1 17/10/2017 Variation between Mental Health Trusts Wexham Park - - PDF document

SLIDE 1

17/10/2017 1

Keeping quality at the heart of patient experience

September 19th 2017, Guildhall, London

Where have we come from?

2009

• CQC was established, bringing together 3 organisations: HCC, MHAC, CSCI
• Generic model of inspection, with inspectors expected to cover care homes, GPs,

dental practices, hospitals, mental health etc.

• Mental Health Act work carried out in isolation from other inspections

2013

• Francis Report on Mid Staffordshire, February 2013
• Concerns that other problems had not been uncovered (e.g. Winterbourne View;

Morecambe Bay)

• Keogh reviews of 14 trusts with high mortality
• “Raising standards, putting people first” CQC Strategy May 2013
• “A new start” consultation June 2013
• CQC appoints 3 chief inspectors
• Wave 1 inspections for 18 acute hospitals

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Where have we come from?

2014

• Hospitals Directorate established
• Comprehensive inspection programme rolled out across acute, mental

health and community health trusts 2016/17

• All trusts and independent sector providers inspected
• MHA incorporated into operational teams
• Good overview of services that can inform wider policy
• Methodology being refreshed

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Current Ratings: NHS Trusts

N I RI G O Acute 136 7% 57% 32% 4% Specialist 18

• 28%

44% 28% Ambulance 10 20% 40% 30% 10% Community 18

• 44%

56%

• Mental Health

55

• 58%

38% 4% Overall 238 5% 54% 36% 5%

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Current Ratings: Independent Sectors

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N I RI G O Acute hospitals 113 1% 29% 65% 4% Single speciality 2 50% 50% Community 3 67% 33% Mental Health 205 4% 26% 66% 3% Overall 323 4% 26% 66% 3%

Variation between Acute trusts/locations

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Frimley Park NHS Foundation Trust 2014 Wexham Park Hospital 2014

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17/10/2017 2

Variation between Mental Health Trusts

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Safe Effective Caring Responsive Well-led Overall Adult acute wards & PICU's Inadequate Requires Improvement Good Inadequate Inadequate Inadequate Adult long stay / rehabilitation wards Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable Forensic inpatient / secure wards Inadequate Requires Improvement Requires Improvement Requires Improvement Inadequate Inadequate CAMHS Requires Improvement Good Good Good Good Good Wards for older people Requires Improvement Requires Improvement Good Inadequate Requires Improvement Requires Improvement Wards for people with a learning disability or autism Inadequate Requires Improvement Good Requires Improvement Inadequate Inadequate Adult community-based services Requires Improvement Requires Improvement Good Requires Improvement Inadequate Requires Improvement Community-based crisis services & HBPoS Requires Improvement Requires Improvement Good Requires Improvement Inadequate Requires Improvement Specialist community- based services for children & young people Requires Improvement Requires Improvement Good Requires Improvement Requires Improvement Requires Improvement Community-based services for older people Requires Improvement Good Good Inadequate Requires Improvement Requires Improvement Community-based services for people with a learning disability or autism Good Good Good Good Good Good Overall Inadequate Requires Improvement Good Requires Improvement Inadequate Inadequate

Norfolk & Suffolk NHS FT 2014 East London NHS Trust 2016

Safe Effective Caring Responsive Well-led Overall Acute wards for adults of working age and psychiatric intensive care units (PICU's) Good Good Outstanding Outstanding Outstanding Outstanding Long stay/rehabilitation mental health wards for working age adults Good Good Good Good Good Good Forensic inpatient / secure wards Requires Improvement Good Outstanding Good Good Good Child and adolescent mental health wards Good Good Outstanding Good Outstanding Outstanding Wards for older people with mental health problems Good Good Outstanding Outstanding Outstanding Outstanding Wards for people with a learning disability or autism Good Requires Improvement Good Good Good Good Community-based mental health services for adults of working age Good Good Good Good Outstanding Good Mental health crisis services and health based places of safety Good Good Good Outstanding Good Good Specialist community mental health services for children and young people Good Good Outstanding Outstanding Good Outstanding Community-based mental health services for older people Good Good Outstanding Requires Improvement Outstanding Good Community mental health services for people with a learning disability or autism Good Good Good Good Good Good Overall Good Good Outstanding Outstanding Outstanding Outstanding

Wexham Park Hospital

2014 2015

Safe Effective Caring Responsive Well-led Overall Urgent and emergency services Good Good Good Outstanding Outstanding Outstanding Medical care (including older people's care) Good Good Good Good Good Good Surgery Good Good Good Good Outstanding Good Critical Care Good Good Outstanding Good Outstanding Outstanding Maternity and Gynaecology Good Good Good Good Good Good Services for children and young people Good Good Good Good Good Good End of life care Good Good Good Good Good Good Outpatients and Diagnostic Imaging Good Inspected but not rated Good Good Good Good Overall Good Good Good Good Outstanding Good

Calderstones Partnership NHS FT

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Calderstones Partnership NHS Foundation Trust 2014 (shadow ratings not published)

Safe Effective Caring Responsive Well-led Overall Forensic inpatient / secure wards Inadequate Requires Improvement Good Requires Improvement Requires Improvement Requires Improvement Community-based services for people with a learning disability or autism Requires Improvement Inadequate Good Requires Improvement Requires Improvement Requires Improvement Overall Inadequate Inadequate Good Requires Improvement Requires Improvement Inadequate

Calderstones Partnership NHS Foundation Trust 2015

Safe Effective Caring Responsive Well-led Overall Forensic inpatient / secure wards Good Good Good Good Good Good Community-based services for people with a learning disability or autism Requires Improvement Good Good Good Good Good Overall Good Good Good Good Good Good

Impact of our inspections on quality and safety

• We know that providers make improvements before our

inspections – but difficult to quantify

• We observe improvements when we raise immediate concerns

during an inspection

• We observe changes in response to enforcement action
• The provider survey tells us that our inspections are helpful in

identifying areas for improvement

• Ultimately: We reinspect to assess change over time

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Our next phase of regulation

“A more targeted, responsive and collaborative

approach” Strategic objectives

• Encouraging improvement among providers
• Intelligence driven inspections
• Developing a shared view of quality
• CQC becoming more efficient

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NHS trust inspections – what we are proposing to change

Changes to KLOEs and inspection methodology

• Focus our inspections where we

have the greatest concerns or services that might have improved

• Develop our local relationships

with providers, with Healthwatch and local and regional public

• rganisations
• Accommodate new models of care
• Align our approach with NHS

Improvement to avoid duplication

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17/10/2017 3

Next phase of inspection – regulatory framework

Provider information request

• More targeted

– less detail

• Used for

monitoring, inspection and rating

• Includes a

provider’s statement of quality Regulatory planning meeting

• Internal CQC

meeting

• Determine

inspection activity

• Using

stakeholder views, CQC Insight, local relationships Inspection

• Announced

well-led

• At least one

unannounced core service

• Smaller

teams Reporting

• Shorter

reports – summary + evidence appendix

• Ratings grid

shows new and existing ratings Inspection cycle moving towards annual frequency Monitoring – ongoing

• Replacing Intelligent Monitoring

with new Insight model

• Strengthened relationship with

providers

• Focused inspections if concerns

– change core/location rating only

• Continue to listen to people who

use services

The updated well-led framework: Key Lines of Enquiry

Is there the leadership capacity and capability to deliver high-quality, sustainable care? Is there a clear vision and credible strategy to deliver high-quality sustainable care to people, and robust plans to deliver? Is there a culture

• f high-quality,

sustainable care?

Are services well-led?

Are there clear responsibilities, roles and systems of accountability to support good governance and management? Is appropriate and accurate information being effectively processed, challenged and acted on? Are there clear and effective processes for managing risks, issues and performance? Are the people who use services, the public, staff and external partners engaged and involved to ensure high- quality sustainable services? Are there robust systems and processes for learning, continuous improvement and innovation?

Other changes in next phase

Maternity/gynaecology: Separate Outpatients/Imaging: Separate Mental Health in acute trusts: New approach Use of Resources: Work in progress with NHSI

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NHS Improvement has brought together six organisations

Patient Safety

from NHS England

NHS TDA Advancing Change Team

(from NHS Improving Quality)

Monitor Intensive Support Teams

(from NHS IMAS)

Operational Productivity

(Carter, GIRFT, Model Hospital) 16

Our Single Oversight Framework was launched in September 2016

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Segments for providers

1 2 3 4

Mandated support: significant concerns Special measures Targeted support

• ffers

Maximum autonomy

Breach Concerns

The segmentation approach intends to help identify the support that providers need across the five SOF themes:

• quality of care
• finance and use of resources
• operational performance
• strategic change
• leadership and improvement

capability Segmentation will not in itself determine the precise support package, which will need to be individually tailored to providers’ needs.

Single Oversight Framework themes

• CQC assessment: safe, effective, caring, responsive
• Progress in implementing 7-day services

Quality of care

• Financial performance and efficiency, control totals
• Use of resources assessments

Finance and use of resources

• Includes A&E, 18 weeks, 62-day cancer waits
• Performance vs Sustainability & Transformation Fund

trajectories and absolute targets where relevant

Operational performance

• How providers are supporting strategic change in

their local health economy – 5YFV, Sustainability & Transformation Plans, new care models, devolution

Strategic change

• Build on existing tools (eg well led framework),

working with CQC

Leadership and improvement capability

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17/10/2017 4

Example quality challenges / concerns

• Increased financial pressures ( pay budget)
• Continued focus on driving efficiency savings
• Demoralised / pressurised workforce
• How to meet safe and sustainable staffing levels
• Poor operational performance (proxy for quality)
• Continued iatrogenic harm (falls, pressure ulcers,

recognition of deteriorating patient)

• Environmental risks (ligatures, accommodation)
• Prone restraint, high suicide, poor crisis case
• Delayed transfer of care
• Poor patient / service user experience

Recurrent issues in CQC reports

• Culture where staff unable or unhappy to raise concerns
• Staffing levels / skill mix of staff
• Disconnect between risks articulated by front line staff and

formal risk intelligence (risk registers)

• Gaps in effective investigation of and learning from incidents
• Gaps in basic safety checks (equipment , meds)
• Poor pt flow, inappropriate admissions and delayed

discharges

• Poor leadership and teamwork in clinical teams that is not

effectively addressed

• History of leadership taking false assurance from inadequate

information

• Weak relationships with external stakeholders

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CQC ratings July 2017 Driving Improvement

• Quality improvement methodology
• Leadership development
• Oversight of quality plans
• Quality reviews.
• Workforce and safer staffing
• Learning from incidents

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