identified in each division. Network events to be instigated for training/ shared learning. Increased training across clinical services

Consolidate ability to identify areas of concern via better triangulation of evidence. Increase use of outcomes measures to facilitate early identification of areas of concern.

4. Ensure the Measure Board has rehearsed The clinical audit Board challenge focuses itself subject to audit for The audit programme is


clinical audit programme is relevant to board strategic interests and concerns.

priorities and can match audit programme to its priorities

programme should be aligned to the strategic objectives through the board assurance framework generated by the board & used as an ongoing working document

on clinical compliance with standards and better practice & asks the appropriate assurance questions about clinical audit.

materiality, completeness and return on investment.

Results are always turned into action plans, followed through and re-audit completed

Current position

Audit programme linked to strategic and annual objectives. Clinical Audit strategy aligned to Trust objectives

Strategy objectives tracked for completion as a working document; Report on this quarterly to Assurance Committee

Assurance committee reviews compliance and improvement via Divisional Governance structures

Annual report to review programme completeness/ improvements

Process in place for ensuring action plans are produced and audit cycle is completed to ensure improvement/ completion of action plans.

Actions to improve

Trust Boart sign off of Clinical Audit Programme & Strategy

Track strategic objectives related to Clinical Audit in line with those in Trust Business Plan

Embed new reporting and monitoring process. Update training for Board in Clinical Audit and Assurance

Annual report to be drafted Embed new process; increase % of audits with action plans and that are re-audited through 2013/14

5. Ensure there is a lead clinician who manages clinical audit within the trust, with partners / suppliers outside,

Measure Lead clinician identified who is clearly

Accountable at Board level

Lead clinician is clear of role and resources available and has access to the corporate board.

Lead clinician has adequate resources and commitment is supported through CQUINs, job descriptions, induction, job plans & merit payments.

Lead clinician is strategically linked, with high level leadership skills and is delivering on key outcomes.

Lead clinician has national as well as a local profile and networks to drive integrated audit possibly as a shared post across a healthcare economy .

Current position

Medical Director identified as lead clinician accountable at Board Level

In place New team in place to support clinical audit across services; Clinical audit etc written into job plans of Clinical Leads

Linked nationally, delivering on outcomes

Lead clinician driving ICPs and audit to demonstrate quality/ safety across healthcare sector.

Actions to improve

Increase resource for audit in job plans/ appraisal etc

Evidence outcomes as part of EBP

6. Ensure patient involvement is

Measure Share with patients priority setting, means of engagement,

Patients influence is recorded and has impact

Patients and health and social care partners involved in priority setting

Users have direct access and influence over audit selection, planning and

For FTs share the development audit strategy with governors so


considered in all elements of clinical audit

sharing of results and plans for sustainable improvement.

for clinical audit.

results without need for mediators between the patient and the audit

that they have a context to inform them. Use the Healthwatch to inform priorities.

Current position

Minimal patient involvement in clinical audit programme

New post – PPI facilitator to support increased activity

Actions to improve

Strategy has improvement in PPI activity as one of 5 core goals.

7. Build clinical audit into planning management and reporting

Measure Clinical audit cycle aligned to planning cycles

Long term and immediate (one year plans) draw on audit results and capacity

Reporting is integrated and covers systems and behaviours, quality and costs

Clinical and financial/system audit programmes are integrated

Clinical audit Is an integral part of the culture & the operating process of the organisation

Current position

Clinical Audit results inform service delivery at a local level -

Operating plans includes clinical audit objectives

Quarterly audit reports and monitoring inform service design and delivery

Clinical and financial audit overseen by Audit & Risk Committee

Actions to improve

Feed up to corporate planning

Embed and integrate

8. Ensure with others that clinical audit crosses care boundaries and encompasses the whole patient pathway

Measure Primary, acute, ambulance. Independents and social care invited to engage in joint audit plan

Joint audit plan agreed across primary, acute and social care

Audits cover the patient journey not just our component of it

Action plans agreed across primary, acute and social care

Whole system approach seeking to rationalise service improvement is the norm

Current position

Where services are delivered across sectors, audits are carried out in partnership

Joint actions agreed for service level audits

2013/14 audit programme to include audits of integrated care pathways

Some examples of joint action planning in shared care services

Some examples of whole pathways approach

Actions to improve

Increase number of cross sector audits

Instigate joint planning for NICE guidelines audits where they cross

Audit all ICPs within 2013/14 and instigate shared action plans

As previous box


Source: Good Governance Institute/ Healthcare Quality Improvement Partnership, Clinical Audit: A Simple Guide for NHS Boards http://good-governance.org.uk/Products/clinical-audit---simple-guide-for-nhs-boards.htm

healthcare sectors

9. Agree the criteria of prioritisation of clinical audits,.

Measure Balance national and local interests, and the need to address specific local risks, strategic interests and concerns

Recognise the tension between national and local audit – Boards must realise there is a tension

Boards are allowed to prioritise audit subjects

Criteria for prioritisation of clinical audits is in place, explicit and applied. Boards agree the audit programme

Audit shows the board has agreed the clinical audit programme using the agreed risk assessed prioritisation approach.

Current position

Audit programme is prioritized according to national, Trust and local priorities

National Audit participation mandated – resources in place to support

Trust Board approves annual audit programme; Divisional Governance prioritise local audits

Prioritisation agreed at Assurance and Board; Board to sign off annual audit programme

Board to approve plan for 2013/14 Agenda Item on annual Board Agenda cycle

Actions to improve

Embed new process

10. Confirm clinical audit is leading to improved outcomes

Measure A clear process in place that links areas of failing service to inform the annual clinical audit programme

A system of expected outcome improvements as a return on investment (ROI) is in place

Action plans are developed setting out both service improvement and cost savings and implementation is audited against these expectations

Re-audits/monitoring takes place that demonstrates improvements in patient care related to patient feedback/complaints.

An exemplar organisation would come out in the top quartile of patient satisfaction, renowned for its customer care and have a low number of complaints referred on to the Ombudsman.

Current position

In place – consultation for 2013/14 audit programme has taken place and audits planned around failing services

Identification of outcomes in process

Action plans always lead to improvement and have to demonstrate cost efficiency and safety

Patient feedback and clinical audit linked via new software

Actions to improve

Link outcomes data with other evidence form clinical audit and PROMS

Consolidate process; build cost savings into action plan templates or evidence of improvement

Require better triangulation of evidence around complaints and compliments

http://good-governance.org.uk/Products/clinical-audit---simple-guide-for-nhs-boards.htm

http://good-governance.org.uk/Products/clinical-audit---simple-guide-for-nhs-boards.htm


Appendix 5: Summary of Objectives, and Timeframe for Delivery Objective Action Achieved by Timescale

To provide an organisational hub for the collation of best evidence via research, evaluation and clinical audit activity and to ensure clinicians are enabled to deliver evidence based quality improvements into service delivery and improve patient outcomes

Motivate staff to be involved in evidence informed practice: Ensure all staff and services understand how research, evaluation & clinical audit fit into their clinical practice; processes around governance of these activities, and ways of sourcing support

Increase profile of research, service evaluation and clinical audit activity via regular communications via Team Brief and the intranet

Regular attendance at team meetings and divisional governance meetings

Production of reports for each clinical division/ service line highlighting open and outstanding projects, key findings, actions and improvements

Production of an Evidence Based Practice Pack, available to staff and services with guidelines on governance processes

Celebrate success via news items, SHINE, and Trust conferences/ forums

Continuous information and ‘news’ via website, posters

March 2013

March 2013

March 2013

October 2013

October 2013

March 2014


Objective Action Achieved by Timescale

Providing regular and accessible training for staff on evidence based practice, research, evaluation and clinical audit

Deliver a series of face to face training workshops which focus on applied skills – minimum of three a year

Training for all medical trainees and nurses/ AHPs on the preceptorship programme

Provide access to training via University, research network or HQIP schemes

Provide online training modules in evidence informed practice accessible to all staff

Invest in clinical academic posts – minimum of 2 per division

April 2013

October 2013

April 2013

March 2013

March 2015

Ensure that there is adequate expertise for support with data collection and analysis and associated training for staff

Ensure the correct skill mix in the Research, Service Evaluation & Clinical Audit team to provide expertise in methodology, data analysis and in the translation of evidence into action/service and cost improvement.

Create supporting posts to work across clinical divisions in respect to evaluation and clinical audit planning, implementation and action planning.

March 2013

March 2015



Ensuring that evidence from research and innovation is fed back into services

Consolidate partnerships between services and academic institutions. It is important that there are tangible links between academic leads and relevant innovation. In particular link with Wessex AHSN

Ensure access to research publications and findings as per condition of research approval in the Trust is achieved

Ensuring these publications and evaluation/ clinical audit findings are available on the intranet

Hosting an annual Solent NHS Trust Research, Evaluation and Clinical Audit Conference. Trust staff and students will be encouraged to present at this conference.

July 2013

March 2014

October 2013

Annual

Ensure that this evidence is linked to outcomes and feeds into service or cost improvement plans

As part of the evaluation registration and governance process, ensure a system is in place for translating evaluation and clinical audit findings into service improvement plans, cost improvement plans or refined outcome measures.

Develop forward plans for service evaluations and clinical audits to provide the evidence base needed and to support the cycle of continuous improvement through PDSA (Plan, Do, Study, Act) cycles.

Engage with Trust Board via the monitoring of research, service evaluation and clinical audit findings and subsequent implementation of innovation and improvement

March 2014

March 2013

October 2013



Ensure understanding of policies and processes by regular audit against adherence.

Annual, first by March 2014

Prioritise the development of research, service evaluation and clinical audit projects that will provide an evidence base to improve community based care and support national priorities around transformation and develop auditable evidence based clinical outcome measures across all services

Secure funding to invest in research staff posts within clinical divisions to support National and Trust objectives (for examples the Dementia Challenge)

Meet annual CLRN business objectives to secure activity based funding and negotiate support for posts in priority areas

Using Research Capability Funding to invest in further clinical academic posts

Maximise commercial income from research for investment in research capability – 2 new studies by 2014

Seek joint funded posts across the Trust and Universities and the Health Sector

March 2014

May 2013

March 2014

March 2015

Produce an annual programme of Clinical Audit and Evaluation in consultation with the Board and Clinical Divisions to align to local and national priorities

To include national, regulatory and service led projects March 2013



Increase the number of research projects hosted in priority areas

Investing in staff to identify relevant studies on the NIHR portfolio – at least one post per division

Enhancing partnerships with HEIs to consolidate understanding of Solent NHS Trust services via:

links with education

website

Proactively engaging with Industry with information pack about Solent and research capacity

Working in partnership with other Trusts to secure projects across integrated care pathways

May 2014

March 2015

March 2013

December 2013

March 2014

Establish a clear link between the Business and Marketing team and the Research, Service Evaluation and Clinical Audit team

Contribute to the annual business objectives for the Trust operating plan

To ensure that products generated as a result of research are supported in terms of commercial activity and possible income generation, via marketing, licensing etc. At least one example in 2013/14

March 2013

March 2014



Engage with commissioning groups to incorporporate the collection of best evidence (including outcome based KPIs) into contractual arrangements

Propose forward plan annually & mutually agree

Where appropriate or useful, negotiate commissioning of evaluations/ audits or research to support an evidence base. Engage with CCGs in project planning. One example in the first year

Ensure that outcome measures can be used as KPIs for commissioners

March 2013

March 2014

March 2014

Facilitate and increase the scope of research activity and the number of patients and staff that are engaged with research projects.

Increase the number of patients recruited to research studies& the number of studies open to recruitment by:

Horizon scanning and proactively approaching study managers to increase numbers of studies opened by 100% over four years.

Ensuring processes for gaining consent maximise access to patients for invitation to participate in trials

Improve awareness of research opportunities for patients via improved communications in all clinical areas.

Increasing the number of services involved in research by 20% over four years

Increasing the numbers of patients involved in studies to meet annual targets set by the NIHR

Establishing agreements with research networks and other NHS Trusts for sharing accruals equitably

March 2016 (20% pa)

March 2014

March 2014

March 2016

March 2014

March 2014



Focus on commercial studies

Ensure there is clinical engagement and willingness to carry out commercial trials.

Work with the CLRN and other research networks to identify suitable trials for Solent NHS Trust.

Engage directly with pharmaceutical and medical device companies and CROs working on their behalf to promote Solent as a preferred research site.

Incentivise staff via the development of an income distribution policy to enable investigators to reinvest earnings from research back into the development of further research capability. Ensure investigators are aware of policy.

Ensure there are adequate patient numbers to meet delivery targets set by commercial companies via partnerships with neighbouring NHS Trusts.

Ensure governance processes are streamlined to guarantee approvals do not cause unnecessary delay. Where suitable, adopt co-ordinated and consistent approaches to approval (such as single point of negotiation) with partner Trusts.

Dec 2013

October 2014

March 2014

October 2013



Invest in protected research time for staff

Invest in a network of research nurses/ therapists who work in a clinical and an academic capacity from within clinical divisions – at least one per division

Invest in clinical academic posts at doctoral and post doctoral level to work within services and identify studies open in their service area – 2 extra posts

Engage with medics, medical trainees and other clinicians to encourage and facilitate research activity in their service area.

Provide training in clinical research and in the use of evidence in practice for new and developing investigators.

Include research in the appraisal and objective setting process.

Improve financial incentives for staff and services to participate in research

Celebrate and promote achievement.

March 2014

October 2014



Increase research income for the Trust

The annual target for numbers of patients recruited into studies must be realistically negotiated and then achieved.

The numbers of studies approved must increase and must be approved within national metric timeframes. In addition attracting NIHR funded grants as an NHS host organisation will increase our Research Capability Funding Allocation (previously Flexibility and Sustainability Funding).

Studies must be monitored to ensure they are recruiting to time and to target.

The number of commercial trials opened in Solent NHS Trust must increase to maximize direct earnings and indirect performance management associated funding from the CLRN.

The costing of studies must ensure that all direct costs incurred are covered, and that there is some allocation for overhead and research development costs.

Exploit opportunities for innovation in its research partnerships. Protect Intellectual Property Rights of the Trust and seek to encourage and support staff to participate in the generation of Intellectual Property (IP) as part of its commitment to encourage innovative practice and to deliver excellent healthcare



To engage in a programme of clinical audit and service evaluation across all clinical services which reflects key national and local drivers for quality improvement, as well as divisional priorities and the interest of service users, carers and clinicians.

Develop and annual clinical audit and service evaluation plan to fit with corporate objectives, national priorities and clinical need

Engage with Trust board, Clinical Leads, Divisional Governance Leads and clinicians to identify and approve an annual programme of Clinical Audit and Service Evaluation

Prioritise the activity within the programme.

March 2013

Meet statutory and mandatory obligations with respect to clinical audit

To include participation in audit, and monitoring of recommendations

March 2013

Support the Trust Board to meet the standards of an ‘Exemplar’ Trust according to the Framework outlined by the Good Governance Institute in all ten dimensions.

See Appendix 4



Institute streamlined policies for clinical audit and registration

Update the clinical audit policy to reflect new governance arrangements and to incorporate service evaluation

Develop a registration process that combines clinical audit and service evaluation for clarity to support front line staff

Develop a reporting system for tracking completion of audits, implementation of actions and completion of the cycle via re-audit.

Link the policy around mandatory registration and monitoring to appraisal, revalidation and training programmes (for medics, nurses and AHPs)

March 2013

March 2013

October 2013

March 2014

Ensure governance and tracking of action plans identified from clinical audit and service evaluation

Ensure that each clinical division is tracking its audit programme in terms of timely completion of audits, and completion of the audit cycle via a programme of re-audit

Ensure that governance structures within clinical division support and can evidence the monitoring of action plans

Ensure that the governance structures within clinical divisions can support training and communication to clinical staff around processes for clinical audit and service evaluation.

October 2013

October 2013

October 2013



Ensure clinical audit is linked to incident reporting, complaints etc and findings triangulated with other evidence such as from outcome measures (to include PROMS) and patient feedback

Institute systems for identifying audit need as a result of incidents and complaints, and quality priorities.

Assure triangulation of information from incident reporting, patient experience and other quality indicators to inform programmes of clinical audit and service evaluation

July 2013

March 2014

Ensure adequate training for clinical audit for all staff, in terms of methods, reporting and translation into quality improvement

Insure that all staff are empowered to undertake clinical audit and service evaluation via training. This will take the form of

A series of face to face workshops which have demonstrable translation into clinical audit activity and quality improvement. At least three workshops each year

Access to online training packages for clinicians, the Board and members of the public

Delivery of training for students via the medical trainee and preceptorship programmes

Specialist training arranged as part of the Learning and Development portfolio of training courses

March 2014

October 2013

March 2014

March 2014



Link audit to medical revalidation and the appraisal process

Systems will be put in place to ensure that doctors have the tools and recording systems to support their quality improvement portfolio

Software will be rolled out to support this process, as well as patient feedback for revalidation

Service Evaluation and Clinical Audit which is not registered with the Clinical Audit and Evaluation team will not be accepted as evidence for appraisals or revalidation.

Ensure these processes and systems can be extended to nurses and AHPs when their programme of revalidation is launched in 2014.

July 2013

July 2013

Embrace and lead the way with a culture of patient and the public involvement in research, evaluation and clinical audit

A dedicated post to promote patient and public involvement in research, service evaluation and clinical audit

Feb 2013

Formalised partnerships with the Research Design Service, INVOLVE, HQIP and networks to promote PPI



Lay membership in all significant or strategic events such as:

Membership on the R&D Committee

Membership in evidence informed practice forums

Representation at the annual conference

Membership on panels for awarding funding/ prizes etc

Input into changes to strategy

Active contribution to the website

Revisions to the R&D approval process Ensure support for staff and external researchers to increase patient involvement in projects

Monitoring of public involvement across all studies

Monitoring of appropriateness of materials and methods for the dissemination of findings

March 2013

March 2014

March 2014

Revisions to the Clinical Audit and Service Evaluation registration and monitoring process to increase public and patient involvement in quality improvement

October 2013

Guidance on the website and support for lay members and researchers

Appropriate literature and marketing material in clinical areas to promote research and patient and public involvement

March 2013

December 2013



Establishment of a network of PPI representatives/ service users who can support evidence informed practice

October 2013

Support for PPI representatives to have access to local and national networks and forums in which they can share and disseminate best practice and success

March 2014

Identification of funds to support PPI activity as per national guidance

May 2013

Policy to facilitate the appropriate re-numeration of lay members as per national guidance

March 2014

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