An assurance framework
is a structure which identifies how an organisation will gain assurance (evidence of achievement, or otherwise) against a set of objectives, targets or requirements. It typically identifies a number of sources of assurance that relate to the objective to allow a judgement as to whether the organisation can be confident (assured) in its achievement.
Assurance frameworks exist in a number of areas of CCG work, including safeguarding and continuing healthcare.
Governing Body assurance framework
This framework is currently composed of all the red rated risks on the corporate risk register. These are seen as the key risks to achievement of our strategic objectives. The assurance framework sets out the risks and the systems, processes and structures (controls) that are in place to manage them. It then identifies any gaps in those controls and sources of assurance that the organisation can access. This enables them to assess whether they are successfully managing the risk and achieving the objective. For example, mortality rates, serious incident investigations, CQC reports and safeguarding alerts all contribute to assurance on our systems around quality and safety of services. While absence rates, turnover and training figures help inform us about our systems for recruitment and retention.
The assurance framework is seen by the Governing Body regularly. The red risks which comprise it are also reviewed by the finance committee, quality and performance committee or workforce committee, as well as by our executive management team.
The audit committee maintains oversight of the assurance framework as part of its remit to review to systems of integrated governance, risk management and internal control across NHS Kernow.
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Commissioning intentions set out the context for commissioning healthcare.. They enable a conversation between commissioners and providers about what needs to change.
Commissioning intentions are part of an on-going dialogue with providers to agree what can be delivered through contracts. They lead to operational plans and service development and improvement plans.
- wish to move to a community-based model of care, focusing on the needs of the whole population with an emphasis on prevention
- are focused on gathering community services around people, making better use of those who can help to support others: family, friends, neighbours and volunteers as well as investing in more community-based care
- have a vision for unplanned care that is fully joined-up across GP surgeries, out-of-hours clinics, community hospitals, urgent care centres, emergency departments and advice services such as NHS 111
- aim to deliver on the domains and clinical priority areas set out in the CCG Improvement and Assessment Framework to provide assurance that NHS Kernow is fit for purpose and the services we commission meet national standards and targets
The CCG Improvement and Assessment Framework cover 4 domains:
- Better health.
- Better care.
What is the Francis report?
In 2010 the Government commissioned Robert Francis QC to report on failings of care at the Mid Staffordshire NHS Foundation Trust. His report is lengthy and critical of the care provided at Mid-Staffs. Stories of patients left in their own faeces, so thirsty they had to drink from flower vases and suffering from inadequate pain relief. Worse still it became clear these were not isolated incidents but due to the culture of Mid-Staff, which had become so damaged these occurrences had become normal practice.
An overwhelming message from the report was that the concept of the culture of the Mid Staffordshire NHS Foundation Trust (and perhaps the wider NHS) needs to change. Too often the system makes it easier to comply with or ignore poor care rather than highlight it. Francis wants this to change and so do we at NHS Kernow. NHS Kernow have reviewed the findings and recommendations from the Francis report. We are working to ensure that they are embedded within our own work and that of our providers to help avoid a repeat of the poor care given and received in Mid-Staffs.
Listen to our patients
- commit to working with patients and other members of the public to ensure their feedback is used to develop local services
- work with members of the public when making our commissioning decisions and take their views into account before producing and publishing our strategy on inclusion and engagement
- actively involve members of the public in the decision making process including giving the wider public a chance to ask questions at our governing body meetings
Develop capacity to deliver high quality care
- ensure patients have access to high quality care by monitoring the standards of our commissioned services
- actively share information with providers so that we can quickly identify and act on any issues that need to be addressed
- commission (plan and fund) services using the latest clinical evidence and patient feedback
Develop our Governing Body and our organisation
- commit to being open and transparent in the work we do and to meet the contractual requirements for the NHS ‘Duty of Candour’ which means being honest with people when things go wrong
- actively support our staff and our board members to question any decisions we make if they feel they compromise on our commitments to quality of care
- make it easier for staff, as well as members of the public to raise concerns and to have those concerns investigated
- ensure that our clinical leaders have the support they need to implement changes that improve care for our patients and communities
Work with our providers
- set up regular meetings with key staff at our providers including directors of nursing and medical directors to share best practice and discuss any issues
- continue to work with quality managers in our providers to maintain and improve standards
- look into findings of local and national reviews and surveys to implement changes where we need to
- work with all our providers ranging from the large NHS trusts to smaller independent healthcare providers to help ensure the highest quality care and services are being provided