Quality

Aim 1: Quality

Provide the highest quality care to achieve the best outcomes for service users and their loved ones.

We want to deliver outstanding care and support to the people we serve, based on a public mental health approach to prevention as well as delivering high-quality care to those in need. Co-production of our services with service users will influence the planning and prioritisation of safety and mean they are involved as equal partners in their care.

We want to make sure people have access to the best advice and support when they need it, that we always provide high quality services, and that when someone is in crisis, they feel that they have a safe place to go.

Prevention concordat for better mental health

In 2017, Public Health England launched the ‘prevention concordat’ programme based on a public mental health informed approach to prevention. Promoting relevant NICE guidance and existing evidence-based interventions and delivery approaches, such as ‘making every contact count’, the prevention concordat aims to provide a structure for
cross-sector action to increase the adoption of public mental health approaches across local authorities, NHS, private and voluntary sector organisations, education and employers.

In Kent and Medway mental wellbeing is a priority in strategic plans ranging from COVID-19 recovery, suicide prevention, community safety partnerships and Health and Wellbeing Boards. Partners have also signed up to the Time to Change Programme.

With the advent of COVID-19 in 2020, changes to NHS structures in the form of the introduction of integrated care services, integrated care partnerships, and primary care networks, and the high prominence given to mental health and wellbeing as a public health priority it is a critical opportunity to sign up to the national concordat. The concordat has been used to strengthen wellbeing partnerships across Kent and Medway and is the foundation stone of our plans to provide the highest quality care in partnership across the Kent and Medway health and care system.

To build on the current quality of our services, and drive further improvements, we will focus on the following six objectives:

1. Increase our focus on improving the quality of services and support we provide
2. Address health inequalities to improve outcomes for people
3. Implement programmes that drive improvement of clinical care pathways through a culture of learning to reduce variation and maximise outcomes
4. Develop and deliver a new KMPT clinical strategy
5. Embed quality improvement in everything we do
6. Drive a coherent approach to research and development and evidence-based decisions to promote an improvement culture and maximise our impact on the quality of care and people’s outcomes.

Given the national and local context of system working and partnership, it is critical that we deliver these objectives with our system partners.

Objective 1

Increase our focus on improving the quality of services and support we provide.

Since the beginning of 2020, we’ve been working to deliver priorities that will improve the quality of our services whilst saving time and reducing any wasting of money:

• Maximising the opportunity for service users to safely achieve and sustain positive outcomes, whilst driving delivery of efficiency and productivity gains
• Delivering our ‘quality account’ priorities in the domains of patient safety, patient experience and clinical effectiveness
• Developing a co-ordinated approach to quality improvement.

We will maintain a strong commitment to all aspects of quality. By 2023 we want service users and their loved ones to consistently tell us that our services provide a positive experience and that they are safe and effective. By improving the quality of our services, we will reduce cost, drive out unwarranted variation and improve patient experience and outcomes, monitored through the delivery of clinical outcomes.

We will work more closely with our service users, their carers, and our partners to better understand their needs and the needs of their communities. In doing so we will seek to design and deliver the best possible services, and care that is safe, effective and of consistently high quality whilst still aligned to local need. Through our ‘Participation and involvement strategy’ we will extend our engagement reach, and talk and work with people to co-design and produce support and services that meet the needs of those that need them.

We will use national and international research and development practice to provide the best evidence for approaches to delivering the highest quality care.

Our ‘Quality account’ is a published, annual report about the quality of services we provide. Quality accounts are an important way for us to report on quality and show improvements in the services we deliver to local communities and stakeholders.

The quality of our services is measured by looking at outcomes on patient safety, the effectiveness of treatments our patients receive, and patient feedback about the care we have provided.

"We want people in Kent and Medway to recognise KMPT as a high-quality provider of care and actively seek our services when they need help and support."

Objective 2

Address health inequalities to improve outcomes for people.

We are focused on supporting our most vulnerable service users and staff and have established a health inequalities group to share research and evidence to support clinical and workforce innovation to help address the impacts of inequalities across Kent and Medway. Acknowledging the impact of COVID-19 on the BAME population, including staff as well as service-users, is vital if we are to address existing inequalities as well as the additional inequalities that the pandemic has exposed.

Working collaboratively with our system partners, this work is supported by local health and population data and intelligence as well as emerging evidence and data as a result of the pandemic. Different service user populations have different needs.

By using the data and information available on health inequalities, we will be able to adapt and flex innovations and solutions to meet the needs of different groups, including those from BAME populations, those living in areas of deprivation, older people and people with learning disabilities and autism.

Objective 3

Implement programmes that drive improvement of care pathways through a culture of learning to reduce variation and maximise outcomes

Aligned to the NHS Long Term Plan and the Community Mental Health Transformation Framework for Adults and Older Adults, we are implementing several programmes to improve clinical care pathways that will enhance people’s experience and the quality of care and treatment they receive.

We will deliver a coherent and consistent set of clinical interventions that are systematised, aligned to NICE guidance, and designed within a robust programme management framework.

This in turn will ensure we use our resources effectively and deliver improved productivity. The care pathways are co-developed by people with lived experience of mental ill health and clinical staff. By working together to design solutions we will promote and ensure quality, safety and positive outcomes for people using KMPT services.

Through this approach we will encourage and support our staff to deliver the very best care possible.

We have five main clinical care pathway programmes: community; acute mental health; older adults; rehabilitation; and forensic services. Work has begun across all programmes.

The work aims to maximise quality, safety and outcomes for people using our services. It also aims to support staff to deliver services and care efficiently and effectively and with minimal duplication and wastage. This is done through:

• Implementing consistency of care through each of the care pathways, including across our Community recovery and Acute care groups
• Providing more reliable, safe, and evidence-based care
• Making sure we have more efficient and managed use of staff time
• Understanding the costs of delivery
• Collecting data on outcomes relating to interventions
• Supporting clinicians to work in a flexible way to meet the needs of the service and help optimise their performance and support them to do their best work
• Organising clinical resources with a balanced and managed system of office and homebased clinics
• Optimisation of our estate to match the delivery requirements of each of the five care pathways.

The key clinical principles we have adopted within the model are set out below.

1. All components are needs-led (i.e. age itself is not a barrier to receiving any component of care)
2. If a component of care starts within a community team (younger or older adult), and the patient is well enough to continue to engage with this whilst under home treatment or inpatient care, then they will continue with that component
3. Interventions have been grouped into three clinical thematic pathways:
   -Mood disorders
   - Psychotic disorders (unusual experiences)
   - Complex emotional difficulties
4. Within each thematic pathway there are elements for: psychological therapy; daily life (practical support); medications; family, friends, and carers; physical healthcare; and self-management.

Through co-producing the clinical care pathways we can consistently improve the quality of the care that people receive.

Our core aims are to:

• Develop a clinical model which meets local needs and aligns with the NHS Long Term Plan
• Implement consistent care through coproduced clinical care pathways across our care groups
• Provide reliable, safe, and evidence-based care
• Ensure efficient and effectively managed use of staff time and resources
• Develop outcomes that are defined and understood and related to efficacy and costs
• Improve the use of mobile technology and mobile working.

"Since inception, service user involvement has been key in the clinical care pathways work. Many service users and
carers have given input at every level of development, having personally been invited to the first scoping workshop and almost every meeting thereafter. Even before then a project was undertaken to find out service user, carer and staff views on how improvements could be made, and this underpins everything trialled in the pathways.
Person with lived experience

Objective 4

Develop our new clinical strategy

To extend and embed our commitment to delivering the mental health and learning disability priorities set out in the NHS Long Term Plan, we are developing KMPT’s Clinical strategy aligned to this organisational strategy. During 2020, clinical and managerial leaders and system partners worked together to begin development of a new KMPT
clinical strategy which will be published later in 2021.

The strategy will set out how we deliver clinical quality through embracing partnership working and innovation over the next five years. This means creating a dynamic and flexible system of care, so that people receive the right help, at the right time, in the right setting and get the right outcome. Our Clinical strategy will be flexible, recognising that communities and the health and care system in Kent and Medway is changing and we must be able to adapt to the local care needs of people across our four Integrated Care Partnerships and 42 Primary Care Networks.

Our Clinical strategy articulates the KMPT vision for Brilliant care through brilliant people, recognising the diversity of the population and staff and complexity of services we provide. The strategy will align to the external context including the Kent and Medway ICS.

It will promote working in collaborative partnerships with other service providers including primary care services, acute care providers and community services in Kent and Medway.

KMPT provides good care in many areas of mental health, learning disability and autism services across Kent and Medway. We are recognised as an innovative organisation and many of our specialist services are nationally recognised for providing high quality care. The strategy will establish best practice across the organisation following the CQC principles of being safe, effective, caring, responsive, and well led. We will measure and monitor these domains as part of the outcome focus of the strategy.

1. Safe – Our ambition is to offer safe and high-quality services in environments where people feel safe and empowered to recover
2. Effective – We will offer a wide range of effective interventions that meet the needs of all our service users
3. Caring – We will always be compassionate in our approach to delivering care
4. Responsive – Our services must be responsive and provide access to flexible support, recognising the changing needs of service users
5. Well-led – All our services will be clinically well-led, encourage collaborative, inclusive clinical leadership and empower all our clinical and healthcare professionals to act

Our Clinical strategy’s core aim is to “Consistently deliver brilliant care to our patients as close to home as possible with support to their families and to build resilience in our communities”. This is aligned to the NHS Five Year Forward View and the NHS Long Term Plan priorities for mental health, learning disability and autism. It is also aligned to this KMPT organisational four year strategy and will be underpinned by our organisational
values of respect, openness, accountability, excellence, innovation and working together.

The Clinical strategy focuses on a person-centred approach – what happens with and what matters to our patients across the organisation.

The strategy has been developed around three key principles:

1. All care and support practice is underpinned by the evidence base
2. We always strive to provide high quality clinical services
3. Our clinical delivery always aims to provide a positive experience for our service users, their carers and loved ones and our staff.

Delivery of our Clinical strategy will be supported by our key enabler strategies, covering people and culture, clinical technology, informatics, estates, quality improvement and research.

The NHS Mental Health Implementation Plan sets out nine key priorities nationally. We have a critical role to play in the delivery of the NHS Mental Health Implementation Plan in Kent and Medway. While we do not control the whole care pathway against each of the nine priorities, and work with partners who are responsible for some areas of the plan, we do have expertise around the provision of specialised elements. Our clinical strategy will be aligned to the nine priorities so our expertise fully supports the Kent and Medway system to deliver outstanding quality.

Objective 5

Embed quality improvement into everything that we do

Quality improvement is about an individual, team and/or organisation taking systematic and ongoing actions that lead to improvements in healthcare. Quality improvement will be embedded in everything that we do to meet the needs of our service users, improve quality, and maximise productivity. We are committed to working in collaboration with our service users, carers, staff, and partners to ensure we have a coherent and consistent
approach to achieve the objectives articulated in our Quality improvement strategy:

• Clinically led quality improvement culture throughout the organisation
• To empower all levels of the organisation to speak openly and define how things are now and how they can improve
• To embed coproduction, inclusion and equality involving service users and carers throughout our Qi journey
• To learn from and apply quality improvement best practice nationally and internationally
• To successfully deliver measurable improvement achieved through quality improvement projects
• To deliver quality improvement projects through a robust programme management approach

By successfully embedding our quality improvement approach we will:

• drive up quality improvement activity in KMPT
• demonstrate that we are a listening and learning organisation
• enable our staff to drive improvement in quality as they identify and take ownership of areas for quality improvement
• get the right balance between quality assurance, quality control and quality improvement. We will work with patients and carers to do this, making sure we focus most on what matters to them.

"We want to enable people to develop and deliver positive change through the art and science of quality improvement."

Objective 6

Drive a coherent approach to research and development and evidence based decisions to promote an improvement culture and maximise care quality and outcomes.

Research is a key enabler to the operational and strategic priorities of our organisation. It gives us the evidence that contributes to improving care and treatment, whilst also adding transparency to our decision making and clinical transformation.

As described earlier in this strategy document, we are using the challenges of the COVID-19 response as a springboard to facilitate transformation and improvement across our service areas. We are also working with the Kent Surrey Sussex (KSS) Academic Health Sciences Network (AHSN) Innovation Leads network to share and embed learning following the pandemic, recognising the positive impact that transformation because of the pandemic has had on both service users and staff.

This includes understanding the impact of changed pathways on our workforce, exploring how remote working can help address workforce issues, and strengthening relationships with the voluntary sector.

As set out in our ‘Research and innovation strategy’, we will embed co-produced research into the culture of our organisation. Our ambition is to be known as a national centre for evidencing the impact of our clinical innovation and for the integrity and spirit we demonstrate in delivering all research.

"In November 2020, a KMPT clinician submitted an online psychotherapy paper to the British Journal of Psychotherapy. The paper focuses on the nuance of therapeutic relationships when delivering services through video conferencing rather than face-to-face, as practised throughout the pandemic in some service areas - we are awaiting approval and acceptance."

We will deliver this approach across four ambitions:

• Lead – We will design and lead on more of our own high-quality research that addresses the needs of our service users, carers, and local patient need. We will drive innovation, research dissemination, and implementation in the pursuit of the delivery of high quality, evidence-based practice
• Co-produce – Co-production will occur as standard in all research activity. To us this means ensuring that we include those with relevant lived, educational, and professional experience as part of every research project
• Embed – Research is integral to driving improvements in the services we provide to our service users and patients. It will be embedded and visible throughout the organisation; from ward to board, in the same way that any other trust-wide service would be. An important part of this objective lies in creating a visible senior clinical leader for research as well as strengthening our participation in National Institute for Health Research studies to enable our service users, carers, and staff to have access to research opportunities
• Evidence our impact – We will be known for evidencing the impact of our effective clinical innovation. Our research findings will enable us to demonstrate how we have improved the current and future health and care of our service users.