Thursday, 21 March 2013

Francis is an opportunity. A chance to re-assess what we are doing as commissioners and why!

At our CCG Governing Body meeting in March 2013, we held our first discussion in public about the consequences for commissioners of the Francis Report.
To simplify this we produced Francis on a page.  It was not meant to be comprehensive, but was intended to provoke an open discussion about change!

Quality first
  •   Basic standards of care should ALWAYS be applied.  If/where this is established not to be the case then commissioners should act on this.  Commissioners should challenge themselves with this.  ‘How would we know?’  Where appropriate commissioners should request the suspension of services on the grounds of safety
  • Nursing leadership and appropriate capacity should be in place on every Hospital ward, for every shift.  This should be properly resourced (and enforced through the contract)
  • More attention is needed on the fundamental care of the frail and elderly.  This should apply to all   commissioned settings of care.
Getting the basics right
  • Commissioners should have the tools to assess and/or assure themselves about service quality 
  •  National targets and pledges may not get to the fundamental requirements of safety.  
  •  Commissioners should have active and ongoing engagement with service users and the public, and  patient stories should be used to supplement and/or challenge data and other system/process outputs
  • Changes to organisational structure and/or configuration and/or leadership can lead to a loss of corporate memory regarding service quality and safety.  Mechanisms to provide continuity are important.
An open culture
Commissioners should:
  • Welcome complaints
  • Be open in acknowledging service difficulties, and encourage providers to do the same. 
  • Acknowledge and promote the need for transparency.

Contracts that work for patients and clinicians

Commissioners should consider how to enforce, and specifically :
  • Improve service specifications so that the quality of service and patient experience aspects are more relevant to the patient receiving the service, and the professionals providing the day to day care.
  • Enhanced quality standards should be devised and paid for by commissioners, local knowledge should lead to a more intelligent design.
  • Contractual service standards should be agreed with front-line clinicians, and expressed in a way that is relevant to day to day care.
  •   Monitoring of contract standards should be relevant to clinicians and the public.
  • Sanctions and incentives are legitimate, they need to be understandable, and acceptable to medical and nursing leadership.
  • Finance and contract leadership should recognise the importance of resources being deployed to the front-line.

We purchase care on your behalf

Commissioning is a confusing term.  CCG’s should explain to the public that ‘we purchase care on your behalf’.  CCG’s should also:
  • Use multiple ways of engaging, and keep refreshing this.
  • Find ways that work, of patients monitoring standards on our behalf.
  • Ask patients about their experience at an individual/practice level and collate this.
  • Encourage member Practices to follow-up with more patients to assess whether the care experience was positive.
  • Make more information available to patients so they can assess how good a doctor/ward/hospital is before making a choice.
  • Be prepared to tell good and bad stories about services and the patient experience.  Emphasising good care is also important.

This debate was important, it was stimulating and challenging, clinicians and lay members and the management team all offered their perspective.  What is more important is what we do and how we do it.  Contracts are about to be agreed for services in 2013/14.  It is essential that they provide a framework to improve quality and patient care.

Francis is an opportunity.  A chance to re-assess what we are doing as commissioners and why!

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