Quality improvement and collaborative working: partnerships across services in East London, Bedfordshire and Luton

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Navina Evans is Chief Executive of East London NHS Foundation Trust


East London NHS Foundation Trust provides mental health and community services to several London boroughs and Bedfordshire and Luton. In 2016 we had our first inspection by the Care Quality Commission (CQC). In my experience, delivering effective health care today means commitment to constant improvement, and the CQC approach can support this. We found that developing a constructive and collaborative relationship with the CQC was key to benefiting from the inspection process. Recent research from The King’s Fund and Alliance Manchester Business School also highlights the importance of ongoing partnership working between provider and regulator.

The CQC inspection team returned to our Trust earlier this year to inspect a range of services, giving us the opportunity to continue the dialogue on how to keep getting better. We are keen to focus continuously on quality, rather than waiting for the next inspection. So the Trust has developed a unique approach called the CQC Readiness Programme. This involves our Quality Improvement team working with every service across the Trust on a rolling basis, with service users working alongside clinicians. Every service takes part in the rolling review at least once in three years, and we publish the report of each service review. 

For our Trust, the first CQC inspection in 2016 heralded the start of a process that we have now embedded and made routine. Although inspections make considerable demands on staff, the CQC approach has helped us to foster a culture of improvement. In practice, this means that we are not afraid to keep learning, and the key to this is developing a range of collaborative partnerships on many fronts. An essential part of this process is letting our staff know that, whatever the external pressures facing us, they have the power to make their own changes. The CQC Readiness Programme is about creating and maintaining a space for collaboration and the sharing of expertise, to keep developing and improving. This in turn can help staff to improve outcomes and increase the quality of life for our patients. 

If we see the CQC inspection process as one that generates a list of demands, we risk remaining stuck in the old culture of seeing health care as something we do to people rather than with them, as partners. So, the other side of the changes we introduced is establishment of the People Participation service across the whole of the East London Trust. With the CQC Readiness programme, this is embedded in everything we do. People Participation involves families and carers leading in helping us to create better ways of working. This is practical, active participation and requires a dynamic partnership at all levels, all the time. Our People Participation partners tell us what isn’t working, suggest how things can be better and support us to trial new approaches where needed.  

Just one of the areas pioneering this approach is the London borough of Newham, where our extended primary care team is integrated with primary care providers, GPs and social services to support patients in monitoring their own health using mobile phone and computer technology. Our people take their own daily readings and upload these to the Telehealth system, allowing us to work smarter and focus our resources in a timely and effective manner. Using technology in this way promotes independence: patients understand what the readings indicate and, through working with our specialists, they are empowered to manage their own care more closely.

We face a future with a greater strain on finite resources, an ageing demographic and the additional challenges unique to the places and neighbourhoods we serve. Our experience is that the CQC is not looking for perfection, but for assurance that organisations are: providing a good standard of care, aware of areas for improvement and have plans in place to address these. I know that the calibre of the people and the processes embedded across the whole of the East London Trust will be a big part of responding to these future challenges. Partly thanks to the approach of the CQC, we are well on the way to creating a culture of ongoing readiness across the Trust. 

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