Hertfordshire and West Essex ICS Quality Strategy

Foreword from ICB Director of Nursing and Quality

It is a great pleasure to welcome you to our Hertfordshire and west Essex Quality Strategy which not only sets out our strategic direction but also our unwavering commitment to improving quality. Quality that is evident in our everyday work and behaviours and the golden thread underpinning all that we do, whatever our role or part in the ICS.

This strategy shares our system’s aims and priorities for the next three years, to support the delivery of our vision to becoming an outstanding system delivering the best quality and safest care to the people and communities that we serve, and has been developed in consultation with our staff, partners and most importantly the people who we care for. This strategy both supports and complements the quality strategies that many of our local system partners have already developed, or are in the process of developing.

We will work across the wider health and care system in ways that promote partnership working, co-operation, and build on shared values of respect, integrity, trust, pride, inclusion and fairness. We are grateful to all of you who have made such valuable contributions and look forward to making a positive difference, harnessing our collective knowledge and skills to achieve the very best outcomes we can.

Jane Kinniburgh, Director of Nursing and Quality

Please note that Professor Natalie Hammond assumed the role of Director of Nursing and Quality in July 2023.

A snapshot of organisations in our Integrated Care System area – who are we?

• 1.6 million people
• 1 Integrated Care Board
• 1 Integrated Care Partnership
• 3 geographically-based Health and Care Partnerships
• 1 Mental Health, Learning Disability and Autism Health and Care Partnership 
• 1 Voluntary, Community, Faith and Social Enterprise Alliance, representing thousands of local organisations
• 2 county councils and 13 district/borough councils
• 4 mental health and community providers
• 3 acute providers
• 305 care homes, 675 home care providers
• 130 GP practices working in 35 Primary Care Networks
• 276 community pharmacies
• 225 opticians 
• 243 dental practices

The benefits of joined up working and our system’s strategic priorities

Collaborating as an Integrated Care System will help health and care organisations in Hertfordshire and west Essex to tackle the complex challenges facing our population and achieving our six equal, strategic priorities:

Priority 1 –  Giving every child the best start in life

Priority 2 –  Support our communities and places to be healthy and sustainable

Priority 3 – Support our residents to maintain healthy lifestyles

Priority 4 –  Enable our residents to age well and support people living with dementia

Priority 5 –  Improve support to people with long term conditions, long term health conditions, physical disabilities, and their families

Priority 6 – Improve our residents’ mental health and outcomes for those with learning disabilities and autism

What do we mean by a shared single view of quality?

High quality, personalised and equitable care for all, now and into the future.

Quality runs through everything we do. It is important that those working in the system can work together effectively to deliver care that is:

Safe: delivered in a way that minimises errors and maximises delivery of safe care continuously reduces risk, empowers, supports and enables people to make safe choices and protects people from harm, neglect, abuse and breaches of their human rights; and ensures improvements are made when problems occur.

Effective: informed by consistent and up to date high quality training, guidelines and evidence; designed to improve the health and wellbeing of a population and address inequalities through prevention and by addressing the wider determinants of health; delivered in a way that enables continuous quality improvements based on research, evidence, benchmarking and clinical audit.

Positive Experience.

Responsive and personalised: shaped by what matters to people, their preferences and strengths; empowers people to make informed decisions and design their own care; coordinated; inclusive and equitable. 

Caring: delivered with compassion, dignity and mutual respect

Well led: driven by collective and compassionate leadership, which champions a shared vision, values and learning; delivered by accountable organisations and systems with proportionate governance; driven by continual promotion of a just and inclusive culture, allowing organisations to learn rather than blame.

Sustainably resourced: focused on delivering optimum outcomes within financial envelopes, reduces impact on publish health and the environment.

Quality care is also equitable: everybody should have access to high quality care and outcomes, and those working in systems must be committed to understanding and reducing variation and inequalities.

How we deliver quality – The National Quality Board’s ambitions for Integrated Care Systems

Together we will work to deliver the ambitions that has been set out by the National Quality Board. Those ambitions are set out on this page.

1. Setting clear direction and priorities

To deliver a new service model for the 21st century which delivers better services in response to local needs, invests in keeping people healthy and out of hospital, and is based on clear priorities, including a commitment to reducing health inequalities.

2. Bringing clarity to quality

Setting clear standards for what high quality care and outcomes look like, based on what matters to people and communities.

3. Measuring and publishing

Quality measuring what matters to people using services, monitoring quality and safety consistently sharing information in a timely and transparent way using data effectively to inform improvement and decision making.

4. Recognising and rewarding quality and learning

Recognising, celebrating and sharing outstanding health and care, learning from others and helping others learn, recognising when things have not gone well.

5. Maintaining and improving quality

Working together to maintain quality reduce risk and drive improvement.

6. Building capability for improvement

Providing multi professional leadership for quality; building learning and improvement cultures; supporting staff and people using services to engage in coproduction; supporting staff development and wellbeing.

7. Staying ahead

By adopting innovation, embedding research and monitoring care and outcomes to provide progressive, high quality heath and care policy.

The Quality Principles set out by the National Quality Board

Based on learnings from many health and care systems to date, there are six key principles that underpin decisions around quality in health and care systems, those principles can be found here. Our local Quality Principles build on the National Quality Board’s principles and can be found on pages 10, 11 and 12.

1. A shared commitment to quality: partners have a single understand of quality, which is shared across all services. Partners work together to deliver shared quality improvement priorities and have collective ownership and management of quality challenges.

2. Population-focused: clear quality improvement priorities are based on sound understanding of quality issues within the context of the local population’s needs, variation and inequalities.

3. Co-production with people using services, the public and staff: meaningful engagement ensures that people using services, the public and staff shape how services are designed, delivered and evaluated.

4. Clear and transparent decision-making: partners work together in an open way with clear accountabilities for quality decisions, including ownership and management of risks, particularly relating to serious quality concerns.

5. Timely and transparent information sharing: partners share intelligence and data across the system in a transparent and timely way.

6. Subsidiarity: management of quality largely take place locally; and is undertaken at scale where there is a need to improve the health and wellbeing for the local population.

The National Quality Board Position Statement on quality within Integrated Care Systems highlight these principles, as well as some consistent operational requirements that all Integrated Care Systems are expected to have in place in 2021-22 and beyond.

The Hertfordshire and West Essex Integrated Care System vision for quality

Together we will plan and deliver the best possible joined-up and high-quality and safe services which promote equal access, positive experiences and good clinical outcomes. We will endeavour to do this in partnership with staff and our local people, so that all who use our services have opportunities and feel empowered to contribute to improving the care provided across Hertfordshire and west Essex.

The Quality Principles of the Hertfordshire and West Essex Integrated Care System

The development of the five local Quality Principles for the Hertfordshire and West Essex Integrated Care System occurred following a Quality Strategy event attended by each of the below organsiations, as well as members of our population. These build on the National Quality Board’s Principles and are tailored to the needs of our system.   

1. Developing, providing and co-designing services which are person centred
2. To effectively collaborate across organisations to continually improve care
3. To create a healthy and positive environment for our population and workforce
4. To use information and technology in the best possible way
5. To ensure the services we provide are accessible and  available to everyone

The Integrated Care System will be working together to set out how each of the Principles will be measured throughout 2023-2034 so we can understand how well we are performing and where further opportunities for improvement can be made.

1) Developing, providing and co-designing services which are person centred

Collectively working with our people to develop an environment where learning, transparency, openness and a true person-centred approach is taken in both the planning and delivery of care.

High Level Principle Outcome – Feedback from our population which tells us they feel involved in the care process and feel empowered to share their ideas and desired outcomes with a health or social care professional. Increased number of co-produced pathway re-design of services.

2) To effectively collaborate across organisations to continually improve care:

To meaningfully and effectively communicate and work with colleagues across the Integrated Care System to join up care and improve together without organisational boundaries

High Level Principle Outcome – By listening to each other and working together to continually learn to improve the planning and delivery of care, improvements will be seen in the safety of our people and also their experiences. Establishing and creating environments where all parts of the system have a voice though both formal and informal meetings, groups and other mechanisms.

3) To create a healthy and positive environment for both staff and patients to provide and receive the best possible and safe care

To create a positive culture where we have an effectively skilled, stable and happy workforce to provide high quality and safe care, with their contributions are seen and heard, recognised and rewarded. To also work with our population to inform and educate them to take responsibility for their own health and care, when appropriate.

High Level Principle Outcome – Positive outcomes would include higher level of staff engagement, cross-organisation training and development to ensure our workforce are equipped with the right skills and competences to fulfil their roles in the ever-changing health and social care environment.  To work with our population to provide co-produced information and education sessions so they remain as healthy as possible for as long as possible and in the place of their choice.

4) To use information and technology in the best possible and most effective way

To create opportunities to maximise the right use of information and digital technology to provide an accurate picture of quality, which in turn creates opportunities to identify improvements to patient care.

High Level Principle Outcome – By utilising technology and by streamlining data and other sources of information time will be spent on focusing on areas for improvement. Potential impacts will be seen in patient safety, capturing patient experience and working more efficiently to focus on positive patient outcomes. Consideration on how this is measured will be important. Whilst working to this Principle the ICS will be mindful not to ‘digitally exclude’ any person and offering alternative options where required.

5) To ensure the services we provide are available to everyone

Each of our Quality Principles have a part of play in addressing and reducing health and care inequalities in our population, as well as ensuring the Hertfordshire and West Essex Integrated Care System is a great place to work.

High Level Principle Outcome -By contributing, influencing and taking an active role in reducing inequalities key outcomes affected will relate to patient and staff experience, accessibility to care and services and therefore also patient safety.

Person involvement and co-production

NHS England have devised a model to enable co- production which is a way of working that involves people who use health and care services, carers and communities in equal partnership; and which engages groups of people at the earliest stages of service design, development and evaluation. Co production acknowledges that people with ‘lived experience’ of a particular condition are often best placed to advise on what support and services will make a positive difference to their lives. Co production helps to ground discussions and maintains a person centred perspective. It is a cornerstone of self care, of person centred care and of health coaching approaches.

These are the co-production values and behaviours that we will be guided by relation to Quality during the life cycle of this strategy, ensuring that they become the norm. (Coalition for Personalised Care, NHS England).

Seven steps to make it happen:

1. Agreement from senior leaders to champion
2. Open and fair approach to recruit a range of people
3. Systems to reward and recognise peoples’ input
4. Early on in project design think where co-production can have a genuine input
5. Build into our work programmes so that it becomes our way of working
6. Train and develop staff and people
7. Regular review and reporting on progress moving to “We said, We did”

“Co-production and community building are not just ‘nice to have’ things – they are crucial….factors that impact on health outcomes, community wellbeing and the efficiency, quality and sustainability of NHS services.” 

C. Wilton, NHS Leadership Academy (2018)

“There is much more potential to involve patients – and their carers where appropriate – as partners in care.”

Chris Ham, Chief Executive, The Kings Fund (Ham 2014)

• Ownership, understanding and support of co-production by all
• A culture of openness and honesty
• A commitment to sharing power and decisions with citizens
• Clear communication in plain English
• A culture in which people are valued and respected

Working together to deliver quality – how can we do it together?

As commissioners and funders

• Set clear quality standards and expected outcomes when commissioning, which are considered as part of performance management
• Have clear governance and accountability arrangements for Quality
• Work and communicate together to ensure seamless pathways between commissioned services, including identifying and managing quality issues
• Develop a just culture which is open, transparent and continuously learning and improving
• To co produce with local communities to shape the design and delivery of services

People and communities

• Know what high quality care looks like, what they have the right to expect and what to do when their experience falls short
• Have care that is personalised and empowering, including access to different types of support from voluntary and other organisations
• Are respected, listened to and treated with dignity and equity, as well as able to live the life they want to
• Are equal partners in decision making about their own care
• Shape and coproduce how services are designed, delivered and improved locally

For professionals and staff

Increasing support for staff to:

• Enjoy their work and feel motivated and are supported to deliver high quality care
• Receive training and support to enable career progression and allow them to continually improve the quality of care they provide
• Be inclusive and respond to the needs of those who face disadvantage and potential discrimination
• Feel safe and confident to speak up when they have concerns and are supported afterwards

Working with regulators

•  To ensure that providers are delivering high standards of quality and care, monitoring and inspecting against these standards
•  Share learning, best practice and insights across system partners to support improvement
•  Work together to share intelligence on quality issues and risks
•  Support improvement where potential or actual failures in the quality of care are identified
•  Set clear standards of competence and conduct for health and social care professionals

For providers

• Set clear quality standards and expected outcomes
• Experience a coherent system of quality assurance, measurement and regulation
• Are accountable for the quality of care they provide, driving quality improvement which translates into improved health outcomes and reduced health inequalities
• Understand their wider role as an anchor institution, including bringing local people into the health and care workforce and helping them build careers
• Develop a just culture which is open, transparent and continuously improving

Collaborate with research and innovation partners

• Support the system to continually improve and maintain quality and safety
• Triangulate data and evidence across pathways and services, presenting it in a meaningful way. This includes feedback from those accessing services
• Share learning, best practice and  innovations across system partners to influence and improve delivery

What’s next for our Quality Journey Plan 2023-2026

We plan to hold a further Quality Strategy Workshop in early 2024 to look back to see what has been achieved and to look ahead to see what else we can do, together.

Our ambition is to continue to work in partnership with providers, partners and our population to drive up the quality of services for our population. As we move to system reform, it becomes even more important to ensure we continue to co-produce and provide services of the highest quality, delivered with respect and compassion, and a positive experience for all.

As our integrated care system matures, we will implement further review of system wide governance to ensure clear direction and delivery of NHS values and our priorities. This will include a review of Quality and Performance Improvement processes to take collective oversight of clinical risk, problem solving for escalated concerns and the sharing of learning and best practice.

Create new ways of working within our new integrated approach, being openly transparent and sharing for improved outcomes. There will be a robust clinical assurance framework to reflect each level, retaining a clear line of sight for the system, at-place and individual organisational performance. With the ability to report at each level to ensure accountability.

As a developing integrated care system we will work with our partners to inform the strategic approach. As part of our Strategic approach to Quality, we will work to make shared decisions with providers on population health, quality outcomes, service transformation and quality improvements, ensuring equality of personalised care provision, as we continue to implement our Long Term Plan. Leading to greater provision of proactive, personalised care.

Who has been involved in the development of the Hertfordshire and West Essex Integrated Care System Quality Strategy?

We thank the following organisations for their contributions to the development of this document:

• Central London Community Healthcare NHS Trust
• Essex Partnership University NHS Foundation Trust
• Essex County Council
• East and North Herts NHS Trust
• Healthwatch Hertfordshire
• Healthwatch Essex
• Hertfordshire Care Provider Association
• Hertfordshire Community NHS Trust
• Hertfordshire County Council, including their Sensory Services Team and the Hertfordshire Integrated Health and Care Commissioning Team
• Hertfordshire Partnership NHS Foundation Trust
• Hertfordshire and West Essex Integrated Care Board, including Nursing and Quality Team and the Primary Care Team
• Members of the Hertfordshire Dental Committee
• Members from general practice
• Members from our local population (volunteers)
• Princess Alexandra Hospital NHS Trust
• Safeguarding Boards in both Essex and Hertfordshire
• West Hertfordshire Teaching Hospitals NHS Trust

Our Quality Strategy Workshop

During the development phase of the ICS Quality Strategy a multi-stakeholder Workshop was held to ensure our Strategy is as tailored to the Hertfordshire and West Essex system as possible. The below ‘word-cloud’ reveals the common words and phrases used on the day which were then used in the development of the Quality Vision and also the local Quality Priorities laid out within this document. Seven key questions were asked on the day and those questions can be found below:

1. What does good quality care mean to you?
2. What do we do well and what make it so good?
3. What needs improving for our population?
4. How do we know we are getting better?
5. What is a priority right now for our population?
6. How do we motivate and inspire people?
7. How do we all play our part?

Download the full strategy

Full ICS Quality Strategy (2MB pdf)

Download an Easy Read version of this strategy

Easy Read: How we work together to give you good care (5MB pdf)