Annual Quality Statements 08 January 2014 Annual Quality Statements A perspective from 2013 Structured Assessment work PLEASE PRINT HANDOUTS IN BLACK AND WHITE Carol Moseley

Content Background to: Structured Assessment 2013; and review of AQS’ What did we look at? What did we find? drafting contents Improvement suggestions for Year 2 Annual Quality Statements 2013

Background: Structured Assessment Structured Assessment work has formed part of the Wales Audit Office annual audit programme at Welsh NHS bodies since 2010 The work examines the arrangements NHS bodies have in place to support good governance and the efficient, effective and economical use of resources In 2013, our Structured Assessment approach included: a specific focus on quality governance arrangements; and a high level review of Annual Quality Statements Annual Quality Statements 2013

Background: review of Annual Quality Statements In reviewing the Annual Quality Statements: We accounted for Welsh Government guidance/requirements; and what we might expect to see in an annual quality statement The work provided a general overview; it was not a compliance audit We did not report on the Annual Quality Statements in detail as part of our local work, but have provided suggestions for improvement where applicable it was not a compliance audit, but used to compare with our findings and overall view of the quality governance arrangements and quality processes Annual Quality Statements 2013

What did we look at? Auditors broadly looked at: Use of the summary Description of: the overall quality framework; quality performance; quality and safety risk management quality improvement initiatives & actions Internal review and publishing Accessibility – style, language Balance What did we look at: AQS review criteria Quality Statement Summary: Includes a summary which Highlights the organisational commitment to quality and key points from the body of the statement Sets out how the NHS body is working with partners to ensure good quality, effective and safe services demonstrates a culture of candour and transparency recognising both strength and weakness.   Overall Quality Framework: Quality and Safety and sub-Committee Structure Quality and Safety Committee and sub-committee attendance records Coverage of the Quality and Safety Committee's work How the Board receives assurance via the quality framework Quality performance: Information on complaints, Concerns, Incidents and Whistle blowing Information on Redress, Putting things right Self-assessment of quality of services Self-assessment of effectiveness of quality framework Information on access to services Information on patient outcomes Information on patient experience Quality and Safety Committee and Sub-committee Reporting: Highlights of Quality and Safety Ctte reports Highlights of External Reviews (HIW, DSU etc.) Highlights of clinical audit reports and conclusions Highlights of Welsh Risk Pool reports Doing Well Doing Better: Promotes use of standards for service review, share good practice, identify current effectiveness and improvement aims with a focus on Standards 3, 6, 7, 22 and 23. 1000 Lives: Engages with 1000 lives programme & promotes improvement Quality and Safety Risk Management: Risk assessment & risk profile How risks to quality and safety are managed Any newly identified risks or high risks Internal review and publishing Internal audit review: Ensuring consistency with audit knowledge Ensuring a fair and balanced view is presented Ensuring internal controls are in place over the collection, calculation and reporting of measure and indicators Publishing requirements: AQS is formally signed off by Executive The AQS has been published by 30 September 2013 Annual Quality Statements 2013

What we thought about drafting and publication of Annual Quality Statements Published by required timeframe Reviewed by internal audit in advance Significant variation in format, style and length Some quite technical and not ‘public’ facing too many acronyms and NHS jargon Variation in how promoted/communicated to the public/ stakeholders AQS’s ranged from 34 pages to 102 pages. Shorter statements were more readable and publically accessible, but lacked detail – longer statements had good detail, but were not, in general as accessible to the lay public. Is there a happy medium? Could separate summaries help? Annual Quality Statements 2013

Overall view of the contents of the Annual Quality Statements Most organisations are effectively describing their environment, identifying their strengths, quality improvement initiatives and providing some quality performance information Organisations were reasonably effective at providing an overview of quality arrangements for their locally provided services Most organisations were not good at identifying their quality objectives, targets and their key risks to the quality of services. Most Health Boards were not effective at defining its quality oversight and control arrangements for services commissioned from partners Annual Quality Statements 2013

Our thoughts on areas for improvement for year 2 (i) Start to embed the quality assurance / statement process in your organisation’s directorates and localities Develop the Annual Quality Statement as part of the on-going quality assurance framework. Make it live - not a year end exercise Make sure the lay-reader could understand it: does it pass the plain language test? Include consideration of the quality assurance approaches for commissioned services For example the North Locality in Powys has produced a locality annual quality statement, which sets local context, quality arrangements and expectations for achievement of quality services for the locality. This type of approach would make drafting the corporate AQS very easy, if adopted and embedded across organisations. Annual Quality Statements 2013

Our thoughts on areas for improvement for year 2 (ii) Candour and openness: we saw differences in the degree of candour this year, in describing the quality of services, the risks and actions being taken to improve Set quality objectives and targets which are ambitious and realistic use the AQS to help drive quality improvements Better balance of detail, length and readability if detailed, consider an accompanying Quality Statement Summary that highlights the key points for the public Include highlights and messages from external regulators every organisation has difficulty at some point the AQS should provide an honest and fair view of the quality of services, the risks and actions being taken to improve C&V introduction was notably honest Annual Quality Statements 2013

Questions? Annual Quality Statements 2013