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HEYWOOD MIDDLETON & ROCHDALE
CLINICAL COMMISSIONING GROUP
QUALITY STRATEGY
2015/16 – 2018/19
1
Contents
Section
Page
1
Foreword
3
2
HMR CCG Vision and Values
4
3
What is Quality?
4
4
The Case for Change
5
5
Our Vision for Quality
5
6
Key Drivers
6
7
Safeguarding
10
8
Our Approach to Quality
11
9
Our Quality Goals for 2015/16 – 2018/19
12
10
Embedding Quality
13
11
Working in Partnership
15
12
Assuring Quality
15
13
Measuring Quality
17
14
Quality in Care Homes
17
15
Primary Care Quality
18
16
Sharing Good Practice
19
18
Equality & Diversity
20
19
Monitoring
21
20
Conclusion
21
21
Action Plan
22
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Foreword
NHS Heywood Middleton and Rochdale Clinical Commissioning Group’s (“The CCG”)
ambition is to commission safe, effective, and clinically-led services for the people of the
borough of Rochdale and secure better quality of life and health for our population who
experience some of the poorest health outcomes in the country.
Ensuring the delivery of safe, clinically effective high quality care for the population of
Heywood, Middleton & Rochdale is a key priority for the CCG. Quality of care is at the
heart of every commissioning decision we make and is inherent throughout this strategy
which has been developed to support us in keeping quality at the heart of all we do.
This strategy communicates our vision, the key drivers which underpin it and our
ambitions for quality which include strengthening partnership working and greater
patient/public involvement ensuring that service user experience really is a core
component of quality monitoring and service development processes. The strategy
explains how we will deliver our vision and the outcome measures which we will use to
measure success.
Whist we are pleased with the progress made to date in improving patient experience
and reducing avoidable harm, we recognise there is further work to be done to ensure
that all our services consistently provide high quality care. This includes ensuring that
safeguarding arrangements for children and adults at risk are robust. From 1 April 2016,
we will take on delegated responsibility for commissioning of general practice and we will
continue to support our member practices in making improvements to their services.
The strategy is built around the priorities identified by the CCG for commissioning high
quality healthcare services for its population. Reflecting national and local drivers for
quality, it supports and complements the NHS HMR CCG Strategic Commissioning Plan
2014/15 – 2018/19 and builds on the achievements of the HMR CCG Quality Framework
2013/15.
Dr Chris Duffy
NHS HMR CCG Chair
Simon Wotton
Accountable Officer NHS HMR CCG
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HMR CCG Vision and Values
HMR CCG’s vision is to support people in the Borough of Rochdale to live longer and
healthier lives; to commission a range of services that meet their needs and help them to
enjoy a better quality of life – adding life to years and years to life.
We want to commission services that protect individual human rights, promote dignity,
independence and well-being, hear and respond to the needs of children, young people,
adults and carers and demonstrate assurance that any child, young person or adult
thought to be at risk, is safeguarded and protected from harm or abuse.
The values that lie at the heart of the organisation's work are:
 No decision about me, without me, applicable to all stakeholders
 Care and compassion in everything we do
 Being honest, open and visible
 Providing constructive challenge and being open to challenge
 Being bold, radical, innovative and aspirational
This quality strategy supports the HMR CCG vision and values.
What is Quality?
In referring to “quality”, HMR CCG is adopting the three part definition of quality as
safety, effectiveness and patient experience (figure 1). This definition was first
articulated by Lord Darzi1 and is now enshrined in the 2012 Health and Social Care Act
as well as the NHS Constitution which sets out the patients’ right to high quality care.
Figure 1
How this definition of quality applies to patients and service users is;
Safety – Patients and service users need to be assured that they will not come to
avoidable harm and that services have systems in place to protect and safeguard them.
They need to be assured that when things do go wrong, a prompt robust investigation
will be undertaken and appropriate measures put in place to share the learning and
1
(Department of Health. High quality care for all: NHS Next Stage Review final report. Department of
Health 2008)
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prevent future recurrence.
Clinical Effectiveness – Patients and service users need to have confidence that the
care and treatment which they receive will be appropriate, based on the best available
evidence that clinically addresses their needs and delivers the best outcomes. They
need to be assured that all providers are able demonstrate that they comply with best
practice standards (including NICE technology appraisals and guidance) and that
nationally measured outcomes (eg for joint replacements and hernia repairs) and
mortality rates compare favourably with equivalent organisations.
Patient Experience – Patients and service users want to be treated with compassion,
dignity and respect at all times, receiving care that is personal and inclusive to them and
which is a positive experience. They need to be assured that there are mechanisms in
place for them to provide their feedback and that this will be captured, meaningfully
analysed and used to continually improve services.
The CCG recognises that quality care is not achieved by focusing on one or two aspects
of this definition; high quality care encompasses all three aspects with equal importance
being placed on each.
We believe that the delivery of high quality care can only be achieved by a shared
understanding of quality and a joint commitment to keeping it at the centre of everything
we do. We will therefore ensure that quality is at the centre of all our discussions with
providers and stakeholders and remains the central focus of all commissioning decisions.
The Case for Change
There have been a number of high level failures in the NHS such as those at Mid
Staffordshire NHS Trust, Winterbourne View Hospital and more recently, Morecambe
Bay (see below “Key Drivers for Change”). These put quality of healthcare in the public
spotlight, leading to high profile reviews and the publication of key reports with far
reaching implications for commissioners and providers.
HMR CCG has understood the lessons and recommendations from these national
reviews and has developed and implemented action plans in response. We recognise
that these signal a shift in how we should commission services and what needs to be
done to ensure that all our providers deliver high quality care.
We have used the key findings from high level inquiries together with our legal duties to
inform this strategy.
Our Vision for Quality
The HMR CCG vision for quality is that our local population will be kept safe and free
from avoidable harm. They will receive care and treatment which is appropriate for them,
which is evidence based and clinically effective. Overall, their experience of care and
treatment will be a positive one.
We want people to be cared for;
 in the right way (developing and maintaining a workforce that is highly skilled,
motivated and competent to deliver the care required)
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 at the right time (accessible services available 7 days a week providing
treatment when the patient needs them)
 in the right place (provision of treatment/services locally wherever possible
and in specialist centres where necessary).
 with the right outcome (improving health, reducing variation in clinical
outcomes, reduction in potential years lost to conditions amendable to
treatment)
Key Drivers for Quality
The key national and local drivers which inform HMR CCG’s approach to assuring and
improving the quality of commissioned services are described briefly below;
National Drivers
 The NHS Constitution2
The NHS constitution sets out rights for patients, public and staff. It outlines NHS
commitments to patients and staff, and the responsibilities that the public, patients and
staff owe to one another to ensure that the NHS operates fairly and effectively. All NHS
bodies, private and third sector providers supplying NHS services are required by law to
take account of the Constitution in their decisions and actions.
In relation to quality and safety, the Constitution states that people have the right to be
treated with a professional standard of care, by appropriately qualified and experienced
staff, in a properly approved or registered organisation that meets required levels of
safety and quality. People also have the right to expect NHS organisations to monitor,
and make efforts to improve, the quality of healthcare they commission or provide.
HMR CCG is committed to ensuring that the NHS Constitution is upheld by the CCG and
by all providers of commissioned services.
 The NHS Outcomes Framework
Refreshed annually, the NHS Outcomes Framework builds on the definition of quality by
setting out 68 indicators which measure performance in the healthcare system at a
national level. It is structured five domains, which set out the high level outcomes that the
NHS should be aiming to improve.
2
DoH (2012). NHS Constitution. London: DoH.
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The domains of the NHS Outcomes Framework are a crucial element of focus for the
HMR CCG’s commissioning strategic plan, acting as driver for the CCG’s local priorities
for quality and commissioning.
 The CCG Assurance Framework
NHS England has a statutory duty to make an annual assessment of each CCG’s
performance. It meets this duty through the CCG Assurance Framework. A new CCG
Assurance Framework was published in March 2015 which includes a self-certification
process. This will provide NHS England with additional assurances from those CCGs
who have taken responsibility for the commissioning of primary medical care services
under delegated authority (delegated functions) or a joint commissioning arrangement.
In relation to quality the main focus of assurance will be how well the CCG maintains and
improves quality and ensures better outcomes for patients.
 The Care Act 2014
The Care Act 20143 which came into force on 1 April 2015 represents a significant
change to social care legislation. The vision for the Care Act is for integrated care and
support that is person centred, tailored to the needs and preferences of those needing
care and support. It requires local authorities to carry out their duties with the aim of
joining up services, in line with the requirements on Clinical Commissioning Groups and
NHS England in the NHS Act 2006, and in the context of Joint Strategic Needs
Assessments and Health and Wellbeing Strategies
The CCG quality team will support the integration of health and social care functions,
ensuring that quality remains the central focus of all commissioning intentions and that
integrated services provide high quality care.
 Francis Report 4
A public enquiry into events at Mid Staffordshire NHS Trust led by Robert Francis QC,
uncovered a catalogue of serious and systemic failings. It led to publication of the
Francis Report in 2013 which suggested that a fundamental change in culture was
necessary to address the systemic failures and made a number of high level
recommendations.
The key aims of the Francis recommendations can be summarised as;
 A common culture which puts the patient first;
 A set of fundamental standards which are easily understood, against which
compliance can be measured and breach of which will not be tolerated.
 Openness, transparency and candour throughout the system
 Greater accountability; individual & organisational
 Improved support for compassionate, caring and committed nursing
 Stronger patient centred healthcare leadership
 Accurate, useful and relevant information to allow effective comparison
3
The Care Act 2014
Francis, R (2013). Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. London: Department
of Health.
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Berwick Report5
Following publication of the Francis Report, the Government commissioned an advisory
group in April 2013, to distil the patient safety lessons learnt and specify the changes
needed to improve the safety of patients in England. The advisory group was led by
Professor Don Berwick, an internationally recognised expert on patient safety and its
report was published in August 2013.
The Berwick report highlights the main problems affecting patient safety in the NHS and
makes recommendations to address these problems saying that the health system must:
 recognise with clarity and courage the need for wide systemic change
 abandon blame as a tool and trust the goodwill and good intentions of the staff
 reassert the primacy of working with patients and carers to achieve health care
goals
 use quantitative targets with caution - they should never displace the primary
goal of better care
 recognise that transparency is essential and expect and insist on it
 ensure that responsibility for functions related to safety and improvement are
established clearly and simply
 give NHS staff career-long help to learn, master and apply modern methods for
quality control, quality
 improvement and quality planning
 make sure pride and joy in work, not fear, infuse the NHS
 performance by patients and the public
Keogh Report6
Professor Bruce Keogh carried out reviews of 14 NHS hospitals in England in 2013.
The fourteen hospitals were selected by their Summary Hospital-Level Mortality
Indicator (SHMI) or the Hospital Standardised Mortality Ratio (HSMR) which had been
shown to be higher in comparison to other NHS hospitals over the previous two years.
The report identified common challenges facing the NHS and set out a number of
ambitions for the NHS in England to achieve in the next 2 years including;
 The implementation of early warning systems to detect deteriorating in high risk
patient’s condition especially out of hours and at the weekends.
 Demonstrable progress towards reducing avoidable deaths in our hospitals.
 The utilisation of junior doctors as change agents.
 Patients, carers and the public should be more involved and be able to give
“real time” feedback.
 Nurse staffing levels and mix of skills should be appropriate to the patients
being cared for on any given ward.
Winterbourne View7
An investigation into events at Winterbourne View hospital revealed shocking criminal
5
Berwick, D (2013). A Promise to Learn – A commitment to act – Improving the safety of patients in England.
London: Department of Health.
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Keogh, B (2013) Review into the quality of care and treatment provided by 14 hospital trusts in England:
overview report, London:
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Department of Health (2012). Transforming Care - A national response to Winterbourne View Hospital.
London: Department of Health.
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abuse by staff, and a failure to protect vulnerable people with learning difficulties. It led
to the Winterbourne View Joint Improvement Programme which provides leadership and
support to transform services locally, building on good practice.
HMR CCG will work in partnership with Rochdale Metropolitan Borough Council to
deliver the concordat which supports the Joint improvement Programme ensuring that
wherever possible, vulnerable patients are care for in local community settings. This will
improve the quality of the care offered to children, young people and adults with learning
disabilities or autism who have mental health conditions or behaviour that challenges to
ensure better care outcomes for them.
Kirkup Review8 (Morecambe Bay)
Dr Bill Kirkup was commissioned by the Department of Health to investigate failings in
maternity care at Furness General Hospital (FGH) over a period of several years. His
investigated identified at least seven missed opportunities at “almost every level” which
meant poor clinical care was not investigated and led to the preventable deaths of one
mother and 11 babies.
Dr Kirkup’s final report (“The Kirkup Report”) report was published makes a series of
recommendations, for both the University Hospitals of Morecambe Bay NHS Foundation
Trust and the wider NHS, to prevent such failings happening in future.
The recommendations for the wider NHS are;
 Action by the professional regulatory bodies to investigate the conduct of
registrants involved in this case.
 A national review of the provision of maternity care in challenging
circumstances – this could be broadened out to take in all types of care
delivered in “rural, difficult to recruit to or isolated” areas.
 A review of the opportunities and challenges for smaller units.
 The drawing up of clear standards for incident reporting and investigation in
maternity services.
 Introduction of a duty of candour for all NHS professionals.
 A duty for all NHS Boards to openly report the findings of external
investigations, including promptly notifying the CQC and Monitor.
 Introduction of a clear national policy on whistleblowing.
 Clarification from professional regulatory bodies on the duty of staff to report
concerns.
 National standards setting out the duties and expectations for clinical leads at
all levels, as well as standards setting out the responsibilities for clinical quality
of other managers.
 A national protocol on the duties of trusts and their staff in relation to inquests.
 A fundamental review of the NHS complaints system.
 Effective reform of the Local Supervising Authority system for midwives
8
Kirkup, B (2015) The Report of the Morecambe Bay Investigation, London: DoH.
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 CQC and Monitor to draw up a memorandum of understanding specifying the
relationship between their organisations, including roles, relationships and
communication.
 A similar memorandum of understanding to be drawn up between the CQC and
the PHSO.
 NHS England should draw up a protocol to clarify the potential ambiguity that
still exists in the division of responsibilities for oversight of service quality and
the implementation of measures to correct failures.
 DH should review how it carries out impact assessments of new policies, as a
result of the significant pressures new policies and processes place on
management capacity.
 DH should also draw up a protocol on how to manage organisational change
that transfers responsibilities and accountabilities.
 Recording systems for perinatal death should be improved.
 A mechanism should be introduced to independently scrutinise perinatal and
maternal deaths.
 Reviews of deaths by medical examiners should be extended to stillbirths as
well as neonatal deaths.
 Systematic guidance should be drawn up setting out a framework for external
reviews, and all external reviews of suspected service failures should be
registered with the CQC and Monitor.
A National Review of Maternity services has been set up following the Kirkup report and
a working party agreed. The review is being led by Baroness Julia Cumberledge. The
timescale for reporting is the end of 2015.
HMR CCG will work with our provider of Maternity services to undertake a gap analysis
using the recommendations from the Kirkup report and to implement any necessary
changes.
Safeguarding
Safeguarding children and adults at risk is a key priority for the CCG. We believe an
integrated approach to Quality and Safeguarding serves to protect those most vulnerable
to abuse and helps to identify where safeguarding practice can be improved to prevent
and reduce the risk of abuse and neglect to both adults and children.
The CCG Safeguarding Team takes the lead role in ensuring that the CCG’s statutory
responsibilities are fully met. Designated Safeguarding Professionals provide
safeguarding leadership across the health economy. Their functions include reviewing
safeguarding arrangements within commissioned health services to determine whether
they are meeting their statutory safeguarding responsibilities and holding providers to
account if any deficiencies are identified.
Seeking assurances from commissioned services is undertaken through the use of
formal audit tools and through working in collaboration with the safeguarding leads within
these services.
The
Designated
Safeguarding
Professionals
also
review
how
effectively
all
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commissioned health services work together to safeguard children and vulnerable adults,
ensuring that there are appropriate integrated working arrangements in place. This
oversight provides a crucial element of quality assurance, given that vulnerable people
are often in receipt of health services from multiple providers. HMR CCG will continue to
utilise the expertise within the Safeguarding Team to fulfil this vital role.
Members of the CCG Safeguarding Team are also working closely with member GP
Practices, supporting them in improving the quality of their safeguarding arrangements.
This work includes the delivery of safeguarding training, providing case advice,
undertaking audits and progressing safeguarding practice development.
We recognise that robust safeguarding arrangements within primary care are necessary
to safeguard the most vulnerable members of our population and will ensure that this is a
key element of our primary care quality framework.
Bi-monthly Safeguarding & Quality network meetings provide a forum for healthcare
professionals from all settings to come together and share learning, good practice
discuss challenges to the provision of high quality care. They also provide an opportunity
for learning with presentations from wider CCG staff and external organisations.
The detailed processes by which the CCG will meet its statutory obligations to safeguard
children and adults at risk can be found below;
https://www.rbscb.org
https://www.rbsab.org/professionals/multi-agency-policy-and-procedures/
http://greatermanchesterscb.proceduresonline.com/
Our Approach to Quality
Our approach to quality is;

To provide strong leadership across the CCG, equipping staff with the necessary
skills and knowledge to deliver the quality strategy and ensure a consistent focus
on quality and safety in all aspects of CCG business.

To promote a culture of openness and transparency

To work collaboratively across the CCG and with a range of partners (eg
patients/carers/voluntary organisations/providers/local authority), triangulating all
sources of information and using this meaningfully (eg to inform all planning and
commissioning decisions, to inform the service review process, to share good
practice and to alert to early signs of quality failings).

To maintain and promote access to all, ensuring services help to reduce social
inequalities and improve access for vulnerable or excluded groups.

To monitor quality and performance of commissioned services holding providers to
account for any identified failings.

To gather hard and soft intelligence and use this to identify risks to patients and
staff and understand at an early stage if there are any concerns in any service or
provider organisation.

To harness and embed shared learning for the benefit of all parties.

To incentive providers to continually improve clinical quality.
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Our quality goals for 2015/16 – 2018/19
Goal 1: Patients and service users will feel safe and will not suffer avoidable harm
We will achieve this goal by;
 Holding providers to account for reducing the incidence of avoidable severe
harm and death and having robust and effective processes in place for the
reporting and investigation of all adverse incidents/accidents.
 Gathering data in 2015/16 and using this as a baseline for improvement in
2016/17 & 2017/18.
 Promoting a culture of openness and transparency and monitoring compliance
with the Duty of Candour when things go wrong.
 Implementing a rolling programme of Patient Safety Walk-rounds across all
care settings.
 Requiring providers to demonstrate a reduction in the incidence of healthcare
associated infections (HCAI) in line with agreed trajectories through
implementation of robust and stringent Infection Prevention and Control policies
& procedures.
 Ensuring that robust systems and processes are in place to fulfil specific duties
of co-operation and best practice in relation to the safeguarding of vulnerable
people.
 Implementing robust and effective systems for managing serious incidents in
accordance with National and local requirements and assisting with complex
investigations.
 Ensuring that lessons learned from serious incidents, complaints, inquests and
external reviews are appropriately shared and action taken to embed this
learning to prevent future recurrence.
 Establishing assurance mechanisms for implementation of recommendations
from key inquiries (eg Francis, Berwick, Keogh) and Statutory/Regulatory
bodies (eg Department of Health/NHS England/NICE/Monitor).
 Maintaining and strengthening quality monitoring/early warning systems to
monitor quality and alert to failings.
 Ensure the delivery of safe and effective maternity services which reflect the
learning from the Kirkup Report, serious incidents and external investigations.
 Working closely with other organisations – including the North East Sector
CCGs, Care Quality Commission, Monitor, NHS England, Local Authorities and
Health Watch to share information about the quality and safety of health
services.
Goal 2: Patients and service users will receive care and treatment which is
evidence based, clinically effective and provides value for money
We will achieve this goal by;
 Embedding quality standards & key performance indicators into all of our
contracts with providers.
 Developing our staff to ensure they have the skills to commission services with
effective systems for managing and improving quality and safety with a focus on
continuous improvement.
 Ensuring
that
providers
comply
with
national
and
local
standards/guidance/recommendations made by Regulatory/Statutory bodies
(eg Department of Health NHS England/Monitor/NICE) and guidance from other
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





professional bodies eg Nursing and Midwifery Council, General Medical
Council.
Requiring providers to demonstrate a cycle of continuous improvement
underpinned by clinical audit.
Ensuring that systems and processes are in place for reviewing mortality data
and securing a reduction in mortality rates.
Monitoring provider compliance with safer staffing levels.
Incentivising quality, rewarding excellence by linking a proportion of healthcare
provider incomes to the achievement of quality improvement goals (CQUINS)
Supporting providers to implement 7 day services.
Establishing processes for reviewing provider Cost Improvement Plans (CIPs)
and evaluating the impact of these on the quality of commissioned services.
Goal 3: Patients and service users will have a positive experience of healthcare
services
We will achieve this goal;
 Actively seeking the views of patients, carers, member Practices and the wider
community about their experience of NHS services and how they can be
improved
 Ensuring that systems and processes are in place to capture patient and
service user feedback from complaints and PALS enquiries and used to drive
service improvements. We will triangulate this with other sources of intelligence
to monitor the quality of care and hold providers to account where failings are
identified and remedial action required.
 Requiring providers to implement national guidance (eg Friends and Family
Test/In Patient Survey/Staff Survey) in line with national guidance and use the
results to deliver demonstrable improvements.
Embedding Quality
Quality is embedded throughout the HMR CCG structure;
 HMR CCG Governing Body
The CCG Governing Body will receive regular reports and information on the quality of
commissioned services across Primary, Secondary and Community Care including
reports from the Quality & Safety Committee which reports directly to the CCG
Governing Body on patient safety, patient experience and clinical outcomes. There is
also a Lay Member on the Board who is the Lay Member lead for Quality
 HMR CCG Quality Team
Made up of experienced clinicians and support staff with extensive backgrounds in NHS
services, the team supports the Director of Quality & Safety/Executive Nurse to ensure
that care provided in our services is safe, clinically effective and provides the best
possible experience for patients and services users.
The quality team does this by continuously monitoring the quality of care in provider
organisations against the standards set in our contracts with them and taking actions to
ensure that providers make improvements where services are not of good enough
quality.
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Working collaboratively with other teams across the CCG including Safeguarding,
Medicines Management and Continuing Health Care, the quality teams ensures that
there are mechanisms in place to capture and act upon all forms of information and
intelligence.
 HMR CCG Quality & Safety Committee
This is a formal sub-committee of the CCG Governing Body. Its role is to:
 Monitor and manage the quality of services that are commissioned
 Provide appropriate assurances to the CCG Governing Body about the quality
of the services it commissions for the local residents
 Looks at the Patient Experience, Patient Safety and Clinical Effectiveness of
services
 Ensures overall performance against key quality indicators
 Reviews quality performance on exception basis across primary, community
and hospital based system
 Commissions deep dive work from Commissioning Boards in relation to quality
matters
Committees/ Groups in the HMR CCG Governance Structure
Quality is intrinsic in the Terms of Reference of all other Committees/ Groups to ensure
that it becomes embedded in everything HMR CCG does. Whilst the Quality & Safety
Committee will take a holistic overarching view to quality, it will have the ability to
request detailed investigative work should it be required to form a more detailed picture
on quality matters be it from Committees or groups are responsible for performance
managing contracts or specific programme related Groups.
Key Committees/Groups with specific Quality related functions and responsibilities
include;
 HMR CCG Patient Experience Assurance Committee
Established to provide assurance that the patient voice is heard, that patients, carers
and the public’s views and experiences influence the development, design and
commissioning of services and that this is clearly evidenced within commissioning
plans/outcomes. Additionally, the Committee ensures that patient’s experiences
influence the performance and contract management of services commissioned by
HMR CCG.
A key duty of this Committee is to measure the performance and quality of
commissioned services from the patient’s perspective. It does this by triangulating all
sources of patient experience data/intelligence and where necessary, requesting
additional assurance or requesting focused pieces of work.
 HMR CCG Finance Performance and Risk Committee
Works in collaboration with the Clinical Commissioning Committee, the Quality and
Safety Committee and the Patient Experience Assurance Committee to provide
assurance that commissioned services are delivered with due regard to patient safety,
quality, effectiveness and best practice, and excellent patient experience. One of the
duties of this Committee is to scrutinise the key risks around quality of commissioned
services.
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Clinical / Managerial Leadership
A key recommendation from recent national inquiries has been the development of
strong clinical and managerial leadership. The importance of clinical and managerial
leadership is clearly reflected in the way HMR CCG conducts its business. The CCG
Chair provides a level of clinical leadership across the organisation and is supported by
Locality Leads, Clinical Leads and Committee Leads (those Chaired by GPs).
Locality Leads provide the clinical leadership and support required through
underpinning safe and effective health commissioning. They provide a focal point for
building clinical understanding and ownership of the strategic agenda with their peers
and clinicians from other professions.
Clinical Leads are clinical experts in their field and undertake their commissioning
functions with the continual intention to secure the highest quality of care for local
patients.
We will continue to develop our Governing Body via development sessions and review
the current GP Quality Lead role to ensure we have effective clinical leadership.
We will strengthen the CCG quality team with the creation of new roles and will
proactively promote and develop leadership skills within the quality team to ensure
delivery of quality improvement programmes and overall delivery of this quality strategy.
Working in Partnership
HMR CCG will work in collaboration with a range of partners to ensure the delivery of
this quality strategy. Partners will include NHS England, Rochdale Borough Council, GP
member practices, Pennine Acute NHS Trust, Pennine Care FT, Care Homes, smaller
contract providers, Health Watch, Health Education England, Care Quality Commission,
Trust Development Agency, third sector/voluntary organisations and charities.
Assuring Quality
Quality assurance is the systematic and transparent process of checking to see whether
a product or service being developed is meeting specified requirements. The
mechanisms through which HMR CCG will assure the quality of commissioned services
are as follows:
Clear expectations of quality;
All contracts will specify the quality outcomes and quality standards, planned monitoring
arrangements and penalties where these apply. Where a threat to quality is identified,
the CCG will escalate as appropriate and will use appropriate commissioning and
contractual levers to bring about improvements
Provider Quality monitoring;
Quality monitoring meetings will be held with providers as required by the national NHS
Contract. The frequency of meetings will vary according to the size of contract and level
of risk. Meetings with large organisations will take place monthly. Meetings with smaller
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low-risk providers may not be required more frequently than quarterly.
Standalone quality monitoring meetings may be held with some providers, for others
there may be joint quality & performance meetings. Our quality monitoring systems will
allow the CCG Quality team to identify any risks and to schedule additional meetings if
required.
Providers will be required to submit quality and performance reports that provide
evidence of performance against national and locally agreed quality standards.
Minimum data requirements for these reports will include; healthcare acquired
infections, serious incidents, complaints/PALS, compliance with NICE guidance, staffing
levels, patient experience data (eg Friends and Family test) and workforce data. These
requirements will be reviewed periodically and following the publication of any relevant
national guidance.
Where appropriate, ‘deep dives’ or “quality reviews” will be undertaken to analyse data
and information to gain a greater understanding of quality issues within a provider. Any
concerns will be highlighted and remedial actions agreed.
Provider Walk-rounds
The CCG will have in place a planned programme of walk-rounds across all providers.
Some of these will be conducted in conjunction with other North East Sector CCGs or
across the Commissioner footprint. Others will be conducted by the CCG alone,
whether as lead commissioner or for locally commissioned services. Associate
commissioners to contracts will be invited to participate in walk-rounds.
In addition to planned walk-rounds, the CCG will also undertake ad hoc walk-rounds in
response to identified quality concerns or evidence of possible quality failings.
Walk rounds may be notified to providers in advance or, may be unannounced. The
decision whether a walk-round in announced or unannounced will depend on the nature
of the quality issues to be assured.
The outcome of provider walk-rounds will be notified to providers who will be given an
opportunity to comment on the findings. They will also be reported at provider quality
monitoring meetings and to the CCG Quality & Safety Committee. Associated action
plans will be monitored through these mechanisms.
Quality Dashboards
Quality dashboards are a key element of the CCG quality assurance process. The HMR
CCG Quality & Safety Committee will receive dashboard reports detailing performance
against key quality metrics and targets together with details of assurance received and
action being taken to address underperformance or quality concerns.
Quality Accounts;
Providers of NHS care are required to publish annual quality accounts. These must
contain a retrospective review of performance of key quality initiatives and priorities and
set out the quality priorities for the forthcoming year. Providers are also required to
outline clinical audit activity. The account will be available publicly however CCGs must
be given the opportunity to comment on providers’ accounts and providers before
publication and must include any comments from the CCGs in their entirety in the final
publication of the account.
16
HMR CCG will review the quality accounts for all providers and there they are lead
commissioner, will co-ordinate and provide comments on the quality accounts for the
provider. Where HMR CCG is an associate commissioner, they will provide comments
to the lead commissioner for submission to the provider. Providers will be monitored for
performance and progress against the clinical priorities through the quality meetings.
Quality Surveillance Group
HMR CCG is a member of the Greater Manchester Quality Surveillance Group. This is a
high level group which meets bi-monthly with representation from all Greater
Manchester CCGs and other key organisations including NHS England, Care Quality
Commission and Healthwatch. , where concerns and risks are escalated and shared on
a wider basis.
Each CCG will manage the relevant quality monitoring mechanism appropriate to the
provider for which it is designated as the co-ordinating lead. However informal and
formal conversations within the CCG, between commissioners, providers and
stakeholders on a day to day basis may illicit ‘soft intelligence’ to be triangulated against
other measures.
To support the sharing and triangulation of information, a high-level Leeds Quality
Surveillance Group has been convened which meets on a bi-monthly basis.
Membership includes the medical and nursing directors of each CCG, head of quality,
head of governance and risk, quality managers and representatives from Healthwatch
and the CQC. The meeting forms part of the governance structure of each CCG and is
minuted. The purpose of the group is to jointly review quality performance and share
information in order to identify potential or actual risks to quality and agree a response.
Measuring Quality
Measures against which we will monitor the quality of healthcare services include;
• Patient outcomes (eg the extent to which the services improve a patient’s situation or
condition)
 Patient Safety Indicators (eg incidence of adverse incidents & errors resulting
in harm to patients)
 Mortality Rates (HSMR, SHMI)
 Healthcare Acquired Infection incidence
• Patient experience (eg feedback from patients/service users about how they were
treated by the services, and how satisfied they were with their experience of NHS
healthcare.)
 Clinical Effectiveness (eg results
implementation of NICE Guidance)
of
clinical
audits,
evaluation
of
Quality in Care Homes
The Quality Team is committed to enhancing the quality and delivery of nursing care
within Care Homes; by supporting staff and managers to achieve the optimum levels of
care delivery within HMR. Working closely with the CCG Safeguarding and Continuing
Healthcare teams and in partnership with Rochdale Borough Council and other
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agencies, the CCG has implemented a quality monitoring system which alerts to early
indictors of possible quality or safety failings.
The quality monitoring system includes;



Care Partnership Meetings – attended by representatives from a number of key
organisations including the CCG, Local Authority, secondary care providers and
community providers. These are the forum for multi-agency discussion of care
home quality issues/concerns and for escalation of risks and serious concerns to
the appropriate body or organisation eg CQC/LASAB/Police etc
Care Homes Dashboard – developed by the CCG Named Nurse for Adult
Safeguarding this is a “live” dashboard which is continually updated with quality
related information eg CQC inspections, Safeguarding alerts, serious incidents etc.
It provides an “at a glance” view of current quality issues regarding care homes
across HMR and alerts to the signs of possible risks to the quality & safety of care
home provision.
Safeguarding & Quality Network meetings – bi monthly meetings facilitated by
the CCG Safeguarding and Quality teams open to all care homes across HMR.
The network aim is to promote best practice, sharing of lessons learned and
provide specialist updates on issues of quality & safety relating to care homes eg
medicines management/Mental Capacity and infection prevention & control.
The care homes quality monitoring system is supported by a local Escalation Plan and
Accountability Framework for Care Provision. Developed by the HMR CCG Named
Nurse for Adult Safeguarding and adopted by the CCG, Rochdale Borough Council and
the Rochdale Borough Safeguarding Adults Board, the Framework sets out the
processes, actions and responsibilities HMR CCG and Rochdale Borough Council
(RBC) in the event of a care provision concern. This incorporates the responsibilities
under the Care Act 2014, including our joint response to managing provider failure.
Primary Care Quality
The members of HMR CCG are not just clinical commissioners but, just as importantly,
are also responsible for the provision and quality of primary medical services. HMR
CCG is committed to supporting our members in fulfilling this responsibility, ensuring
that the population of Heywood Middleton & Rochdale receives excellent primary
medical care.
From 1 April 2016, HMR CCG will take on fully delegated responsibility for
commissioning primary care GP services under “co commissioning” arrangements with
NHS England. Delegated commissioning will support the development and
implementation of new integrated out of hospital models of care. This includes
multispecialty community providers and primary and acute care systems, as set out in
the NHS Five Year Forward View, to transform primary care.
The HMR CCG Primary Care Strategy sets out the vision for primary care and what the
CCG is aiming to achieve through co-commissioning. Aligned to the CCG corporate
objectives and commissioning intentions, the strategy describes the key priorities for
primary care and the underpinning initiatives.
The CCG recognises that under delegated commissioning arrangements, it will remain
accountable for its pre-existing statutory functions in relation to quality assurance, but
that these will need to be extended across the primary care contracts for which it will
take on responsibility.
Delegated commissioning will require the CCG to create a ‘primary care commissioning
committee’ to oversee the exercise of delegated functions. This Governing Body sub
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Committee will have appropriate level membership including Executive Directors, Lay
members, Clinical leads and representation from Patient/Public groups.
The CCG quality team will support the CCG primary care team in managing quality and
developing the required quality assurance processes to meet the responsibilities of
delegated commissioning in a safe and effective way.
The HMR CCG Primary Care Improvement Group (PCIG) has a role in monitoring and
driving quality improvements in primary care general practice. Membership of this group
will include a CCG Quality team representative. Quality functions of PCIG include;
 Monitoring variations in primary care quality and performance including
monitoring progress against the CCG GP Quality Standards, performance
against GPOS / GPHLI indicators, QOF outcomes, monitoring outcomes of
CQC Inspections and progress against associated action plans
 Data Analysis (eg QOF Performance, GP Practice High Level Indicators (NHS
England), prescribing data, delivery of enhanced services
 Triangulation; various sources of data (eg GP quality feedback, complaints,
incidents, Friends & Family test results) will be triangulated and reviewed in
order to gain an insight into primary care quality across HMR.
NHS England Local Area Team (AT) has established a Direct Commissioning Quality
Surveillance Group (DCQSG) where primary care quality is reviewed across Greater
Manchester. The CCG is an active member of the QSG and the work of this group will
link directly into our Primary Care Improvement Group to ensure that we remain fully
engaged in the wider developments of primary care quality.
The quality team will also oversee the GP Quality Feedback process. This is the
mechanism by which feedback from GP members on a range of quality issues is used
as an early warning system to alert to concerns about quality/safety issues in secondary
care and a range of other providers.
The NHS Five Year Forward View signals a clear and continued shift towards
commissioning based on the specific needs of a local area and its patients. In 2016/17,
NHS England will be exploring options for the possible expansion of co-commissioning
into wider primary care areas, with full and proper engagement of CCGs, NHS Clinical
Commissioners and the relevant professional groups. This includes community
pharmacy, dentistry and ophthalmic where scoping work will focus upon scoping how to
strengthen partnership working between NHS England and CCG commissioners.
HMR CCG has embraced the ambitions and challenges set out in the NHS Five Year
Forward View. Moving forwards, the CCG will consider future proposal and
developments in relation to expansion of co-commissioning, ensuring as always that
quality remains central to all commissioning activities.
Sharing Good Practice
HMR CCG recognises the importance of sharing good practice and lessons learned.
Working in partnership with NHS England and local CCGs, we will share good practice
across Heywood Middleton & Rochdale in all areas of healthcare, including Foundation
Trusts, independent providers, primary care, particularly lessons learned from CQC
visits, serious incidents and safeguarding reviews. Where appropriate, we will ensure
the wider sharing of lessons learned, eg across Greater Manchester or nationally.
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Equality & Diversity and Human Rights
NHS Heywood Middleton and Rochdale CCG is committed to promoting equality,
diversity and human rights in the delivery of all of its functions, in order to ensure that
NHS services are accessible and appropriate and are developed and delivered based
on the needs of local patients and stakeholders.
The CCG recognise that Equality is an integral part of this Quality Strategy. The
purpose of including this within the Quality Strategy is to ensure we meet our duties:
 Under the Human Rights Act 1998 to respect, protect and fulfil people’s human
rights.
 Under the Equality Act 2010 to have due regard, when delivering our functions,
to the need to:
o eliminate discrimination,
o advance equality of opportunity
o foster good relations between groups
 In relation to the ‘protected characteristics’ of age, disability, gender
reassignment, pregnancy and maternity, race, religion and belief, sex and
sexual orientation.
However, we view this as more than mere legal compliance. This is a means to an end
and not an end in itself. The end is good quality care for all. Respecting diversity,
promoting equality and ensuring human rights will mean that everyone using health and
social care services receives good quality care.
To put this principle into practice, we will continue to improve the equality performance
of our providers through robust procurement and monitoring practice by:
 Raising the profile of the equality agenda at Quality Monitoring meetings with
providers to develop and implement plans to address key areas of
disadvantage.
 Reviewing the Equality KPI, a requirement of the NHS Standard Contract
Quality Schedule to ensure a clear linkage to the GM Equality, Diversity and
Human Rights contract Schedule (EDHR), which ensures the equality functions
of Providers are clear, focussed and addresses Public Sector Equality Duty.
 Exploring potential CQUIN indicators to drive up EDHR performance.
 Where possible, supporting providers in developing good practice and connect
this into the work of EDS2 and Healthwatch.
 Connecting the equality implications of Keogh and Francis report via quality
schedule (EDHR schedule and Quality and Performance Group plan)
 Exploring options to enhance analysis of patient experience across protected
groups where needs are greatest.
 Incorporating EDHR principles within our programme of Patient Safety Walk
rounds.
The CCG is committed to delivering the EDS2 goals and outcomes as described at
Appendix 2 with the aim of ensuring the quality of care experienced by vulnerable
groups of patients is improved.
There are logistical challenges in achieving this which we are addressing. All providers
are required to gather data about their patients in relation to the protected
characteristics. As a CCG we have requested that this data be included in patient
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safety, complaints and patient experience reports. This needs to be strengthened
moving forward but is hampered by national electronic systems for capturing patient
data which does not allow for data collection against all the protected characteristics.
We will work with our Providers to ensure they have plans in place to improve the
collection of this data against the 9 protected criteria. This will be monitored through
quality monitoring meetings with providers.
Within the CCG, the CCG Quality & Safety Committee is responsible for monitoring
performance against our EDHR objective, whilst the CCG Patient Experience and
Assurance Committee will ensure the ethos of Equality and Diversity is a golden thread
through HMR CCG, by continuing the inclusive approach and including voices from
local protected groups, vulnerable groups and emerging communities.
Monitoring
Progress against the strategy and action plan (see appendix 1) will be monitored by the
HMR CCG Governing Body through the HMR CCG Quality & Safety Committee. It will
be reviewed annually to ensure that the strategy continues to reflect national and local
priorities for quality and will be refreshed/revised as required.
Conclusion
Within this document HMR CCG has set out an ambitious strategy for ensuring and
improving the quality of care for its population. The CCG is committed to delivering this
strategy.
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QUALITY STRATEGY ACTION PLAN
Goal 1 – Patients and Service Users will feel safe and will not suffer avoidable harm
Outcome Measure
The CCG has assessed progress
against its Francis/Berwick/Keogh
action plans and addressed areas of
partial or non-compliance.
Agreed processes will be in place to
ensure effective performance
management of serious incidents and
compliance with current NHS England
Serious Incident Management
Framework.
CCG Quality team members will be
trained in serious incident investigation
techniques and sit on Serious Incident
Investigation panels where a
comprehensive investigation is
required.
Provider contracts will specify quality
outcomes and standards together with
planned monitoring arrangements and
penalties when these apply.
Contractual penalties and levers in
place for Never Events and
underperformance against quality
indicators
Annual programme of Patient Safety
Walk-rounds in place across all care
settings
Systems and processes in place to
monitor compliance with the Duty of
Candour and contractual penalties in
place for non –compliance.
Early Warning Systems in place for all
providers to alert to potential serious
failings.
Annual schedule of Quality Monitoring
Meetings across all providers and
associated work-plans
Mechanisms in place for monitoring the
quality impact of Provider cost
improvement plans (CIPS)
Active participation in NHS England
Greater Manchester Quality
Surveillance Group
Active participation in NHS England
Greater Manchester Quality Leads
Collaborative
Revised GP Quality Feedback Process
Date for
Completion
November
2015
Responsible Lead/Committee
November
2015
Director of Quality & Safety/Quality &
Safety Committee
March 2016
Director of Quality & Safety/Quality &
Safety Committee
Director of Quality & Safety/Quality &
Safety Committee
Ongoing
On-going
Director of Quality & Safety/Quality &
Safety Committee
On-going
Director of Quality & Safety/Quality &
Safety Committee
On-going
Director of Quality & Safety/Quality &
Safety Committee
On-going
Director of Quality & Safety/Quality &
Safety Committee
On-going
Director of Quality & Safety/Quality &
Safety Committee
On-going
Director of Quality & Safety/Quality &
Safety Committee
On-going
Director of Quality & Safety/Quality &
Safety Committee
On-going
Director of Quality & Safety/Quality &
Safety Committee
October 2015
Director of Quality & Safety/Quality &
22
in place and triangulation with other
sources of intelligence eg Serious
Incidents/Complaints/CQC reports
Care Home Quality & Safeguarding
Partnership Meetings in place
Processes in place to monitor provider
compliance against Safer Staffing
levels
Reduction of Healthcare Associated
Infections in line with NHS England
trajectories
Post Infection Review (PIR) processes
in place
HMR CCG newsletter will share best
practice and lessons learned.
The CCG receives regular reports from
providers which triangulate data from
incidents, complaints, PALS, claims,
inquests and demonstrates how the
learning from these has been
embedded into practice.
Safety Committee
On-going
On-going
Director of Quality & Safety/Quality &
Safety Committee
Director of Quality & Safety/Quality &
Safety Committee
On-going
Director of Quality & Safety/Quality &
Safety Committee
On-going
Director of Quality & Safety/Quality &
Safety Committee
Director of Communications &
Engagement/Quality & Safety
Committee
Director of Quality & Safety/Quality &
Safety Committee
On-going
On-going
Goal 2: Patients and service users will receive care and treatment which is evidence
based, clinically effective and provides value for money
Outcome Measure
Date for Completion Responsible Lead/Committee
CCG Research Champion
Completed
Director of Quality & Safety/Quality &
appointed
Safety Committee
Implementation of approved
April 2016
Director of Quality & Safety/Quality &
HMR CCG Research
Safety Committee
Strategy
50% Increased uptake of
December 2016
Director of Quality & Safety/Quality &
research activity across
Safety Committee
HMR CCG member
practices
NICE Quality Standards as
April 2016
Director of Quality & Safety/Quality &
part of contractual
Safety Committee
requirements with all
providers.
Providers can demonstrate
April 2016
Director of Quality & Safety/Quality &
that the care and treatment
Safety Committee
they provide is in
accordance with NICE
Guidance/technology
appraisals
Review of provider clinical
On-going
Director of Quality & Safety/Quality &
audit programmes will form
Safety Committee
part of work programme for
quality monitoring meetings
Cancer Peer Review
September 2015
Director of Quality & Safety/Quality &
findings are reported to
Safety Committee
Commissioners and
progress against associated
action plans monitored
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through the Clinical Quality
Leads meeting.
Quality team will participate
September 2015
in HMR CCG Service
Review Process
Patient Reported Outcome
On-going
measures (PROMS)
included in quality indicators
Provider Quality Accounts
On-going
will include an assessment
of the organisations priorities
for continuous improvement
and a summary of progress
on the previous year
priorities.
Director of Quality & Safety/Quality &
Safety Committee
Director of Quality & Safety/Quality &
Safety Committee
Director of Quality & Safety/Quality &
Safety Committee
Goal 3: Patients and service users will have a positive experience of healthcare services
Outcome Measure
Date for Completion Responsible Lead/Committee
Quality Team representation Completed
Director of Quality & Safety/Quality &
on the HMR CCG Patient
Safety Committee
Engagement & Assurance
Committee
Friends and Family Test
On-going
Director of Quality & Safety/Quality &
results reported by providers
Safety Committee
and use to drive service
improvements.
Work plans that takes into
Completed
Director of Quality & Safety/Quality &
account key milestones eg
Safety Committee
National In-Patient
Survey/Staff Survey
Patients and service users
On-going
Director of Quality & Safety/Quality &
are able/supported to
Safety Committee
provide feedback on the
care and treatment they
Director of Operations &
have received through a
Engagement/Patient Assurance &
variety of mechanisms.
Engagement Committee
Elephant kiosks are
December 2015
Director of Quality & Safety/Quality &
effectively utilised to capture
Safety Committee
a wide range of patient and
service user feedback.
Patients/service users will
December 2015
Director of Quality & Safety/Quality &
be represented on provider
Safety Committee
committees/forums.
Director of Communications &
Engagement/Patient Engagement &
Assurance Committee
Development and
On-going
Director of Communications &
implementation of processes
Engagement/Patient Engagement &
which demonstrate to the
Assurance Committee
public that HMR CCG has
received and acted upon
information received.
Providers have mechanisms Completed
Director of Quality & Safety/Quality &
in place to monitor and
Safety Committee
24
respond to complaints,
PALS enquiries and other
sources of patient/service
user feedback (eg NHS
Choices) and report to
commissioners
Mechanisms in place to
ensure that patients and
service users are included in
commissioning decisions.
On-going
Director of Commissioning/Clinical
Commissioning Development Group
Director of Communications &
Engagement/Patient Engagement &
Assurance Committee
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Appendix : 2 EDS 2 Goals & Outcomes 2014
Goal 1: Better Health Outcomes
1.1 Services are commissioned, designed and procured to meet the health
needs of local communities.
1.2 Patients’ health needs are assessed, and resulting services provided, in
appropriate and effective ways
1.3 Transition from one service to another, for people on care pathways, is made
smoothly and everyone is well informed.
1.4 When people use NHS Services, their safety is prioritised and they are free
from mistakes, mistreatment and abuse.
1.5 Screening, vaccination and other health promotion services reach and
benefit all local communities.
Goal 2: Improved Patient Access & Experience
2.1 Patients, carers and communities can readily access hospitals, community
health and primary care services, and should not be denied access on
unreasonable grounds
2.2 People are informed and supported as they wish to be in decisions about
their care.
2.3 People report positive experiences of the NHS.
2.4 Peoples complaints about services are handled respectfully and efficiently
Goal 3: A Represented & Supported Workforce
3.1 Fair NHS recruitment and selection processes lead to a more representative
workforce
3.2 The NHS is committed to equal pay for work of equal value and expects
employers to use equal pay audits to help them fulfil their legal obligations.
3.3 Training and development opportunities are taken up and positively
evaluated by staff
3.4 When at work staff are free from abuse, harassment, bullying, violence from
any source
3.5 Flexible working options are available to all staff consistent with the needs of
the service and the way people lead their lives.
3.6 Staff report positive experiences of their membership of the workforce
Goal 4: Inclusive Leadership
4.1 Boards and senior leaders routinely demonstrate their commitment to
promoting equality is advanced within and beyond their organisations.
4.2 Papers that come before Boards and other major committees identify
equality- impacts including risk, and say how these risks are to be managed.
4.3 Middle managers and other line managers support their staff to work in
culturally competent ways within a work environment free from discrimination.
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