YORKSHIRE & THE HUMBERYORKSHIRE & THE HUMBER

RREEGGIIOONNAALL IINNDDIICCAATTOORRSS FFOORR 22001100//22001111

CCOOMMMMUUNNIITTYY CCQQUUIINN SSCCHHEEMMEE

VVeerrssiioonn 11..00 -- FFiinnaall

Standard template for CQUIN schemes in national contracts

COMMUNITY

Coordinating Commissioner [to be completed by commissioner]

Associate Commissioners [to be completed by lead commissioner]

Expected financial value of Scheme £ [to be completed by commissioner]

Goals and Indicators

Goal no.

Description of goal

Quality Domain(s) 1

Indicator number2

Indicator name National or Regional indicator 3

Indicator weighting

1 Increasing the number of personalised care plans that assist patients in experiencing seamless responsive care in accordance with their wishes. Agencies will have a single, common vehicle to improve communication and understanding. Reducing admissions and improving health outcomes.

Effectiveness

Patient Experience

Improving and sharing personalised care plans for patients with Long Term condition

Regional Locally determined

2 Patients and carers will be able to expect the highest possible standards of end of life care

Effectiveness

Patient Experience

Improving the quality of palliative care

Regional Locally determined

3 Improve safeguarding of vulnerable children by improving the numbers of level 3 staff having supervision

Patient Safety

Use of Common Assessment Framework (CAF) for vulnerable children

Regional Locally determined

1 Safety / Effectiveness / Experience / Innovation 2 May be several for each goal 3 Nationally mandated / Regionally mandated/ Regionally suggested/ No

4 Level of Child Protection Supervision given to Level 3 staff that has regular contact with Children, young people and parents

Patient Safety

Child Protection Supervision

Regional Locally determined

5 Improve the focus on the care of the patients, in line with Essence of Care. Use of validated nutritional indicator screening tool will be encouraged to reduce rates of malnutrition and associated adverse outcomes

Patient Safety

Patient Experience

Effectiveness

Care and compassion – Nutrition

Regional Locally determined

6 Improvement in pressure Ulcer prevention and management in line with Essence of Care.

Patient Safety

Patient Experience

Effectiveness

Care and compassion – Pressure Ulcers

Regional Locally determined

Detail of Indicator 1 – Long Term Conditions

Description of indicator Improving and sharing personalised care plans for patients with Long Term condition

Denominator 1 The total of GP registered population in the health economy

Numerator 1 The number (WTE) of community Matrons/Case Managers employed purely for the purpose of managing people with long term conditions*

Denominator 2 The number of people at the end of the quarter with a long term condition* on the caseload of a mainstream nursing service

Numerator 2 (i) The number of these people (Denominator 2) who have a single personalised care plan developed by the community provider which is shared with, recognised and used by all agencies in contact with the patient

(ii) The number of patients on a caseload at the end of the quarter who are cared for by community Matrons/Case managers

(iii) Number of admissions of these people (Denominator 2) in the quarter

Denominator 3 The number of people at the end of the quarter on an end of life pathway who are on the caseload of a mainstream nursing service.

Numerator 3 The number of these people (Denominator 2) who have a single personalised care plan developed by the community provider which is shared with, recognised and used by all agencies in contact with the patient

Rationale for inclusion

Evidence exists that agencies often act in silos and this indicator attempts to provide a solution by making provider arms responsible for developing personalised care plans for use by all agencies. Patients will begin to experience seamless responsive care in accordance with their wishes and agencies will have a single, common vehicle to improve communication and understanding. Reducing admissions and increasing health outcomes.

Data source and frequency of collection

Community provider arms will become responsible for developing a single personalised care plan in conjunction

with patients in contact with their service who have a long term condition or are on an end of life pathway.

The single plan will be shared with, recognised by and used by all agencies with whom the patient comes into contact including acute and ambulance trusts, independent contractors, out of hours providers and social care providers.

The use of the Year of Care template (or equivalent) for long term conditions or Liverpool Care Pathway (or equivalent) for end of life will be expected. The provider will be responsible for completing and sharing the ‘do not attempt resuscitation’ element of the documentation.

Organisation responsible for data collection

Provider

Frequency of reporting to commissioner

Quarterly

Baseline period / date Quarter 1

Baseline value To be agreed

Final indicator period / date (on which payment is based)

Quarter 4 – Interim achievement may be agreed

Final indicator value (payment threshold)

Final indicator reporting date

Quarter 4

Rules for partial achievement of indicator at year-end

Rules for any agreed in-year milestones that result in payment

Rules for delayed achievement against final indicator period/date and/or in-year milestones

Providers to have a static or decreasing trend in admission rates of the patients on the community Matron caseload.

Additional Information

*Definition of Long Term Condition: Long Term Condition is defined as those conditions that cannot, at present, be cured, but can be managed by medication and other therapies. They include diabetes, asthma, heart failure, enduring mental health problems and chronic obstructive pulmonary disease.

Detail of Indicator 2 – End of Life Care

Description of indicator Improving the quality of palliative care

Denominator 1 Number of patients identified as being End Of Life

Numerator 1 Number of patients identified as being End Of Life and who are on the End of Life Care Register.

Numerator 2 No. of patients (Numerator 1) who are on the Liverpool Care Pathway or equivalent.

Denominator 3 Number of patients who died whilst on the Liverpool Care Pathway or equivalent and who had a preferred place of death

Numerator 3 Number of patients who died whilst on the Liverpool Care Pathway or equivalent, who had a preferred place of death and did actually die in that place.

Rationale for inclusion Patients and carers will be able to expect the highest possible standards of end of life care

Data source and frequency of collection

Quarterly Provider returns

Organisation responsible for data collection

Provider

Frequency of reporting to commissioner

At the end of each Quarter

Baseline period / date Qu 1 10/11

Baseline value [to be completed by commissioner]

Final indicator period / date (on which payment is based)

Quarter 4

Final indicator value (payment threshold)

Final indicator reporting date Quarter 4

Rules for partial achievement of indicator at year-end

Rules for any agreed in-year milestones that result in payment

Providers to increase the number of patients dying at their preferred place of death by 10% on 2009/10 baseline and ensure the patients are on a Gold standard or equivalent

Quarter 1 – set baseline from 2010/11 quarter 1 data Quarter 2 set trajectory of 10% improvement for each trust, to be monitored over Quarter 2,3 & 4

Rules for delayed achievement against final indicator period/date and/or in-year milestones

Additional Information For those patients that state ‘no preference’ as expressed choice, are excluded from the count of Numerator 1 and Numerator 2

Detail of Indicator 3 – Common Assessment Framework

Description of indicator Use of Common Assessment Framework (CAF) for vulnerable children

Denominator 1 For each age band 0-5, 6-11, 12-18:Total number of children with a CAF initiated during the quarter

(i) For each age band 0-5, 6-11, 12-18: the number of (Denominator 1) where the CAF was initiated by a health professional

Numerator 1

(ii) For each age band 0-5, 6-11, 12-18: the number of (Denominator 1) where the CAF is led by a health professional irrespective of who initiated it

Rationale for inclusion Improve safeguarding of vulnerable children

Data source and frequency of collection

Provider Quarterly returns

Organisation responsible for data collection

Provider

Frequency of reporting to commissioner

Quarterly

Baseline period / date 2009/10 data

Baseline value [to be completed by commissioner]

Final indicator period / date (on which payment is based)

Quarter 4

Final indicator value (payment threshold)

Final indicator reporting date Quarter 4

Rules for partial achievement of indicator at year-end

Rules for any agreed in-year milestones that result in payment

Rules for delayed achievement against final indicator period/date and/or in-year milestones

Target CAFs initiated by health professionals

70% (0-5yrs)

50% (6-11yrs)

40% (12-18yrs)

Target CAFs led by health professional

60% (0-5yrs)

50% (6-11yrs)

40% (12-18yrs)

Additional Information

Detail of Indicator 4 – Child Protection Supervision

Description of indicator

Child Protection Supervision

Level of Child Protection Supervision given to Level 3 staff that have regular contact with Children, young people and parents. (Level 3 as defined in Safeguarding Children and Young People:

Roles and Competences for Health Care Staff

Intercollegiate Document

June 2006, RCPCH)

Denominator 1 Number of Level 3 staff eligible for child protection supervision during the quarter.

Numerator 1 Number of Level 3 staff who have had child protection supervision during the quarter.

Rationale for inclusion

‘Effective communication is important to promoting good standards of practice and to support individual staff members.’ (Working Together to Safeguard Children, DH 2006) We would like to know the number of staff who have had child protection supervision who have had regular contact with children, young people and parents.

Data source and frequency of collection

Provider quarterly

Organisation responsible for data collection

Provider

Frequency of reporting to commissioner

At the end of each quarter

Baseline period / date Quarter 1

Baseline value [To be completed by commissioner]

Final indicator period / date (on which payment is based)

Quarter 4

Final indicator value (payment threshold)

Final indicator reporting date Quarter 4

Rules for partial achievement of indicator at year-end

Rules for any agreed in-year Payment will be paid on achievement 85% uptake

milestones that result in payment delivered from Q2 onwards

Rules for delayed achievement against final indicator period/date and/or in-year milestones

Detail of Indicator 5 - Nutrition

Description of indicator Care and Compassion – Nutritional

Denominator 1 By ward and by age band 18-64 and 65+: The number of patients admitted and remaining for more than 48 hours of the episode of care, during the quarter

Numerator 1

(i) By ward and by age band 18-64 and 65+: The number of admitted patients who underwent nutritional screening within 24hrs of admission

(ii)By ward and by age band 18-64 and 65+: The number of patients (of Numerator 1) where appropriate action was followed, in accordance with essence of care, after screening

Denominator 2 By ward and by age band 18-64 and 65+: The number of patients discharged during the quarter

Numerator 2

(i) By ward and by age band 18-64 and 65+: The number of patients undergoing nutritional screening 24 hours prior to discharge

(ii) By ward and by age band 18-64 and 65+: The number of admitted patients (of Numerator 2i) who were at ‘High’ nutritional risk at discharge

(iii) By ward and by age band 18-64 and 65+: The number of patients assessed as ‘high’ nutritional risk (numerator 2ii) with appropriate referrals/continuing care plans in place

Action Plan Delivery of essence of care Action plan to be agreed by commissioner Trust to ensure that there is an action plan in place which demonstrates how the following indicators will be met to best practice standards in “Essence of Care”pp51-64 DH June 2009

1. Screening and assessment

People who are screened on initial contact and identified at risk receive a full nutritional assessment

2. Planning, implementation, evaluation and revision of care

People's care is planned, implemented, continuously evaluated and revised to meet individual needs and preferences for food and drink

3. Monitoring People's food and drink intake is monitored and recorded

4. Environment People feel the environment is conducive to eating and drinking

5. Assistance People receive the care and assistance they require with eating and drinking

6. Information People and carers have sufficient information to enable them to obtain their food and drink

7. Provision People are provided with food and drink that meets their individual needs and preferences

8. Availability People can access food and drink at any time according to their needs and preferences

9. Presentation People's food and drink are presented in a way that is appealing to them

10. Promoting health

People are encouraged to eat

Rationale for inclusion

Improved focus on the care of the patients. Use of a validated nutritional indicator screening tool will be encouraged to reduce rates of malnutrition and associated adverse outcomes.

Data source and frequency of collection

Provider quarterly

Organisation responsible for data collection

Provider

Frequency of reporting to commissioner

Quarter 1 - submit data (baseline)

Quarter 2 – submit data and submit agreed Action plan

Quarter 3 – submit data

Quarter 4 – submit data showing achievement against baselines showing improvement against each numerator.

Baseline period / date Quarter 1

Baseline value

Action plan must be approved by commissioner and progress reported quarterly

Final indicator period / date (on which payment is based)

Quarter 4

Final indicator value (payment threshold)

Quarter 4

Final indicator reporting date

Rules for partial achievement of indicator at year-end

Rules for any agreed in-year milestones that result in payment

Submission of Action plan and agreed improvement trajectories against baselines

Rules for delayed achievement against final indicator period/date and/or in-year milestones

Providers must agree their evidence based tool with their PCT commissioner accordingly.

The data on malnutrition will only be required from PCT Providers with bedded areas.

If trusts change their validated nutritional indicator screening tool they must then agree this with commissioners before re-submitting.

Additional Information

“High” risk is defined as MUST - Score 2 and above(or equivalent if a different screening tool is used)

Detail of Indicator 6– Pressure Ulcers For community wards

Description of indicator Inpatients experience care that maintains or improves the condition of their skin and underlying tissues for all ages

Denominator 1 Submitted as Denominator 1 in Indicator 5

Numerator 1 Total number of patients (of Denominator 1) who have one or more existing pressure ulcers on admission of Grade II and above, broken down by setting (Home, Care home or other facility)

Numerator 2 The number of incident forms completed for grade II ulcers and above

Numerator 3 The number patients with one or more pressure ulcers, with the highest ulcer having NICE Trigger Grading II

Numerator 4 The number patients with one or more pressure ulcers, with the highest ulcer having NICE Trigger Grading III

Numerator 5 The number patients with one or more pressure ulcers, with the highest ulcer having NICE Trigger Grading IV

Numerator 6 The number of root cause analysis investigations undertaken for patients with NICE Grade III pressure ulcers and above

Numerator 7 Ensure an action plan is in place which demonstrates how the following indicators will be met to best practice standards in “Essence of Care”pp75-84 DH June 2009

Factor Best practice

1. Screening and Assessment

People who are screened on initial contact and identified at risk of developing pressure ulcers receive a full assessment of their risk

2. Information People and carers have ongoing access to evidence-based information concerning pressure ulcer prevention and management

3. Planning, implementation, evaluation and revision of care

People's care is planned, implemented, continuously evaluated and revised to meet their individual needs and preferences concerning pressure ulcer prevention and management

4. Prevention - repositioning

People are repositioned to reduce the risk, and manage the care, of pressure ulcers

5. Prevention - pressure redistribution

People are cared for on pressure redistributing support surfaces to reduce the risk, and manage the care, of

pressure ulcers

6. Prevention - resources and equipment

People have the resources and equipment required to reduce the risk, and manage the care, of pressure ulcers

Rationale for inclusion Improve pressure ulcer prevention and management.

Data source and frequency of collection

Quarterly

Organisation responsible for data collection

Provider

Frequency of reporting to commissioner

Quarterly

Baseline period / date Quarter 1

Baseline value Action plan must be approved by commissioner and progress reported quarterly

Final indicator period / date (on which payment is based)

Action Plan must be approved by the commissioner and then progress reported at Quarter 4

Final indicator value (payment threshold)

Final indicator reporting date Quarter 4

Rules for partial achievement of indicator at year-end

(i) Providers must reduce the grading of pressure ulcers setting a downward trajectory for NICE Grade III and above, agreed locally.

(ii) Providers must also have 100% root cause analysis of pressure ulcers with NICE Triggers Grading III and above.

(iii) Providers must submit Action Plans detailing delivery of Essence of Care by end of Quarter 2.

Rules for any agreed in-year milestones that result in payment

(iv) Payment will be based on (i),(ii) and (iii) all being achieved

Rules for delayed achievement against final indicator period/date and/or in-year milestones

Additional information It is understood that NICE guidelines around pressure ulcers

may change due to EPUAP guidance being in place from September 2010. If providers transfer onto EPUAP in year, providers must negotiate with commissioners the relevant changes to the pressure ulcer measure and seek approval for the change from the SHA on behalf of the Regional Quality Forum

Detail of Indicator 7– Pressure Ulcers For non ward Services (excluding any patients reported in Indicator 6

Description of indicator Patients experience care that maintains or improves the condition of their skin and underlying tissues for all ages

Denominator 1 The total population of the local health economy

Numerator 1 The number of incident forms completed for grade II ulcers and above

Numerator 2 The number patients with one or more pressure ulcers, with the highest ulcer having NICE Trigger Grading II

Numerator 3 The number patients with one or more pressure ulcers, with the highest ulcer having NICE Trigger Grading III

Numerator 4 The number patients with one or more pressure ulcers, with the highest ulcer having NICE Trigger Grading IV

Numerator 5 The number of root cause analysis investigations undertaken for patients with NICE Grade III pressure ulcers and above

Numerator 6 The number of patients with more than one pressure ulcer

Numerator 7 The number of patients who have acquired pressure ulcers in the community broken down by setting (home, care home or other facility)

Action Plan Ensure an action plan is in place which demonstrates how the following indicators will be met to best practice standards in “Essence of Care”pp75-84 DH June 2009

Factor Best practice

1. Screening and Assessment

People who are screened on initial contact and identified at risk of developing pressure ulcers receive a full assessment of their risk

2. Information People and carers have ongoing access to evidence-based information concerning pressure ulcer prevention and management

3. Planning, implementation, evaluation and revision of care

People's care is planned, implemented, continuously evaluated and revised to meet their individual needs and preferences concerning pressure ulcer prevention and management

4. Prevention - repositioning

People are repositioned to reduce the risk, and manage the care, of pressure ulcers

5. Prevention - pressure redistribution

People are cared for on pressure redistributing support surfaces to reduce the risk, and manage the care, of pressure ulcers

6. Prevention - resources and equipment

People have the resources and equipment required to reduce the risk, and manage the care, of pressure ulcers

Rationale for inclusion Improve pressure ulcer prevention and management.

Data source and frequency of collection

Quarterly

Organisation responsible for data collection

Provider

Frequency of reporting to commissioner

Quarterly

Baseline period / date Quarter 1

Baseline value Action plan must be approved by commissioner and progress reported quarterly

Final indicator period / date (on which payment is based)

Action Plan must be approved by the commissioner and then progress reported at Quarter 4

Final indicator value (payment threshold)

Final indicator reporting date Quarter 4

Rules for partial achievement of indicator at year-end

If one of the milestones is not achieved, providers must seek clarification from the commissioner on the % of payment or part year effect for payment.

(i) Providers must set a downward trajectory, reducing the grading of pressure ulcers setting a downward trajectory for NICE Grade III and above, agreed locally.

(ii) Providers must also have 100% root cause analysis of pressure ulcers with NICE Triggers Grading III and above.

(iii) Providers must submit Action Plans detailing delivery of Essence of Care by end of Quarter 2.

Rules for any agreed in-year milestones that result in payment

(iv) Payment will be based on (i),(ii) and (iii) all being achieved

Rules for delayed achievement against final indicator period/date and/or in-year milestones

Additional information

It is understood that NICE guidelines around pressure ulcers may change due to EPUAP guidance being in place from September 2010. If providers transfer onto EPUAP in year, providers must negotiate with commissioners the relevant changes to the pressure ulcer measure and seek approval for the change from the SHA on behalf of the Regional Quality Forum

CQUIN Definitions:

“Scheme”

The agreed package of goals and indicators, which in total, if achieved, enables the provider to earn 1.5% of its contract value. Where the provider has multiple contracts, the scheme should be reflected within all contracts, (exceptions specified within guidance).

“Goal”

A description of the intended objective which is being incentivised by the CQUIN scheme, eg. “to improve patient satisfaction within maternity clinics”, or “to improve the health of the population by delivering effective stop smoking advice to smokers and ensuring referral pathways to the local NHS Stop Smoking Services” . A goal may be measured using several indicators (see below).

“Indicator”

A measure which determines whether the goal or an element of the goal has been achieved, and on the basis of which payment is made. The achievement of one indicator should not be dependent on the achievement of a separate indicator within the scheme.

“Payment threshold”

The level of performance against the indicator which must be achieved to earn payment. This should be informed by available evidence, (eg. a NICE Quality Standard, a National Service Framework or benchmarking) and by the provider’s own baseline. Where a baseline needs to be set in-year, the payment threshold may also need to be confirmed in-year.

In addition to the final indicator value, it may also be appropriate to agree payment thresholds for a) partial achievement of the indicator and/or b) in-year milestones. However any locally agreed rules should comply with the national policy on rewarding measurement through CQUIN schemes; acute schemes cannot reward measurement in 2010/11, hence any payments for in-year milestones should reward real process or outcome improvements only.