1. Birmingham Community Healthcare NHS Trust 2013/14 CQUIN Progress Report December 2013 Introduction The CQUIN payment framework makes a proportion of providers’ income conditional on quality and innovation. Its aim is to support the vision set out in High Quality Care for All of an NHS where quality is the organising principle. The CQUIN schemes are agreed between the Trust and Commissioners on a yearly basis and comprise 2.5% of the contractual value. Each CQUIN scheme has goals and targets to be achieved throughout the year in order to secure the payment from Commissioners. BCHC CQUIN schemes form part of the following contracts: 1.Multi-Lateral Agreement (MLA) 2. Birmingham Dental Hospital 3. Combined Community Dental Services (CCDS) 4. Rehabilitation Services 5. Learning Disabilities For 2013/14 the combined value of all CQUIN schemes is £4,902,203.

2. MLA Contract CQUINS Overview MLA CQUIN Schemes – total value £3,676,638 Name Divisions involved WeightingValue Corporate Adults & Communities Children & Families 1 Friends & Family Test  5% £183,832 2 Patient Safety Thermometer  7.5% £275,748 3 Dementia  20% £735,328 4 VTE Risk Assessment & RCA  7.5% £275,748 5 Pharmaceutical Risk Assessment  10% £367,664 6 Formulary Adherence  10% £367,664 7 Pressure Ulcers  20% £735,328 8 Common Assessment Framework  20% £735,328

3. MLA Contract CQUINS Scheme 1. FRIENDS & FAMILY TEST - comprised of three indicators, 1A, 1B & 1C RequirementPaymentValue Q4 By July produce an action plan detailing the staff survey results, broken down by directorate & milestones for actions to be completed. The goal for payment is an improved score in the annual staff survey by the end of Quarter 4 100% - Forecast Amber Risk. Organisational Development has worked with Divisions to implement: Staff Survey Action Plan Focus Groups; they identified 4 themes for improvement: 1.Management engagement & communication. 2.Promoting our commitment to patient care. 3.Recognising the value of individuals and 4. Job satisfaction Comprehensive action plans identifying transformational & transactional actions & ‘quick wins’ for each theme have been progressed throughout the year. Significant work to reduce work related stress; month of activity in November to recognise National Stress Awareness Day. Resilience Toolbox Training & Be Well Roadshows were organised at various sites across the patch. The success of the indicator will not be known until the staff survey results are available, this uncertainty creates an amber risk considering previous performance. £75,533 Indicator 1A - Improved performance on the staff Friends & Family Test. Value £75,533 Indicator 1B - Use of the Friends & Family Test to drive improvements across BCHC. Value £75,533 RequirementPaymentValue Oct 13 Provide action plan with specific measureable outcomes with timescales for improvement. 50% - Achieved The action plan is being monitored via Patient Safety & Experience Group. £36,766 Apr 14 Provide report & action plan with completed trajectories for improvement. The final action plan & achievements must be agreed by Commissioners 50% - Forecast Compliance - improvements are being made as per the action plan £36,766 Areas for improvement: Staff attitude / Interpreters Availability / Patient boredom Noise & responsiveness at night / Communication / Staffing levels Actions: Promote iCare training & ‘Dignity Champions’ / Reissue interpreter process / Volunteer programme / Undertake night time audit / Recruitment plan

4. MLA Contract CQUINS Scheme 2. NHS SAFETY THERMOMETER - Increase in Harm Free Care in line with National Guidance. Value £275,748 RequirementPaymentValue Q1 Develop methodology for all patient to be asked FFT: include all who may have been previously excluded i.e. dementia, learning disability, frailty. 20% - Achieved £7,353 Q2 Implement FFT for all patients. Data to be presented broken down using national template & using amended template 20% - Achieved£7,353 Q3 Implement FFT for all patients. Data to be presented broken down using national template & using amended template 20% - Forecast Compliance The response rate for the vulnerable patient group is continuing to show improvement £7,353 Q4 Show an increase in the response rate for FFT across all inpatient units. This will be the cumulative figure for pts responding using both the nation FFT & the locally amended FFT. 20% - Forecast Compliance The response rate for the vulnerable patient group is continuing to show improvement £14,706 Indicator 1C - Vulnerable Patient Group Increased response rate. Value £36,766

5. MLA Contract CQUINS Indicator 3A - Finding, assessing & investigating Dementia. Value £367,664. Identify new patients with dementia using agreed screening tool. Inform GP with a discharge summary that includes blood test results & screening results within 48 hours of discharge. Support patient & carers by signposting to community services. Excluded patients: (<75/ delirium / sepsis / end of life /previous known diagnosis, patients who are discharged within 72 hours) Indicator 3B - Clinical Leadership - Training of staff. Value £183,832 Scheme 3. DEMENTIA – the scheme is comprised of three indicators, 3A, 3B & 3C

6. Indicator 3C - Supporting Carers of People with Dementia - Inpatients. Value £183,832 MLA Contract CQUINS Scheme 3. DEMENTIA – the scheme is comprised of three indicators, 3A, 3B & 3C

7. Indicator 4A - VTE Risk Assessment - 95% compliance target for risk assessment. Value £137,874 MLA Contract CQUINS Scheme 4. VTE is comprised of 2 indicators Indicator 4A - VTE Root Cause Analyses- 100% of VTEs have a root cause analysis. Value £137,874 Scheme 5. Pharmaceutical Risk Assessment - audits to highlight medication risks. Value £367,664 Aim is to increase communication with Primary Care & reduce medicines-related admissions.

8. MLA Contract CQUINS Scheme 6. Formulary Adherence - the % of prescribed items that are prescribed in line with the local formulary. Value £367,664 Scheme 7 Common Assessment Framework - this is a national approach to providing a way of assessing children with additional needs, in the areas of growth & development, educational requirements, family & environmental issues, and/or specific needs of the parent/carer. The purpose is to initiate and support early intervention and improved joint working and communication between children’s practitioners from a variety of agencies. Value £735,327

9. Dental Hospital and CCDS Contract CQUINS Dental Hospital CQUIN Schemes – total value £280,758 Name Divisions involved WeightingValue Corporate Dental Hospital CCDS 1 Friends & Family Test  40% £112,303 2 Managed Clinical Networks for Oral Medicine & Restorative Dentistry  60% £168,455 CCDS CQUIN Schemes – total value £95,347 1 Managed Clinical Networks for Special Care Dentistry & Paediatric Dentistry  50% £47,634 2 Patient Experience  50% £47,634

10. Dental Hospital and CCDS Contract CQUINS Scheme 1. FRIENDS & FAMILY TEST - comprised of two indicators, 1A & 1B Indicator 1B - Use of the Friends & Family Test to drive improvements across BCHC. Value £56,152 Indicator 1A - Improved performance on the staff Friends & Family Test. Value £56,152

11. Managed Clinical Networks Continuing Development: Value £216,127 Oral Medicine & Restorative Dentistry (BDH Scheme 2) £168,455 Special Care Dentistry & Paediatric Dentistry (CCDS Scheme 1) £47,673 Dental Hospital and CCDS Contract CQUINS The Development work for the four MCNs is taking place as a combined project. Objectives for the Network CQUINS are broad at this stage, as networks will define their own objectives and plans to be delivered. These are expected to include integration of pathways as per integration project. The requirement for each MCN is the same as per the below: Dental Hospital and CCDS Contract CQUINS

12. Rehabilitation Contract CQUINS Rehabilitation Services CQUIN Schemes – total value £442,010 NameWeightingValue 1 NHS Safety Thermometer – Improvement 5% £22,101 2 VTE Root Cause Analyses 5% £22,101 3 Access to Specialist Spinal Rehabilitation 45% £198,905 4 Access to Specialist Neuro Rehabilitation 45% £198,905

13. Rehabilitation Contract CQUINS Scheme 1. NHS SAFETY THERMOMETER – Reduction in harm-free care; focusing on old or new pressure ulcers. Value £22,100 Scheme 2. VTE Risk Assessment and Root Cause Analyses. Value £22,100

14. Rehabilitation Contract CQUINS Scheme 3 Access to Specialist Spinal rehabilitation. Value £198,905 This scheme aims to improve the access to specialised rehabilitation for patients with spasticity. This will include: Providing a nominated spasticity support service with advice & outreach service to local DGH’s across the region Clear management for those patients who suffer this debilitating side effect of CNS damage Acting as a hub, providing expertise, skills, mentoring and training & were necessary referring patients to WMRC Training resources available in a number of different media – including online and electronically for team members to access

15. Rehabilitation Contract CQUINS Scheme 3 Access to Specialist Spinal rehabilitation. Value £198,905 This scheme is a continuation from the pilot in 11/12. The aim is to continue improving access to specialised rehabilitation through delivering a regional outreach service to DGHs to support patient assessment & suitability for rehabilitation. This includes Maintaining an up-to-date regional rehabilitation directory, sharing it with key stakeholders and users of the pathway. Providing an advice service & outreach service to local DGH’s across the region. Signposting for patients not suitable for access to their service. Acting as hub advising MTC’s & DGH’s on rehabilitation, providing expertise, skills, mentoring & training Maintaining a central referral centre for its referrals only to operate a ‘pull’ system for patients to access rehabilitation from MTC’s and DGH’s.

16. Learning Disabilities Contract CQUINS Learning Disabilities CQUIN Schemes – total value £407,478 NameWeightingValue 1 Patient Experience 20%£81,495.60 2 NHS Safety Thermometer – Improvement 20%£81,495.60 3 Access to Healthcare 20%£81,495.60 4 Bed Management Performance 20%£81,495.60 5 MECC Year 2 20%£81,495.60

17. Learning Disabilities Contract CQUINS Scheme 1. Patient Experience– To capture the Experience of the Patient on Discharge by using a patient survey questionnaire for Identified Services. Value £81,495 Scheme 2. NHS SAFETY THERMOMETER – Focus on Pressure Ulcer prevalence & serious falls. Value £81,495

18. Learning Disabilities Contract CQUINS Scheme 3. Access to Healthcare for People with Learning Disabilities - Coding and Flagging People with Learning Disabilities. Value £81,495 Scheme 4. Bed Management Monthly Performance Reporting. Value £81,495

19. Scheme 5. Making Every Contact Count. Value £81,495 Learning Disabilities Contract CQUINS