NHS England Improvement and Assessment Framework rating for Tower Hamlets CCG

NHS England Improvement and Assessment Framework Tower Hamlets CCG

How is the CCG’s performance managed?

Every year, NHS England rate the performance of Clinical Commissioning Groups (CCGs) using a tool called the Improvement and Assessment Framework (IAF). Anybody can view these ratings, by looking at the My NHS website. The IAF plays an important role for NHS Tower Hamlets Clinical Commissioning Group (Tower Hamlets CCG) because it helps us to improve the outcomes for patients who live in and use NHS services in Tower Hamlets.

How does the IAF measure performance?

The IAF looks at four areas of the CCG’s performance:

  • Better health: This area looks at how the CCG is helping to improve the health and wellbeing of its population
  • Better care: This area focuses on care redesign and performance against constitutional standards and outcomes in important clinical areas
  • Sustainability: This area looks at how the CCG is maintaining financial balance and securing good value for patients and the public
  • Leadership: This area assesses the quality of the CCG’s leadership and its plans, how the CCG works with its partners and the governance arrangements that the CCG has in place to ensure it acts with probity, for example in managing conflicts of interest

Performance successes in 2016-17

Tower Hamlets CCG performed well in a number of areas this year, with mental health and dementia being some of our strongest performance areas. Within mental health, 100% of adult mental health care placements stayed in Tower Hamlets and 100% of people who were experiencing their first episode of psychosis started a package of care within two weeks of being referred. 

Some other areas where we performed well included:

  • Diabetes- 45.9% of patients with diabetes are meeting the treatment targets. This is the highest average in North East London and higher than the national average.
  • Low injury from fall rates- Tower Hamlets had one of the lowest rates of injuries from falls in people over the age of 65, with this happening to 287 people. This is the lowest in North East London and significantly lower than the national average of 1,985.
  • Reduced waiting time for hospital treatment- This year more people were seen in hospital within 18 weeks of being referred than last year.

There are other areas where we performed well this year. Further details about our areas of good performance can be found in the full IAF report on the MyNHS Website.

What are we doing to improve performance in key areas

There are a number of areas where we are working to make improvements. The sections below provide details about these areas as well as the steps we are taking to improve our performance.

Management of long-term conditions

People with a long-term condition should feel that they have had enough support from local services or organisations to help them manage their long-term health condition.

An ambitious ‘Tower Hamlets Together’ programme aims to coordinate care and support for people with long term conditions and to improve their health and wellbeing. We have made some key improvements in coordinating care and support for people with long term conditions by:

  • creating a single point of contact for patients with all types of care needs
  • responding quickly to those with an urgent health problem
  • improving access to health, social care and wellbeing support
  • reducing duplication (lots of different services delivering the same support) and improving the way we share information
  • giving people more choice of where they receive care and treatment, providing care close to people’s homes and preventing people from being kept in hospital for longer than they need to
  • Ensuring people are given the information and support they need to manage their own conditions and ultimately improve their health and wellbeing.

Number of people with personal health budgets

Since this data was collected, the number of people with personal health budgets in Tower Hamlets has increased to over 100. From 1 June 2017, the eligibility criteria for personal health budgets has been simplified and expanded to include more groups of people which will further improve access and increase uptake of personal health budgets in Tower Hamlets. We are working with key partners and the community and voluntary sector to improve awareness and uptake of personal health budgets in Tower Hamlets.

Progress against workforce race equality standard

Tower Hamlets CCG has developed an equality and diversity strategy which was published shortly after the IAF data was gathered in 2015. Our strategy is linked to our partner’s equality and diversity strategies, which allows us to align our polices and ways of working across Tower Hamlets. This means we can coordinate our efforts to implement processes and programmes aimed at improving equality standards and outcomes for the workforce in our borough.

Over the past year we have made great improvements around the workforce race equality standard, and to further build upon these improvements we have set up an Equality and Diversity Working Group. One of the focal areas of this group will be to work closely with our providers to address areas that require improvement and to seek assurance through the monitoring of the NHS Standard Contract and ensuring they meet the relevant duties.

Tackling childhood obesity

Although rates for childhood obesity for children aged 10-11 years remain higher than the regional and national average, we have made improvements in this area since the IAF data was published in 2015.

One way we are addressing the high rates of childhood obesity is through the Tower Hamlets Childhood Obesity Programme, which aims to reduce the amount of unhealthy food available by legislating to create healthier food environments, promoting physical activity and encouraging local organisations to do their part in promoting healthy lifestyles to children in Tower Hamlets. There are also a number of strategies and policies in place to ensure that ‘healthy weight and nutrition for children’ is a priority for commissioners and programme leads in Tower Hamlets. These strategies have led to the development of the infant feeding and healthy schools programmes which are proving successful.

Cancer: early diagnosis

In order to diagnose cancer earlier, we are focusing on promoting prevention and public awareness of cancer through educating people about the key signs and symptoms and where they can go to get these checked. This work is carried out through a coordinated campaign with the London Borough of Tower Hamlets (the local council), the Health and Wellbeing Board and the NHS England Screening Local Area Teams.

In addition, to improve earlier diagnosis we are carrying out a review of the current ways people are checked for cancer which will help us better understand the best methods to find and diagnose cancer. We are also working to improve the way people receive cancer care in Tower Hamlets to improve patient experience and enable earlier diagnosis.

Cancer: one-year survival rates

One of the reasons Tower Hamlets has poor cancer survival rates is due to late diagnosis which can be caused by a variety of issues including discovery of cancer at more advanced stages and delays in referrals and investigations. We know that earlier discovery of cancer increases the one-year survival rate. In order to support earlier diagnosis, we are reviewing the way we check for and report on cancer. Additionally, we have developed an ongoing programme of support for early detection through supporting GP’s to diagnose cancer as early as possible. We are also continuously promoting uptake of the bowel, breast and cervical screening service together with NHS England, local partners and GP’s.

Cancer: patient experience

Our aim is to provide holistic support to Tower Hamlets residents who are living with and beyond cancer, especially as the number of those living with cancer is expected to rise. In order to improve the support available to people, we are implementing the ‘recovery package’ which is a combination of interventions that when delivered together aim to greatly improve the care and health of people living with and beyond cancer.

Maternity services

Women’s experience of maternity services and choice in maternity services in Tower Hamlets were both rated below the national average. These figures are based on data from 2015 and progress has been made to improve the experience of care and increase choice in maternity services since then.

We continue to work with our colleagues at Barts Health to improve maternity services. The Lotus Birth Centre opened in December 2016 at the Royal London Hospital and provides more tailored maternity care for local women. The local Maternity Voices Partnership continues to engage many local mothers-to-be gathering their views on services and working with providers to improve patient experience of maternity care.

Work also continues on improving provision for the most vulnerable mothers-to-be in Tower Hamlets. We are reviewing the services in the borough for vulnerable mothers-to-be in order to ensure the best use of resources and coordinated care to support women and their babies who are most risk of poor health outcomes. 

Patient experience of GP services

Patient experience in GP practices is slightly below average in Tower Hamlets. Since this data was gathered in 2015, we have been working on a variety of initiatives including a quality improvement programme designed to manage the high demand on primary care services. This quality improvement programme will ultimately improve patient experience by improving access and allowing GPs to focus more on patient centred care. Additionally, GP practices have access to current data on their own performance which supports continuous quality improvement.

Tower Hamlets is ranked in the top three CCG areas nationally for 10 of the 65 clinical indicators that make up the latest NHS quality and outcomes framework (QOF). Tower Hamlets also ranked highest in London for practices that were rated ‘Outstanding’ (10.8%) by the Care Quality Commission (CQC).

Quality of life for carers

The CCG is working with local carers and the London Borough of Tower Hamlets to develop and implement a local carers’ strategy that aims to improve the quality of life for local carers. The strategy is made up of five priority areas:

  • Identification and recognition

Supporting those with caring responsibilities to identify themselves as carers at an early stage, recognising the value of their contribution and involving them from the outset both in designing local care provision and in planning individual care packages

  • Realising and releasing potential

Enabling those with caring responsibilities to fulfil their educational and employment potential

  • A life outside of caring

Personalised support both for carers and those they support, enabling them to have a family and community life

  • Supporting carers to stay healthy

Supporting carers to remain mentally and physically well

  • Transition

Supporting carers to make the transition to the use of Adult Services smoothly, providing the necessary information and guidance to parents of young people who are transitioning to using Adult Services

The draft strategy is available at: https://democracy.towerhamlets.gov.uk/mgConvert2PDF.aspx?ID=100141     

As part of this work, a carers’ lead will soon be appointed to work across all key health and social care partners to better understand and improve the experience of carers into the future.

Staff engagement index

The CCG has participated in the NHS Staff Survey since 2015. This helps us to understand the experiences of our workforce. The overall staff engagement score for Tower Hamlets CCG, was 4.11 out of 5. This was significantly higher than the national CCG average of 3.89. The survey data forms part of other data sets that are used to measure this staff engagement index.

We were particularly pleased with our staff engagement score in 2016. Survey results showed significant improvements in staff feeling able to contribute to change at work and feeling valued by the CCG appraisal process. We were also significantly higher than average in relation to people feeling satisfied with opportunities, feeling supported and valued at work and feeling that the organisation takes an active approach to health and wellbeing. Overall, we feel that we are a strong, collaborative organisation, where staff are valued and engaged, listened to and involved; in testament to this, 85% of staff said that they would recommend Tower Hamlets CCG as a place to work.

We take pride in the investment we make in our workforce including in areas such as appraisal, learning and development, engagement and health and wellbeing.  Tower Hamlets CCG will be building on our existing programmes in 2017/18 to continue to support and enable a strong and healthy workforce.

Provision of high-quality care

NHS Tower Hamlets CCG commissions Barts Health NHS Trust and East London Foundation Trust to deliver acute and mental health services for the people in Tower Hamlets.

Following a CQC inspection visit to ELFT in June 2016, the organisation was rated as an ‘outstanding’ provider of mental health services. ELFT remains one of two mental health providers nationally to be rated as ‘outstanding’ by the CQC. The CCG continues to work with ELFT to support delivery of outstanding services in Tower Hamlets.

During 2016-17, Barts Health NHS Trust continued its efforts to improve the quality of services it delivers. The Royal London Hospital moved from an ‘inadequate’ rating to ‘requires improvement’. To support improvements to the quality of services it delivers, Barts Health have implemented a new leadership model, focusing on site leadership and the development of strong clinical leadership. In recognition that leadership in maternity services needed to improve at the Royal London Hospital, a Clinical Director has been appointed to strengthen clinical leadership with the Maternity and Obstetrics service. The CCG also focuses on maternity improvement on a quarterly basis at Clinical Quality Review Meetings.

Where can I get more information?

Tower Hamlets CCG is encouraged by the improvements that have been made across a wide range of key indicators since this data was compiled for this assessmment in 2015, and continues to focus on improvement across all performance areas.

Tower Hamlets CCG continues to face a number of challenges in ensuring improvement in the healthcare services we commission. However, through our commitment to working in partnership and supporting improvement, we are confident we will be able to address these challenges and continually improve the quality of care and life for the people of Tower Hamlets.

For the full IAF report, please see the MyNHS website

If you would like to hear more about our work and our recent assurance results, please contact us at thccg.info@nhs.net