Quality Improvement in Mental Health: Policy Briefing

A Policy Briefing is available for LKS staff to share in their organisations.  Produced by the JET Library at Mid Cheshire Hospitals NHS Foundation Trust.  Feel free to reproduce it (with acknowledgement).

What does this mean for libraries? 

• LKS can provide the evidence and knowledge for quality improvements
• Service user involvement in mental health will present an opportunity for LKS to support health literacy and critical thinking skills

Source: The Kings Fund

Link to main document 

Date of publication: July 2017

Summary of driver: This report describes the quality improvement journey of three mental health organisations (two in England and one in Singapore). It provides key insights and lessons for others considering embarking on a similar journey.

Developing People – Improving Care: A national framework for action on improvement and leadership development in NHS-funded services.

Title of driver: Developing People – Improving Care: A national framework for action on improvement and leadership development in NHS-funded services.

Source: National Improvement and Leadership Development Board

Impact on library policy/practice:

• Library staff should take up the opportunity to attend training which their organisations provide, to develop leadership and talent management skills for the benefit of themselves, their library services and for when working with other libraries and services in wider projects.

• There may be increased interest in the resources the library can provide to support the in-house development of leadership, talent management, systems leadership skills and training courses. Some libraries may wish to expand their collections in these areas.

• Libraries may be able to highlight how their provision of literature searching skills training, literature search services and inter-library loan services can ease access to leadership and improvement resources; which the framework indicates can be difficult to access.

Link to main document:

https://improvement.nhs.uk/uploads/documents/Developing_People-Improving_Care-010216.pdf

Summary: https://improvement.nhs.uk/uploads/documents/10591-NHS_-Improving_Care-Summary.pdf

Publication format: PDF

Date of publication: 1 December 2016

Summary of driver: This is the framework developed by 10 organisations that form the National Leadership and Improvement Board, to guide the development of compassionate leadership, systems leadership, quality improvement and talent management skills amongst NHS staff.

This is the first version of the framework – further regular updates are envisioned.

Key features of driver:

• This is a framework for developing the skills of NHS funded staff at all levels, in clinical and non-clinical roles; and will in future include social care staff.
• The focus is on developing leadership and improvement skills and knowledge to close gaps identified in the NHS Five Year Forward View:
  • Systems leadership, for cross boundary working and joining up healthcare systems,
  • Quality improvement methods knowledge
  • Compassionate and inclusive leadership
  • Talent management

• The ultimate aim is that these capabilities will later be represented in senior leadership and management teams.

 

• These skills should result in continuous improvement of the healthcare system, patient care, improve population health and value for money, and will develop future leaders.

• Local organisations are tasked with reviewing their people development strategies, priorities and budgets so that these capabilities can be developed; primarily by: using their existing funding, developing training in-house and sharing knowledge and experience amongst themselves.

• National oversight bodies see their role as providing to support, supporting structures and schemes, and guidance for the development of these skills.

• The framework lays out a series of actions for the next 12 months and for 1 – 3 years’ time for national oversight bodies to provide this support, build networks and develop national leadership and management schemes. These actions are mainly for: NHS England, Health Education England, NHS Leadership Academy, NHS Equality and Diversity Council, NHS Improvement, Care Quality Commission, Department of Health and the National Improvement and Leadership Development Board.

Primary audience: Senior managers in NHS organisations and partners, and the organisations making up the National Leadership and Improvement Board.

Date last updated: February 2017

Due for review: February 2018

Group member responsible: FG

Operational productivity and performance in English NHS Acute Hospitals: Unwarranted variations

Title of driver: Operational productivity and performance in English NHS Acute Hospitals: Unwarranted variations

Alternative Titles: Productivity in NHS hospitals Carter Review

Source: Lord Carter of Coles (Independent report commissioned by the Department of Health)

Link to main document https://www.gov.uk/government/publications/productivity-in-nhs-hospitals

Publication format: PDF

Date of publication: February 2016

Summary of driver:

Report sets out the findings of Lord Carter’s review of how non-specialist acute hospital trusts can reduce unwarranted variation in productivity and efficiency to save the NHS £5 billion each year by 2020 to 2021.

15 recommendations are made to reduce this variation, including proposing a set of metrics be developed for a ‘model hospital’ for trusts to be benchmarked against.

Key features of driver:

Various sources of unwarranted variation in productivity, costs and efficiency in acute hospitals were identified.

The review looked at clinical staffing, pharmacy and medicines, diagnostics and imaging, procurement, back-office functions, estates and facilities; and at the quality and efficiency of clinical specialties.

The report makes recommendations in 15 areas to reduce this variation, improve quality and productivity, make cost savings, use resources in a cost effective manner and increase efficiency.

The report calls for action by NHS Improvement, NHS England, the Department of Health and hospital trusts with recommendations for the below areas:

• Developing and implementing a national people strategy – simplifying system structures, raising people management capacity, building greater engagement and improving leadership capability.
• Ensuring hospital pharmacies and pathology and imaging departments achieve their benchmarks – resulting in pharmacists spending more time on clinical activities, and a consistent approach to the quality and cost of diagnostic services
• Procurement – trusts should report procurement information monthly to NHS Improvement; collaborate with other trusts and the NHS Supply Chain; and commit to the NHS Procurement Transformation Programme – resulting in increasing transparency and at least 10% reduction in non-pay costs across the NHS.
• Estates and facilities management – trusts should meet or operate above NHS Improvement’s benchmarks. Including not exceeding a maximum of 35% of floor space for non-clinical functions and 2.5 % of space unoccupied/underused.
• Trust corporate and administration functions – should be rationalised so that costs don’t exceed 7% of their income by April 2018 and 6% of income by 2020, or have plans for shared service consolidation or outsourcing to other providers.
• NHS Improvement and NHS England should establish joint clinical governance to set standards of best practice for all specialties.
• Key digital information systems – should be in place in all trusts.
• The Department of Health, NHS England and NHS Improvement should work with local government to provide a strategy for trusts focusing patient care on recovery and how patients can leave acute hospital beds as their clinical needs allow.
• Quality and efficiency opportunities for better collaboration and coordination of clinical services across local health economies – NHS England and NHS Improvement should work with trust boards to identify these.
• NHS Improvement should develop the Model Hospital and underlying metrics so there is one source of data, benchmarks and practice.
• Metrics and reporting – NHS Improvement should develop an integrated performance framework to ensure there is one set of metrics and approach to reporting; reducing the reporting burden for trusts.
• Various deadlines are suggested- all trusts should work towards these and national bodies should develop timetables for efficiency and productivity improvements.

Primary audience: Department of Health, NHS Improvement, NHS England, Acute Trust Boards

Impact on library policy/practice:

Libraries are not specifically mentioned but:

• The focus on efficiency, quality and benchmarking may lead to increased interest in resources for business decision making, and clinical/service auditing.
• Consortia purchasing of library resources could contribute towards cost reduction.
• Libraries can supply resources on leadership and people management to support the staffing changes proposed.
• Library staff could partake in any leadership training and development made available by their trusts – for CPD and to improve the structure and leadership of the library service.
• Library services can highlight that by having trust computers available in their setting – they are supporting staff to have access to the digital information systems the report calls for.
• Working in collaboration with other libraries to deliver projects and services e.g. inter-library loans could support the initiative of collaboration and cost reduction.

However with the stipulation for the maximum percentage of hospital floor space for non-clinical functions – if trusts feel they need to reduce non-clinical floor space, libraries may be one of the areas that faces challenges to their use of space. Library managers will need to highlight the value of the library service to counter this pressure.

Date last updated: November 2016

Due for review: November 2017

Group member responsible: FG

NHS Operational Planning and Contracting Guidance

Link to main document:

Publication format:  PDF

Date of publication: 22/09/2016

Summary of driver: This document outlines how NHS operational planning and contractual processes will change to support Sustainability and Transformation Plans (STPs) and the “financial reset”. STPs are a different way of working and are seen as the way forward with partnership behaviours and reducing silo working.

Key features of driver:

• Streamlining of the annual round of NHS planning and contracting.
• Move away from annual contracts towards two year contracts as default
• Priorities and performance assessment – lists nine “must do” priorities, originally listed in 2016/17 and will remain in place for 2017/18 and 2018/19.  These must be delivered within the financial resources available each year
• Developing operational plans and agreeing contracts for 2017-19
• Finance and business rules – submission of local finance plans illustrating achievement  financial balance within available resources
• Specialised services and other direct commissioning- new framework enabling STPs to contribute specialised care to population based health services and outcomes
• Commissioning in the evolving system – continued evolvement of CCG ‘s role
• System-wide set of changes in order to ensure NHS can deliver the right care in the right place with optimal value
• Working with local government/patients/communities and creating wider partnerships with the third sector

List of annexes to support guidance.

• Annex 1 – The Government’s Mandate to NHS England 2020 goals
• Annex 2 – The CCG Improvement and Assessment Framework
• Annex 3 – NHS Improvement Single Oversight Framework
• Annex 4 – October Guidance on STPs
• Annex 5 – NHS England and NHS Improvement approach to establishing shared financial control totals
• Annex 6 – General Practice Forward View Planning requirements
• Annex 7 – Cancer services transformation planning requirements
• Annex 8 – Mental health transformation planning requirements

Primary audience: NHS/healthcare senior management, local government, third agency staff, public health staff, commissioners.

Impact on library policy/practice:

• LKS already work collaboratively across boundaries- opportunities to expand and push to national as well as show in-house how collaborative and partnership working can benefit organisations. Initiative in working closer with LKS colleagues in relevant STP footprint
• Opportunities to create and strengthen links with CCGs’ as their role evolves and increase
• Support the Government’s Mandate to NHS England 2020 goals for the NHS to be the world’s largest learning organisation via the provision of resources to enable staff to deliver the required recommendations
• Support/ provide evidence requests for information on service reconfiguration/collaboration, operational topics / efficiency savings

Date last updated: November 2016

Due for review:  November 2017

Group member responsible: LK

Implementing the NHS five year forward view: aligning policies with the plan

Source:  Link to main document: http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/implementing-the-nhs-five-year-forward-view-kingsfund-feb15.pdf

Publication format:  PDF (36 pages)

Date of publication: February 2015

Summary of driver: This is the implementation plan for the NHS Five Year Forward View, which was published October 2014 and proposes major change within the NHS over a five year timeframe. The implementation plan describes why the changes need to be made, makes practical proposals to remove barriers to healthcare and how the new implementation models can be supported. The report highlights the levels of funding required to meet this vision and the need for the NHS to have high-quality and consistent leadership.

Key features of driver:

The document lists four key drivers, each with recommendations for action and finishes with a summary of recommendations

How services are commissioned and paid for

• Innovations in commissioning and contracting – NHS commissioners to be supported by national bodies in order to achieve this
• Importance of investing in the development of system leaders
• Development of federation/networks/super partnerships (multispecialty community provider) to enable general practices to deliver a wider range of services
• Provision of proactive care in the community
• Integrated commissioning- combining CCG and NHS England funding
• NHS commissioners to work with interested general practices as pilot MCPs.
• Formation of primary and acute care systems- single organisations to provide NHS services (GP/hospital/mental health/community care) running as virtual or physical organisations
• Innovation in payment systems- capitated budgets/pooled budgets/integrated personal commissioning

How the NHS is regulated

• Improvements in quality of health and social care- CQC to survey patients and service users
• Whole-system intervention regime to support challenged health economies
• NHS England and Monitor should review current rules on procurement and tendering to enable creation of new care models
• Opportunity for local areas to have access to central legal advice

How improvements in care are delivered by local leaders

• Development of leaders at all levels in the NHS
• Providing all NHS staff with the skills and support requires to improve patient care
• Every NHS organisation to take responsibility for the development of leaders and providing staff with skills in quality improvement
• National bodies to develop explicit strategy for quality improvement
• Currently most NHS leaders are organisational leaders and the Five Year Forward View is aligned with system leaders
• Provider leadership- outlined in the Dalton review

How might a transformation fund contribute?

• King’s Fund has argued for a transformation fun d to help provide financial support through change
• Prime role is for transformation fun to pump-prime new care models whilst existing models are decommissioned
• Important to recognise that some health economies may gain, some may lose and new organisations may be created
• Looking to how mental health moved from hospital care to community services and lessons learned

Where next?

• Care models set out in the Five Year Forward View are a starting point and not the end of the story
• Commitment to real-time evaluation and learning
• Creation of vanguard sites to fast-track new care models
• Imbalance between the opportunities offered by the Five Year Forward View and the current situation of financial deficits/A&E pressures/waiting time performance
• National bodies have the responsibility to reinforce the idea that the delivery of the Five Year Forward View is as important an operational performance

Primary audience: NHS England, NHS Commissioners, NHS Providers

Impact on library policy/practice:

None of drivers are specifically aimed at libraries but there opportunities for libraries.

• The recommendation for ‘Leadership and improvement expertise’ when referring to the NHS becoming a learning organisation states ‘national support for improvement being provided through small teams of credible experts’. We are the credible experts in our field (p20).
• Vision of NHS becoming a learning organisation (as outlined in Berwick report 2013) is a great opportunity to expand and promote our skill sets and services (p20).
• Providing all NHS staff with the resources required to update their skills – literature search training/critical appraisal training/how to access information online, I order to improve patient care.
• Undertake literature searches on the relevant subjects and promote current awareness on leadership and community topics.
• Possibility of keeping GPs engaged with library and knowledge services.

 

Date last updated: February 2015

Due for review:  December 2016

Group member responsible: LK

End of Year Learning Guidance

Title of driver: End of Year Learning Guidance

Source: NHS Improving Quality

Link to main document http://www.nhsiq.nhs.uk/capacity-capability/knowledge-and-intelligence/iq-handbooks/learning-handbook/end-of-year-learning-guidance.aspx

Publication format: Interactive Prezi slideshow with hyperlinks to supporting documentation. Also available as a PDF.

Date of publication: 2014

Supporting documentation: NHS Improving Quality, (2014), Learning Handbook http://www.nhsiq.nhs.uk/capacity-capability/knowledge-and-intelligence/iq-handbooks/learning-handbook.aspx

Summary of driver:

Outlines the need for teams to conduct end of year, or end of project, lessons learned reviews.

Provides information on the recommended style of learning activity – retrospect review.

The guidance highlights the benefits of conducting lessons learned reviews and capturing the knowledge acquired during the team’s work.

Key features of driver:

• This guidance focuses on documenting tacit knowledge, through learning activities and the production of a lessons learned report.
• Capturing and sharing this knowledge is seen as key to ensuring that NHS organisations are resilient, and positive outcomes can be repeated.
• The benefits of end of year, or end of project, learning activities include: sharing knowledge throughout the organisation; and identifying positive and negative actions so that they can be repeated or avoided in the future for similar projects.
• Recommends using the retrospective review method.
• The guidance acknowledges there are other possible learning activity methods. The guidance includes hyperlinks to the appropriate pages of the NHS Improving Quality’s Learning Handbook for further details of the methods.
• Stresses that learning activities should focus on the ‘how’ and ‘why’ projects progressed in the way they did; and why they were successful or not successful compared to the team’s expectations prior to the work.
• Learning activities should include all members of the team involved in a project – NHS staff and any external members, to ensure that everyone’s learning points and knowledge are included.
• The lessons learned reports should be produced in an appropriate format, and stored and distributed in a way that makes them accessible to all staff within the organisation.
• Includes links to a suggested lessons learned report template in the Learning Handbook.
• Document also includes a link to a YouTube video explaining the concept of tacit knowledge.

Primary audience: Anyone working in the NHS

Impact on library policy/practice:

• Although the guidance focuses on end of the financial year learning activities, the method could be used at the end of any project.
• Library or information service staff could use learning activities to review their own work and projects.
• Library staff may be able to facilitate lessons learned activities for other teams, or provide training on the use of various lessons learned activity methods.
• As a contribution towards knowledge management, libraries may take on the task of storing and making available the lessons learned reports from departments throughout the organisation – using the library’s cataloguing system, other document storage system or Trust intranet.

Date last updated: March 2015

Due for review: March 2016

Group member responsible: FG

 

Expert Patients

Title of driver: Expert patients

Source: Reform

Link to main document: http://www.reform.uk/wp-content/uploads/2015/02/Expert-patients.pdf

Publication format: PDF

Date of publication: February 2015

Summary of driver: This report recommends stronger patient engagement in the NHS as it is key for the health service to achieve savings of £22 billion by 2020-21.

Patient engagement can improve outcomes and use of resources through patients being better able to manage their conditions, and so reducing medical interventions and invasive procedures, as well as improved public health.

Key features of driver:

• Patient engagement could achieve £2 billion savings by 2020-21 (10% of NHS England target savings).
• These savings would come from better self-care, improved public health, and greater patient contribution to their care.
• For the NHS to become fit for “full engagement” private providers and outside expertise will be needed.
• Outside the NHS, apps and social networking sites are already used by the public to take control over their health and conditions, helping the expert patient to emerge more quickly outside the NHS than within it. The NHS has made limited progress in the use of social media and technologies to improve the patient experience.
• NHS providers and commissioners should appoint a “Director of Patient Experience” at board level.
• The NHS should measure levels of patient engagement, activation and involvement and embrace patient engagement regardless of where it originates (whether outside the NHS or within).

Primary audience: Policy-makers, managers and leaders, commissioners, and NHS providers.

Impact on library policy/practice:

Libraries are in an ideal position to provide educational materials to enable patients to learn about their health and their conditions. Public libraries hold Books on Prescription and other resources while health libraries can support staff to educate patients.

Health libraries are also increasingly asked to provide resources or information for patients.

Libraries can adapt to the use of new technologies for customer service and can share expertise with the wider NHS.

Date last updated: February 2015

Due for review: February 2016

Group member responsible: (HS)

White Paper: the new era of thinking and practice in change and transformation

Title of driver: White Paper: the new era of thinking and practice in change and transformation: a call to action for leaders of health and care

Source: NHS Improving Quality

Link to main document

Publication format: Available as PDF and e-publication

Date of publication: July 2014

Summary of driver:

This paper examines trends in change and transformation from multiple industries, and argues that change needs to happen at a faster rate and become more disruptive.

The paper tries to identify the implications and opportunities for leaders of health and care, including embracing disruption and ‘disruptors’ to create an environment where innovation is encouraged. It provide leaders of change with 15 actions to support change, and makes available ideas, opinions, research and resources about the future direction of change.

Key features of driver: 

The paper asks several questions about organisational and system change, including:

• Who does it (many change agents, not just a few)
• Where it happens (increasingly ‘at the edge’ of organisations and systems)
• The skills and mindsets that change agents need

The paper also includes four case studies:

• Living Well in Cornwall and the Isles of Scilly – Striving for a collective humility in finding a way to work together for the person’s benefit
• A grass-roots movement sparked by students coming together to prevent avoidable pressure ulcers
• The NHS Change Day ‘hubbies’: a voluntary self-organising network of local leaders
• The School for Health and Care Radicals – teaching change agents to rock the boat and stay in it

Primary audience: Leaders in health and care

Impact on library policy/practice:

One of the five enablers of the ‘emerging direction’ in change outlined in the paper is ‘Curate rather than create knowledge’. It suggests that improvement leaders will need to become curators of knowledge (collecting, filtering, evaluating, contextualising and sharing knowledge from multiple sources) and this will include more tacit knowledge or ‘know-how’ in future.

This might mean library staff supporting the knowledge management agenda in their organisations, or supporting leaders to use the necessary tools to curate knowledge (which could include applications such as Twitter, Storify and LinkedIn).

In one sense curation of knowledge is something we already do in literature searches, and we already teach users how to collect and filter knowledge using traditional tools such as bibliographic databases. It may be that we simply need to rebrand some of what we do, or extend it to cover new tools.

Digital skills will become increasingly important for leaders, and again this may involve library staff in providing training and support for non-traditional information resources and applications.

Date last updated: October 2014

Due for review: October 2015

Group member responsible: JC

The Mid Staffordshire NHS Foundation Trust Public Inquiry

Title of driver: The Mid Staffordshire NHS Foundation Trust Public Inquiry

Source: Chaired by Robert Francis QC

Link to main document

Publication format: Web page with links to each volume

Date of publication: February 2013

Summary of driver:
The Mid Staffordshire NHS Foundation Trust Public Inquiry was launched in 2010 and was a full public inquiry into the role of the commissioning, supervisory and regulatory bodies in the monitoring of Mid Staffordshire Foundation NHS Trust. It builds on the Independent Inquiry into care provided by Mid Staffordshire NHS Foundation Trust January 2005 to March 2009, and provided a detailed analysis of what contributed to serious failures in care.

It concluded that what happened was the result of a system failure, as well as a failure of the organisation and called for a fundamental change in culture across the NHS.

In February 2014, NHS England published a progress report called ‘The Francis Report: One Year On‘ detailing some of the changes that have taken place as a results of the public enquiry.

• Launching the Friends and Family Test
• Rolling out a the Compassion in Practice strategy
• Review of the quality of care and treatment provided by 14 hospital trusts that are persistent outliers on mortality indicators
• Network of Patient Safety Collaboratives
• Every Trust in England has been directed to publish actual versus expected nurse, midwifery and care staffing levels and to clearly explain how they have decided on their staffing numbers in each ward and clinical area.
• New National Patient Safety Alerting System (NPSAS)
• Quality Surveillance Groups have been put in place
• Begun publication of outcome data from consultants in 12 surgical specialties
• Plans for a new national safety website

Key features of driver:

• The report contains 290 separate recommendations.
• The Government published a response in November 2013, covering each these, though not all of which were accepted in full
• The Government response addresses 5 thematic areas (‘Compassion and care’, ‘Leadership’, ‘Values and standards’, ‘Information’ and ‘Openness and transparency’)

Primary audience: Policy-makers, managers and leaders, education providers, CCGs, NHS Trusts and professional bodies.

Impact on library policy/practice:

Among the recommendations accepted by the Government are several that could have a direct impact on libraries, including:

• Recommendation 187 is that aspiring nurses have one year’s practical experience as a health care assistant before entering an undergraduate nurse education course and this could have implications for the numbers of health care assistants needing to access library services
• Recommendation 194 suggests that in time nurses will be required to undergo revalidation
• Recommendation 197 that nurses have access to leadership training and this could be a driver to support the development of leadership resources in libraries

Date last updated: June 2014

Due for review: June 2015

Group member responsible: JC

AQuA (Advancing Quality Alliance)

Source: Advancing Quality Alliance

Link to AQuA website

Publication format: Website

Date of publication: n/a

Summary of driver: The Advancing Quality Alliance (AQuA) is the North West’s health care quality improvement organisation. AQuA aims to:

• promote and share best practice
• provide improvement training to strengthen NHS organisations locally
• provide intelligence and comparative information to stimulate innovation

Key features of driver:
AQuA run a number of projects, including Advancing Quality, Stroke 90:10, the North West Reducing Mortality Collaborative, Developing Safety Networks programme, plus a number of training packages.

AQuA also run the AQuA Observatory, which aims to compile intelligence and knowledge in order to ‘stimulate innovation’, share good practice and benchmarked quality intelligence within the North West.

AQuA also support local NHS Trusts in developing their own ‘improvement capacity’ and the training opportunities available are listed on their Portfolio of Improvement Activities.

Primary audience: All NHS Trusts. AQuA’s main focus is commissioner and provider organisations within the NHS. AQuA works with organisational leaders, boards and senior managers and clinicians, as well as with frontline staff.

Impact on library policy/practice: AQuA can provide a useful resource to library staff in highlighting areas of improvement in the NHS. As part of its Innovation Portal, AQuA collates case studies (and produces an accompanying RSS feed) which provide examples of innovation from across the region. These case studies may be useful for library staff in providing examples of good practice to library users via literature searching or current awareness services.

The AQuA website signposts a number of resources for clinical evidence (including NHS Evidence). HCLU are working closely with AQuA to ensure that NHS library and information services are on their ‘map’ of the information world.

Libraries should be aware of the work of AQuA, identify their Trust’s AQuA Associate and liaise accordingly. There is an opportunity that they could raise the profile of libraries. AQuA also provide free courses e.g. on Lean via Webex.

Case studies /Project plan examples mapping to this driver: None as of 30.12.10

Date last updated: 30.12.10

Due for review: 31.12.11

Group member responsible: Not yet identified