Partnering for Quality: raising standards of care in care homes and improving outcomes for people.
Work undertaken jointly by Walsall CCG and Council has enabled a whole care home sector to raise quality standards of care and measurably improve outcomes for patients. The council and CCG were familiar with a sector where Yo-yo-ing homes responded to ad hoc intervention only to revert to poor quality after scrutiny was reduced. The development of a Walsall Quality Partnership Board was key to overseeing and driving forward a range of initiatives and processes to ensure sustained high quality care provision and patients safety.
Through the development of a quality dashboard we are able to see at a glance the quality outputs which in turn inform a range of improved outcomes for patients in care home , these include:
significant improvements in the reporting of category 3 and 4 pressure ulcers in nursing homes, where during 11/12 23 acquired pressure ulcers were reported compared 9 being reported in 12/13 this is a reduction of 40%.
- reduction in C Difficile infections across homes from nine in Q2, 3 and 4 in 11/12 to just 3 in the same period the following year 12/13.
- an increase in contract concern reporting but a reduction in suspensions and restrictions across the same time period demonstrating a more transparent positive reporting culture across the sector with an overall reduction in severity.
A Suffolk resident collapsed following a Stroke in London; continuing health care assessment would only be assessed and commissioned if the patient was in Suffolk resulting in an admission to a Hospice. The family wanted the patient home but the risk associated with airway management would have been high resulting in patient and family choice being restricted. Communication between various organisations involved was poor, lacked appropriate coordination, which resulted in delays.
Aspects of complaint
- Poor communication
- Delays experienced
- Risk not explained to family and appropriate mitigation put in place to enable family choice
- Commissioning of the care package did not involve the family
What we did
Following the complaint, an independent review was undertaken and the recommendations and action plan is now being taken through a working group involving both Ipswich and East Suffolk and West Suffolk Clinical Commissioning Groups.
As part of lessons learnt, the Chief Nursing Office arranged to meet with the patient’s family to share report, discuss case and explain the actions to take forward in order to improve care pathways. Some key learning points from this case include;
- Improve communication and links with providers (including those out of county)
- Monitor care packages
- Ensure family members are happy, confident and have full understanding of care being commissioned and provided
Specialised services are often provided in a smaller number of centres than other types of healthcare and by smaller clinical teams with the specialised expertise and equipment to treat rarer conditions or undertake specialised procedures. This makes it all the more important to actively share information on innovation, patient safety and quality improvement.
As part of our work to promote high quality care, quality dashboards are now being developed across the specialised services portfolio. These have been developed with clinical and patient involvement and aim to highlight and share key aspects of patient safety, clinical outcomes and patient experience.
An initial set of 20 dashboards have been piloted in the following areas:
- Blood and Marrow Transplants
- Cardiac Surgery
- Clinical Genetics
- Cystic Fibrosis
- Hyperbaric Oxygen Therapy
- Immunoglobulin Therapy
- Major Trauma
- Mental Health
- Neonatal Intensive Care
- Paediatric Intensive Care
- Paediatric Cardiac Surgery
- Paediatric Neurosurgery
- Spinal Surgery
Work is now underway to enable these to be shared more widely as an opportunity to identify, promote and share good practice between clinical teams and other stakeholder groups. A further 20 dashboards are due to be developed in 2013/14.