QUALITY STRATEGY
2016 – 2018
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SUMMARY
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The Quality Strategy sets out how the CCG intends to achieve continuous
improvement in all commissioned services, reflecting national and local
priorities and reinforcing the CCG’s commitment to the development of
validated quality improvement within and between care settings.
Interim Head of Governance
Director of Quality & Integrated Governance
All staff
Director of Quality & Integrated Governance
Assistant Director of Quality, Governance & Risk
Quality & Risk Sub Group
Clinical Reference Group
Policy
N/A Template completed
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Quality & Safety Committee 18 June 2016
Version 5.3
CCG staff Intranet
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GP Intranet
Outlined in Appendix 1 (Local Policies/Drivers)
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April 2018
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DOCUMENT CONTROL
Date
2013
Version
1
09/07/14
2
11/05/15
3/4
06/04/16
11/04/16
5
5.1
11/04/16
5.2
27/04/16
5.3
18/05/16
5.3
Action
First Quality Strategy for CCG authorisation
First re-draft of strategy following CCG
authorisation
First re-draft of strategy based on final
strategy published for 2014/15
2016-17 refresh
Incorporating AF
requirements
Incorporating BP
comments
Incorporating comments from Quality and
Risk sub committee
Approved by Quality and Safety Committee
Author
AF - Director of Quality &
Governance
RC - Clinical Governance Lead
Integrated
RC - CCG Clinical Governance Lead
SI - Interim Clinical Governance Lead
SI - Interim Clinical Governance Lead
SI - Interim Clinical Governance Lead
SI - Interim Clinical Governance Lead
SI Interim Head of Quality
“The CCG incorporates and support the human rights of the individual as set out in the
European Convention on Human Rights and the Human Rights Act 1998”
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Contents
Forward................................................................................................................................. 3
The Quality Strategy on a Page ............................................................................................ 4
Introduction ........................................................................................................................... 5
National context .................................................................................................................... 6
Local context ......................................................................................................................... 8
What is quality?..................................................................................................................... 9
Values and approach .......................................................................................................... 10
Quality commitment ............................................................................................................ 11
Quality Assurance ............................................................................................................... 12
Governance ........................................................................................................................ 14
Quality Strategy Implementation ......................................................................................... 15
Appendix 1 - National and Local Policy and Drivers ............................................................ 16
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Forward
Place the quality of patient care, especially patient safety, above all other aims.
Engage, empower, and hear patients and carers at all times.
Foster whole-heartedly the growth and development of all staff, including their ability and
support to improve the processes in which they work.
Embrace transparency unequivocally and everywhere, in the service of accountability, trust,
and the growth of knowledge.
Professor Donald Berwick, August 2013.
This document reflects Enfield CCG’s strategy to ensure that the people of Enfield have
ease of access to high quality, cost and clinically effective services that have been shaped
by the feedback we receive from the local population.
From feedback Enfield CCG has received from service users we know that people accessing
healthcare services judge those services by varying criteria including good clinical care and
outcomes; effectiveness and efficiency; and ease of access. Enfield CCG will use the
feedback we receive in these areas to help us commission safe and effective services that
are responsive to the needs of the local population.
We also know that our local population want to be treated as individuals and to be properly
communicated with in a respectful and listening manner that is clear and simple. We are
committed to work in a way that enables the voice of service users to be heard and that they
are at the centre of decisions made about them. We will work with service providers to
ensure that there is transparency and honesty in all dealings with service users and we will
utilise the intelligence we receive about the experiences of patients to help us commission
patient centred services.
Our commitment is to work with the people of Enfield; providers of services; and other health
and social care partners to continually improve the quality of services available to the people
of Enfield.
Dr Mo Abedi - GP Member and Chair
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The Quality Strategy on a Page
The people of Enfield have a right to have a safe experience and receive effective care wherever they are cared for in NHS services. Enfield
CCG will continue to use feedback about the safety and effectiveness of services to inform the commissioning decisions that we make. We will
build on the successes of previous years and make changes informed by the lessons we have learned.
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Introduction
This Quality Strategy builds on previous strategies and outlines our continuing approach for
ensuring that quality is at the heart of commissioning decisions undertaken by Enfield CCG.
The refreshed 2016-18 Quality Strategy and Quality Strategy Implementation Plan reflects the
increasing requirements for greater collaboration between partner organisations to ensure that
commissioned services are safe, effective and responsive services for the people of Enfield.
Appendix A details the wide range of national and local policies and drivers that we used to
influence the development of this strategy.
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National context
The Health and Social Care Act 2012 moved the responsibility for commissioning health services
from the former primary care trusts to local groups of clinicians through the establishment of
clinician-led clinical commissioning groups (CCGs).
As commissioners of healthcare services, CCGs have a statutory duty to:
• Secure continuous improvement in the quality of services provided to individuals for or in
connection with the prevention, diagnosis or treatment of illness; and
• To act with a view to securing continuous improvement in the outcomes that are achieved
and, in particular, outcomes which show the effectiveness of their services, the safety of the
services provided, and the quality of the experience of the patient.
In order to fulfil this responsibility CCGs are required to:
• Be a clinically led commissioning organisations;
• Have in-depth knowledge about local health services and communities;
• Receive and analyse feedback from local people using local healthcare services;
• Place quality at the heart of their commissioning activities;
• Work in close partnership with other commissioning and healthcare provider organisations to
get the best services for local people.
The NHS Constitution, first published in March 2011, supports the 2012 Health and Social Care Act
and is enshrined in law. Under the NHS Constitution CCGs has a responsibility to commission high
quality healthcare that’s free at the point of need and can be accessed by all.
Under the NHS Constitution, the rights of patients are:
• 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;
• Be treated with dignity and respect, in accordance with their human rights;
• Expect NHS bodies to monitor, and make efforts to improve continuously, the quality of
healthcare they commission or provide. This includes improvements to the safety,
effectiveness and experience of services;
• Be able to have access to drugs and treatments that have been recommended by NICE for
use in the NHS, if their doctor says they are clinically appropriate for them.
The NHS Constitution also sets out core operating principles for quality:
• the patient and the public comes first – not the needs of any organisation;
• quality is everybody’s business – from the ward to the board; from the supervisory bodies to
the regulators, from the commissioners to primary care clinicians and managers;
• if we (health and care professionals, staff as well as patients and the wider public) have
concerns we speak out and raise questions without hesitation;
• we listen in a systematic way to what our patients and staff tell us about the quality of care;
and
• if concerns are raised, we listen and ‘go and look’.
In addition to the core operating principles for quality set out in the NHS, the NHS Outcomes
Framework (NOF) sets out the national outcomes that commissioners and providers of NHS funded
care should be contributing towards. Indicators in the NHS Outcomes Framework are grouped
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around five domains, which set out the high level national outcomes that the NHS should be aiming
to improve:
Domain 1
Preventing people from dying prematurely;
Domain 2
Enhancing quality of life for people with long-term conditions;
Domain 3
Helping people to recover from episodes of ill health or following injury;
Domain 4
Ensuring that people have a positive experience of care;
Domain 5
Treating and caring for people in a safe environment; and protecting them from
avoidable harm.
To provide further structure and support to commissioning and provider organisations, the NHS in
England published NHS Five Year Forward View in 2014. Developed by the NHS and partner
organisations, this document sets out a new shared vision for the future of the NHS based around
the new models of care. Patient groups, clinicians and independent experts provided their advice to
create a collective view of how the health service needs to change over the next five years if it is to
close the widening gaps in the health of the population, quality of care and the funding of services.
The NHS Five Year Forward View details how the NHS will:
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Back diverse solutions and local leadership;
Create aligned national NHS leadership;
Support a modern workforce;
Exploit the information revolution;
Accelerate useful health innovation;
Drive efficiency and productive investment.
In addition to the NHS Five Year Forward Plan, NHS England (responsible for holding CCGs to
account) has led a number of national programmes to guide the quality and effectiveness of
healthcare services. The Right Care programme is currently at the forefront of this work and is
focused on maximising value:
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The value that the patient derives from their own care and treatment;
The value the whole population derives from the investment in their healthcare.
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Local context
Enfield Clinical Commissioning Group (CCG) became statutory body on 1 April 2013 and
commissions healthcare services from providers that are registered with the Care Quality
Commission (CQC). The services commissioned by Enfield CCG include the majority of NHS
funded healthcare services such as:
• Planned hospital care;
• Rehabilitative and continuing care;
• Urgent and emergency care (including out of hours services);
• Most community health services; and
• Maternity, mental health and learning disability services.
Enfield CCG commissions these services on behalf of Enfield residents and primarily services are
provided by:
• Barnet Enfield and Haringey Mental Health Trust
• North Middlesex University Hospital NHS Trust
• Royal Free London NHS Foundation Trust
• London Ambulance Service NHS Trust
From October 2015, the five CCGs in north central London (Barnet, Enfield, Camden, Haringey and
Islington) took on formal joint commissioning responsibilities for GP services in partnership with
NHS England. Together the CCGs are looking at ways of improving local services for people,
including:
• Improved access to primary care and wider out-of-hospitals services, with more services
available closer to home;
• Improved health outcomes, equity of access, reduced inequalities; and
• A better patient experience through more joined up services.
Currently Enfield CCG is not responsible for directly commissioning primary care services, such as
dental care, pharmacy, ophthalmology (optician); this is currently the responsibility of NHS England.
However, the NHS Five Year Forward View sets out 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 and Enfield CCG will be fully engaged in any work undertaken.
The NHS Enfield Clinical Commissioning Group Constitution details how the organisation will
discharge its statutory duties set out in the Health and Social Care Act 2012 and the NHS
Constitution. In particular, the NHS Enfield CCG Constitution details how the CCG will:
• Promote a comprehensive health service;
• Meet the public sector equality duty;
• Work in partnership with the London Borough of Enfield to develop joint strategic needs
assessments and joint health and wellbeing strategies
• Work with the local population and partners to collect local intelligence to inform
commissioning decisions;
• Secure continuous improvement in the quality of services commissioned;
• Support the improvement of quality in general practice.
This Quality Strategy and the annual Quality Strategy Implementation Plan form part of the CCG
internal governance framework that supports the delivery of the NHS Enfield CCG Constitution and
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assists the organisation to meet its statutory requirements for commissioning safe, effective and
responsive healthcare services.
What is quality?
Local people have told Enfield CCG they expect consistently high quality health care services but
we know that quality can mean different things to different people. Therefore, to help the CCG
measure the quality of services and to support us to communicate quality outcomes it is essential for
us to have a clear and transparent model of quality.
The CCG uses a model for quality which embraces the three domains of quality first set out in High
Quality Care for All in 2008 following the NHS Next Stage review led by Lord Darzi. We believe this
model, which has been embraced across the NHS, sets out three domains of quality that
encompass the expectations of the people of Enfield.
1. Clinical effectiveness – quality care is delivered according to the best evidence available
that demonstrates the most clinically effective options available that are likely to improve a
patient’s health outcomes.
2. Safety – quality care is delivered in a way that reduces the risk of any avoidable harm and
risks to a patient’s safety.
3. Patient experience – quality care provides the patient (and their carers) with a positive
experience of receiving and recovering from the care provided, including being treated
according to what the patient (or their representatives) wants or needs, and with
compassion, dignity and respect.
The three domains of our quality model, including and how these sit across the five domains of the
National Outcomes Framework, are shown below.
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Values and approach
The values of the NHS are set out within the NHS Constitution and are:
• Working together for patients;
• Respect and dignity;
• Commitment to quality of care;
• Compassion;
• Improving lives;
• Everyone counts.
Enfield CCG has adopted these values as we believe they provide the foundations for the quality
improvement work we have already commenced and are planning to undertake. How we have
applied these to assist us in monitoring the quality of the services we commission is shown below.
Intelligence we receive whilst we are monitoring the quality of services is analysed and used to
inform each stage of the commissioning cycle. An overview of how we use the intelligence we
receive is shown below.
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Quality commitment
Enfield CCG is committed to building on previous work to improve the safety, effectiveness and of
healthcare services available to Enfield residents and to ensuring that patients have a positive
healthcare experience.
To help measure the safety, effectiveness and patient experience for the services commissioned by
Enfield CCG we continue to benchmark ourselves against three key principles identified by
Professor Donald Berwick, August 2013, in A Promise to Learn – A Commitment to Act: Improving
the safety of patients in England.
Patient safety
Patients, the local population and partner organisations tell us that
commissioned care intended to help did not cause harm.
Clinical effectiveness
Patients, the local population and partner organisations tell us that
commissioned services have contributed to an improvement in health
outcomes.
Patient experience
Patients tell us they are active partners in their healthcare and always
are treated as such by those providing their healthcare.
Patients and Enfield residents are present, powerful and involved at all
levels of Enfield CCG.
In order to continue to deliver the quality commitment of Enfield CCG we will continue to:
Patient safety
Work with partners to maintain a positive, open and transparent
culture that safeguards vulnerable children and adults;
Utilise national safety tools and other best practice tools to monitor
safety of commissioned services.
Clinical effectiveness
Commission innovative services focused on improving health
outcomes;
Monitor commissioned services for compliance with nationally
mandated standards, performance measures and best practice
guidance;
Implement local quality improvement goals underpinned by best
practice and research.
Patient experience
Ensure patient rights under the NHS Constitution are being promoted;
Listen to and act on patient and public feedback, ensuring the patient
and carer voice is heard and directly influences commissioning
decisions.
Enfield CCG will continue to produce a year on year improvement plan to help us deliver the quality
commitment and we will continue to monitor our performance against these plans.
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Quality Assurance
As a statutory organisation, Enfield CCG is responsible to the organisation’s Governing Body for the
delivery of both statutory and constitutional duties, and improvements in the health outcomes of the
local population.
NHS England has a responsibility to seek assurance that the CCG is fulfilling all statutory and
constitutional duties and does this through the implementation of an assurance framework.
NHS England is introducing a new CCG Improvement and Assessment Framework in 2016/17 to
replace both the existing CCG assurance framework and CCG performance dashboard. This new
framework provides a greater focus on assisting improvement alongside our statutory assessment
function. It aligns with NHS England’s mandate and planning guidance, with the aim of unlocking
change and improvement in a number of key areas. This approach aims to reach beyond CCGs,
enabling local health systems and communities to assess their own progress from ratings published
online.
The framework is intended as a focal point for joint work and support between NHS England and
CCGs, and was developed with input from NHS Clinical Commissioners, CCGs, patient groups and
charities. It draws together the NHS Constitution, performance and finance metrics and
transformational challenges and will play an important part in the delivery of the Five Year Forward
View.
The components of the assurance framework are shown below.
A key focus within the NHS England assurance framework will be how well Enfield CCG:
• Delivers improved services;
• Maintains and improves quality; and
• Ensures better outcomes for patients.
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In addition to the NHS England assurance framework, Enfield CCG will maintain the organisation’s
internal quality assurance processes so that standards of care and expected outcomes are
effectively demonstrated and monitored including:
• Ensuring that standards for quality improvement are the founding principles on which the
organisation delivers its business;
• Continuing to support and improve quality across all care pathways and with all providers to
address patient need;
• Reducing variation and tackling unwarranted variation by striving for continuous quality
improvement;
• Preventing harm and keeping people safe through robust governance processes that the
CCG has put in place to assure quality and safety, especially in relation to safeguarding of
children and adults at risk;
• Ensuring that innovation, research and clinical audit outcomes inform commissioning
decisions;
• Measuring quality through the three key quality domains patient safety; clinical effectiveness
and patient experience.
For commissioned services, the mechanisms through which Enfield CCG will seek assurance on
service quality are:
• Defining and monitoring clear expectations of quality;
• Regular provider monitoring;
• Provider visits;
• Quality accounts.
Where appropriate ‘deep dives’ will be undertaken to analyse data and information to gain a greater
understanding of the provider or associated service. Any concerns will be highlighted and remedial
actions agreed.
Services provided by Enfield CCG are also subject to scrutiny and report on quality compliance via
the governance process set out in the next section of this report. These services are:
• Medicines Management;
• Continuing Healthcare; and
• Enfield Referral Management Service.
The CCGs Quality Strategy also incorporates its approach to clinical audit, research & innovation.
The CCG promotes research and innovation through the:
• Inclusion in service specifications a caveat that requires providers to engage in research and
innovation;
• Oversight of NICE guidance and research implemented and conducted by provider
organisations, and ways in which innovation is promoted, through provider reports at Clinical
Quality Review meetings.
Within the CCGs Transformation Team, NICE is routinely reviewed in the development process of
pathways and service specifications.
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Governance
The Constitution for NHS Enfield Clinical Commissioning Group (30 April 2015) details the
overarching governance arrangements in place within the CCG. This includes how the CCG will
discharge its quality duties set out in the Health and Social Care Act 2012 in the following areas:
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Securing continuous improvement to the quality of services, including the use of clinical audit;
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Promoting the involvement of patients, their carers and representatives in decisions about
their healthcare;
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Acting in a manner that enables patients to make choices by ensuring robust, appropriate
arrangements for safeguarding children and adults;
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Promoting innovation and research.
The governance structure, shown below, was established to support the CCG to discharges its
duties set out in the Health and Social Care Act 2012.
The above governance structure supports the reporting and escalation of concerns about the quality
of commissioned service and services provided by Enfield CCG.
In line with these established governance arrangements, implementation of the Quality Strategy will
be monitored by the Quality and Safety Committee on a quarterly basis and a progress report will be
provided to the Governing Body on an annual basis.
In addition to the internal governance arrangements, Enfield CCG is a member of the North Central
and East London Quality Surveillance Group. The Quality Surveillance Group brings together
commissioners, regulators, local Healthwatch representatives and other bodies on a regular basis to
share information and intelligence about quality across the system. This enables system wide
actions to be taken to when quality issues arise.
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Quality Strategy Implementation
An annual Quality Strategy Implementation Plan will focus on the year on year actions required to
achieve our quality ambitions set out in this strategy. The Quality and Safety Committee will receive
quarterly reports on the progress made against the Quality Strategy Implementation Plan. This will
include our approach to research and clinical audit. The 2016/17 Quality Strategy Implementation
Plan will also incorporate outstanding actions from the 2015/16 Clinical Audit Action Plan.
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Appendix 1 - National and Local Policy and
Drivers
National
Report/Drivers
A Call to Action
(NHS England)
Everyone Counts
(NHS England)
Planning for
patients 2014-18.
The NHS
Operating
Framework
The Francis Report
Hard Truths
The Keogh Report
The Berwick
Report
Compassion in
Practice (6C strategy)
Better Care Fund
Five Year Forward
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Key themes which have informed the Quality Strategy
A request to patients, public, staff and partners to join a national conversation about the
future demand on NHS services, the impact of changing health needs and how we will
meet these challenges. The Key themes of the CCGs’ public and staff call to action
consultation events are included in the introduction of this strategy.
A new strategic five-year approach to local commissioning planning, using outcome
ambitions to set trajectories and twice-yearly operating plans.
Quality is as much about behaviours and attitudes to patients as human beings as it is
about the transactions we need to make to ensure services improve. Three nonnegotiable items the NHS expects to be part of every relationship between a
commissioner and provider:
1. Lessons from Francis report and recommendations included in Hard Truths, and drive
for right staff, right skills, right place and right time approach (NQB nurse staffing report)
2. Recommendations of the Berwick report (patient safety and culture of the NHS)
3. Transforming Care: A national response to Winterbourne View Hospital – delivering
the core principles of commissioning for people with learning disabilities.
This includes five domains as below. See section 3 and appendix A of this policy
1. Living longer lives
2. Enhancing quality of life for people with long term conditions
3. Helping people to recover from episodes of ill health or following injury
4. Ensuring that people have a positive experience of care
5. Caring for people in a safe environment and protecting them from avoidable harm.
1. Putting patents first
5. Openness and candour
2. Common culture
6. Performance and Information
3. Standards of service
7. Leadership
4. Complaints handling
1. Preventing problems: duty of candour, new patient safety collaborative
2. Detecting problems quickly: outliers, surveillance and listening to patients
3. Taking action promptly: national ratings and risk assessment framework
4. Ensuring robust accountability: consequences for failure (sanctions)
5. Ensuring staff are trained and motivated: engagement and morale, leadership
1. Reduce avoidable deaths
5. No hospital will be an island
2. Use data in pursuit of improvement
6.Staffing levels/skill mix reflect caseload
3. Involve patents and public in design 7.Junior doctors to be clinical leaders today
and assessment of services
and tomorrow
4. Patients and staff play an active part in 8.Understand the impact of happy,
inspections
engaged staff on patient outcomes
1. Reduce harm by embracing learning
6. Capacity for learning created
2. Put patient safety above all else
7. Quality data available and transparent
3. Empower patients/carers to be involved 8. Patent and carer voice
4. Staffing levels driven by safety needs
9. Regulation – simple and consistent
5. Quality science part of basic training
10. Criminal sanctions rare
The 6Cs - care, compassion, competence, communication, courage and commitment.
The transfer of NHS funding to Adult Social Care to enable better integrated health and
social care;
- Providing an opportunity to improve the lives of some of our most vulnerable
people in our society, giving them control
- Placing them at the centre of their own care and support, and, in doing so,
providing them with a better service and better quality of life.
A new shared vision for the future of the NHS based around the new models of care.
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View
Right Care Right
Time
NHS Standard
Contract
Care Quality
Commission
National Institute
for Health and
Care Excellence
(NICE)
Maximising the value that the patient derives from their own care and treatment and the
value the whole population derives from the investment in their healthcare.
Mandated by NHS England for use by commissioners for all contracts for healthcare services
other than primary care
Fundamental Standards of Quality and Safety to regulate providers of health and social
care, evaluated through data monitoring and visits, and also licences professionals and
providers in order to provide regulated services legally.
Provides national guidance, advice, quality standards and information services for
health, public health and social care. Also provides resources to help maximise use of
evidence and guidance.
Local Drivers
The CCG has drawn on many additional sources of local information and data to determine its
quality strategy.
Key local documents that have informed this strategy include:
• The CCGs’ communications and engagement framework
• The Human Resources Policy Framework (including training and whistleblowing procedures)
• The CCGs Risk Management Strategy/Policy, Board Assurance framework and Risk
Registers
• The CCGs’ policies for safeguarding adults and children
• Infection control and prevention plan
• The Enfield Health and Well Being Strategy
• The Enfield Joint Strategic Needs Assessment
• Plus a wide range of evidence from health provider quality contract monitoring
• Incident & Serious Incident Policy
• Complaints Policy
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