NHS Wales Collaborative Commissioning Annual Report 2015-16

National Collaborative Commissioning

National Collaborative Frameworks for Adult and CAMHS Mental Health and Learning Disability Hospital Services Annual Report 2015-16

About this Annual Report ABBREVIATIONS The following abbreviations will be used for Local Health Boards (LHBs)

ABMUHB Abertawe Bro Morgannwg University Health Board ABUHB Aneurin Bevan University Health Board BCUHB Betsi Cadwaladr University Health Board CVUHB Cardiff and Vale University Health Board CTUHB Cwm Taf University Health Board HDUHB Hywel Dda University Health Board

This section explains the context and assumptions made to support the reader in understanding, interpreting and positively using this annual report.

The NHS Wales National Collaborative Framework for the Provision of Medium Secure, Low Secure, Controlled Egress and Uncontrolled Egress Adult Mental Health and Learning Disability Services shall be referred to as ‘The Framework (Adults)’ within this annual report.

The NHS Wales National Collaborative Framework for the Provision of Low Secure and Acute CAMHS Mental Health and Learning Disability Services shall be referred to as ‘The Framework (CAMHS)’ within this annual report.

The terms ‘medium’ and ‘low secure’ are used within the National Collaborative Frameworks to denote units that have a secure entrance, and perimeter and high degree of relational and procedural security. Medium secure units normally care for patients with a higher-risk profile.

PTHB Powys Teaching Health Board

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National Collaborative Frameworks — Annual Report 2015-16

The term ‘controlled egress’ is used within The Framework (Adults) to denote a unit (usually termed locked rehabilitation) that has a restricted exit/entrance.

The term ‘uncontrolled egress’ is used within The Framework (Adults) to denote a unit (usually termed open rehabilitation) that has an unrestricted exit/entrance during working hours.

The term ‘acute’ is used within The Framework (CAMHS) to denote a unit that normally has a restricted exit/entrance.

This report covers those patients receiving assurance under The Framework.

It does not cover any patient placed with a provider not providing services under The Framework.

Activity savings are estimated as savings to hospital care and will be available to offset possible incurred costs in non-hospital settings.

Foreword The NHS Wales National Collaborative Frameworks for Adult and CAMHS Mental Health & Learning Disability Hospitals continue to deliver prudent healthcare by improving quality whilst reducing cost.

I commend this annual report as it demonstrates that since approval by the Minister for Health and Social Services in April 2014, the National Collaborative Frameworks have: Mrs Carol Shillabeer Chair of the Mental Health and Learning Disability Collaborative Commissioning Group.

And Lead NHS Wales Chief Executive for all age mental health.

Continued to deliver robust scrutiny and performance management of providers. This has enabled commissioners to be assured that their patients are cared for in safe and effective environments, demonstrated through 182 wards being subject to a quality assurance review last year. This is a remarkable achievement for the Quality Assurance Improvement Team.

Established an intolerance of sub-standard care. This has been demonstrated by the suspension or termination of several units from The Framework, and the issuing of circa 900 separate improvement actions last year.

I am pleased that the quality of care, as audited by the Quality Assurance Improvement Team, has shown an improvement from last year.

Proven the usefulness of the innovative Quality Assurance Rating system, which presents NHS Wales with an uncomplicated yet robust performance yardstick. This has been demonstrated through 68% of adult patients being placed with a ‘3Q’ provider, although the aim is for this number to be higher in future.

I am pleased that all of CAMHS patients were placed with a ‘3Q’ provider.

Provided information systems that enable patients to be ‘insight and in-mind’ even where the placement is some distance from the LHB (although the majority of placements continue to be made within Wales). However, there are further improvements to be made in this area; and Enabled potential cost reductions in excess of £5m.

I will be taking forward many of the strategic issues raised in this report through the MH & LD Collaborative Commissioning Group working with LHB. I am confident that the next year will see further, continued improvement in the quality of care for this vulnerable group.

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Contents Section 1 Background to National Collaborative Frameworks........... Page 5

28 Incidents.................................................. Page 32

01 Introduction.............................................. Page 6

31 Spend and costs...................................... Page 37

02 Legal status............................................... Page 6

32 Activity costs........................................... Page 37

03 Scope......................................................... Page 7

33 Cost reductions....................................... Page 38

04 Benefits..................................................... Page 8 05 Commissioning responsibilities................ Page 8

29 Complaints.............................................. Page 35 30 Safeguarding.......................................... Page 36

Section 3 National Collaborative Framework (CAMHS). . ............... Page 39

Section 2 National Collaborative Framework (Adults). .................... Page 9

34 Overview................................................. Page 40

06 General overview 2016........................... Page 10

36 Country of placement............................. Page 41

07 Overview by Local Health Board............ Page 10

37 Length of stay......................................... Page 42

08 Three year national trend 2014-2016.... Page 10

38 Hospital quality assurance reviews........ Page 42

09 Three year trend by LHB......................... Page 11

39 Quality assurance ratings....................... Page 43

10 Learning disabilities/mental health distribution.................................. Page 12

40 Incidents.................................................. Page 43

11 Male/female distribution........................ Page 12

42 Safeguarding.......................................... Page 45

35 Providers................................................. Page 41

41 Complaints ............................................. Page 45

12 Age distribution...................................... Page 13 13 Country of placement............................. Page 13 14 Length of stay......................................... Page 14 15 Providers ................................................ Page 15 16 Role of NHS Wales Quality Assurance Improvement Team............... Page 15 17 Hospital Quality Assurance Reviews...... Page 16 18 Maintaining the quality of care ............ Page 16

Appendices.................................... Page i Appendix A: Local Health Board Trends..............Page ii

I. A bertawe Bro Morgannwg University Health Board (ABMUHB)......... Page ii II. A neurin Bevan University Health Board (ABUHB)............................. Page ii

19 Improving the Quality of Care............... Page 20

III. Betsi Cadwaladr University Health Board (BCUHB).............................. Page ii

20 Respecting Privacy, Dignity, Equality, Diversity and Human Rights................... Page 21

IV. Cardiff and Vale University Health Board (CVUHB)............................. Page iii

21 Attendance at patient reviews............... Page 22

V. C wm Taf University Health Board (CTUHB)............................. Page iii

22 Quality assurance ratings ...................... Page 23 23 ‘Quality first’ placement process............ Page 25 24 Information management...................... Page 27 25 Effective communication using the secure file sharing portal................. Page 28 26 Commissioning care assurance performance system............................... Page 29 27 Required care outcomes......................... Page 30

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VI. Hywel Dda University Health Board (HDUHB)............................ Page iii VII. Powys Teaching Health Board (PTHB) ......................................... Page iii Appendix B: Quality Improvement Plan 2016/17............................................................Page iv

National Collaborative Frameworks — Annual Report 2015-16

Section 1 Background to National Collaborative Frameworks

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Background to National Collaborative Frameworks 01 INTRODUCTION Prior to 2012 non-NHS Wales mental health and learning disabilities hospital services were commissioned separately by each LHB or through the Welsh Health Specialised Services Committee (WHSSC). These commissioning arrangements led to disparity in costs, contractual obligations, standards and performance management across NHS Wales.

Oversight of these hospitals was the remit of individuals or small

“The expectation for effective collaborative working across NHS and with partners is clear.

Solutions to the challenges we face will be found in the opportunities of regional and national approaches with health and other partners.”1 teams within LHBs with little or no collaboration. An independent review in 2012 stated that the use of the independent sector

by NHS Wales prior to the development of the National Framework was “inefficient, ineffective and inconsistent”.2

1 Dr Andrew Goodall, Chief Executive of NHS Wales, NHS Wales Planning Framework 2015/16 page 2

6

2 Tayside Centre for Organisational Effectiveness (2013). Review of the NHS Wales Mental Health & Learning Disability Secure Services Procurement Project, a retrospective view. Cardiff: NHS Wales

National Collaborative Frameworks — Annual Report 2015-16

In March 2012 a National Collaborative Framework for medium and low secure care was launched, and was successful in improving quality assurance and reducing costs. Subsequently the Chief Executives of the NHS Wales Local Health Boards considered that a broader suite of services required this level of assurance.

Subsequently the NHS Wales National Collaborative Framework for Adult Mental Health & Learning Disability Hospitals was developed and launched in April 2014.

In 2014 the WHSSC Joint Committee requested that a NHS Wales National Collaborative Framework for Low Secure and Adult CAMHS Mental Health & Learning Disability Hospitals be developed. This subsequently launched in April 2015.

02 LEGAL STATUS The NHS Wales National Collaborative Frameworks are formal agreements and mechanisms developed by the NHS Wales Collaborative Commissioning Unit and Shared Services Partnership. This enables all parts of NHS Wales to procure and performance-manage services under pre-agreed standards, costs, terms and conditions of a contract in a compliant manner in accordance with EU and UK Procurement Regulations and LHB Standing Orders and Financial Instructions.

03 SCOPE The scope of services covered by the National Collaborative Frameworks are:

24,056 individual standards audited in 2015/16

Independent and NHS England hospitals providing the following services: Medium secure, mental health, adult male; Medium secure, mental health, adult female; Medium secure, learning disabilities, adult male; Medium secure, learning disabilities, adult female; Low secure, mental health, adult male; Low secure, mental health, adult female; Low secure, learning disabilities, adult male; Low secure, learning disabilities, adult female;

Low secure child/adolescent male; Low secure child/adolescent female; Controlled egress, mental health, adult male; Controlled egress, mental health, adult female; Controlled egress, learning disabilities, adult male; Controlled egress, learning disabilities, adult female; Uncontrolled egress, mental health, adult male; Uncontrolled egress, mental health, adult female; Uncontrolled egress, learning disabilities, adult male; Uncontrolled egress, learning disabilities, adult female; Acute child/adolescent male; Acute child/adolescent female.

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Background to National Collaborative Frameworks 04 BENEFITS The National Collaborative Frameworks were developed to enable: An approved directory of suitably qualified, financially viable providers to meet NHS Wales’ quality, service and cost criteria; The establishment of bespoke NHS Wales care standards, standard contract terms/ conditions, and a transparent pricing framework; Access to management information and the provision of clear and consistent patient-level data to underpin a performance management framework; and

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National Collaborative Frameworks — Annual Report 2015-16

Consistent and sustainable high-quality service provision and improved patient outcomes.

05 COMMISSIONING RESPONSIBILITIES The National Collaborative Frameworks provide the enacting mechanism for the commissioning of services. These services are provided once a patient is placed through the National Collaborative Framework processes and an individual patient placement agreement is generated. Therefore a contract enacted, between the commissioner (LHB or WHSSC) and provider.

Section 2 National Collaborative Framework (Adults)

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National Collaborative Framework (Adults) CVUHB had 15.8% (56) of the total patients;

Part 1: Overview 06 GENERAL OVERVIEW 2016

4.7%

increase in the number of patients receiving assurance under The Framework (Adults) since 2014

On 31 March 2016 there were 355 patients of NHS Wales receiving assurance under The Framework (Adults). Fig. 1. shows the total number of patients in brackets by type of care and as a percentage of the overall number.

07 OVERVIEW BY LOCAL HEALTH BOARD In terms of the 355 patients receiving assurance under The Framework (Adults) on 31 March 2016: ABMUHB had 17.7% (63) of the total patients; ABUHB had 18.6% (66) of the total patients; BCUHB had 22.3% (79) of the total patients;

Figure 1.

Medium Secure (63)

18%

Low Secure (166)

47% Controlled Egress (96)

27%

Uncontrolled Egress (30)

8%

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National Collaborative Frameworks — Annual Report 2015-16

CTUHB had 12.4% (44) of the total patients; HDUHB had 7% (25) of the total patients; and PTHB had 6.2% (22) of the total patients.

The proportion of patients by responsible LHB by specific type of care is detailed in Fig. 2.

08 THREE YEAR NATIONAL TREND 2014-2016 On 31 March 2016 there were 355 patients of NHS Wales receiving assurance under The Framework (Adults), compared to 339 on 31 March 2014. This denotes an increase of 4.7% (with a 3.8% increase from 342 patients in 2015) with specific adjustments in the following areas: Number of patients cared for by providers of medium secure care decreased by 3.1% between 31 March 2014 and 31 March 2016; Number of patients cared for by providers of low secure care increased by 5.1% between 31 March 2014 and 31 March 2016; Number of patients cared for by providers of controlled egress type increased by 20% between 31 March 2014 and 31 March 2016;

08 THREE YEAR NATIONAL TREND 2014-2016 (Cont’d) Number of patients cared for by providers of uncontrolled egress care decreased by 16.7% between 31 March 2014 and 31 March 2016.

Fig. 3. compares the number of patients receiving assurance under The Framework (Adults), by type of care on the 31 March in 2014, 2015 and 2016.

09 THREE YEAR TREND BY LOCAL HEALTH BOARD [Appendix A provides details on the number of patients by type of care by responsible LHB over the three year trend] The three year trend in the number of patients receiving assurance under The Framework (Adults) varied by responsible LHB, specifically: ABMUHB had 12.5% more patients receiving assurance in 2016 than in 2014; ABUHB had 4.3% less patients receiving assurance in 2016 than in 2014; BCUHB had 27.4% more patients receiving assurance in 2016 than in 2014; CVUHB had 7.7% more patients receiving assurance in 2016 than in 2014;

“The possession of accurate, relevant, and useable information from which the safety and quality of services can be ascertained is the vital key to effective commissioning.”3 Figure 2.

40 35 30 25 20 15 10 5 0 ABMUHB

ABUHB

BCUHB

CVUHB

CTUHB

HDUHB

PTHB

Figure 3.

180 150 120 90 60 30 0

Medium Secure 2014

2015

Low Secure

Controlled Egress

Uncontrolled Egress

2016

3 Public Health Wales (2014) Achieving prudent healthcare in NHS Wales

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National Collaborative Framework (Adults) Part 1: Overview

Fig. 4. demonstrates the number of patients receiving assurance under The Framework (Adults) by LHB on each 31 March in 2014, 2015 and 2016.

Figure 4.

80 70 60

10 LEARNING DISABILITIES/MENTAL HEALTH DISTRIBUTION

50 40 30 20 10 0 ABMUHB

ABUHB

BCUHB

2015

2014

CVUHB

CTUHB

HDUHB

PTHB

2016

4 of the 7 Local Health Boards had shown a levelling off or decrease in the number of patients receiving assurance under The Framework (Adults) since 2014.

Figure 5.

52

140

70

25

Mental Health

11 26

5 26

Learning Disabilities 0

50 Medium Secure

100 Low Secure

150

200 Controlled Egress

250

300

Uncontrolled Egress

4% decrease in patients cared for in learning disabilities units since 2015.

CTUHB had the same number of patients receiving assurance in 2016 than in 2014; HDUHB had 26.5% less patients receiving assurance in 2016 than in 2014; and PTHB had the same number of patients receiving assurance in 2016 than in 2014.

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National Collaborative Frameworks — Annual Report 2015-16

[Note that figures denote patients admitted per classification of hospital not diagnosis] Of the 355 patients receiving assurance under The Framework (Adults) on 31 March 2016, those cared for in ‘mental health units’ make up 81% of the total (287).

Those cared for in ‘learning disability units’ make up the remaining 19% (68). This number has reduced from 71 since 2015.

Fig. 5. shows the percentage of patients receiving assurance under The Framework (Adults) on 31 March 2016 in ‘mental health units’ or ‘learning disability units’. The are a percentage of the overall number cared for within a type of care.

11 MALE/FEMALE DISTRIBUTION As of 31 March 2016, of the 355 Welsh patients receiving assurance under The Framework (Adults), 68% (243) of the total were male and 32% (112) were female. This is shown in Fig. 6.

The number of female patients receiving assurance under The Framework (Adults) as a proportion of the total number of patients has increased by 1% (from 31% to 32%) since 2015.

12 AGE DISTRIBUTION

Figure 6.

355 Welsh patients receiving assurance under The Framework (Adults)

The age of patients receiving assurance under The Framework (Adults) on 31 March 2016 ranged from 18 years old to 84 years old.

243

Grouping both male and female patients together across all types of care demonstrated that: 17% (62) of patients were aged between 18-24 years old; 40% (143) of patients were aged between 25-40 years old; 32% (114) of patients were aged between 41-59 years old; and 10% (36) of patients were aged between 60-84 years old.

These age distributions have remained relatively unchanged over the last 2 years. Fig. 7. details the age (in ranges) and sex of patients receiving assurance under The Framework (Adults) on 31 March 2016.

13 COUNTRY OF PLACEMENT Mapping patients receiving assurance under The Framework (Adults) within the borders of either England or Wales (none were placed in any other country) shows that overall 64% of patients were cared for in hospitals within Wales.

The other 36% were cared for in hospitals within England.

Since 1 April 2015 there has been a 4% increase (from 32%) in the number of patients cared for in

112

Men

Women

Figure 7.

17%

40%

18-24 years old

25-40 years old

33

96

29 47

32%

10%

41-59 years old

60-84 years old

80

34 2

34

Male

Female

hospitals within England. Although note that placement by country is subject to quality of suitable providers at the time of placement, provider’s ability to meet specific patient’s needs and bed availability.

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National Collaborative Framework (Adults) Part 1: Overview

Figure 8.

64% of patients were cared for in hospitals within Wales.

128

44.9% (86) had a length of stay of less than a year; 40.3% (55) had a length of stay of between 1 and 3 years;

England Wales

227

The total length of stay with their final provider prior to discharge was:

13.6% (46) had a length of stay of less of between 3 and 7 years; and 1.1% (10) had a length of stay of greater than 7 years.

Figure 9.

25 20

Will be designed in style of report

15 10 5 0

Medium Secure < 6 months 3 to 5 years

Low Secure 6 months to 1 year 5 to7 years

Controlled Egress 1 to 2 years 7 to 10 years

Uncontrolled Egress 2 to 3 years 10> years

Since 2015 a 17.8% increase in patients with a completed length of stay of less than 2 years.

35%

decrease in the number of patients with a length of stay of 3 years or longer since 2015

14

Fig. 8. details the percentage of patients receiving assurance under The Framework (Adults) on 31 March 2016 by country.

14 LENGTH OF STAY A total of 176 patients who received assurance under The Framework (Adults) were discharged between 1 April 2015 and 31 March 2016.

National Collaborative Frameworks â&#x20AC;&#x201D; Annual Report 2015-16

The number of patients receiving assurance under The Framework (Adults) with a completed length of stay of less than 2 years has increased by 17.8% (from 58.8% in 2015 to 76.7% in 2016). Although note that length of stay can vary enormously depending on patient needs, response to treatment, complexity and/or risk. Patients can require assessments that take weeks or hospital treatment that takes many years.

Fig. 9. details the completed length of stay of patients receiving assurance under The Framework (Adults) and discharged between 1 April 2015 and 31 March 2016 by type of care.

In terms of the length of stay of patients who were continuing to receive assurance under The Framework (Adults) there has been a 35% decrease (from 62 to 46) in the number of patients with a length of stay of 3 years or longer since 2015.

Part 2: Providing Assurance & Improving the Quality of Care 15 PROVIDERS At the launch of The Framework (Adults) on 1 April 2014 there were 88 hospital sites and 290 individual units (wards) providing or potentially providing services.

On 31 March 2016 there were 82 hospital sites and 254 individual units providing or potentially providing services. The variation

of 36 units is a result of units withdrawing or being terminated.

Reasons for withdrawal or termination are reconfiguration of units, closure of units and inability to meet required standards within The Framework (Adults).

The map below shows the approximate geographical position of hospitals caring for adult patients.

16 ROLE OF NHS WALES QUALITY ASSURANCE IMPROVEMENT TEAM The NHS Wales Quality Assurance Improvement Team is a national team serving the seven LHBs and WHSSC. The team performance manages The Framework (Adults) providers by: Challenging substandard provider performance and advising on improvement; Collating and analysing performance management information in line with the National Collaborative Frameworks specifications, standards and contract conditions; Ensuring providers reduce risk and dependency and promote hope, recovery and rehabilitation; Ensuring all procured services are provided and deliver value for money;

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National Collaborative Framework (Adults) Part 2: Providing Assurance & Improving the Quality of Care

Ensuring provider quality and safety concerns are raised, discussed and disseminated with commissioners and statutory agencies; and Facilitating collaborative working between providers and commissioners to ensure safe, effective and high quality care that improves patient experience.

17 HOSPITAL QUALITY ASSURANCE REVIEWS Hospital quality assurance reviews are undertaken by the NHS Wales Quality Assurance Improvement Team. These involve obtaining assurance that the provider is maintaining the required clinical standards, ensuring good clinical practice underpins care, reducing risk and dependency. They also ensure the promotion of hope, recovery and rehabilitation.

171 individual units were subject to a provider hospital quality assurance review between 1 April 2015 and 31 March 2016. The team also undertook 36 focused reviews (shorter audits directed at specific issues) at individual units.

These were in response to concerns raised by performance data, local safeguarding teams, whistleblowers, LHBs or regulators.

This total number of reviews (207) is a rise of 36% in the number of provider units subject to a hospital quality assurance review or focused review from 157 in 2014/15 –111 to a full provider hospital quality assurance review and 46

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to a focused review. Subsequent to each hospital quality assurance review a ‘provider assurance report’ is completed and published on the Commissioning Care Assurance Performance System (CCAPS).

18 MAINTAINING THE QUALITY OF CARE

36%

increase in units subject to review since 2015

It is a requirement of providers to maintain the standards of care set out within The Framework (Adults).

There are 155 bespoke Welsh standards based on best evidence, experiential learning and good

“...a good system, you get told when a provider is no longer meeting all the requirements, which means you can address patient issues for those already placed with provider or not choose that provider next time.”4 clinical practice across 24 areas of care delivery within The Framework (Adults) at present. The standards were updated on 1 October 2015, rising from 76.

140 provider units were audited across all 24 care areas/155 standards between 1 October 2015 and 31 March 2016. 31 provider units were audited across 76 standards between 1 April 2015 and 30 September 2015. In all 24,056 individual standards were audited (excluding focused reviews and remedial action plans).

National Collaborative Frameworks — Annual Report 2015-16

4 Words used to describe the Commissioning Care Assurance Performance System by commissioning in Kosnes, L & Anderson, P. (2016), Evaluation of the Commissioning Care Assurance & Performance System, University of Swansea Centre for Health Economics.

Figure 10.

Multi-disciplinary team meeting

64.7%

Care and Treatment Planning

70.6%

Clinical Records

72.5%

Medical Devices and Resuscitation Equipment

73.5%

Physical Health and Health and Well Being Promotion

76.1%

Environment

80.4%

Risk Assessment and Risk Management

82.4%

Meaningful and Culturally Appropriate Activities

83.8%

Pharmacological Interventions and Medicines Management

85.1%

Supportive and Therapeutic Patient Observations

85.3%

Information and Communication

85.9%

Patient Engagement and Satisfaction

88.2%

Physical Interventions and/or Seclusion/Time Out/Intensive Support

89.7%

Nutrition

90.8%

Staff

91.2%

Psychological/therapeutic interventions

91.8%

Respecting Privacy, Dignity, Equality, Diversity and Human Rights

91.8%

Discharge Planning

92.6%

Visiting and maintaining contact

93.7%

Leave

94.1%

Robust Governance and Accountability

95.3%

Emergency Planning and Response

96.1%

Safety and Welfare of Patients

96.5%

Complaints 0%

97.8% 20%

The average number of standards verified as being maintained across the 140 provider units subject to a hospital quality assurance reviews between 1 October 2015 and 31 March 20165 was 86.5%. This was a rise of 3.7% from 82.8% in 2015.

40%

60%

Individual provider units were verified as maintaining between 64.7% and 97.8% of the 155 standards through hospital quality assurance reviews.

Fig. 10. details the average achievement for each of the 24 care areas across 140 provider units audited from 30 October 2015 to 31 March 2016.

80%

100%

3.7%

rise in average number of standards verified as maintained by providers of care

5 Only standards reviewed between 1 October 2015 and 31 March 2016 can be compared due to the standards being modified on 1 October 2015.

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National Collaborative Framework (Adults) Part 2: Providing Assurance & Improving the Quality of Care Figure 11.

Achievement

Standard

Foremost reasons for non-maintenance of standard

Standard maintained by 17.6% of provider units

That the patient is (i) enabled and encouraged to participate in the MDT meeting (ii) that language used in the meetings attended by the patient is clear, non-technical and (iii) that the patient is given assistance to understand the information if necessary.

The patientâ&#x20AC;&#x2122;s Care and Treatment Plan(s), effectiveness and outcomes from care and treatment interventions, risk assessments, management plans and discharge plan must be reviewed at the meeting.

Patient not supported during the MDT meeting No record of patient attending the MDT meeting No record of effectiveness of interventions being reviewed No record of discharge plan being reviewed

Standard maintained by 29.4% of provider units

Care and Treatment Plan(s) are developed in accordance with the Mental Health (Wales) Measure 2010, good clinical practice, professional standards and national and local guidance and (i) identify one or more outcomes for each identified need and (ii) identify one or more pharmacological and or psychological/therapeutic interventions to be undertaken and/or maintained to achieve these outcomes and (iii) record any needs which will remain unmet during the duration of the Care and Treatment Plan.

Care and Treatment Plan is not developed in accordance with the Mental Health (Wales) Measure Care and Treatment Plan is not developed in accordance with good clinical practice All needs not identified within the Care and Treatment Plan Interventions and/or outcomes not identified to address need Unmet needs not recorded

Standard maintained by 44.1% of provider units

That continued requirement for and outcomes of Physical or Health and Well Being interventions must be reviewed (i) at a maximum interval of one month via the multi-disciplinary meeting or (ii) whenever necessary through change of presentation or circumstance.

Physical or Health and Well Being interventions not reviewed every month Physical or Health and Well Being interventions not reviewed by MDT

Standard maintained by 50% of provider units

The area used for storage of resuscitation equipment is clearly identifiable.

No signage donating location of the resuscitation equipment Signage donating location of the resuscitation equipment is not clearly visible

Standard maintained by 50% of provider units

Furniture and decor within the environment of care (i) is in a good state of repair and (ii) maintenance is undertaken at a maximum interval of one month (iii) that there is in place a system for the patient to request maintenance/repairs.

Furniture in poor state of repair (stains, rip, worn etc) Decor within the environment of care is not adequate No record of regular maintenance No system in place for the patient to request repairs

18

National Collaborative Frameworks â&#x20AC;&#x201D; Annual Report 2015-16

Figure 12.

17

The patient has access to hot and cold drinks within reasonable hours and is encouraged to prepare his or her own hot and cold drinks after appropriate risk assessment.

The patient can receive a private conversation with a care professional on request with due regard to risk, safety, best interests and confidentiality.

The patient is encouraged to maintain contact with family members, carers and friends, subject to appropriate assessment of risk, safety, best interests and confidentiality.

At least one staff member on duty or on call (and able to attend within two hours) has the knowledge and skills to be able to deliver an appropriate response. They must ensure business and service continuity in the event of an incident or emergency situation.

There is an identified doctor that can attend the unit within four hours when out of hours and can attend the unit within one hour when during normal working hours.

standards measured 100% compliance

The five specific standards of the total 155 that measured the lowest compliance rate within the 140 provider units audited from 30 October 2015 to 31 March 2016 and the (foremost) reasons for non-maintenance of that particular standard are detailed in Fig. 11. The standard achieving the lowest compliance rate is ranked first. Where there was a failure to maintain a standard, a Performance Improvement Notice has been served (see Section 19).

17 of the total 155 specific standards measured 100% compliance rate for the 140 provider units audited from 30 October 2015 to 31 March 2016.

As a sample five of these 17 are detailed in the Fig. 12.

â&#x20AC;&#x153;...[there is] increased awareness of quality requirements.â&#x20AC;?6 6 Words used to describe the Commissioning Care Assurance Performance System by commissioning in Kosnes, L & Anderson, P. (2016), Evaluation of the Commissioning Care Assurance & Performance System, University of Swansea Centre for Health Economics.

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National Collaborative Framework (Adults) Part 2: Providing Assurance & Improving the Quality of Care

19 IMPROVING THE QUALITY OF CARE After the NHS Wales Quality Assurance Improvement Team has undertaken either a full or focused hospital quality assurance review, a Performance Improvement Notice is issued if one or more areas of substandard care are identified.

There were a total of 82 Performance Improvement Notices issued between 1 April 2015 and 31 March 2016. Each improvement notice details the justification for identifying non-attainment of the required standard. It also details a series of actions to be completed by the provider in order to provide assurance that The Framework (Adults) requirement can be met.

Performance Improvement Notices and progress reports are published on CCAPS. Across all the Performance Improvement Notices issued between 1 April 2015 and 31

March 2016 there were circa 900 improvement actions. An example of an improvement action that would be documented within a Performance Improvement Notice is shown in Fig. 13.

During the Performance Improvement Notice period, the provider is subject to enhanced performance management.

Regular updates on progress towards completion of the actions within the Performance Improvement Notice are required by the NHS Wales Quality Assurance Improvement Team.

Failure to complete the actions within the Performance Improvement Notice has resulted in the unit’s suspension – where the unit cannot accept any more patients under The Framework (Adults) or termination from The Framework (Adults).

Over

900

improvement actions issued in 2015/16

The Performance Improvement Notice is concluded once the team has verified that all requested actions have been completed.

Figure 13.

AREA: Pharmacological Interventions and Medicines Management Standard

Audit outcome

Assurance required

Core Service Requirement not maintained.

That all individualised There was no evidence that medication prescribed medication was reviewed for at least 3 months. is available and offered Not all medications had an identifiable as prescribed to the purpose for prescription with descried patient and is the clinical outcome within the notes. minimum required to PRN medication remains as on admission achieve the identified without evidence of review. clinical outcome(s)

20

National Collaborative Frameworks — Annual Report 2015-16

The provider will review all prescribed medications to ensure they are the minimum required to achieve the identified clinical outcome(s) Each medication will have a purpose for prescription written in the clinical notes.

20 RESPECTING PRIVACY, DIGNITY, EQUALITY, DIVERSITY AND HUMAN RIGHTS A requirement of the National Collaborative Frameworks is to ensure that providers respect each patient’s privacy, dignity, equality, diversity and human rights. The Framework (Adults) sets out nine specific requirements, each of which must be maintained by providers in respect of this area.

The average achievement across all 140 units audited between 30 October 2015 to 31 March 2016 for the standards in the area of Respecting Privacy, Dignity, Equality, Diversity and Human Rights was 91.8%. This ranged from 73.5% to 100%.

91.8%

achievement in Respecting Privacy, Dignity, Equality, Diversity and Human Rights

The specific achievements against each of the nine specific requirements are shown in Fig. 14. The standard with the lowest average achievement is listed first.

Figure 14.

Achievement

Requirement

Standard maintained There is facility for the secure storage of the patient’s personal property and the patient by 73.5% of providers can have supervised access to this facility.

Standard maintained (i) The patient’s needs in respect of the Equality Act 2010 (i.e. needs in relation to race, by 88.2% of providers disability, gender, sexual orientation, age, relationships and family life, religion or belief, gender identity, pregnancy and maternity) are identified and addressed.

Standard maintained The environment of care protects the privacy of the patient. by 85.3% of providers Standard maintained The patient has access to appropriate reflective, faith or multi-faith (i) facilities by 91.2% of providers (ii) pastoral care.

Standard maintained Wherever possible and following appropriate risk assessment, the patient’s bedroom by 93.3% of providers accommodates individual needs and preferences.

Standard maintained A designated, purposely designed, decorated and equipped low-stimulus area/quiet area by 97.1% of providers is available, without a television or telephone, and distant from communal areas.

Standard maintained Patients are enabled and encouraged to access, where appropriate, (i) Independent by 97.1% of providers Mental Health Advocacy (ii) Independent Mental Capacity Advocacy (iii) advocacy.

Standard maintained by 100% of providers

The patient can receive a private conversation with a care professional on request with due regard to risk, safety, best interests and confidentiality.

Standard maintained by 100% of providers

The patient is informed about their rights (i) on admission or as soon as possible soon after and (ii) at a maximum interval of two calendar months and (iii) on request.

National Collaborative Frameworks — Annual Report 2015-16

21

National Collaborative Framework (Adults) Part 2: Providing Assurance & Improving the Quality of Care

22

These achievements demonstrate that The Framework (Adults) has a positive impact on compliance with the equality policies and national legislation. They show that The Framework (Adults) supports the legal requirement to foster good relations between groups with protected characteristics.

that all patients irrespective of their culture, ethnicity or lifestyle receive high quality care. This area is continually monitored by the NHS Wales Quality Assurance Improvement Team.

Despite the positivity of The Framework (Adults) ensuring that providers respect privacy, dignity, equality, diversity and human rights, inequalities continue to exist in healthcare services for some people. In view of this, each provider is required to ensure

The NHS Wales Quality Assurance Improvement Team monitors the attendance at patient reviews. This is done in order to ensure that the patient moves through the pathway of care and back to their home communities as quickly as possible.

National Collaborative Frameworks â&#x20AC;&#x201D; Annual Report 2015-16

21 ATTENDANCE AT PATIENT REVIEWS

From 1 April 2015 to 31 March 2016 a total of 261 patients received assurance under The Framework (Adults) for a period of 1 year or more. They therefore would have been expected to have attended a documented review (i.e. pre-discharge meeting, care and treatment planning review).

Attendance at the Care and Treatment Planning, pre-discharge or other care reviews by the designated care coordinator/LHB representative complies with the Mental Health (Wales) Measure 2010 and is considered good practice.

Please note that nonattendance at reviews does not signify a complete absence of patient contact, as professionals may have visited the patient at other times.

The average percentage attendance at a documented review by a designated care coordinator or a LHB representative (including social services) for all LHBs was 88% in 2015/16. This was a decrease from 92% in 2014/15.

Fig. 15. Demonstrates the percentage of reviews held for a patient receiving assurance under The Framework (Adults) attended by either a care coordinator or a LHB representative between 1 April 2015 and 31 March 2016.

Figure 15.

100% 80% 60% 40% 20% 0%

ABMUHB

ABUHB

BCUHB

CVUHB

CTUHB

HDUHB

PTHB

% of reviews attended by a Care Co-ordinator or other representative in 2014/15 % of reviews attended by a Care Co-ordinator or other representative in 2015/16

22 QUALITY ASSURANCE RATINGS The NHS Wales Quality Assurance Improvement Team has developed a bespoke ‘Quality Assurance Rating System’.

The Quality Assurance Rating System has been developed to ensure that providers provide care in safe and high-quality environments.

They ensure that providers promote rehabilitation and recovery, using treatments that are evidence-based and effective, whilst ensuring public protection and value for money.

The system works by making it a contractual obligation for providers to make every effort to maintain a ‘rating’ of ‘3Qs’ (Q standing for quality). This rating is then periodically revalidated

National Collaborative Frameworks — Annual Report 2015-16

23

National Collaborative Framework (Adults) Part 2: Providing Assurance & Improving the Quality of Care

throughout the contractual term by the NHS Wales Quality Assurance Improvement Team.

If a provider fails to meet part of the specification it will constitute a performance issue and be docked one or more ‘Qs’ depending on the consequences or possible consequences of the failure.

The three ‘Qs’ are re-established after the NHS Wales Quality Assurance Improvement Team is satisfied the performance issue is rectified.

The Quality Assurance Rating System allows as ‘real time’ as possible representation of current provider quality. This informs commissioning organisations at the point of patient placement and throughout the patient’s treatment.

There were 187 patient placements commissioned between 1 April 2015 and 31 March 2016. The quality assurance rating at the time of placement across all LHBs (Note this can be influenced by bed availability

and provider’s ability to meet specific patient’s needs) were: 67.9% (127) of patients were placed with a provider maintaining 3Qs in 2015/16 compared to 75% (149) in 2014/15; 25.1% (47) of patients were placed with a provider maintaining only 2Qs in 2015/16 compared to 22% (43) in 2014/15;

68%

of patients were placed with a provider maintaining 3Qs

6.4% (12) of patients were placed with a provider maintaining only 1Q in 2015/16 compared to 4% (7) in 2014/15; 0.5% (1) of patients were placed with a provider maintaining no Qs in 2015/16 compared to 0% (0) in 2014/15.

Fig. 16. Demonstrates the quality assurance rating of providers at the point of placement for each of the 187 patient placements commissioned between 1 April 2015 and 31 March 2016 by LHBs.

Figure 16.

50%

40%

30%

20%

10%

0%

3 Qs

24

ABMUHB 2 Qs

ABUHB 1Q

BCUHB

CVUHB

Zero Qs

National Collaborative Frameworks — Annual Report 2015-16

CTUHB

HDUHB

PTHB

Figure 17.

Service type – Low Secure – Mental Health – Male Unit name

Quality assurance rating

Bed availability

Cost

Example Unit A

QQQ

2

£300

Example Unit B

QQQ

4

£350

Example Unit C

QQ

1

£275

Example Unit D

Q

2

£250

Example Unit E

QQQ

0

£350

23 ‘QUALITY FIRST’ PLACEMENT PROCESS The Framework (Adults) uses a ‘quality first, then cost’ ranked provider model. Each of the 254 provider units is given a quality assurance rating and ranked with other units who provide the same service.

The provider units are ranked in the first instance by their current quality assurance rating. This ensures that those units maintaining the ‘3Q’ quality assurance rating are ranked above all those achieving ‘2Q’ quality assurance rating; those achieving ‘2Q’ quality assurance rating are ranked above all those achieving ‘1Q’ quality assurance rating etc. Suspended units are not eligible to receive placements.

The providers all achieving the same quality assurance rating are then ranked by cost, with the lowest

cost provider ranked above those with higher cost. An illustrative listing is shown in the Fig. 17.

Those provider units without current vacancies are ranked below those provider units with vacancies.

As can be seen in the example, since it has the lowest quality assurance rating ‘Example Unit D’ is ranked below all other units even though it has the lowest cost.

‘Example Unit E’ is ranked last due to inability to accept a placement due to bed availability.

In order to ensure that providers are incentivised to maintain quality and offer best value, the process of The Framework (Adults) encourages commissioners, where clinically appropriate to do so, to place patients with the highest ranked provider.

National Collaborative Frameworks — Annual Report 2015-16

25

National Collaborative Framework (Adults) Part 2: Providing Assurance & Improving the Quality of Care

CCAPS provides a national electronic patient placement function. This presents commissioners, at the point of placement and in partnership with patients, their carers and local care team, with all the information and intelligence to make an informed choice on the most suitable provider to meet the clinical, social and geographical needs of the patient.

The process for the national electronic patient placement function is: i. Commissioner identifies most suitable service type to meet the clinical needs of the patient; ii. Commissioner is presented with the ranked list of provider units who have beds available supported by the most recent information of each provider. In order to support care ‘closer to home’ when appropriate, they

26

National Collaborative Frameworks — Annual Report 2015-16

are able to see the distance to each potential provider by road; iii. Commissioner identifies highest ranked and most suitable provider to meet the clinical, social and geographical needs of the patient; iv. Contact details of the provider unit is supplied including ability to send email directly to a specific provider’s referrals manager; v. Clinical assessment by provider.

If it’s agreed that the provider can meet the needs of the patient and the patient is satisfied with the provider, then the commissioner agrees an admission date; and vi. Post admission, CCAPS generates a specific contract between commissioner and provider.

Part 3: Ensuring Safe and Effective care 24 INFORMATION MANAGEMENT Through the Commissioning Care Assurance Performance System the NHS Quality Assurance Improvement Team gathers a substantial quantity of information on patients receiving assurance under The Framework (Adults). This comes directly from providers and uses the information functional relationships pyramid of Data, Information, Knowledge and Wisdom to ensure its effective use.

In order to adhere to the values of patient-centered care, the data gathered by the NHS Wales Quality Assurance Improvement Team is not anonymous data on provider’s performance (e.g. average length of stay). It is prudently chosen data to create an ’information picture’ on each individual patient receiving assurance under The Framework (Adults). For example for each patient the following information is collected:

Data Information Knowledge

Wisdom

NHS number, name, age, sex and predominant need; E-CAARE process record including why the current provider was chosen for the patient, as well as the provider’s quality assurance rating at time of patient placement; Current patient placement agreement (LHB-Provider patient contract); Every serious and non-serious incident concerning the patient including incident type, date, time and whether investigation report is available; Every safeguarding incident concerning the patient. This includes type of incident (financial, physical etc) date, name of the local safeguarding person the incident was reported to and when; Every complaint made by patient including date and complaint category; Patient’s admission source and discharge destination; Care and Treatment Planning and any other documented review-dates and recorded attendance from local services; Length of stay in current provider and whole patient pathway (all previous admissions); and Cost per day of current placement, cost of whole patient pathway and additional services (staff) requiring costing.

National Collaborative Frameworks — Annual Report 2015-16

27

National Collaborative Framework (Adults) Part 3: Ensuring Safe and Effective care

This allows the NHS Wales Quality Assurance Improvement Team to have knowledge of a provider (or individual ward or hospital) to be ‘built up’ from individual patient’s information.

Patients

95%

increase in unique users of the Secure File Sharing Portal since 2014/15

Unit

Hospital

This knowledge allows the effective deployment of the NHS Wales Quality Assurance Improvement Team clinical assets in order to fully understand, performance-manage and improve (wisdom) care delivery within National Collaborative Framework providers.

25 EFFECTIVE COMMUNICATION USING THE SECURE FILE SHARING PORTAL The National Framework Secure File Sharing Portal is a safe and efficient way of sharing information through an online application.

This is managed and facilitated by the NHS Wales Quality Assurance Improvement Team and hosted by NHS Wales Informatics Service. The portal ‘connects’ each provider of National Collaborative Framework

28

National Collaborative Frameworks — Annual Report 2015-16

Provider

services with each commissioning organisation to safely transfer and receive clinical, contractual and patient identifiable information.

On 31 March 2016 there were 469 unique users, up 95% (from 240) in 2015 and 9,909 folders in total, making it the biggest portal in use

by NHS Wales.

The main objectives of the National Collaborative Framework Secure File Sharing Portal are to: Ensure sensitive data cannot be intercepted, corrupted or misplaced; Support a ‘paperless NHS’; Enable sharing of large volume information; Enable information to be shared instantly; and Eliminate postage costs.

ischarge plans • In • D cid s en e t ts da p re u po l a r ic

ts

Cl in

National Framework Secure File Sharing Portal

NHS England providers

ABMUHB HDUHB

ABUHB

Independent providers in Wales

PTHB C&VUHB

BCUHB

NHS Quality Assurance Improvement Team

r Te

al hi st o

ry

CTUHB

Independent providers in England

m

i

na

ti o

n

no

ti c

es

• C a re

& Tr e a t m e n

tp

la

ns

•

ic in Cl

providers to deliver beneficial outcomes for a person receiving care, care providers and commissioners as detailed below.

CCAPS benefits a person requiring care by: giving a choice of care setting providing assurance on the expected quality of care monitoring health and wellbeing improvements ensuring prompt response to any complaints/incidents/safeguarding concerns CCAPS benefits care providers by: promoting their bed availability reporting their performance against quality expectations enabling their prompt reporting of concerns to commissioners and care coordinators

26 COMMISSIONING CARE ASSURANCE PERFORMANCE SYSTEM The Commissioning Care Assurance Performance System (CCAPS) has been developed through a partnership between the NHS Wales Quality Assurance Improvement Team and NHS Wales Informatics Service.

CCAPS is an informatics resource to enable the commissioning of integrated, long-term publiclyfunded care and support the performance management of care

enabling efficiencies by having a consistent approach across commissioners CCAPS benefits commissioners by: sharing intelligence on care providers matching a care setting to a person’s needs knowledge about a care setting’s quality evidencing the care received for the cost incurred enabling efficiencies by supporting an integrated commissioning approach

National Collaborative Frameworks — Annual Report 2015-16

29

National Collaborative Framework (Adults) Part 3: Ensuring Safe and Effective care

Between 1 April 2015 and 31 March 2016 CCAPS collated 33,598 items of data, had 88 unique LHB users and 219 provider users.

“Data remains the single most important motivator and tool for a clinical leader: high quality, comparative, unit-level and individual-level clinical and financial data.”7 From April 1 2016 CCAPS can be accessed by: NHS Wales Care coordinators for each patient receiving assurance of The Framework (Adults) from health and social care organisations; Strategic commissioners (i.e. continuing healthcare teams or gatekeepers, finance officers); Quality, complaints or safety leads; and Providers.

The NHS Wales Quality Assurance Improvement Team also host a ‘service support desk’ for CCAPS; this desk recorded 911 calls from 25 July 2015-1 June 2016.

7 Public Health Wales (2014) Achieving prudent healthcare in NHS Wales

30

National Collaborative Frameworks — Annual Report 2015-16

In 2016 an independent review of CCAPS took place and CCAPS users returned an overwhelmingly positive response to the system, including:

‘fantastic’ ‘useful’

‘invaluable’ ‘a good system’ ‘very easy to use’ ‘would recommend it to anyone’‘includes everything you need’ ‘transparent’

‘wish everyone was using it’

‘time saving’

The report concluded with: “CCAPS appears uniquely placed to empower commissioner decision making by delivering timely information on provider quality and conduct.”8

27 REQUIRED CARE OUTCOMES In place of numerous key performance indicators measuring organisational data normally seen in contracts, NHS Wales Collaborative Commissioning has developed patient-level outcome measures.

These align with the patient-centred values of NHS Wales.

There are currently six ‘Required Care Outcomes’. They are collated, analysed and verified by the NHS Wales Quality Assurance

8 Kosnes, L & Anderson, P. (2016), Evaluation of the Commissioning Care Assurance & Performance System, University of Swansea Centre for Health Economics

Improvement Team for each patient receiving assurance under The Framework (Adults) every month.

This is done in order to: Compare performance across providers delivering similar care; Provide a detailed account of the provider’s attainment of the required patient-level performance targets;

13,621

Provide an indication of issues that may require remedial action; and

assessments of required care outcomes in 2015/16s

Indicate where there is potential to improve the effectiveness of care.

Each Required Care Outcome has three ‘achievement guidelines’ (information given to providers on attainment of the Required Care Outcomes’). As examples, two of

the six Required Care Outcomes with corresponding Achievement guidelines are shown in Fig. 18.

There were 13,621 assessments of Required Care Outcomes for patients receiving assurance under The Framework (Adults) between 1 April 2015 and 31 March 2016.9 Of these 13,621 assessments, the range of reported achievement (meaning the Required Care Outcomes have been recorded as having been achieved by the provider) was between 96.1% and 98%. The average achievement across all Required Care Outcomes for eligible patients was 96.8%, a decrease by 1% (from 97.8%) since 2014/15.

9 Required Care Outcomes were modified on 1 October 2015.

Figure 18.

Required Care Outcomes

Achievement guidelines

Prudent pharmacology

a. All medications were available and offered as prescribed to the patient and were at the minimum required level to achieve the identified clinical outcome(s).

Improved mental health, b. On each occasion of, and reasons for, the failure to provide for, or the well-being and patient patient failing to accept/receive any individualised prescribed medication, experience through effective is clearly documented. and minimum use of pharmacological interventions. c. Effectiveness and side effects of the prescribed medication regime was reviewed (at a maximum interval of 1 month) via the multi-disciplinary meeting.

Ensuring a high-quality environment

a. Environment of care was at all times clean and daily inspection of the environment’s cleanliness was undertaken.

Improved mental health, wellbeing and patient experience through providing care in a high-quality environment.

b. The environment of care, including furniture and decor, was in a good state of repair, and maintenance was undertaken on a weekly basis. c. The hospital and unit perimeter remained secure and prevented unauthorised access and egress to the hospital and unit.

National Collaborative Frameworks — Annual Report 2015-16

31

Fig. 19. Displays the Required Care Outcomes as reported being achieved by providers, as a percentage of each Required Care Outcome from 1 April 2015 to 31 March 2016.

The incidents are monitored against a bespoke 54 point matrix of 14 care areas and 5 levels of severity.

28 INCIDENTS

A total of 13,546 incidents involving patients receiving assurance under The Framework (Adults) were reported between 1 April 2015 and 31 March 2016.

All incidents involving patients receiving assurance under The Framework (Adults) are monitored by the NHS Wales Quality Assurance Improvement Team to highlight areas requiring intervention, remedial action or improvement.

Examples of two of the 14 sections of the incident matrix are shown in Fig. 20.

The 13,546 incidents constitute a rise of 63.4% from the 8,288 incidents reported in 2014/15.

(Note that there were 3.8%

Figure 19.

% of RCOs recorded as achieved

32

Required Care Outcome

96.1%

Effective interventions Improved mental health, well-being and patient experience through effective use of psychological/therapeutic interventions.

96.1%

Prudent pharmacology Improved mental health, well-being and patient experience through effective and minimum use of pharmacological interventions.

96.9%

Improved physical health Improved mental health, well-being and patient experience through effective physical health interventions.

96.2%

Effective risk assessment/management Improved mental health, well-being and patient experience through effective risk assessment and management.

97.7%

Effective use of staff resources Improved mental health, well-being and patient experience through effective use of staff resources.

97.9%

Ensuring a high-quality environment.

Improved mental health, well-being and patient experience through providing care in a high-quality environment.

National Collaborative Frameworks â&#x20AC;&#x201D; Annual Report 2015-16

more patients receiving care in 2015/16 and the increase could be accounted for through increased reporting).

In terms of the severity of the 7,635 incidents reported between 1 October 2015 and 31 March 201610: 54.9% of incidents were classed as negligible in 2015/16 compared to 59.7% in 2014/15; 34.7% of incidents were classed as minor in 2015/16 compared to 31.9% in 2014/15;

8.7% of incidents were classed as moderate in 2015/16 compared to 6.9% in 2014/15; 1.5% of incidents were classed as severe in 2015/16 compared to 1.3% in 2014/15; and

13,546 incidents reported in 2015/16

0.1% of incidents were classed as critical in 2015/16 compared to 0.1% in 2014/15.

10 CCAPS introduced a ‘direct’ reporting system in October 2015

Figure 20.

Area

Medication

Victim of verbal abuse threats or bullying

Guidance

Prescribing error Dispensing error Administration error NOT refusal

Verbal abuse Any discriminatory abuse e.g. racial, homophobic, disability.

Negligible

An error in the prescribing or dispensing of medication to a Welsh patient, which is not administered or results in no harm.

A Welsh patient has been the victim of non-directed verbal abuse or easily diffused disruptive behaviour.

Minor

An error in the administration of medication to a Welsh patient, which results in minimal or no harm.

A Welsh patient has been the victim of Verbal abuse – persistent/causing distress.

Moderate

An error in the prescribing, dispensing or administration of medication to a Welsh patient requiring medical monitoring.

An event involving controlled medication.

A Welsh Patient has been the victim of verbal abuse – threats to cause harm or damage.

Any discriminatory abuse, e.g. raciallymotivated abuse.

Severe

An error in the prescribing, dispensing or administration of medication to a Welsh patient, which requires medical treatment.

N/A

Critical

An error in the prescribing, dispensing or administration of medication to a Welsh patient, which results in actual or potentially life threatening harm or death.

N/A

National Collaborative Frameworks — Annual Report 2015-16

33

National Collaborative Framework (Adults)

Area

Guidance

Victim of disruptive, physically aggressive behaviour, violence

• Violence • Aggression • Persistent disruptive behaviour • Hostage taking

Perpetrator of disruptive, physically aggressive behaviour, violence

• Violence • Aggression • Persistent disruptive behaviour • Hostage taking

Victim of verbal abuse threats or bullying

• Verbal abuse • Any discriminatory abuse e.g. racial,

Perpetrator of verbal abuse, threats or bullying

• Verbal abuse • Bullying • Any

Self-harming behaviour/suicide

• Deliberate self harm • Attempted suicide • Suicide

Victim of sexual abuse/sexual violence

4.5%

1.1%

22.6% 10.1%

0.3% 1%

To tal

Cr itic al

Se ve re

Mo de rat e

Figure 21.

Mi no r

Ne gli gib le

Part 3: Ensuring Safe and Effective care

5.9% 0.1%

33.9%

1.5%

0.3%

0.1%

12%

5.1%

0.9%

0.1%

18.1%

13.4% 11.6%

1.3%

0.1%

26.4%

• Inappropriate sexual behaviour/ comments • Sexual assault • Rape

0.2%

0.1%

0.0%

Perpetrator of sexual abuse/ sexual violence

• Inappropriate sexual behaviour/ comments • Sexual assault • Rape

0.4%

0.6%

0.5%

0.0%

1.5%

Access, admission, transfer, discharge (including missing patient) – AWOL

• Absconsion • AWOL • Missing patient • Detention deemed

1.3%

0.1%

0.2%

0.2%

1.8%

Medication

• Prescribing error • Dispensing error • Administration error • NOT refusal

1.2%

0.9%

0.0%

Patient injury resulting from an accident or incident or is unexplained i.e. NON-CLINICAL

• Slips, trips and falls • Failure of buildings or equipment,

2.7%

1%

0.2%

Patient injury or harm resulting from any act or omission relating to care and treatment, clinical procedure or intervention i.e. CLINICAL

• Physical intervention • Infection control • Failure of observations • Medical device failure or misuse • Unavailable equipment

0.2%

0.1%

0.1%

Documentation, record keeping, data and legal, and property

• Confidentiality breach/data protection issue • Consent • MHA Documentation • MOJ/MAPPA breach • Clinical record/data loss • Misidentification • Loss of patient property

0.5%

0.2%

0.0%

0.1%

0.4%

0.5%

1.3%

0.7%

2.%

homophobic, disability

discriminatory abuse e.g. racial, homophobic, disability • Bullying

unlawful/lapsed in error

fixtures and fittings • Exposure to substances • NOT illness

Illicit substance/alcohol use or possession

• Possession or use of: alcohol/

Breach of security/contraband items

• Failure of security equipment or procedure • Contraband • Age inappropriate material • NOT

illicit substances

including alcohol/illicit substances

34

National Collaborative Frameworks — Annual Report 2015-16

1.9%

0.4%

2.1%

0.0%

0.1%

4.1%

0.5%

0.3%

1%

Fig. 21. shows the incident type and severity level of incidents, as a percentage of the total number of incidents, reported by providers between 1 October 2015 and 31 March 201611 involving patients receiving assurance under The Framework (Adults).

Fig. 21. demonstrates that, together, four types of reported incidents accounted for over half (57.7%) of all the incidents reported between 1 October 2015 and 31 March 2016: 22.6% Perpetrator of disruptive, physically aggressive behaviour, violence (negligible outcome)

29 COMPLAINTS All reported complaints involving patients receiving assurance of The Framework (Adults) are monitored by the NHS Wales Quality Assurance Improvement Team to highlight areas requiring investigation or improvement.

Reported complaints by patients receiving assurance of The Framework (Adults) are categorised against a bespoke 53 point matrix of 10 complaints areas with at least 4 sub-categories in each.

An example of two sections of the complaint matrix is shown in Fig. 22.

13.4% Self-harming behaviour/ suicide (negligible outcome) 11.6% Self-harming behaviour/ suicide (minor outcome) 10.1% Perpetrator of disruptive, physically aggressive behaviour, violence (minor outcome)

11 Only Incidents reported between 1 October 2015 and 31 March 2016 can be compared due to the incident matrix being modified in October 2015.

Figure 22.

Sub-category

Complaint area Hotel Services

Clinical Treatment

A. Food (quality/quantity/availability)

A. Relating to any act or omission

B. Accommodation (Facilities/maintenance)

B. Relating to physical health

C. Accommodation (cleanliness)

C. Relating to talking therapies

D. Lack of privacy/dignity

D. Side effects (effects/discussion of)

E. Accommodation (other)

E. Physical interventions F. Discontent/disagreement with treatment plan G. Includes Section 17 leave/community sessions H. Therapeutic sessions cancelled I. Poor access to staff for treatment/care purposes J. Clinical treatment (other) National Collaborative Frameworks â&#x20AC;&#x201D; Annual Report 2015-16

35

National Collaborative Framework (Adults) Part 3: Ensuring Safe and Effective care

30 SAFEGUARDING

Figure 23.

4% 1%

% of complaints 2014/15

1% 3%

Attitude/Behaviour of Staff Behaviour of other Patient(s) Equality & Diversity

14%

Patient Property

32%

4%

Hotel Services

18% 14%

Communication

9%

Clinical Treatment Hospital Protocols

4%

% of complaints 2015/16

4% 4%

1% 1%

Legal Other

29%

6% 14% 17%

20%

A total number of 258 complaints by patients receiving assurance of The Framework (Adults) were reported between 1 April 2015 and 31 March 2016.

The 258 complaints constitute a rise of 0.4% from the 257 complaints recorded in 2014/15 (although there were 3.8% more patients receiving care in 2015/16).

Across the 10 complaint areas Fig. 23. details the number of complaints (as a percentage of total complaints) received between 1 April 2015 and 31 March 2016.

These are compared to those reported between 1 April 2014 and 31 March 2015.

36

National Collaborative Frameworks â&#x20AC;&#x201D; Annual Report 2015-16

Safeguarding concerns can be potential or actual and they can cover physical abuse; sexual abuse; psychological abuse; financial or material abuse; discriminatory abuse; neglect; and acts of omission.

All potential safeguarding concerns involving patients receiving assurance of The Framework (Adults) are monitored at a patient, unit, hospital and provider, and service type by the NHS Wales Quality Assurance Improvement Team. Areas requiring investigation, intervention or improvement are highlighted.

The information includes type of safeguarding incident; the date safeguarding incidents occurred; date reported; name; and contact number of person reported to.

A total of 337 safeguarding concerns were reported to local safeguarding teams that involved patients receiving assurance of The Framework (Adults) between 1 April 2015 and 31 March 2016.

These safeguarding concerns are subsequently confirmed by local safeguarding teams as a reportable safeguarding event or not. Between 1 April 2015 and 31 March 2016 62% were confirmed (209) as reportable safeguarding concerns and 38% (128) were not.

The 337 safeguarding concerns constitute a decrease of 23.2% from the 439 safeguarding concerns reported in 2014/15.

32 ACTIVITY COSTS

Part 4: Delivering Better Value Whilst Improving Quality 31 SPEND AND COSTS The total annualised spend by NHS Wales on services provided through The Framework (Adults) as at 31 March 2016 equalled £54.143m per annum. This is up from £52.242m per annum on 31 March 2015 due to higher activity, and placements with higher cost providers. Fig. 24. demonstrates the distribution of this cost across each commissioning organisation.

Since the launch of The Framework (Adults) in 2012 the activity costs over a 4 year period from 20122016 equates to a reduction of £7.92m. This is detailed across the seven LHBs (all activity except medium secure) and WHSSC (medium secure).

Fig. 25. (overleaf) shows activity costs decreases or increases over each of the years The Framework (Adults) has been operational (‘-‘ denotes decrease in activity costs, ‘+’ denotes increase in activity costs).

Figure 24. £12,000,000

£10,000,000

£8,000,000

£6,000,000

£4,000,000

£2,000,000

0

12 Welsh Government, (2012) Together for Mental Health: A Strategy for Mental Health and Well‐being in Wales.

Cardiff: Welsh Assembly Government.

ABMUHB

ABUHB

BCUHB

CVUHB

CTUHB

HDUHB

PTHB

WHSSC

“We will require safe, effective and efficient services to provide value for money.”12 National Collaborative Frameworks — Annual Report 2015-16

37

National Collaborative Framework (Adults) Part 4: Delivering Better Value Whilst Improving Quality

33 COST REDUCTIONS

potential cost reductions of £5.214m for LHBs across providers since this date. This has been achieved by reductions in providers’ daily costs; and ‘price refresh’ exercises (permitted periodic revised price submissions by providers).

[Note that cost reductions do not include additional staffing costs, which historically cost several £m and which the National Collaborative Framework includes within the daily cost]

Fig. 26. details the potentially recurrent cash savings by each LHB, with the key dependency being patient activity and profile.

Based upon the patient placement profile as at 1 April 2012, The Framework (Adults) has delivered

Figure 25.

Activity costs 2013

Activity costs 2014

Activity costs 2015

Activity costs 2016

Total activity costs 2012-2016

ABMUHB

-£838,187

£384,946

£1,340,955

£355,660

-£1,243,374

ABUHB

-£3,352,747

£0

-£389,335

£1,092,109

-£2,649,973

BCUHB

£419,093

-£1,347,310

-£928,524

£1,466,442

£390,299

CVUHB

-£628,640

-£1,154,837

£937,707

£500,955

-£344,815

CTUHB

£209,547

-£1,732,256

-£183,460

£258,230

-£1,447,939

HDUHB

£628,640

-£962,364

-£362,482

-£1,229,813

-£1,926,019

PTHB

-£419,093

£0

-£427,714

£414,304

-£432,503

WHSSC

£210,848

-£1,768,878

£535,685

-£958,468

-£1,980,813

Total

-£3,770,539

-£6,580,699

£522,833

£1,899,420

-£7,928,985

Figure 26.

£1,300,000 £975,000 £650,000 £325,000 £0

ABMUHB

ABUHB

Recurrent cash saving 2014/15

38

BCUHB

CVUHB

CTUHB

Recurrent cash saving 2015/16

National Collaborative Frameworks — Annual Report 2015-16

HDUHB

PTHB

WHSSC

Section 3 National Collaborative Framework (CAMHS)

National Collaborative Frameworks â&#x20AC;&#x201D; Annual Report 2015-16

39

National Collaborative Framework (CAMHS) 34 OVERVIEW

The majority of information in this section is for the period 1 July 2015 to 31 March 2016 when NHS National Collaborative Commissioning acquired responsibility for performance and contractual management of The Framework (CAMHS).

On 31 March 2016 there were 10 patients of NHS Wales receiving assurance under The Framework (CAMHS) compared to 12 on 1 April 2015. This is a decrease of 20%.

There are 3% of patients receiving assurance from The Framework (CAMHS) compared to that of the The Framework (Adults) so caution must be exercised in forming comparisons.

Fig. 27. shows the total number of patients by type of care from 1 April 2015 to 31 March 2016.

As of 31 March 2016, of the 10 Welsh patients receiving assurance under The Framework (CAMHS), 30% (3) of the total were male and 70% (7) were female. This is shown in Fig. 28.

Figure 27.

Figure 28.

10

Female 70%

8

6

4

2

0

Male 30% Low Secure Male Number of patients 1 April 2015

40

Low Secure Female

Acute Male

Acute Female

Number of patients 31 March 2016

National Collaborative Frameworks â&#x20AC;&#x201D; Annual Report 2015-16

35 PROVIDERS There were 15 hospital sites and 29 individual units (wards) providing or potentially providing service under The Framework (CAMHS) on 31 March 2016.

The map right shows the approximate geographical position of hospitals caring for CAMHS patients.

36 COUNTRY OF PLACEMENT Mapping CAMHS patients receiving assurance under The Framework (CAMHS) within the borders of either England or Wales (none were placed in any other country) shows that overall 60% of patients were cared for in hospitals within Wales on 31 March 2016 (compared to 16.7% on 1 April 2015). 40% were in hospitals within England.

Since 1 April 2015 there has been a more than threefold increase in the number of CAMHS patients cared for in hospitals within Wales.

Fig. 29. details the number of patients receiving assurance under The Framework (CAMHS) between 1 April 2015 and 31 March 2016 by country.

Figure 29.

10

8

6

4

2

0

England 2015

Wales

2016

National Collaborative Frameworks â&#x20AC;&#x201D; Annual Report 2015-16

41

National Collaborative Framework (CAMHS) 37 LENGTH OF STAY

44%

of CAMHS patients had a stay of less than 6 months

38 HOSPITAL QUALITY ASSURANCE REVIEWS

A total of 29 patients who received assurance under The Framework (CAMHS) were discharged between 1 April 2015 and 31 March 2016.

The total length of stay with their final provider prior to discharge was:

Hospital quality assurance reviews on The Framework (CAMHS) providers are undertaken by the NHS Wales Quality Assurance Improvement Team.

44.4% (12) had a length of stay of less than 6 months;

11 individual The Framework (CAMHS) provider units were subject to a provider hospital quality assurance review between 1 July 2015 and 31 March 2016.

40.3% (11) had a length of stay of between 6 months and 1 year; and

Subsequent to each hospital quality assurance review, a ‘provider assurance report’ is completed and published on CCAPS.

13.6% (6) had a length of stay of between 1 and 2 years.

Fig. 30. details the completed length of stay of patients receiving assurance under The Framework (CAMHS) and discharged between 1 April 2015 and 31 March 2016 by type of care.

Figure 30.

1

2

1

1

1

4

5

8

4

2

Less than 6 months Low Secure Male

42

Low Secure Female

6 months to 1 year Acute Male

Acute Female

National Collaborative Frameworks — Annual Report 2015-16

1 to 2 years

39 QUALITY ASSURANCE RATINGS There were 15 patient placements commissioned13 between 1 April 2015 and 31 March 2016 under The Framework (CAMHS). 100% of these were placed with a provider who had maintained the ‘3Q’ quality assurance rating.

40 INCIDENTS A total of 1,144 incidents involving patients receiving assurance under The Framework (CAMHS) were reported between 1 July April 2015 and 31 March 2016.

Of these incidents: 839 or 73.3% were classed as negligible; 269 or 23.5% were classed as minor; 29 or 2.5% were classed as moderate; 4 or 0.3% were classed as severe; and 3 or 0.3% were classed as critical.

13 There were also 4 patients transferred onto The Framework (CAMHS) on 1 April 2015.

National Collaborative Frameworks — Annual Report 2015-16

43

Se ve re

Guidance

Victim of disruptive, physically aggressive behaviour, violence

Violence • Aggression • Persistent disruptive behaviour • Hostage taking

0.6%

1.0%

0.3%

0.1%

Perpetrator of disruptive, physically aggressive behaviour, violence

Violence • Aggression • Persistent disruptive behaviour • Hostage taking

12.9%

8.2%

0.6%

Perpetrator of verbal abuse, threats or bullying

Verbal Abuse • Any discriminatory abuse e.g. racial, homophobic, disability • Bullying

3.2%

1.2%

0.2%

Self-harming behaviour/ suicide

Deliberate self harm • Attempted suicide • Suicide

55.0% 11.9%

1.3%

Victim of sexual abuse/ sexual violence

Inappropriate sexual behaviour/ comments • Sexual assault • Rape

Perpetrator of sexual abuse/ sexual violence

Inappropriate sexual behaviour/ comments • Sexual assault • Rape

0.3%

0.5%

0.9%

Access, admission, transfer, discharge (including missing patient) – AWOL

Absconding • AWOL • Missing patient • Detention deemed unlawful/lapsed in error

0.7%

0.1%

0.8%

Medication

Prescribing error • Dispensing error • Administration error • NOT refusal

0.2%

0.3%

0.4%

0.1%

Patient injury resulting from an accident or incident or is unexplained i.e. NON-CLINICAL

Slips, trips and falls • Failure of buildings or equipment, fixtures and fittings • Exposure to substances • NOT illness

Documentation, record keeping, data and legal, and property

Confidentiality breach/data protection issue • Consent • MHA documentation • MOJ/MAPPA breach • Clinical record/data loss • Misidentification • Loss of patient property

0.1%

Breach of security/ contraband items

Failure of security equipment or procedure • Contraband • Age inappropriate material • NOT including alcohol/illicit substances

0.3%

44

0.1%

National Collaborative Frameworks — Annual Report 2015-16

2.1%

0.1%

0.1%

21.9%

4.7%

68.2% 0.1%

0.1%

To tal

Mo de rat e

Area

Figure 31.

Cr itic al

Ne gli gib le Mi no r

National Collaborative Framework (CAMHS)

0.1%

0.4%

0.2%

0.1%

0.1%

0.3%

Fig. 31. shows the incident type and severity level of incidents, as a percentage of the total number of incidents, reported by providers between 1 July 2015 and 31 March 2016 involving patients receiving assurance under The Framework (CAMHS). Only those areas with reported incidents have been shown. A full table can be seen in The Framework (Adult) section of this report: Fig. 31. demonstrates that, together, two types of reported incidents accounted for the majority 67.9%) of all the incidents reported between 1 July 2015 and 31 March 2016: 55% Self-harming behaviour/ suicide (negligible outcome) 12.9% Perpetrator of disruptive, physically aggressive behaviour, violence (negligible outcome)

41 COMPLAINTS A total number of 11 complaints by patients receiving assurance under The Framework (CAMHS) were reported between 1 April 2015 and 31 March 2016. Fig. 32. provides details of these 11 complaints.

42 SAFEGUARDING A total of 14 safeguarding concerns were reported to local safeguarding teams that involved of placements patients receiving made with assurance under The 3Q providers Framework (CAMHS) between 1 April 2015 and 31 March 2016.

100%

These safeguarding concerns were subsequently confirmed by local safeguarding teams as a reportable safeguarding event or not, between 1 April 2015 and 31 March 2016.

42.9% (6) were confirmed as reportable safeguarding concerns and 57.1% (8) were not.

Figure 32.

3

Behaviour of other patient â&#x20AC;&#x201C; directly or indirectly Noise

2

Attitude

2

Staff (other)

2

Poor communication skills

1

Physical interventions

1

National Collaborative Frameworks â&#x20AC;&#x201D; Annual Report 2015-16

45

46

National Collaborative Frameworks â&#x20AC;&#x201D; Annual Report 2015-16

Appendices

National Collaborative Frameworks â&#x20AC;&#x201D; Annual Report 2015-16

i

Appendix A National Collaborative Framework (Adults) Local Health Board Trends

This Appendix will provide an analysis of the National Collaborative Framework (Adults) Local Health Board patient profile on 31 March 2014, 2015 and 2016 by type of care.

Figure A (i).

30 25 20 15 10 5 0 Medium Secure 2014

2015

Low Secure

Controlled Egress

Uncontrolled Egress

2016

Figure A (ii).

40

20 10 0 Medium Secure 2014

2015

Low Secure

II. ANEURIN BEVAN UNIVERSITY HEALTH BOARD (ABUHB)

Controlled Egress Uncontrolled Egress

2016

Figure A (iii).

30

III. BETSI CADWALADR UNIVERSITY HEALTH BOARD (BCUHB) The number of BCUHB patients receiving assurance under The Framework (Adults) across all types of care increased by 27.4% between 31 March 2014 (62) and 31 March 2016 (79).

Fig. A (iii) showing the three year trend across all types of care.

25 20 15 10 5 Medium Secure 2014

ii

The number of ABMUHB patients receiving assurance under The Framework (Adults) across all types of care increased by 12.5% between 31 March 2014 (56) and 31 March 2016 (63).

Fig. A (i). showing the three year trend across all types of care.

The number of ABUHB patients receiving assurance under The Framework (Adults) across all types of care decreased by 4.3% between 31 March 2014 (69) and 31 March 2016 (66).

Fig. A (ii) showing the three year trend across all types of care.

30

0

I. ABERTAWE BRO MORGANNWG UNIVERSITY HEALTH BOARD (ABMUHB)

2015

Low Secure

Controlled Egress Uncontrolled Egress

2016

National Collaborative Frameworks â&#x20AC;&#x201D; Annual Report 2015-16

IV. CARDIFF AND VALE UNIVERSITY HEALTH BOARD (CVUHB)

Figure A (iv).

30 25

The number of CVUHB patients receiving assurance under The Framework (Adults) across all types of care increased by 7.7% between 31 March 2014 (52) and 31 March 2016 (56) Fig. A (iv) showing the three year trend across all types of care.

V. CWM TAF UNIVERSITY HEALTH BOARD (CTUHB)

20 15 10 5 0 Medium Secure 2014

2015

Low Secure

Controlled Egress Uncontrolled Egress

2016

Figure A (v).

The number of CTUHB patients receiving assurance under The Framework (Adults) across all types of care remained unchanged between 31 March 2014 (44) and 31 March 2016 (44).

Fig. A (v) showing the three year trend across all types of care.

30 25 20 15 10 5 0 Medium Secure

VI. HYWEL DDA UNIVERSITY HEALTH BOARD (HDUHB)

2014

The number of HDUHB patients receiving assurance under The Framework (Adults) across all types of care decreased by 26.5% between 31 March 2014 (34) and 31 March 2016 (25).

Fig. A (vi) showing the three year trend across all types of care.

VII. POWYS TEACHING HEALTH BOARD (PTHB) The number of PTHB patients receiving assurance under The Framework (Adults) across all types of care remained unchanged between 31 March 2014 (22) and 31 March 2016 (22).

Fig. A (vii) showing the three year trend across all types of care.

2015

Low Secure

Controlled Egress Uncontrolled Egress

2016

Figure A (vi).

25 20 15 10 5 0 Medium Secure 2014

2015

Low Secure

Controlled Egress Uncontrolled Egress

2016

Figure A (vii).

10 8 6 4 2 0 Medium Secure 2014

2015

Low Secure

Controlled Egress Uncontrolled Egress

2016

National Collaborative Frameworks â&#x20AC;&#x201D; Annual Report 2015-16

iii

Appendix B National Collaborative Framework (Adults) Quality Improvement plan 2016/17

In order to demonstrate continuous quality improvement, the NHS Wales Quality Assurance Improvement Team will undertake a greater number of focused hospital quality assurance reviews in 2016/2017.

The focus of these reviews will be on the following areas (as being the standards least maintained in 2015/2016): Patient participation in care plan review meetings; Multi-disciplinary team reviews of Care and Treatment Plan(s), effectiveness and outcomes; Physical or health and well-being care planning and interventions.

NHS Wales Quality Assurance Improvement Team is aiming for a minimum 86% compliance rate (the average in 2015/2016) across the above three areas by March 2017.

The NHS Wales Quality Assurance Improvement Team will also focus on working with providers in addressing the issues that gave rise to complaints in the following areas Patient property – loss of patient’s own property; Attitude/behaviour of staff – attitude; Attitude/behaviour of staff – lack of support.

NHS Wales Quality Assurance Improvement Team will also be undertaking increased compliance reviews in 2016/17. This is to ensure providers’ reporting of incidents, complaints, safeguarding events and required care outcomes conform with National Collaborative Framework contractual obligations.

EXTERNAL RECOGNITION Finalist: HSJ Value in Healthcare Awards 2015

Winner: HSJ Efficiency Awards 2013

Finalist: Patient Safety and Care Awards 2014

Winner: Government Opportunities Award 2012

Winner: Welsh Public Sector Procurement Awards 2013

iv

National Collaborative Frameworks — Annual Report 2015-16

EPILOGUE Thank you for taking time to read this annual report. I have made every effort to ensure all the information within this report is correct at the time of going to print, however, if errors have occurred please let me know.

If you have any queries about this annual report, the National Collaborative Frameworks or the work of the NHS Wales Quality Assurance Improvement Team in

general please contact us on 029 20336278 and we will be happy to answer any queries.

Kind regards

Clinical Lead, NHS Wales National Collaborative Commissioning

DELIVERING IN PARTNERSHIP Bwrdd Iechyd Prifysgol Cwm Taf University Health Board

Partneriaeth Cydwasanaethau

Gwasanaethau Caffael

Shared Services Partnership

Procurement Services

Gwasanaeth Gwybodeg Informatic Service

NHS Wales Collaborative Commissioning is hosted by Cwm Taf University Health Board on behalf of NHS Wales.

The National Collaborative Frameworks are developed and monitored in partnership between NHS Wales Collaborative Commissioning and NHS Wales Shared Services Partnership: Procurement Services on behalf of NHS Wales.

The Commissioning Care Assurance and Performance System was developed in partnership between NHS Wales Collaborative Commissioning and NHS Wales Informatics Services on behalf of NHS Wales.

Delivering Information and Technology for better care

National Collaborative Frameworks â&#x20AC;&#x201D; Annual Report 2015-16

v

This report was written by Shane Mills, Clinical Lead for NHS Wales Collaborative Commissioning Contactable at National Collaborative Commissioning Unit by e-mail at GIG.SSLT@wales.nhs.uk This report was designed by Scarlet Design International Ltd www.franohara.com Barod CIC reviewed the text and design of the Annual Report, to advise on accessibility and readability for the target audiences (www.barod.org).

This report is the property of Cwm Taf University Health Board; it must not be copied in whole or in part without the express permission of the author. ŠNHS Wales, 2016.