Adult social care: quality matters

A Policy Briefing aimed at healthcare professionals is available for LKS staff to share in their own organisations. This has been produced and shared by the JET Library, Mid Cheshire Hospitals NHS Foundation Trust. Please feel free to reproduce it (with acknowledgement to JET Library) for your own purposes.

Impact on library policy/practice: 

Library and Knowledge Services already make an important contribution to safe, high-quality care in the NHS. However, an absence of funding currently prevents library services extending their service and knowledge resources to most social care staff, and the number of providers in the social care sector make it difficult to negotiate service level agreements at a local level. This may change in areas where accountable care organisations are created, bringing health and social care together.

Commissioners of social care in local authorities could be approached to discuss the potential contribution of LKS to quality in the social care sector, and see if any SLAs can be created. This may be something that should be done at a national level, to avoid duplication of effort and ensure equitable funding and access.

Source: Department of Health and Care Quality Commission

Link to main document

Publication format: Webpage, with links to the main document and action plan

Date of publication: July 2017

Summary of driver:

The Quality Matters initiative is co-led by partners from across the adult social care sector, and this document sets out the agreed principles that support high-quality, person centred adult social care. The principles reflect those of the NHS National Quality Board.

There is no change to statutory responsibilities.

Key features of driver:

• There are around 12,000 adult social-care providers in the UK
• They provide care in around 25,000 different locations – excluding people’s homes
• The sector contributes around £20bn to the economy
• It enables families of people being cared for to continue working
• It employs about 1.43m people doing 1.55m jobs
• Challenges include:
  • Rising needs from an ageing population with increasingly complex conditions
  • Rising costs to providers of adult social care
  • Restricted public funds
  • Challenges in recruiting and retaining good-quality staff
• Quality can vary – some is unacceptable and unreliable
• Quality Matters is a shared commitment for everyone who uses works in and supports adult social care. It aims to achieve:
  • A shared understanding of what high-quality care is
  • More effective and aligned support for quality in adult social care
  • Improved quality in adult social care
• Single, shared view of quality including:
  • Equity and equality
  • Person-centre care
• Principles are:
  • Promoting quality through everything that we do
  • Coordinate action
• Priorities to improve quality
  • Acting on feedback, concerns and compliments
  • Measuring, collecting and using data more effectively
  • Commissioning for better outcomes
  • Better support for improvement
  • Shared focus areas for improvement
  • Improving the profile of adult social care
• Seven steps to improve quality:
  • Setting clear direction and priorities
  • Bringing clarity to quality
  • Measuring and publishing quality
  • Recognising and rewarding quality
  • Maintaining and safeguarding quality
  • Building capability
  • Staying ahead

Primary audience: Commissioners, managers and staff in the adult social care sector, users of adult social care, regulators and improvement agencies

Date last updated: September 2017

Due for review: September 2017

Group member responsible: JC

State of Care Report 2015/16

Title of driver: The state of health and adult social care in England 2015/16

Impact on library policy/practice:

Libraries are a knowledge hub providing services such as evidence summaries, literature searching and current awareness which can be linked to challenges faced by the specific organisation (CQC inspection reports for individual organisations can be searched for on the CQC website and can be a good way to identify local priority areas).

We can ensure that the best clinical and management knowledge is available to decision-makers in the organisation, in order to tackle the challenges identified in this report. Libraries are ideally placed to identify and disseminate best practice to assist health care organisations in providing quality care with limited resources.

Collaboration across organisational boundaries is identified as a means to improve services, and this may have implications for libraries as users move between organisations or work jointly between organisations that may have different resources or library access arrangements.

Source: Care Quality Commission (CQC)

Link to main page
Link to 2015/2016 State of Care Report

Publication format: PDF (149 pages)

Date of publication: October 2016

Summary of driver:

Many health and care services were providing good quality care, despite a challenging environment,
but there was substantial variation remaining. Some health and care services were improving, but some were also failing to improve or deteriorating in quality.

People’s views of services broadly remain positive, but this masked significant variation in experiences of care

There were indications that the sustainability of adult social care was approaching a tipping point, and hospitals are under increasing pressure. The CQC was concerned about the sustainability of quality

Key features of driver:

• 71% of the adult social care services inspected, 83% of GP practices, and 51% of core services provided by hospitals were rated good
• By the end of 2015/16, NHS providers had overspent their budgets by £2.45 billion. Local authorities were reported to have spent £168 million more than they budgeted for
• More than eight out of 10 NHS acute trusts were in financial deficit at the end of 2015/16
• Strong, visible leadership continues to be a major factor in delivering and sustaining high quality services, and in making improvements
• The difficulties in adult social care were already affecting hospitals. Bed occupancy rates exceeded 91% in January to March 2016, the highest quarterly rate for at least six years. And in 2015/16, there was an increase in the number of people having to wait to be discharged from hospital, in part due to a lack of suitable care options
• All parts of local health and care systems – commissioners, providers, regulators and local people – need to work together to help transform local areas.

The document looks at the state of care in the period 2015-16, as well as looking at the future resilience of health and social care services in the context of an ageing population.

Throughout the document, there are examples from services rated as outstanding as to how these ratings were achieved.

After the initial review, the report gives more details for each of sectors it regulates.

A summary and infographic of the report findings are also available.

Primary audience: All health and social care providers in England, members of the public and other stakeholders.

Date last updated: May 2017
Due for review: May 2018
Group member responsible: JC

State of Care Report 2014/15

Source: Care Quality Commission (CQC)

Link to main document
Link to 2013/2014 State of Care Report

Publication format: PDF (120 pages)

Date of publication: October 2015

Summary of driver: This is the sixth annual CQC report on the state of health and care services in England. It highlights that despite the challenges of increased need and tough financial demands, inspections show that improvement is possible. It outlines the need to look to the best to understand what works and why.

Key features of driver:
Despite pressures, many services are managing to maintain or improve quality.

• 50% had improved.
• Fewer than 7% had deteriorated further.
• All of these re-inspections took place within a year of the original rating.

• However, some people are receiving care that’s unacceptable. Of the providers rated by the end of May 2015, 7% were inadequate.
• Quality is variable with large differences in quality of care between different services and providers.
• Sometimes quality varies according to who you are or what you need. For example people with mental health needs and long-term conditions and some ethnic minority groups are less likely to report good experiences of care.
• Safety is the biggest concern: of the services we’ve rated so far, 13% of hospitals, 10% of adult social care services and 6% of GP practices were inadequate for safety.

The following are critical to quality improvement:

• Engaged leaders building a shared ownership of quality and safety.
• Staff planning that goes beyond simple numbers.
• Working together to address cross-sector priorities

A summary and infographic of the report findings are also available.

Primary audience: All health and social care providers in England, members of the public and other stakeholders.

Impact on library policy/practice: Libraries are a knowledge hub providing services such as evidence summaries, literature searching and current awareness which can be linked to challenges faced by the specific organisation. We can ensure that the best clinical and management knowledge is available to decision-makers in the organisation, in order to tackle the challenges identified in this report. Libraries are ideally placed to identify and disseminate best practice to assist health care organisations in providing quality care with limited resources.

Date last updated: December 2015
Due for review: October 2016
Group member responsible: TP

State of Care 2013/14

Source: Care Quality Commission (CQC)

Link to main document 

Publication format: PDF (90 pages)

Date of publication: October 2014

Summary of driver: This is the fifth annual CQC report on the state of health and care services in England. It shows that shows there are many excellent health care services but the variation in quality in England is unacceptably wide.

Key features of driver:

• CQC’s tougher, people-centred, expert-led and more rigorous inspections are seeing some outstanding care and we have already rated many good services.
• The report also finds care that is inadequate or requires improvement. The variation in the quality of health and adult social care is unacceptably wide.
• The principle of keeping people safe from harm is fundamental. Too many providers have not got to grips with the basics of safety. Of the first NHS acute hospitals rated, eight out of 82 were rated inadequate for safety, and 57 were rated as requires improvement for safety. (It is important to bear in mind, though, that the early inspections of acute hospitals under the new CQC approach mostly focused on those that were deemed higher risk. This picture is not representative of acute hospitals across England.)
• Strong, effective leadership at all levels within an organisation is vital. Strong, effective leadership drives up quality and safety overall.
• There is a mounting financial challenge in health and adult social care. But this should not excuse inadequate care. Providers must learn from the outstanding examples of others who have the same resources.
• The CQC challenges providers and the care system to accept where there are problems and to use our inspections to drive up care quality.

A summary and infographic of the report findings are also available.

Primary audience: All health and social care providers in England, members of the public and other stakeholders.

Impact on library policy/practice: Leadership is identified as a key theme in this report.  Libraries are in a position to support the educational requirements of those healthcare professionals undertaking development to improve their leadership skills.  Libraries are a knowledge hub; we can ensure that the best clinical and management knowledge is easily available to decision-makers in the organisation, in order to tackle the challenges identified in this report, particularly around quality of care and safety.  Libraries are ideally placed to identify and disseminate best practice that can assist health care organisations in providing quality care with limited resources.

Date last updated: February 2015

Due for review: February 2016

Group member responsible: VT

Research and Development Strategy (Draft) 2013 – 2018

Title: Research and Development Strategy (Draft) 2013 – 2018

Source: NHS England

Link to main document

Publication format: PDF

Date of publication: Dec 2013

Summary of driver: The NHS England research strategy supports the goals set out in the NHS England business plan (NHS England 2013); supporting and developing the commissioning system to improve quality and outcomes. It seeks to develop a culture in the NHS that values and promotes research and engages staff and patients in research activities for improved healthcare outcomes.

Key features of driver:

Key Objectives:

• Working closely with Department of Health (DH) and National Institute for Health and Research (NIHR) to coordinate research into commissioning health services;

• Develop an evidence base to support effective decision making by commissioning groups;

• Enable NHS England and commissioning staff to undertake and implement research in order to help improve the quality of care and treatment in the NHS;

• Encourage patients to take part in research and to be considered when setting priorities for research;

• Better inform the public on current research and outcomes from completed research;

• Maximise outcomes from research to stimulate innovation, improve income generation, develop knowledge and achieve impact.

Key Priorities:

• Promote non-commercial and commercial research in the NHS that have the greatest impact on outcomes;

• Engage with clinical leaders across all professions, with academia, industry, and with non clinical researchers in health and social care;

• Support the NHS Outcomes Framework 2014-15 and innovative practice as outlined in Innovation, Health and Wealth, Accelerating Adoption and Diffusion in the NHS (2011)

• Develop a patient engagement and involvement in research strategy

Primary audience: NIHR, Health Research Authority, Clinical Commissioning leads, NHS Trusts.

Impact on library policy/practice:

• Opportunity to engage with clinical commissioning groups and encourage evidence-based decision making – for example, outsourcing library services to CCGs/CSUs where appropriate;

• Responsibility to support the dissemination of clinical research outcomes to wider stakeholders, including patient groups;

• Responsibility to disseminate NICE guidelines and other high quality research to clinical teams and managers to help foster research awareness, translation of research evidence into practice and the rapid adoption of innovation within local NHS Trusts.

• Good practice to identify clinical and non-clinical priorities within the Trust and provide evidence update services to assist teams / managers with health service planning (e.g. pathway re-design), clinical improvement, commissioning plans and health systems design;

• Good practice to support effective knowledge transfer pathways /systems within local Trusts by ensuring that the library service has clear relationships with key departments and effective reporting channels e.g. Chief Knowledge Officer, Team Knowledge Officers and library representative attends relevant department meetings e.g. Education, Learning and Development, Research and Development, Clinical Governance, Informatics.

Date last updated: 14/07/2014

Due for review: July 2015

Group member responsible: ME

The Keogh Mortality Review

Title: Review into the quality of care and treatment provided by 14 hospital trusts in England: overview report

Source: Professor Sir Bruce Keogh KBE 

Link to main document: http://www.nhs.uk/NHSEngland/bruce-keogh-review/Documents/outcomes/keogh-review-final-report.pdf

Link to additional information: http://www.nhs.uk/NHSEngland/bruce-keogh-review/Pages/published-reports.aspx

Publication format: pdf

Date of publication: 16th July 2013

Summary of driver: On February 6 2013, the Prime Minister announced that he had asked Professor Sir Bruce Keogh, NHS Medical Director for England, to review the quality of care and treatment provided by those NHS trusts and NHS foundation trusts that were persistent outliers on mortality indicators. A total of 14 hospital trusts were investigated as part of this review.

Key features of driver: The review considered the performance of the hospitals across six key areas:

• mortality
• patient experience
• safety
• workforce
• clinical and operational effectiveness
• leadership and governance

Primary audience: Everyone

Impact on library policy/practice: Provide literature as to how healthcare profesionals can reduce harm to patients.

Date last updated: 6th March 2014

Due for review: March 2015

Group member responsible: TO and JR

Review into the quality of care and treatment provided by 14 hospital trusts in England; overview report (Keogh Review)

Source: Independent review commissioned by the Department of Health and led by Professor Sir Bruce Keogh KBE

Link to main document

Publication format: PDF report

Date of publication: July 2013

Summary of driver:
The report is a review into the quality of care and treatment provided by hospital trusts with a high mortality rate. Fourteen trusts were selected on the basis that they had been outliers for the last two consecutive years on either the Summary Hospital-Level Mortality Index (SHMI) or the Hospital Standardised Mortality ration (HSMR). The final report covers in detail, areas for improvement in each of the 14 trusts as well as identifying common challenges facing the wider NHS. Keogh concludes that significant progress is to be made within two years.

There are 8 ambitions (listed below) – which are common challenges facing the wider NHS after working with these 14 hospitals.

• Progress towards reducing avoidable deaths in hospitals rather than relying on mortality statistics to judge the quality of care
• Boards and leaders of provider/commissioner organisations, patients and the public to have access to good quality data
• Patients/carers/members of the public to be treated as equals in assessment of NHS and confident that their feedback is taken on board and to see how this impacts on future patient care
• Patients and clinicians to become active participants in future Care Quality Commissions assessments
• The development and maintenance of a culture of professional and academic recognition
• Nurse staffing levels and skills mix will match caseload and severity of patients. This information to be reported transparently by trust boards
• The contribution made by junior doctors and student nurses within organisations and the harnessing of the knowledge and innovation they bring
• Recognition of the effect that positive and motivated staff have on patient outcomes

Suggestions include the following:
• All NHS organisations need to think about innovative ways to engage staff
• Patient and public engagement must be a central theme to those who plan/run/regulate hospitals
• Implementation of an early warning system, which has the relevant support/back up in place
• Adoption of systematic processes to ensure staff and patient involvement
• Embracing all feedback, concerns and complaints
• The creation of Quality Surveillance Groups to support the CQC
• Evidence based tools to be used to determine appropriate staffing levels and skill mix

Key features of driver: Each of the 14 trusts was reviewed and the process has three sections. Information gathering and analysis, the rapid response review and finally a risk summit and action plan, which sets out the plan of action that each Trust needed to take to improve and who is accountable. The report includes a summary of findings and actions for the 14 trusts involved.

Primary audience: Department of Health, HEE, NHS Trusts, other provider/commissioner organisations.

Impact on library policy/practice: Libraries could support staff with training. This might include:
• Critical appraisal sessions and Information skills training to help staff find and understand the evidence

Date last updated: November 2013
Due for review: November 2014
Group member responsible: LK

Advancing Quality

Source: NHS Northwest (SHA)

Link to main document

Publication format: Website

Date of publication: 2008

Summary of driver: In conjunction with Premier Inc. this programme aims to improve patient care and patient experience in NHS hospitals across the North West by measuring clinical outcomes, Patient Reported Outcome Measures (PROMs) and patient experience. Advancing Quality is funded by all the Primary Care Trusts (PCTs) in the North West. PCTs are NHS organisations which commission services from their local hospitals. Each North West PCT gave 0.1 percent of its budget to develop AQ.

Key features of driver:

October 2008 – start of the 3 year healthcare improvement programme
Aims to improve care and save costs
Currently focussing on 5 key areas relevant to NW:
heart attacks
pneumonia
heart failure
hip and knee replacements
heart by-pass operations
New treatment areas, including mental health, stroke and primary and community services, will be introduced in the next year (2009-2010)
The project will be evaluated by Manchester Business School over a five year period to assess impact on financial savings, lives saved, reduced length of stay, reduced admissions and reduced complications.

Link here for first set of results published 18th June 2010

Link here for second set of results published 2011

Primary audience: The Advancing Quality agenda relates to NW acute trusts with minimal impact on primary care, although future roll out possible. Meeting quality indicators will translate to financial incentives for successful Trusts.

Impact on library policy/practice: Libraries may be asked to provide evidence to support the implementation of new outcome measures in the 5 key areas or identify best practice and performance in other NW Trusts. You could be asked to find out how PROMs are collected and who they are being submitted to.

Keywords: Acute; Hospitals; Quality metrics

Case studies/Project plan examples mapping to this driver are: None

Date last updated: October 2012

Due for review: November 2013

Group member responsible: TP

Darzi Framework

Title of driver: High quality care for all: NHS Next Stage Review final report (Darzi Framework)

Source: Department of Health

Link to main document

Publication format: pdf

Date of publication: 30 June 2008

Review date: None specified

Summary of driver: The Review sets out the government’s plans for NHS reform in England over the next 10 years. Its principal focus is on driving up the standards of quality in health care and putting clinicians at the heart of change. It is also intended to be locally driven. The review is based on the reports from strategic health authorities and clinical pathway working groups that presented a vision for change in their particular localities. It is not a ‘national blueprint’ but a means of enabling these local visions to become a reality (excerpt from summary on King’s Fund website April 2010)

The Operating Framework: for the NHS in England 2010/11 (Dec 2009) sets out the enabling system that will deliver the Review

Key features of driver: Introduces a range of local quality indicators – measuring mortality, complication and survival rates as well as patient perceptions – that will enable clinicians to benchmark and improve their performance. A small proportion of trusts’ income will also become conditional on quality indicators. Trusts will be obliged to produce annual ‘quality accounts’ similar to their financial accounts.

The NHS will have a formal constitution, spelling out its underlying principles and values as well as the rights and responsibilities of patients, the public and staff. * Darzi identified a range of hospital services that could be delivered closer to the patient’s home, including minor surgery and many outpatient consultations, although some services such as stroke and heart disease should be more specialist and centralised.

PCTs together with local authorities will now be responsible for commissioning comprehensive well-being and prevention services. They will target six key goals: tackling obesity, reducing alcohol harm, treating drug addiction, reducing smoking rates, improving sexual health and improving mental health
Patients with complex long-term conditions will be entitled to a named care co-ordinator, such as a community matron, to help them access the services in their personal care plans.
(From http://www.kingsfund.org.uk 14/4/10)

Primary audience: Health and Social Care Professionals (DH website)

Impact on library policy/practice:

Key headings / sections from the Review summary: Easy access for NHS staff to information about high quality care. All NHS staff will have access to a new NHS Evidence service where they will be able to get, through a single web-based portal, authoritative clinical and non-clinical evidence and best practice.

A clear focus on improving the quality of NHS education and training. The system will be reformed in partnership with the professions.

Plus:

Chapter 6: High Quality Work in the NHS, particularly the section ‘High Quality Education and Training’ (11-29)* Many aspects of the review focus on quality improvement; library services can support their organisations to implement changes based on the best evidence

Keywords: darzi, reform, vision, quality, quality accounts, NHS constitution, obesity, alcohol, drug addiction, smoking, sexual health, mental health, long term conditions, NHS evidence

Case studies mapping to this driver:
NW Clinical Librarian Systematic Review

Local service profiles mapping to this driver:
Systematic Review
Mediated Literature Service
Hospital archive digitisation project
Journal Club support service

Information reviewed and updated: 14/4/10 (v1)

Due for review: March 2010

Group member responsible: HG