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Tower Hamlets CCG Quality and Performance Framework 2016-18

Executive Summary

THCCG implemented a quality and performance framework for 2014-2016. The framework allowed us to set the context for our work and supported us in benchmarking ourselves against commissioning recommendations of ‘The Big 4’ reports (Francis, Keogh, Berwick & Winterbourne View) and identifying actions that needed to be taken in response to the reports’ findings.

We are now updating the framework in light of national policy/ guidance, our strategic priorities, complex provider and partner landscape and changes to external assurance processes.

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The link between Quality and Performance

What is quality?

• The NHS definition of quality as defined by Lord Darzi in High Quality Care for All in 2008 sets out three dimensions to quality: Care that is clinically effective, Care that is safe, Care that provides a positive patient experience.

What is performance?

• Performance can be described as the accomplishment of a given standard or ambition measured against a present threshold.

How are they linked?

• If providers are not achieving a standard (performance target) this can impact on the patient in many ways. For example:- the CCG has a threshold for infection control training of 90%. If the provider is not achieving this and levels are below the 90% this could put patients at risk of infection e.g. MRSA because staff are not trained in infection control techniques. In turn the current threshold for MRSA is zero if providers are reporting rates above zero we would then triangulate this with training levels in infection control, patient feedback and PLACE reports.

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An integrated Quality and Performance Framework reflects the CCG’s approach to the integrated

quality and performance function of the organisation.

The purpose of the CCG quality and performance framework

Outline NHS Tower Hamlets CCG’s approach to quality and performance to our governing body members, the public and other key stakeholders

Ensure that quality and quality improvement is placed at the heart of the health care THCCG commissions

To provide a framework for embedding recommendations from National and Local reports

Ensure that there is a robust link between commissioning, clinical quality and performance so that the health needs of the local population (outlined in the Joint Strategic Needs Assessment) are met.

Ensure there are systems and processes in place to provide internal and external assurance that the CCG is able to discharge its responsibilities.

Provide a framework for the development and monitoring of contractual quality and performance requirements with providers.

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The National Picture

National Five year forward view – strategy by which the NHS can

prevent the widening of the health and wellbeing gap, care and quality, and the funding and efficiency gaps. Strong focus on new models of care. STPs.

Five year forward view for mental health – focus on access to IAPT, physical health, children and young people, 24/7 crisis support, perinatal mental health services.

Delivering the Operating Plan

Care Act – adult safeguarding on statutory footing

Local response to National Picture

Organisational change (see team changes)

• More capacity in team

• Focus on in-hospital and out of hospital

• Stronger focus on mental health,, primary care and community services

New strategic objectives for THCCG

Primary care commissioning – delegated authority

Development of strategic priorities

Sustainability and Transformation Plans for the population of East London

Transforming Service Together

Capitated budgets

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Why we need to change

Tower Hamlets CCG Priorities

Person Centred Care: Care will take into account the wider needs of an individual and their family. People will be supported to set their own goals for their wider wellbeing. The achievement of these goals will be supported by excellent, evidence based care, tailored to the individuals’ needs and ability to be engaged in their health and wellbeing.

A focus on mental health: People will have better access to mental health support offered seamlessly with the rest of their healthcare. People with more complex mental health needs will be provided with more support to live independently and spend less of their time with secondary mental health services.

Primary Care at the Centre: Recognising that a successful health system starts with excellent primary care services. As the services used most by people in Tower Hamlets, we will ensure it provides excellent, care, experience and access. Primary care will be the first port of call for people in Tower Hamlets, and ensure that specialist services are reserved for those that need them.

Delivered through a Care Closer to Home Strategy with four key programmes:

Children and Early YearsComplex care, 1-5 strategy

AdultsUrgent care, Non-complex elective care

Adults with Complex NeedsComplex Care, Long term conditions, Personalisation

EnablersIT and Informatics, workforce and OD, Estates, Payment reform

Designated Dr for Safeguarding Children

Julia Hale

Changes to the Performance and Quality Team to meet National and Local Strategic

Priorities, Changes to Provider Landscape and Support a Matrix Working Approach

Director of Performance and QualityArchna Mathur

Named GP for Safeguarding Children

Dr Emma Tukmatchi

Safeguarding Admin Post

Designated Nurse for Looked After Children

(vacant)

Performance and Quality Manager

(vacant)

Performance and Quality Manager

(Pacifique Kimonyo)

Business Manager(Vacant)

Designated Dr for Looked After Children

Ben Ko

Nurse Consultant Safeguarding Children and Designated Nurse

Rob Mills

Designated Nurse/SW for Safeguarding Adults

Deputy Director of Performance and

QualitySandra Moore

Designated Dr for Safeguarding Children

Julia Hale

Director of Performance and QualityArchna Mathur

Tower Hamlets CCG Performance and Quality Team – Focus on In Hospital and Out of Hospital Performance and Quality

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Quality and Performance

Manager (Out of Hospital)

Archna Mathur (9)Director of Quality and Performance

acute, community, mental health, primary care, CHC, EPRR, national

constitutional targets

Sandra Moore (8c)(Deputy Director of Performance and

Quality(Focus: Barts Health Acute, EPRR, out of

hospital)

VacantPerformance and Quality Manager

(8a)Focus: ELFT, Mental Health

Voluntary Sector and Independent Providers,)

Pacifique Kimonyo Performance and Quality manager

(8a) Focus: Community Health Services, Primary Care, Voluntary Sector and Independent Providers, Nursing and Residential Homes)

In Hospital Out of Hospital

Support quality managers in management of out of hospital

Provide opportunities for in hospital experience

VacantTeam Business Support (5)

QUALITY AND PERFORMANCE IN THE COMMISSIONING CYCLE

Strategic Planning and

assessing need for health care

Identify priorities for

service development and redesign

Procurement and

implementation of services

Monitor and evaluate services

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Holding to account• Monitor quality and

performance using quality assurance processes

• Secure improvements as required

• Share learning

Needs - opportunity for improvement• New innovations, best practice guidance• Effectiveness evidence• Identified gaps in quality and performance –

provide data and intelligence• Safety, lessons from incidents and complaints• Development of local CQUINs to support

quality and innovation in strategic priorities

Define and design for quality and performance• Develop service changes, design

pathways, business cases etc.• Specify quality and performance

metrics in service specifications

Procurement and implementation• Assess potential provider bids for

quality, performance and governance processes

• Support mobilisation process

Organisations and Partnerships

Healthwatch

NELSCU

Contracting and performance, CHC, infection control,

complaints, patient experience data

Regulators – CQC, NHS Improvement

(NHSI)

NHSE

local area teams (CCG assurance), specialist

commissioning, primary care

Patients and carers, our local

community

Providers

Barts Health, ELFT, THIPP, GP Care Group, Voluntary

Sector, Independent providers

Local Authority

HWBB, SAB, LSCB, Public Health, OSC

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THCCG , WELC CCGs

Tower Hamlets CCG

work with a wide range

of stakeholders to drive

the quality and

performance agenda

Partner Landscape

NHS Improvement (NHSI) – brings together TDA, Monitor and NHSE patient safety

Healthwatch

NHSE – new assurance process for CCGs

London Borough of Tower Hamlets – health overview and scrutiny committee focus on maternity, member of THIPP

CSU – quality has moved to CCGs, CHC review

Our partner CCGs – STP, TST, Barts Health with site focus

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Provider Landscape – Challenges and Priorities

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Acute Services (Barts Health)

ChallengesTrust in special measures – pending re-inspection by CQC in July but could do an unannounced inspection New local operating model, site focused leadership teams Improvement programme – NHSI oversight Focus on safe, compassionate careChallenges in maternity services – staffing, poor patient experienceNot meeting national constitutional standards – RTT, A/EHigh number of Incidents and Never Events – dentalPoor complaints managementHCAIs – number of MRSAsSafer Staffing – use of bank and agencyPrioritiesMaternity Summit focused on RLH siteContinue to work with BH to ensure actions in the Never Event remedial action plan are implementedNever Event SummitContinue to work with trust on locally agreed trajectories for national constitutional standards (ST Funding performance trajectories)Continue to work closely with RLH site team – joint agenda planning for CQRM using KLOES

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Barts Health in Special Measures

New site focused management structure

CQRMs now site focused

Improvement plans for each site -

Oversight by NHS Improvement

Follow-up Inspection Visit July 2016

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Clinical Area RLH

Urgent and Emergency Care RequiresImprovement

Medical Care Requires Improvement

Surgery Inadequate

Critical Care Good

Maternity and Gynaecology RequiresImprovement

Services for Children and YoungPeople

Inadequate

End of Life Care Inadequate

OP & Diagnostic Imaging RequiresImprovement

Mental Health Services (ELFT, COMPASS)

ChallengesTower Hamlets to become the lead commissioner for the East London Consortium (ELC) from June 2016.IAPT access national standard to increase from 15% to 25% annual target by 2020/21.IAPT services are not consistently meeting the 50% recovery target.Introduction of the Early intervention Psychosis Standard in April 2016; ensuring that at least 50% of people referred begin treatment with high quality care within 2 weeks increasing to 60% by 2020/21.Referral to dementia diagnosis time at the Memory Clinic Service is significantly exceeding the 18 week local target; this is considerable work to be done before we are in a position to increase the numbers of people receiving a dementia diagnosis within 6 weeks of a GP referral by 2020 as per the NHSE Mandate 2016.On-going access issues with ELFT Psychological Therapies Service (PTS).ELFT CQC inspection – June 2016PrioritiesDevelop robust systems and strong relationships with ELFT as ELC lead commissioner.Work with ELFT with CQC preparedness and support Trust with CQC action plan post inspection.Continue to work with Trust on locally agreed trajectories for national Constitutional standardsContinue to work closely with ELFT – joint agenda planning for CQRM using KLOES.Review full PTS pathway including IAPT and local counselling services with ELFT, Compass and other providers to establish better ways of working.Work with ELFT to develop a dementia diagnosis recovery plan and trajectory and monitor through SPR.

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Community Services (GP Care Group, THIPP)

Challenges

New Contract – mobilisation

Multi-providers

Focus of media attention

Limited intelligence on community services currently

Monitoring and reporting of key performance indicators and other quality intelligence

Outcome based contract

Priorities

Fostering a working relationship to ensure transparency and openness moving forward

Work with GP Care Group to support the development of robust performance and quality governance processes

Developing the CQRM to ensure parity of esteem with other providers

Joint agenda planning

Robust links between CRG and CQRM

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Primary Care (General Practice)

Challenges

Limited quality and performance information at a local level

Clarity between what NHSE continues to manage and what the CCG manage

Access

Performance and quality governance processes at a local level, E.g. management and reporting of incidents

Priorities

Develop bespoke package of quality support for primary care e.g. preparing for CQC inspections, management of incidents, safeguarding

Work in collaboration with primary care to develop a primary care quality and performance dashboard

Primary care practice visits (join up with primary care team)

Work closely with Healthwatch to gather intelligence on primary care

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Other providers

London Ambulance Service

Challenges

Trust in special measures

Improvement plan in place

Ambulance turnaround

Priorities

Attendance CQRMs to ensure improvement plan actions are being implemented

Improvement on ambulance turnaround

Nursing and Residential Care Homes (Hawthorne Green and Aspen Court), Home Care Agencies

Challenges

Hawthorne Green – CQC inspection, requires improvement

Quality of continuing health care placements

Monitoring of quality of care home agencies that provide continuing health care

Priorities

Work with CSU in ensuring quality and performance of CHC providers (CSU developing a quality framework for CHC)

Following CHC review ensure provision of robust quality and performance intelligence via CSU

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Summary of Quality & Performance Challenges

7 day workingLondon Quality Standards for Acute, Emergency and Maternity services

GP Feedback Service Serious Incidents

CCG financial targetsCancer targets and patient experience surveys

Patient & carer Experience, complaints and FFT

18 week waiting time targets

Mixed sex accommodation

CQC Inspection outcomes -Barts Health and LAS in special measures

Low levels of staff and patient satisfaction

Never Events -

CQUINS MRSA levels Safeguarding Children and Adults

Impact of cost improvement programmes (CIPs) on quality and workforce

IAPT rates and quality of care for people with Dementia

New NHSE assurance process for CCGs FT pipeline SHMI rates

Community Health Services –new provider

Co commissioning - Quality in Primary Care

Care HomesQuality of Care in Maternity Services

The Big 4 Francis, Berwick, Keogh and Winterbourne

Need to focus on parity of esteem – focus on ELFT

CQRMs19

Delivering five year forward view

Francis, Keogh, Berwick and Winterbourne – Common Themes

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Distortedpriorities of

providers

Poor operational

systems

Low staffing levels

Culture

Lack of clinical

engagement

Ineffective leadership

Weak governance

systems

Lack of patient and

public engagement

Triangulation and sharing of

information

Ineffective commissioning

Safeguarding Children and Vulnerable Adults

The Care Act 2014 became law in April 2015, and in so doing placed adult safeguarding on a formal legal footing for the first time

CCGs as commissioners of local health services need to assure themselves that the organisations from which they commission have effective safeguarding arrangements in place.

CCGs are responsible for securing the expertise of Designated Professionals on behalf of the local health system.

Safeguarding forms part of the NHS standard contract (service condition 32) and commissioners need to agree with their providers, through local negotiation, what contract monitoring processes are used to demonstrate compliance with safeguarding duties.

CCGs must gain assurance from all commissioned services, both NHS and independent healthcare providers, throughout the year to ensure continuous improvement. Assurance may consist of assurance visits, section 11 audits41 and attendance at provider safeguarding committees.

What do we have in place

Systems to train staff to recognise and report safeguarding issues

A clear line of accountability for safeguarding, reflected in our governance arrangements

Arrangements to work with local authorities through our Local Safeguarding Children Boards, Safeguarding Adult Boards and Health and Wellbeing Boards

Arrangements to share information between service providers, agencies and commissioners

Designated doctors and nurses who are responsible for safeguarding children and looked after children.

To be recruited to A designated lead for Adult Safeguarding, Mental Capacity Act and PREVENT .

Two governing body members with a responsibility for safeguarding children and adults

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Sources of information and Intelligence

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Information Sources and their link to CQC Domains

Well Led

Caring

EffectiveResponsive

Patients are safe

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Quality

Workforce monitoringWorkforce wellbeingStaff surveysRaising ConcernsQuality Management Systems VisibilityOrganisational Culture

Patient & Carer SurveysPALS & ComplaintsSocial MediaLocal Quality SchedulesHealthwatchCQCVisits and observationsMLSC feedback

Quality SchedulesCQuINsClinical PathwaysQIPP NICE ComplianceProcurement processContractual Clinical Quality ReviewsClinical AuditPeer ReviewAcademic Health Science NetworkClinical SenatesQuality Impact assessments

Patient FeedbackFriends & Family TestPatient Participation GroupsThemed ReviewsNew models of carePerformance of constitutional targetsInformation governanceHorizon scanning

Serious Incident/ Never Event Significant Event ReviewsSafety ThermometerHCAIsNHS to NHS ConcernsMedicine SafetySafeguardingBenchmarkingSharing best practicePLACE Reports

How intelligence relates to CQC standards

Safe

Effective

Caring

Responsive

Well Led

never events, serious incidents, HCAIs, safety thermometer, staff survey, staffing levels, training, significant event reviews, safeguarding, PLACE reports, clinical harm reviews

HSMR, SHMI, mortality alerts, national clinical audits,

inpatient survey, cancer patient survey, friends and family test, patient stories

waiting time standards, cancelled operations, ambulance stays, analysis of complaints

staff survey, staffing levels, flu vac rates, board minutes, risk registers

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Providers

CQRM

CRG

Trust Board Reports

Improvement Plans and Trajectories (ST Funding performance trajectories

Quality Accounts

Staff satisfaction Surveys, Patient experience surveys, complaints and FFT

‘Clinical Fridays’ and Internal Peer Review

CIP reports

Mandatory Training Levels

CSU Reports

Monthly quality and performance reports

Serious Incident and never event reports

SHMI analysis and broader benchmarking

HCAI reporting & analysis

LAS to Care Home conveyance data

Patient experience dashboard

GP Membership and CCG Internal

Service Alerts

LMC feedback

Practice Audits

Feedback from practice visits

Patient stories

Patient Engagement events

Whistle blowers

Commissioning complaints

External Intelligence

CQC warning notices / inspection reports

Healthwatch feedback

National quality dataset

NHSI intelligence

ECIST (Elective Care Intensive Support Team)

NHS England direct commissioning

GPOS indicators and GP High level indicators

NHSE Quality Hub (London) wide quality and performance benchmarking

Patient Groups

NHS Choices

Quality Intelligence Reporting

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Assurance and Accountability

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Governing Body

Membership

Improved patient

experience and

delivery of NHS

Outcomes

Framework

CCG Strategic Plan underpinned by quality of care

to patients

Quality challenges

Quality Intelligence and reporting

Assurance mechanisms

Accountability

NHS Standard contract [Incentives and Penalties]&

Risk and GovernanceProviders

Tower Hamlets CCG Accountability

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Tower Hamlets CCG has a statutory responsibility to make sure that organisations they commission services from are safeguarding children and adults at risk of abuse and neglect. We have in place the following:-

• Systems to train staff to recognise and report safeguarding issues

• A clear line of accountability for safeguarding, reflected in our governance arrangements

• Arrangements to work with local authorities through our Local Safeguarding Children Boards, Safeguarding Adult Boards and Health and Wellbeing Boards

• Arrangements to share information between service providers, agencies and commissioners

• Designated doctors and nurses who are responsible for safeguarding children and looked after children. A designated lead for adult safeguarding and the Mental Capacity Act

• Two governing body members with a responsibility for safeguarding children and adults

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Safeguarding Governance and Assurance (2)

External Assurance

CQC and Ofsted

Internal Assurance

Monitoring of safeguarding alerts and

Investigations, focused safeguarding visits,

Provider performance dashboards,

Monitoring of training, serious incidents

and other contractual obligations in relation to

Safeguarding and looked after children

Learning

Serious case reviews, domestic homicide reviews, serious incidents

Finance, Performance and Quality committee

THCCG Children and Adults Safeguarding Committees (CCG, provider and local authority membership)

Adults Safeguarding Board

Governing Body

Local SafeguardingChildren's Board

NHSE

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•NHS England Assurance Framework and CCG Balanced Scorecard

•Overview and Scrutiny Committee

•HWBB (Health and Well Being Board

•NHS Improvement

•NHS IQ (Improving Quality)

•Quality leads forum

•Quality Surveillance Group

•CCC (Clinical Commissioning Committee) across WELC CCGs

•Lead Commissioner arrangements and other NCEL CCGs

•Grafton Group

•Finance, Performance and Quality

•Governing Body Meetings

•Serious Incident panels

•Quality visit programme

•Audit Committee

•BAF

•Safeguarding Commissioning Committee

•Urgent Care Working Group

•CCG policies

•NHS Standard Contract

•Clinical Quality Review Meetings

•National Standard Performance/Contract reviews and associated incentives / penalties

•Trust Board reports

•Trust policies

•Peer review visits

•Provider recovery improvement plans and trajectories

Provider level

CCG -Internal

External

Other Stakeholders

and CCG Collaborative

Governance and Assurance Mechanisms

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The NHS Standard Contract

Quality requirements are included in the contracts with our providers. For 16-17 contracts we have included a range of local quality indicators to support quality improvement. There are also contractual levers we can use to support provider compliance with quality and performance. The following key documents inform the national and local quality requirements and support innovations in quality are:-

The NHS Outcomesframework acts as acatalyst for driving quality improvements and outcome measures. This provides focus for the local quality elements in the contract.

The NHS Constitution sets out the principles and values that guide how the NHS should act and make decisions.It also explains the rights and responsibilities of staff, patients and the public, and the NHS’s pledges to them.

The key aim of the Commissioning for Quality and Innovation (CQUIN) framework is to secure improvements in quality of services and better outcomes for patients.

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Quality elements in NHS Standard Contract (The Particulars)

Description Quality element

Schedule 2: The Services, (C) Safeguarding Policies This section highlights the practice providers are expected to undertake to safeguard vulnerable children and adults

safety

Schedule 2: The Services, (K) Transfer of and discharge from care obligations

This part of the contract includes key discharge protocols and sets standards for discharge planning

safety and experience

Schedule 4: Quality Requirements (A) Operational Standards

This part sets out standards for services in relation to waiting times (RTT), ambulance response times, MSA breaches, cancellations

effectiveness and experience

Schedule 4: Quality Requirements (B) National Quality Requirements

This part sets out quality requirements in relation to HCAI, ambulance handovers, waiting times etc

safety, effectiveness and experience

Schedule 4: Quality Requirements (C) Local Quality Requirements

This section sets out the CCG local quality requirements safety, effectiveness and experience

Schedule 4: Quality Requirements (D) Never Events Events that are serious and largely preventable. This section includes a list of never events

safety

Schedule 4: Quality Requirements (E) Commissioning for Quality and Innovation (CQUINs)

This section outlines the quality targets that aim to stretch providers to deliver improvements in quality over and above what is expected. It includes both national and local schemes

safety, effectiveness and experience

Schedule 6: Contract Management, Reporting and Information Requirements (D) Incidents requiring reporting

Reporting of serious incidents safety

Schedule 6: Contract Management, Reporting and Information Requirements (F) Surveys

This includes requirement for providers to undertake national and local surveys

experience

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An Example of Quality Assurance in Practice

Intelligence from a patients on NHS choices identifies poor patient experience on maternity wards at RLH

The maternity survey and information from maternity liaison services committee and FFT feedback provide further intelligence that patient experience is poor

Action: CCG undertake quality assurance visit to that particular ward to obtain feedback on patient experience and other key areas

Action: CCG raise at CQRM

Outcome:

There is now a maternity board with key stakeholders around the table to take forward actions and work on improvement

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Quality Assurance Visits – embedding Francis

We have implemented a programme of quality assurance visits to our providers – acute, mental health, independent sector providers, nursing and residential homes

We also undertake a series of themed visits throughout the year focusing on safeguarding

The visits are a useful tool for gaining assurance of the quality of services Tower Hamlets CCG commission

Our visiting team include governing body members, local authority, GPs and staff from the CCG

Our visits are guided by hard and soft intelligence we receive including feedback from patients and carers

Feedback from the visits is given to our providers and we monitor any actions arising from the visits to ensure they are implemented

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Clinical Quality Review Meetings

Means of gaining assurance from providers on areas of concern

Use of key lines of enquiry based on intelligence

Progress on action plans – e.g. Never events

Assurance on provider internal governance and processes

Opportunity for open discussion

Clinically-led

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Levers for Improving Quality and Performance

CQUINs (provider incentive)

• NHS staff health and wellbeing

• Identification and early treatment of Sepsis

• Improving the physical health for patients with severe mental illness (PSMI)

• Antimicrobial resistance

• Smoking cessation

• Integrated care

• End of life

• Improve the physical health of users of mental health services by providing smoking cessation support

• Complete package of lifestyle care for all initiations of antipsychotics to improve physical health

• Staff training and improvement in the utilisation of the Lester Tool

• Reduction in Staff Smoking

Quality Premium (CCG incentive)

• Cancer diagnosis

• Experience of making a GP appointment Increase in no of GP E-Referrals

• Improved antibiotic prescribing in primary care

• Right care metrics

• Maximum 18 weeks from referral to treatment – incomplete standard

• Maximum four hour waits in A&E departments- standard

• Maximum two month (62-day) wait from urgent GP referral to first definitive treatment for cancer.

• Maximum 8 minute response for Category A (Red 1) ambulance calls

NHS Contract

• National quality requirements

• Local quality requirements

• SDIP

• Use of CQUINs

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Key priorities for Performance and Quality moving forward

Acute

• Maternity

• Continue to work with BH to ensure actions in the Never Event remedial action plan are implemented

• Never Event Summit

• Continue to work with trust on locally agreed trajectories for national constitutional standards (ST Funding performance trajectories)

• Continue to work closely with RLH site team – joint agenda planning for CQRM using KLOES

Mental Health

• Develop robust systems and strong relationships with ELFT as ELC lead commissioner.

• Work with ELFT with CQC preparedness and support Trust with CQC action plan post inspection.

• Continue to work with Trust on locally agreed trajectories for national Constitutional standards

• Continue to work closely with ELFT – joint agenda planning for CQRM using KLOES.

• Review full PTS pathway including IAPT and local counselling services with ELFT, Compass and other providers to establish better ways of working.

• Work with ELFT to develop a dementia diagnosis recovery plan and trajectory and monitor through SPR.

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Community Health Services

•Fostering a working relationship to ensure transparency and openness moving forward

•Work with GP Care Group to support the development of robust performance and quality governance processes

•Developing the CQRM to ensure parity of esteem with other providers

•Robust links between CRG and CQRM

Primary Care

•Develop bespoke package of quality support for primary care e.g. preparing for CQC inspections, management of incidents, safeguarding

•Work in collaboration with primary care to develop a primary care quality and performance dashboard

•Primary care practice visits (join up with primary care team)

•Work closely with Healthwatch to gather intelligence on primary care

LAS

•Attendance CQRMs to ensure improvement plan actions are being implemented

• Improvement on ambulance turnaround

Nursing and Care Home Providers

•Work with CSU in ensuring quality and performance of CHC providers (CSU developing a quality framework for CHC)

•Following CHC review ensure provision of robust quality and performance intelligence via CSU

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