Case study

Virgin Care’s governance frameworkHow Virgin Care demonstrates excellent accountability, decision making, systems and processes

Clinical Governance,Quality & Safeguarding

Committee

Medicines ManagementCommittee

Safeguarding Adults &Children Governance Group

Infection Prevention &Control Committee

Virgin Healthcare Holdings Limited Board

Virgin Care Executive Team

Virgin Care Clinical Governance Commitee

Business Unit ClinicalGovernance Committees

Service CG Team Service CG Team Service CG Team Service CG Team

Service CG Team Service CG Team Service CG Team

SummaryVirgin Care is committed to providing safe, high quality care to all who use our services. This is achieved through strong governance of the organisation.

Governance involves ensuring that the accountabilities, reporting structures, systems and processes are in place to support the delivery of safe, excellent care.

Virgin Care has a clear line of accountability flowing from the Board and Chief Executive through the management structure to individual practitioners and staff.

Systems and processes are in place to provide assurance on the delivery of high quality and safe care, to identify and manage risk and share good practice and learning. When Virgin Care takes on a new service it pledges to make that service better than it was before so that everyone can ‘feel the difference’.

A 2017 Care Quality Commission report on Community Services run by Virgin Care Services Limited said that the leadership, management and governance were ‘outstanding’. Virgin Care’s clinical governance structure

IntroductionThe Virgin Healthcare Holdings Limited Board is responsible for setting strategic aims, values and goals, for providing leadership and making sure the organisation is well managed. The Virgin Care Executive Team, led by Chief Executive, Bart Johnson, is responsible for the day-to-day management of the organisation and for implementing the strategy agreed with the Board.

Accountability flows from the Board to the Chief Executive, through to the Chief Operating Officer and Clinical Director, then to operational managing directors and clinical leaders and, ultimately, to the individual practitioners and staff who are accountable for their own professional practices.

The organisation provides strong leadership and governance within services through structures, systems and processes which are overseen by a small number of committees, sub-committees and working groups covering clinical governance, health and safety and information governance.

These committees provide information to the Executive Team and Board to give assurance that the organisation is well managed and delivers high quality and safe care. They also ensure key information and good practice is shared to encourage a culture of constant improvement.

The challengeWhen Virgin Care takes on a new contract to provide health and social care services it commits to making services better than they were before for the staff and the people using them, in turn providing better value for the commissioner and the public.

When commissioners are looking for a new provider to take on services there are many problems that the bidder needs to demonstrate that it can resolve.

Many services are not integrated with one another and have varying numbers of locations, contact points and phone numbers. In some instances services are run by a number of different providers.

It is important for Virgin Care to demonstrate how it will embed its governance framework across the new service.

The solutionWhen we take on a new service (which becomes a Virgin Care ‘business unit’) we provide commissioners with our ‘roadmap’ making a number of ambitious commitments on when changes will be delivered. Introducing the Virgin Care governance framework within the business unit is one of the first commitments.

At the corporate level governance is overseen by the Clinical Governance Committee, the Health and Safety Committee and the Information Governance Committee. There is also a Clinical Governance, Quality and Safeguarding Committee.

The Clinical Governance Committee brings together lead practitioners to discuss and share issues relating to quality and to assure the effectiveness of services and organisational processes. The committee is supported by sub-committees covering safeguarding, medicines management, prevention and control of infection.

Each business unit (for example Bath and North East Somerset Community Health and Care Services or Primary Care) also has a clinical governance committee to direct, monitor and manage quality across its teams.

It is at this level the Virgin Care governance structure is introduced into the management of the new business unit. The individual services have clinical governance teams to oversee the quality of care provided.

• Three governance committees – clinical governance, health and safety and information governance

• Each business unit has a clinical governance committee and a programme board

• Individual services have a clinical governance team to oversee the quality of care

• ‘Outstanding’ governance – Care Quality Commission report on Community Services run by Virgin Care Services Limited Above 75 per cent – all established services remain in the green on the Clinical Governance RAG scorecard.

• 100 per cent RAG score for North East Lincolnshire Sexual Health Services

• First year deadline to introduce the Virgin Care governance framework into new services

• 85 per cent – RAG score for Wiltshire Children’s Community Health Services from 45 per cent in eight months

• 93 per cent - RAG score for Luton Intermediate Care Service from 75 per cent after eight months

• Amber to green – Bath and North East Somerset

Community Health and Care Services has progressed from the services’ clinical governance teams regularly review quality and risk management such as clinical audit, performance, incidents and patient satisfaction.

The Clinical Governance, Quality and Safeguarding Committee provides assurance to the Board on quality and safety matters such as strategy, systems and service delivery.

The Health and Safety Committee is responsible for agreeing relevant policies and procedures to ensure effective systems are in place to meet legislative and best practice requirements and for monitoring incident and audit reports. It requires and monitors actions needed to address any identified gaps.

Information governance is the way we handle our information, in particular the personal and sensitive data relating to service users and employees.

The Information Governance Committee is supported by working groups covering corporate records and health and social care records. It advises the Executive Team, business units and services on information security and monitors incidents, privacy impact assessments and performance against audit plans.

Each business unit has a Programme Board which oversees the delivery of the transformation ‘roadmap’ as well as delivery of financial and business plans feeding back to the Executive Team and the Board.

The differenceIn August 2017 a Care Quality Commission report on Community Services run by Virgin Care Services Limited – the main operating company for publicly funded services – said the organisation could “demonstrate through documented evidence that following acquisition of services it had managed to bring about sustained, significant improvements to patient care and that the leadership, management and governance were outstanding”.

This governance structure allows operational colleagues to take responsibility for the services they deliver with accountability and support at the most senior level. As a result colleagues say they understand and feel involved in the governance process.

The Clinical Governance RAG (red amber green) scorecard is used to provide an effective measure of each service’s operation of the clinical governance systems and processes within Virgin Care.

Projects and their individual activities are ranked according to their completion and successful outcomes. This in turn is converted into a percentage – the higher the percentage the more elements of the work are rated green or ‘completed’.

All of our services continue to maintain a high level of compliance with the quality elements on the RAG scorecard.

For the past 12 months all established services have remained in the green (above 75 per cent) and our newer services have shown steady progression demonstrating the implementation of our clinical governance processes.

For example Bath and North East Somerset Community Health and Care Services has seen a steady progression from amber (between 50 per cent and 75 per cent) to green as the teams have embedded Virgin Care’s clinical governance processes during the first year.

Luton Intermediate Care Service saw a steady rise in RAG score from 75 per cent in July 2016 just after it joined the organisation to 93 per cent by February 2017. And Wiltshire Children’s Community Health Services improved from 45 per cent to 85 per cent in the same period.

Indeed, North East Lincolnshire Sexual Health Services scored 100 per cent over the year of the CQC inspection.

Case study correct as at time of printing June 2018

About Virgin CareVirgin Care operates more than 400 frontline health and social care services across England with a difference. We run a wide range services including adult and children’s community services as well as GP practices, walk-in centres and urgent care centres, all alongside sexual health, physiotherapy, dermatology and MSK services. From 2017, we started providing, for the first time, adult social care services to help promote the wellbeing of people to help them live independently for as long as possible with wellbeing and volunteering services available.

Virgin Care Limited and Virgin Care Services Limited are both rated ‘good’ by the CQC following inspections in 2017. Inspectors said that the organisation “could demonstrate through documentary evidence that following acquisition of services, they had managed to bring about a sustained, significant improvement to patient care”.

Get in touch

Virgin Care LimitedLynton House7-12 Tavistock SquareLondon WC1H 9LT

t: 0330 332 7890e: info@virgincare.co.ukw: www.virgincare.co.uk

www.virgincare.co.uk