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2 VERSION CONTROL Version Date Author Status Comment 0.1 Ingrid O Neill Draft Ingrid O Neill Draft 2 EEMG May 2016 Ingrid O Neill Draft 3 Public consultation comments May 2016 Sue Harris Draft 4 Formatting May 2016 Claire Connor Final Formatting, front cover, strategy aim description 1. Introduction 1.1 Salford Clinical Commissioning Group (SCCG) is a GP membership organisation with an ambition to make a real difference to the health and healthcare experience of the people in Salford, putting patients at the heart of all our decisions. We are committed to delivering a vision of health delivery using an integrated approach to developing services with our local partners to improve not only the safety and effectiveness of care but the experience of care for patients and service users. The CCG has already built a sound quality assurance process by working with providers and partners in Salford to seek patient experience feedback. 1.2 NHS Salford Clinical Commissioning Group s vision is: To commission and ensure the delivery of high quality health services and enable our population to live longer healthier lives, Our Quality and Safety Strategy was developed in 2014 and includes the following objectives: Engage with all sections of our population to encourage their involvement in improving the quality of care provided; actively seeking feedback on their experiences of healthcare and using this information to improve services Support our members to deliver primary care that is safe, effective and accessible; minimising variation and secure continuous improvement The purpose and scope of the Patient Experience strategy is to ensure that we commission for a positive patient experience, we improve services through measuring patient experience and that we empower leaders and staff with the ability to improve patient experience. The strategy will be delivered alongside the Communications, Engagement and Social Marketing Strategy, Carer s Strategy, Complaints and the Equality & Diversity policies. 1.3 NHS Salford Clinical Commissioning Group s Patient Experience vision is: To ensure that the healthcare provided is safe, timely, reliable and effective; that patients are supported in their decision-making; and are treated with compassion, dignity and respect. Page 2 of 11

3 The cycle of events will be: Patient consultation and input to provided and commissioned services (Communication and Engagement Strategy) Service Provision Patients reflection on their experience Revision of Service/Provision of new service Patient experience is affected positively or negatively by the manner (approach/attitude/statement of intent) in which care is provided; as much as by the clinical outcome. A patient s measure of success can often be different from the clinical view which may be dependent on a successful health outcome. Whilst the provision of information healthcare services performance is useful (it can provide reassurances about successful outcomes), it does not in itself improve the patient experience. 2. Patient Experience and Quality Patient Experience is a vital part of the quality framework. A simple description of high quality services was defined by Lord Darzi (2008) and by Keogh (2013) as services that are: Safe Effective And deliver a high patient experience Figure 1. High Quality Services Model The strategy links to the national references regarding patient experience. It will ensure there are opportunities to learn from poor patient experience in a timely way which are embraced. It will support patient experience initiatives across the economy and enable provider organisations to set their strategic aims for patient experience, ensuring consistency and rigor in approach. This plan will be a living document and updated and developed during this period, continually evaluating implementation and incorporating opportunities as they arise. Page 3 of 11

4 3. What do we mean by patient experience? Alongside safe and effective care, patient experience is a key component of clinical quality. Dr Foster, The Intelligent Board 2010, defines patient experience as: Feedback from patients on what actually happened in the course of receiving care or treatment, both the objective facts and their subjective views of it 3.1 Although a patient may receive effective care and treatment, if these have not been delivered in an appropriate way, for example: late or cancelled appointments, poor environments or by unhelpful staff, the patient may perceive this to be a poor experience. Whilst we appreciate that we don t always get it right, our vision with the implementation of this strategy, is to embark on a journey of learning and continuous improvement, with feedback from our patients being essential to this growth. This strategy includes how we will evaluate and measure success. 3.2 The experience of patients have of the treatment and care they receive how positive an experience people have on their journey through the NHS can be even more important to the individual than how clinically effective care has been." Lord Darzi, The Next Stage review Understanding patient experience can be achieved through a range of activities that capture direct feedback from patients, service users, carers and wider communities, and using it alongside information on clinical outcomes and other intelligence to inform quality improvements including the reshaping of local services and contractual arrangements with providers. Salford CCG is committed to improve our patient engagement and listening to feedback from our patients to understand their needs. This will, in turn, allow us to understand what is important when commissioning high quality patient care and use key considerations in the design of our services 4. What are our legal duties in relation to patient experience? The Government has made it clear that the patient experience is a crucial part of quality healthcare provision and commissioning. The NHS Constitution, the Outcomes Framework and the NICE Quality Standards for Experience and Mental Health Experience all reinforce the need for patient centred care. Patient Experience goes further than clinical treatment; it includes expectations, interactions and perceptions. Patient experience is a key component of quality and better patient outcomes. Put simply, patient experience is what the process of care feels like for the patient, their carer and the family. Figure 2 demonstrates how hearing stakeholders experience is vital to all areas of Commissioning, service re-design and external relationships. Page 4 of 11

5 Engagement Commissioning External relationships Service design and Re-design Experience Decommissioning The NHS Constitution The NHS Constitution came into force in January 2010 following the Health Act The constitution places a statutory duty on NHS bodies and explains the principles, values of the NHS and the patient rights of users. One of these principles is that the NHS aspires to the highest standards of excellence and professionalism in the provision of high quality care that is safe, effective and focused on patient experience. The constitution also states that respect, dignity and compassion should be at the core of how patients and staff are treated. The Equality Act 2010 The Equality Act 2010 unifies and extends previous equality legislation. Nine characteristics are protected by the Act, which are age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion and belief, sex and sexual orientation. Section 149 of the Equality Act 2010 states that all public authorities must give due regard in the course of their duties to the need to: Eliminate discrimination, harassment and victimisation Advance Equality of Opportunity Foster good relations with the public Inequalities in access to care and outcomes achieved between patient groups, and the degree of involvement and patient choice are known determinants that impact on the patient s experience of care. Page 5 of 11

6 The Health and Social Care Act 2012 The Health and Social Care Act, 2012 places statutory duties on CCGs to demonstrate continuous improvements in the quality of health services, with regard patient experience. The Act places a further duty on CCGs to deliver the following: Figure 3 CCG duties that relate to Patient Experience 5. Key Drivers of Patient Experience National Policy NHS England Five Year Forward View In October 2014, NHSE described the ambition of the NHS, to introduce a transformational approach to healthcare including strengthening primary care, joint NHS commissioning with local government and introducing entirely new models of care. In relation to patient experience and commissioner / providers - plans must include ambitions to: Reduce poor experience of inpatient care and general practice. Assess the quality of care experienced by vulnerable groups of patients and how and where experiences will be improved for those patients. Demonstrate improvements from Friends and Family Test (FFT), complaints and other feedback. Deliver all the NHS Constitution patient rights and commitments. Increase transparency of patient outcomes data to promote choice over where and how patients receive care. Page 6 of 11

7 The NHS Patient Experience Framework In 2011, NHS England agreed a working definition of good patient experience to guide measurement and outlines those elements which are considered critical to a patient's experience, described below and see Appendix 1. Figure 4 NHS England's guide to good patient experience NICE Quality Standards for patient experience In 2012, NICE released detailed, evidenced based guidance and quality standards (QS) building on the NHS Patience Experience framework. The standards are mapped against five key areas of care: Knowing the patient as an individual Essential requirements of care: respect for the patient, patient concerns, nutrition, pain management & patient independence, consent & capacity Tailoring healthcare services for each patient Continuity Enabling patients to actively participate in their care NICE Quality Standards provide a gold standard for commissioners and set out performance measures and providers are expected to work towards full implementation. There are currently two standards developed in relation to patient experience, one for adult patients (QS 15) and the second for adult mental health service users (QS 14). Page 7 of 11

8 6. Patient Experience Tools A crucial part of improving the patient experience is providing information back to the public in order to close the information loop. The people of Salford will need to know how the health economy is performing on key metrics, how we compare and how we intend to improve services using this information. Complaints and compliments Friends and Family Test feedback PALS (Patient Liaison Services) feedback Focus groups and in-depth interviews Useful to explore a problem and issues in greater depth. Mystery shopping Simulate the experience of users to provide a useful tool for checking on the quality of specific services. Patient Participation Group members feedback 7.0 Measuring Patient Experience There is a wide range of feedback tools available to measure people s experience, none of which offer a complete picture of the experience. Each one tends to be applicable in different situations, depending on the audience and information you are trying to obtain. Measures can be divided into two groups, both of which are necessary for service improvement; Quantitative, statistically validated measures which tend to be less descriptive, but useful for comparative performance management such as surveys. These measures usually tell us how big the problem is and where performance is better or worse. They will include disaggregating by protected characteristic where possible, to understand whether any one group has a worse experience of care than the general population (differential experiences) Qualitative, less general, but more descriptive measures useful for gaining an in depth understanding of care, such as complaints and patient stories, These measures usually tell us more about why the problem exists and what to do about it 8.0 How we will seek out Patient Experience? We will gain real time feedback from our patients in methods to suit their needs and: Use individual patient stories to learn about any gaps in services Use the Friends & Family feedback to improve the patient experience Use NHS Choices and Patient Opinion to gain feedback Use the NHS Patient Experience Framework and where available the NICE patient experience standards, as the underlying principles of what good looks like, on which to base our commissioning activity. The Salford Standard is applicable to General Practices from 1 April 16, and clearly describes the level of care that Salford patients should expect when accessing Page 8 of 11

9 Primary Care, and we can continue to develop and monitor Patient Experience through the standards. Ask patients to share their stories about care delivery and use these at the start of Governing Body and internal meetings to keep the patient voice at the heart of what we do Ensure feedback to staff is translated into local actions Use the You said We did posters to communicate to patients and visitors what actions have been taken as a result of patient experience feedback Commit to sharing patient feedback with all staff to understand where we can make improvements Commit to sharing patient feedback with external bodies Use the Insight system to gather and triangulate patient experience feedback with other sources of information about services GP s and Patient Participation Groups Support our patient champions & further develop our Patient Participation Groups to gather and share patient feedback using a range of methods Our Patient Participation Group members (Salford PPG Community) will have opportunity to influence the commissioning cycle Develop methods of communication and representation from wider patient groups Continue to utilise the annual GP survey as a measurement for customer satisfaction Provider s and External bodies Strengthen our relationship with all providers including Healthwatch to ensure that they can support us in capturing & sharing patient experience information. Actively seek out and review patient experience information, and how providers are making improvements as a result 9.0 Patient Experience Objectives We have identified 5 objectives to deliver over the next 3 years: Objective 1: We will actively receive and analyse internal Patient Experience data from complaints, compliments, PALS information, patient surveys, Friends and Family Test, Patient Participation Group members along with information displayed on external websites and use to identify trends, risks and service gaps To We will develop a more robust approach to collect, share and use feedback from external websites such as NHS Choices and Patient Opinion, We will promote and encourage patients, family and carers to tell their story about a health or social care experience, in a manner that is suitable (audio, written, video), and at a time convenient to all Use Insight as a real time IT system to capture & triangulate all CCG intelligence with information gathered from providers of peoples experience of their services Page 9 of 11

10 Objective 2: The CCG will routinely use patient experience information to highlight where the gaps in services are, and to influence service improvements: Use patient experience data to inform commissioning, influence service improvements and support high quality monitoring Utilise Friends & Family feedback to identify themes, and make improvements and enhance the patient experience Use the Salford wide Patient Participation Group Community to routinely obtain ongoing feedback with regard to service improvement. Objective 3: We will use the Insight system to capture patient experience data throughout the whole organisation: Influence staff who have direct patient interaction and those who work more indirectly such as managers and corporate staff, provide new insights and reinforce existing understanding for staff and patients to use in designing services Use patient experience stories to reflect the voice of the patient and present at the start of internal quality & Governing Body meetings Objective 4: The CCG will embed effective partnership working, and strengthen relationships with key providers Ensure providers consistently frame patient experience as an integral and equal part of the quality framework, alongside clinical effectiveness and safety Ensure that the CCG receives regular and meaningful reports on patient experience, and this should include instances where the patient experience has been poor and where joint working with patients and staff have resulted in improvements Build on our existing partnership with Healthwatch so that they can support us in gathering patient experience information. Additionally, we will work collaboratively with Healthwatch to pilot the Insight system. Promote use of Patient Experience to influence ongoing improvements Objective 5- Assist and support all member practices work to improve the patient experience in line with the Salford Standard Support practices in developing and running effective Patient Participation groups which meets at regular intervals, empowers patients; assists and supports GP s; and informs and enhances the work of the CCG. Assist and support practices to ensure that the Patient Participation Group s voice is heard and feedback and comments used to make service improvements and influence the commissioning cycle. Support practices to develop continuous improvement action plans using the themes arising from local intelligence and patient feedback from Family & Friends test, comments box, and PPG feedback. Page 10 of 11

11 10. Primary Care The Salford Standard has been developed and the patient experience indicator rationale is incorporated, with specific and measurable Key Performance Indicator s. 11. Partnership working We are committed to working with national and citywide providers and partners 12. Governing Body The Governing Body meets formally bi monthly and receives reports on quality standards, targets, patient feedback, complaints, serious incidents and safeguarding. Patient feedback reports include a range of information relating to the CCG and provider organisations. 13. Engagement and Experience Management Group (EEMG) The role of the EEMG is to provide assurance to the Governing Body, that the appropriate level of input from patients, carers and the public has informed all decisions made by SCCG. Quarterly reports are provided to Governing Body on a range of patient experience issue. 14. How we will implement our objectives? We will develop an operational action plan for 2016/17 which details our broad objectives with a timeline. The objectives will form the patient experience work stream including milestones, monitoring process, output (qualitative and quantitative) and outcomes. 15. Monitoring and Reporting of this Strategy The Engagement and Experience Management Group (EEMG) will receive regular reports on progress against action plans. The EEMG reports to the Quality & Safety Programme Management Group and information is subsequently included in quality reports to Governing Body. References: Collect data and encourage feedback from patients at every opportunity Berwick D (2013) A Promise to Learn A Commitment to Act: Improving the safety of Patients in England. Darzi A (2008). High Quality Care for All: NHS Next Stage Review. DH, London. Dr Foster Limited (2010). The Intelligent Board 2010: Patient experience. Keogh B (2013). Review into the quality of care and treatment provided by 14 hospital trusts in England: overview report. NHSE. National Quality Board (2011) The NHS Patient Experience Framework. NHSE Nice Quality Standards for patient experience The NHS Patient Experience Framework Page 11 of 11