Newham I-QAFNewham Integrated Quality Assessment Framework

Background

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• Developed in early 2014

• Joint working agreement

• Newham I-QAF implemented in July 2014 for

the older people care homes

What is the Newham I-QAF

A comprehensive and joined up approach to assess quality and contract monitor services in a holistic way

• Integrated – LBN and CCG

• Collaborative

• Intelligent and smart data

• Virtuous Cycle

• Continuous improvement

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Key Framework Components

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• Annual Performance Reviews

• Co –production

• CQC domains • ASC & CCG requirements

Quality Metrics

Quality Dashboard

Joint visitsQuality

Assurance Group

Initial Challenges

Data

requirements

Information flow

pathways

Mechanisms

to

engage providers?

Foster continuous

improvement

Strong

Stakeholder

engagement

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Quality Assurance Group

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Identified Key Stakeholders • Contract monitoring leads; • Quality Leads;• Safeguarding leads; • Commissioner leads; • Clinical leads such as GP, District nurse;• Medicine Management leads; • Falls Management leads;• CQC; • London Ambulance Service;• Healthwatch; • Integrated service leads.

Slide 7

• Resident count � Throughput and breakdown on service type

• Care Planning� Life history, end of life, social activity

• Safety � Hospital admissions, falls, pressure ulcers, safeguarding

• Clinical effectiveness� Audits, infection control, medicine management

• Resident experience� Complaints, relatives meetings� Dignity and choice

The Quality Metric

The Quality Dashboard

• High visual impact

� Captures the most significant data

� Measures performance and sets local benchmarks

� Trends and patterns

• Versatile single reporting tool

� Feeds into the Stakeholder Quality Group

� Informs decision making

� Provides care homes with comparable data

• Detects early warning signs

� Concerns and areas of improvement

� Workforce gaps

Slide 8

Involving Providers

• Sharing of the Quality Dashboard

• Preparing for inspection

• Reducing duplication

• Focus the care homes attention to quality

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Approach

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Quality MetricsQuality

Dashboard

Quality Assurance Group

Improvements Provider Feedback

Action taken as a result of the I-QAF � Targeted support provided to care homes

� Shared good practice

� Identification of high risk services

� Provider newsletter and care home forum

� CCG GP clinical lead interventions

� Investigation into a high concerning areas

� CCG nursing care home review

� Changes to pathway/models of care

� End of life group

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Data analytics

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589

473

0

100

200

300

400

500

600

700

2014/15 2015/16

London Ambulance Service

call outs

253220

0

100

200

300

400

500

600

2014/15 2015/16

A & E Admissions

Key Trends

• 20% reduction in London Ambulance call outs

• 13% reduction on A & E admissions

• 31% reduction of falls over the last 9 months

• 4 care homes with improved CQC ratings

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Benefits of Collaborative working• Knowledge sharing

� Access to experienced multi-disciplinary network of staff

• Efficiency through effective working solutions

� Joint reporting mechanism

� Supports safeguarding, pre-empt failures and pro-active solutions

• Faster problem resolution

� Joined oversight and ownership of challenges

� Targeted support

• Better results

Through synergy and whole-systems approach

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Nursing Review

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• Care Home managers to become a part of CEPN

• Model for enhanced medical support to care homes to be defined

• Better end of life care support to be provided to care homes

• Improved GP support to be reinforced

Stakeholder feedback

Head of Commissioning, London Borough of Newham

“The i-QAF has been an invaluable tool in helping to understand the pressures the

homes are working…..,

giving us early insight into workforce gaps in knowledge such as fall management…...

allowed us to tailor training and development initiatives raising staff competence

and avoiding safeguarding incidents.

One of the key strengths of the IQAF is the multi-agency meeting which allows not

only CCG and LA to share information but also the CQC and London Ambulance

service, this means all services are working together to highlight good practice and

manage risks.”

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Stakeholder feedback cont.

Safeguarding

“It has been possible to reduce risks in some instances because of the shared

intelligence available at this forum….having the level of rich detail available is

extremely useful.

Care home

“the good thing about is that it gives a summary and percentage on each section and

this help us to look in to the matter and try to do something about it in improving it ,

this also helps when CQC do their inspection”

Care home

“ when I see the LAS incidents figures in the Quality Dashboard it has raised my

awareness and now I think carefully before calling for an ambulance to ensure it is only

called when appropriate.”

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Stakeholder Feedback Cont.

Associate Director of Integrated Care CCG

“some of the key benefits have been about understanding, considering and addressing

the holistic needs of the residents with regard to health and social care and

addressing whole system pathways collectively .

Its allowed for KPIs from both organisations to be considered and reflected on in order

to get a better sense of the drivers and bottlenecks .”

““…. it has enabled us to have a far better understanding of the key aspect of

requirements and has encouraged us to think through new approaches to old

problems . It’s helped us shape service provision taking into account overlaps and

gaps. The impact has been in changes to service specifications and model of care and

closer working relationships across organisations and with the home providers.”

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Next steps

• Provider incentives

• Roll out across other services

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Questions ?

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Thank you

For more information on the Newham I-QAF

Sarbjit.rai@newham.gov.uk

Chetan.vyas@newhamccg.nhs.uk

tristan.brice@LondonADASS.org.uk

London ADASS

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