1. Quality and Safety of Patient Care Elaine Thompson – Deputy Chief Nurse and Quality Officer

2. Purpose of the session To provide an oversight the key national and local concerns and challenges in respect to quality and safety of patient care To identify the current structures and processes Birmingham CrossCity Clinical Commissioning Group utilises to monitor and improve quality and safety of patient care To consider and discuss the draft priority areas for the Quality and Safety Strategy for Birmingham CrossCity Clinical Commissioning Group

3. Quality and Safety of Patient Care – National Concerns and Challenges Shock stories of failed patient care o Mid Staffordshire NHS Foundation Trust o Winterbourne View Delayed or cancelled treatments Ambulance waits Winter Pressures Hospital mortality rates (The Keogh Review) Increased public expectation Increased demand on services MAJOR reorganisation within both the NHS and Partner Organisations

4. Quality and Safety of Patient Care – National Concerns and Challenges Creating the right culture that puts the patient first Ensuring respect, dignity and compassion for all Duty of candour Robust commitment to quality of care Staff who feel able to raise issues and concerns Early recognition of warning signs Triangulation of hard and soft intelligence to understand quality Development of nationally agreed and locally owned measures of success, focussed on what matters most to patients that are effectively monitored Minimising bureaucracy, enabling time to care and time to lead Taking time to listen – and when we have heard what is said, to ensure that we act To never again allow targets or finance to come before the quality of care

5. Quality and Safety of Patient Care – National Concerns and Challenges Ensuring that ALL patients receive the care and treatment they need, and that this care and treatment is delivered by a caring workforce

6. Quality and Safety of Patient Care – National Concerns and Challenges Recurrent Themes Promoting patient safety and reducing harm Ensuring effective early warning systems and appropriate escalation procedures for deteriorating, high-risk patients, in particular at weekends and out of hours Ensuring that lessons are learnt, changes are embedded Ensuring that all services effectively use and learn from hard and soft data to understand quality, maximising opportunities for Benchmarking Promoting and learning from “real-time” patient feedback Ensuring that the most vulnerable are protected from harm Workforce development - sharing skills, knowledge and expertise, ensuring strong clinical leadership Supporting the growth of Clinical supervision Ensuring that all services have a shared understanding and vision of what “good” looks like, and how to achieve this

7. Quality and Safety of Patient Care – Local Concerns and Challenges General Issues for all Services o Increasing public expectations in respect to healthcare o Working within a tight financial envelope o Busy services, busy staff o Complex systems of healthcare o Increased multi-agency and multi-professional working o Competing demands for services o Maintaining the Quality Agenda o Ensuring systems oversight o Ensuring care for the most vulnerable

8. Quality and Safety of Patient Care – Local Concerns and Challenges Birmingham is a diverse city. Birmingham is a growing city. Since 2001 the population has increased by almost 100,000 (10.2%). This is an average rate of 0.9% per year. Whilst we have some world renowned healthcare services, we also have significant problems: o Serious Case Review - Keanu Williams o Birmingham City Council's Children Services o Homeless epidemic o Highest rate of diabetes in the UK

9. Quality and Safety of Patient Care – Local Concerns and Challenges As a Clinical Commissioning Group We are a new organisation with a massive and ever-changing agenda We serve a large, complex and diverse population often with a variety of health and social care needs We currently have over 50 Provider contracts including: University Hospital Birmingham Foundation Trust Royal Orthopaedic Hospital Foundation Trust Birmingham and Solihull Mental Health Foundation Trust Heart of England Foundation Trust (Good Hope Hospital) Hospices, Primary Care, Urgent Care We have a difficult role, achieving a balance in the relationship we have in respect to “support and scrutiny” of our providers.

10. Quality and Safety of Patient Care CCG Oversight Providers Hard Intelligence Incident data Complaint data Mortality rates Readmission rates Length of stay Delivery against contract standards National benchmarking Survey data CQC reviews Soft Intelligence Feedback from patients Themes from complaints Experiences of care GP feedback Informal staff feedback Assurance spotchecks CCG Structures and Processes to Monitor Quality and Safety

11. Quality and Safety of Patient Care Clinical Quality Review Meetings Assurance Visits to Providers Monitoring Safety Data Contract Review Meetings External Assurances (CQC, Monitor) GP Feedback Themed Reviews CCG Structures and Processes to Monitor Quality and Safety

12. Quality and Safety of Patient Care Driving change forwards Birmingham CrossCity Clinical Commissioning Group is currently in the process of developing a Quality and Safety Strategy which will help us to continue to drive forwards the Quality and Safety agenda. It is suggested that the draft Quality and Safety Strategy has 5 Key Quality Priority Areas: Primary Care Safeguarding vulnerable patients Patient Experience Workforce development Patient Safety

13. Quality and Safety of Patient Care Driving change forwards Primary Care Safeguarding vulnerable patients Patient Experience Workforce development Patient Safety Question 1: Are these the right 5 Key Quality Priority Areas for the CCG to focus on ?

14. Quality and Safety of Patient Care Driving change forwards Primary Care Safeguarding vulnerable patients Patient Experience Workforce development Patient Safety Question 2: If they are, what specific actions should we focus on within these 5 Key Quality Priority Areas?