CWHHE Clinical Commissioning Group ... - Ealing CCG · 6.2 The Committee discuss the implications...

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CWHHE Clinical Commissioning Group Collaborative

Members in attendance

Philip Young (PY) Lay member for audit & governance CWHHE CCGs, Chair [i]

Trevor Woolley (TW) Lay member Hounslow CCG [i]

Mohini Parmar (MP) Chair, Ealing CCG

Nicola Burbidge (NB) Chair, Hounslow CCG (item 5 only)

Fiona Butler (FB) Chair, West London CCG

Clare Parker (CP) Chief Officer, CWHHE

John Riordan (JR) Secondary care consultant, Ealing CCG [i]

Alan Hakim (AH) Secondary care consultant, CWHH CCGs [i]

David Tomlinson (DT) Interim Chief Finance Officer, CWHHE CCGs

Non-members in attendance

[i] = Independent Member

Matthew Bazeley Managing Director, Central London CCG

Janet Cree (JC) Deputy Managing director, Hounslow CCG

Kathryn Magson (KM) Acting Deputy Chief Officer, CWHHE

Louise Proctor (LP) Managing director, West London CCG

Ben Westmancott (BW) Director of Compliance, CWHHE CCGs

Mona Hayat (MotH) Assistant Director of Transformation, CLCCG (item 7)

Matthew Henry (MatH) Head of Planned Care, WLCCG (Item 7)

Simon Carney (SC) Interim Governance Officer, CWHHE CCGs, Secretary

Business items Action

1. Welcome/apologies

1.1. Apologies were received from Rohan Hewavisenti and Sue Jeffers.

2. Declaration of interests

2.1. All GPs present declared a general interest as commissioners and providers. Declaration

was agreed to be sufficient and no recusal was necessary for the items under consideration.

3. Minutes of previous meeting held on 23 April 2015

3.1. The minutes of the previous meetings were approved as a true and accurate record.

4. Matters arising from the actions log

4.1 There were no matters arising requiring discussion that were not already on the agenda.

5. Transitional Transformation Funding – ESIG Q2 and beyond

5.1 All decisions under this item were taken unanimously by the four Independent Members of the Committee.

5.2 Louise Proctor introduced the item and apologised to the Committee for the late submission

of the supporting paper. LP reported that the proposals built upon the commitments made

Minutes of the Investment Committee meeting held on Thursday 18 June 2015 12.05–13.30

Room 5.4, 15 Marylebone Road

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to GP practices in March 2015 and were aimed at underpinning the strategic ambitions of

SaHF.

5.3 The proposals were split into three components:

transformation funding - to support Federations to develop at speed into effective

organisations that are appropriately-staffed and co-ordinated practices manner to

provide full coverage of OOH services to the population, and, through this, support

the wider NWL Strategy and Shaping a Healthier Future ambition for out of hospital

care;

transitional funding – general support for change. This non-recurrent fund would

be used to reimburse individual Practices that have specifically and demonstrably

made losses as a result of the implementation and setup of OOH services; and

transitional risk support fund – for those practices that faced an initial income loss

when moving to the new OOH services contract, it was proposed funding would be

available for up to twelve months that would effectively ‘top up’ the OOH service

income. This should allow practice income and cash flow to be maintained whilst the

practice re-bases its costs in a planned manner.

5.4 The Committee discussed the proposals in significant detail. In seeking to assure itself that that sufficient scrutiny was applied to the detail of the implementation of the proposals, the Committee took the decisions below.

Transformation funding:

the Committee agreed that such funding was required to drive the changes required to enable the fulfilment of the strategic objectives of OOHS and SaHF;

the precise allocation of the £1.25m between the five CCGs was delegated to the Chairs and SMT to decide;

Federations should be told that there is around £200k-250k per CCG available to support their OD transformation programmes. To access the funding, each Federation would need to produce a full implementation plan, setting out the level of investment required to deliver the agreed outcomes and objectives, the activities to be undertaken to that end and how progress will be measured;

such implementation plans will need to be approved by CCGs’ F&P Committees; and

should it become apparent that more than £1.25m is required, the issue must return to the Investment Committee for a decision on how to proceed.

Transitional funding – general support for change:

agreed, noting that the funding source is also that which supports the Extended Hours initiatives and those represent the opportunity cost of this funding.

Transitional Risk Support fund

agreed in principle – sign off of the detail was delegated to the Chair and Trevor Woolley following a detailed review of individual cases and including the provision of an anonymised breakdown, by practice, of LES income compared with that projected under OOHS to provide a sense of scale; and

if the CL CCG allocation is to exceed the £150k estimate then the issue must return

to the Investment Committee for decision.

6. Procurement Framework

6.1 David Tomlinson introduced the item, reporting that the aim of the revised policy was to ensure that careful consideration is given from the outset regarding whether a formal procurement – and all of the resources that such a route requires – is the best and proportionate route to take. The proposed default position was to not use the formal route

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unless the applicable thresholds were at play.

6.2 The Committee discuss the implications of such a move to such an explicit default position. It agreed the direction of travel and supported the overarching aims of the revised policy.

6.3 In reaching that decision, the Committee also agreed that:

a simple process for capturing the reasons underlying decisions to not follow a formal procurement route was required. These decisions should then, in the interests of accountability and transparency, be subject to independent scrutiny and publication;

further guidance on how and when to apply the policy’s principles was required, including when a ‘pilot’ approach is and is not appropriate; and

once the relevant changes were made to the policy and guidance, the revisions should be circulated to the Committee.

DT

DT

DT

7. WL & CL CCGs’ Ophthalmology Tender: Conflicts of Interest

7.1 The Committee endorsed the approach set out in the paper and congratulate those involved for their sensible application of a robust-yet-pragmatic solution. The Committee felt that the approach was one to be held up as good practice to use in similar situations.

8. ECCG – Community-based Cardiology Service Procurement: update

8.1 The Committee endorsed the approach set out in the paper. The Committee confirmed that it remained its firm preference that CCGs retain the flexibility to decide how to specifically address conflicts of interest that arise in the course of a procurement. The Committee did not wish to prescribe beyond the principles of robustness, transparency and proportionality.

9. Any other business

9.1 The Hounslow RFS procurement steering group revised terms of reference, circulated

prior to the meeting after the agenda had been finalised, was approved, subject to any

comments received in correspondence before close of play, 19 June 2015.

9.2 The resignation of the Chair of the Central London User Panel was discussed. It was

agreed that the Chair and Chief Officer would review any potential contributory factors and,

should any relevant matters become apparent, bring those to the appropriate corporate

forum for discussion.

Chair / CP

9.3 In line with good practice, the Chair informed the Committee that he had asked the Director

of Compliance to establish an annual, questionnaire-based Committee effectiveness

appraisal and encouraged all members and contributors to participate fully with the process.

BW

10. Date and time of future meetings

23 July 2015 – 12.00-13.30, Room 5.4 15 MBR; and

10 September 2015 – 12. 00-13.30, Room 5.4 15 MBR.

CWHHE is a collaboration of Clinical Commissioning Groups: Central London, West London, Hammersmith & Fulham, Hounslow & Ealing

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CWHHE CLINICAL COMMISSIONING GROUP COLLABORATIVE

Performance Committee

Thursday 18 June 2015, 10:30am-12.00pm Room 5.4, 15 Marylebone Road


Trevor Woolley (TW) Lay member, Chair

Philip Young (PY) Lay member, CWHHE CCGs

Nicola Burbidge (NB) Chair, Hounslow CCG

Kathryn Magson (KM) Deputy Chief Officer, CWHHE CCGs

David Tomlinson (DT) Chief Financial Officer, CWHHE CCGs

Sue Jeffers (SJ) Hammersmith & Fulham CCG, Managing Director

Louise Proctor (LP) Deputy Managing Director, Hammersmith & Fulham CCG

Matthew Bazeley (MB) Managing Director, Central London CCG

Janet Cree (JC) Acting Managing Director, Hammersmith and Fulham CCG

James Eaton (JE) Associate Director of Performance and Delivery, CWHHE CCGs

Elizabeth Ogunoye (EO) Associate Director of Performance, NWL CCGs

John Riordan (JR) Lay member, Ealing CCG


Non-members in attendance

Riordan Hill (RH) Governance Officer, CWHHE CCGs

Michael Roach (MR) Clinical Improvement & Quality Assurance Manager, CWHHE CCGs

Business Items Action

1. Welcome/apologies

1.1. Apologies were received from Jonathan Webster, Ruth O’Hare and Alan Hakim.

2. Declaration of interests

2.1. No interests were declared at the meeting beyond those identified previously.

3. Minutes from previous meetings

3.1 The minutes from 21 May were approved as an accurate record of the previous meeting, subject to the following addition to [para no. etc]: ‘Providers will present back to the committee, updating on these actions on a quarterly basis’.


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4. Matters arising

4.1. 4.2 David Tomlinson to draft a letter to the DH to address the issues

pertaining to Property Services and report back to this committee.

David Tomlinson tabled a draft letter for the committee to review which

outlined the issues and how they needed to be resolved. As there were still

significant issues for all CCGs regarding the invoicing process, the

committee discussed the implications of withholding payment to Property

Services while the dispute was on-going. It was decided that, for the

moment, no such action would be taken until the issue had been raised

formally with NHSE. The letter would be sent once signed-off by Clare

Parker.

ACTION: David Tomlinson to quantify the extent of the unresolved

financial issues that pertain to Property Services and present

findings back to the committee, including a timeline for addressing

the issues.

ACTION: Place the Property Services issues on the assurance agenda with NHSE.

(DT)

(DT)

4.2. 9.2 David Tomlinson to look at the process of escalating invoices

and consider any potential improvements that all 5 CCGs can

pursue.

Since this process had been brought in-house, the number of outstanding

invoices had reduced from 979 (£2.6m) in February to 127 (£0.35m) in

March.

Further work was being undertaken to improve the processes, including

the automatic approval of invoices under £50. Breac McLeod was leading

the process review.

Action closed.

5. Performance report

5.1 Elizabeth Ogunoye introduced the item, highlighting the following summaries:

- 18 Week Referral to Treatment (RTT) performance; - A&E performance; and - Cancer Performance.

Each is taken in turn below.


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5.2 18 weeks Referral to Treatment (RTT) performance:

a) the backlog at Imperial had reduced from 11,000 three months ago to 4390 at the end of M1; however, this fell short of the 4,000 milestone and more work was required if the 2,500 target was to be met. The trust had completed a plan to reduce the backlog and to deliver RTT targets sustainably. A demand and capacity exercise needed to be completed to inform that plan and work was underway with the provider to ensure that this was done before the assurance meeting with NHSE;

b) concerns were raised regarding London North West Healthcare’s (LNWH) ability to deliver to target, with additional activity required to meet all three standards. A trajectory had been put in place to recover against the non-admitted target by end of Q1 and the admitted target by Q2. Following the trajectory not being achieved for Q1, work had been undertaken with the Trust to clarify what could be delivered. It had been agreed across the patch to assess what monitoring was in place and how this aligned to NHSE requirements; and

c) West Middlesex University Hospital (WMUH) & Chelsea and Westminster (CW) had met all three standards.

5.3 A&E performance;

a) A&E performance at Imperial had improved between M1 and M2. It had been agreed that the Trust would achieve 95% by 16 June and an action plan to take this forward had been put in place. The Trust’s focus had moved to sustaining performance now its waiting time targets were being met. Stress testing the system to ensure that similar problems are not encountered later in the year were being considered;

b) LNWH – Ealing Hospital had recovered its performance and was meeting the 95% standard. Northwick Park had shown a slight improvement but this was not sustained; action and resource planning were required by the end of June;

c) WMUH had achieved the national standard for M2 with 95.0%; and d) CW had achieved the national standard with 97.1%. The

committee discussed the A&E revamp, due to open in August. The impact of this on the other sites needed to be monitored.

5.4 Cancer waits performance:

a) CW had achieved all the cancer waits standards; b) LNWH had not achieved the 62 day standard, in alignment with

their trajectory. c) ICHT had not achieved the screening standard. The Trust will

submit individual breach reports; and d) WMUH had not achieved the screening and consultant upgrade

standards. The Trust will submit individual breach reports. However, given the low volume, the Trust was expected to recovery to achieve Q1 performance.

6. IAPT deep dive Report


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6.1 Elizabeth Ogunoye introduced the item, highlighting:

a) IAPT access – target 3.75%;

b) IAPT recovery – target 50%;

c) 75% of patients had started treatment within 6 weeks of referral or less; and

d) 95% waiting 18 weeks or less.

Each is taken in turn below.

6.2 IAPT Access;

a) CLCCG had achieved 0.78% against 1.25% monthly target; CNWL Mental Health Trust’s under-performance in M1 was due to referrals being brought forward to help achieve the Q4 target. A joint action plan between CLCCG and the provider had been implemented to increase referral rates. Matthew Bazeley advised the committee that CLCCG had considered campaigns and was speaking to GPs directly in a bid to increase referrals;

b) WLCCG had achieved 1.18% against the M1 target of 1.25%. CNWL had sub-contracted the delivery of IAPT services to CLCH and reported issues around staff turnover. CLCH had been asked to see patients over M2 and M3 to recover the position;

c) ECCG had achieved 1.2% against M1 target of 1.25%. It was reported that staff leave had resulted in a reduced capacity to triage referrals;

d) HCCG had achieved 1.15% against the 1.25% monthly target; and. under-performance had been attributed to a broken phone line at Chiswick Health Centre resulting in some telephone assessments being cancelled.

e) HFCCG had achieved 1.35% in M1.

6.3 ACTION: Elizabeth Ogunoye to investigate issue of a broken phone line at Chiswick Health Centre and report back in July. (EO)


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6.4 IAPT recovery (target: 50%):

a) CLCCG had achieved 41.1% at M12. At M1 15/16 CLCCG had achieved 31.8%. The trust had reported complex caseloads and transient populations as key contributors to under performance;

b) WLCCG had achieved 34.4% at M12. At M1 15/16, WLCCG had achieved 34.4%. Staff capacity, complex caseloads and transient populations had been identified at the key contributors to under-performance;

c) The WLMHT Ealing IAPT service had been the only team across NWL to achieve the target at M12 - 50.6%. The target had been consistently met between July 2014 and January 2015. However, as the focus on IAPT access increased in Q4, there had been a decline in performance in February and March. In M1 ECCG achieved 47.2%;

d) Hounslow had achieved a year-to-date performance of 46.7%. The trust had achieved 46.1% in M1. Root cause analysis of the breaches will be undertaken and reported back to the committee; and

e) HFCCG had met the IAPT recovery target since august 2014. For M12 year-to-date the trust had achieved 49.5% and the trust continued to perform well against the target, achieving 50% at M1.

6.5 Waiting times for IAPT had been met consistently across the patch apart from the 6 week KPI in Hounslow which consistently fell beneath the 75% target.

6.6 The committee discussed the nature of under-performance and the following points were made:

a) the services are new and are still being established; and

b) Primary Care counsellors had previously not been able to report on activity, and that had only been resolved in M1.

6.7 The committee discussed IAPT performance as a whole and its disappointment that continued improvements had not been seen. The committee questioned what action was needed to ensure all 5 CCGs meet NHSE requirements.

6.8 ACTION: Elizabeth Ogunoye to compare the figures outlined in the IAPT report with the latest London position and report back to committee, with a view to discussing if inviting the Chief Executives of each provider to present to the committee would be beneficial.

(EO)

6.9 ACTION: Kathryn Magson to raise the issue of how IAPT underperformance can be escalated with the trusts with the SMT and report back to this committee is July in an attempt to achieve sustained performance.

(KM)

6.10 ACTION: Michael Roach to follow up about how each CCG was learning lessons from H&F meeting both IAPT targets.

(MR)

6.11 ACTION: Michael Roach to report back to this committee about IAPT related suicides.

(MR)

7. Matters for escalation

7.1 No matters were escalated to the committee by CCG performance committees.


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8. Any other business

8.1 The terms of reference require us to self-assess the committee on an annual basis. A questionnaire to be sent out to the committee to be returned to the Secretary.

ACTION: Rory to provide anonymised report detailing the responses to a self-assessment questionnaire to the committee in July.

(RH)

Dates of next meeting

Date and time of future meetings:

Thursday 23 July 10:30 – 12:00

CWHHE is a collaboration between the Central London, West London, Hammersmith & Fulham, Hounslow and

Ealing Clinical Commissioning Groups

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CWHHE CLINICAL COMMISSIONING GROUPS COLLABORATIVE

Quality & Patient Safety Committee

Thursday 04 June 2015, 10:30 – 12:00 15 Marylebone Road


Trish Longdon (TL) Lay member, Hammersmith & Fulham CCG (Chair)

Jonathan Webster (JW) Director of Quality, Nursing & Patient Safety, CWHHE CCGs

Ruth O’Hare (RoH) Chair, Central London CCG

Nicola Burbidge (NB) Chair, Hounslow CCG

John Riordan (JR) Secondary Care Consultant, Ealing CCG

Alan Hakim (AH) Secondary Care Consultant, CWHHE CCGs

Leigh Forsyth (LF) Assistant Director for Quality Improvement and Clinical Assurance, Hounslow & Ealing CCGs

Janet Cree (JC) Interim Managing Director, Hammersmith & Fulham CCG

Lizzie Wallman (LW) Assistant Director for Quality Improvement and Clinical Assurance, Central London & West London CCGs

Michael Morton (MM) Lay member, Central London CCG

Phil Portwood (PP) Lay Member, Ealing CCG


Non Members in attendance

Liam Edwards (LE) Assistant Director of Quality Improvement & Clinical Assurance, Hammersmith & Fulham CCG

Mary Mullix (MM) Deputy Director of Quality, Nursing and Patient Safety, CWHHE CCGs

Nicky Brownjohn (NB) Associate Director for Safeguarding, CWHHE CCGs

Sue Pascoe (SP) Deputy Director of Quality, Nursing & Safeguarding, CWHHE CCGs

Samira Ben Omar (SBO) Assistant Director of Patient Experience & Equality, CWHHE CCGs

Nicola Clark (NC) Assistant Director of Patient Safety, CWHHE CCGs

Tandeep Fairman (TF) Head of Planning and Governance, Hounslow CCG (dialling in)

Michael Roach (MR) Clinical Improvement & Quality Assurance Manager, CWHHE CCGs

Steve Buckerfield (SB) Head of Children's Joint Commissioning, CWHHE CCGs

Deborah Kingsbury (DK) Senior Commissioning Manger (London Region), NHSE

Oliver Excell (OE) Shaping a Healthier Future PMO, Strategy & Transformation

Riordan Hill (RH) Governance Officer, CWHHE CCGs

Minutes

CWHHE is a collaboration between the Central London, West London, Hammersmith & Fulham, Hounslow and Ealing Clinical Commissioning Groups

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Business Items Action

1. Welcome/Apologies

1.1. Apologies were received from Rachel Garner, Neville Pursell, Mohini Parmar and Tim Spicer. 2. Declaration of interests 2.1. There were no new declarations of interest. 3. Minutes of Meeting – 07 May 2015 3.1 The minutes were approved as an accurate record of the meeting.

4. Matters Arising

4.1 4.4 – CLCH workforce Issue: Mary Mullix has agreed to undertake further work with Local Authorities in relation to health visiting and school nursing and will report back to the committee. Mary Mullix to present back to the committee in July 2015. Item on agenda for July, Action closed.

4.2 4.7 – Safeguarding children training: Nicky Brownjohn to conduct safeguarding training audit at year end and report back to the committee in May/June. There had been delays in receiving reports from providers. This item has been placed on the agenda for July. Action closed.

4.3 4.9 - HENWL Workforce update: Lizzie Smith to provide an update on work to recruit community nursing and health visitor staff. Item on agenda for July. Action closed.

4.4 7.1 - Hammersmith and Fulham highlight report – Pressure Ulcers: Nicola Clark to present a pressure ulcer review plan at the May committee meeting. On agenda item 13. Action closed.

4.5 4.7 - Patient experience and engagement: Create a reporting structure to highlight where patient experience information is currently reported and reviewed. On agenda, item 15. Action closed.

4.6 4.7 - Primary Care reporting on patient experience and engagement: Summarise the available primary care patient experience feedback of providers and recommend options of implementation across the five CCGs. On agenda, item 15. Action closed.


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4.7 5.1 – Central London CCG highlight report – ICHT patient tracking in cancer pathway: Further assurances to be provided on 31 day standard following discussions at the ICHT CQG meeting. Jamie McFetters has advised of a marked improvement. The Cancer and Performance teams continue to oversee the process to assess if the improvements are sustained. Overall cancer wait times are reducing and Imperial patients in the pathway are being closely monitored. This was discussed at the local quality committee where conversations centred around how robust the admin process was as against gaining clarity on the scale of the problem. Jamie McFetters to report back to Central London Quality & Safety Committee with the results of this monitoring. Assurances have been provided to the performance committee but we don’t have the assurances from a quality perspective. Janet Cree to gain assurances from imperial about improvements in quality in terms of patient experience, staff experience and patient outcomes. Liam Edwards to work with imperial to bring any issues back to this committee through the CQG. ACTION – Liam Edwards to report back to the committee in July regarding what assurances in relation to quality might look like and how to gain assurance, specifically for cancer.

(LE)

4.8 6.1 - West London CCG highlight report – SHSOP Contract: Rachael Garner and Sue Pascoe to discuss clinical risks in further detail. Three CLCH contracts have been signed and movement has been made towards mobilisation. A small group had been set up with Louise Maile to escalate quality concerns. A wash up exercise is to be performed as the end of the SHSOP process to evaluate and consider the lessons learned. Action Closed.

4.9 12.1 – Chronic Fatigue Service Commissioning review: Clare Jarman to present the report to the collaboration board to agree the future for commissioning arrangements across North West London for chronic fatigue services. This item was on the agenda for the Collaboration Board but the meeting overran which meant the item was not discussed. The committee discussed how to take this forward. ACTION – Liam Edwards to liaise with the IFR team and request that they make a recommendation to create a gated service and report back to the committee in July about the next steps

(LE)

4.10 3.6 – Helen Mansfield to circulate the education plan that outlines recommendations around commissioning numbers. Action closed

4.11 3.7 – Helen Mansfield to consider the committees comments regarding assurances for how the workforce issue is being tackled and use this to structure a response when presenting back August. Added to agenda for July. Action Closed.


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4.12 3.8 – Trish Longdon to raise workforce concerns to the SaHF workforce group meeting on Thursday 07 May to discuss if that group should take the lead in developing the strategic workforce direction. All concerns were raised at the SaHF workforce group and it was agreed that the SaHF team will produce a workforce strategy and detailed plans. The committee will be notified as work develops. Action closed.

4.13 5.1 - Michael Roach and James Eaton to report back on progress of the reporting improvements between the performance committee and the quality and patient safety in July. James and Michael to link in with Ben Westmancott to further explore how this link can be made. On the agenda for July. Action closed.

4.14 13.3 – can close when paper sent out.

5. Central London Highlight report

5.1 Central London CCGs Quality and Safety committee were seeking assurances around the performance of Imperial College Healthcare Trust and 18week RTT. The questions that arose were;

- Was the monthly trajectory reviewed at each CQG? - Is there a trajectory in place to measure performance? - Was this trajectory monitored and if so how often? - Was there an action plan in place to address challenges? If yes, is this being

achieved? Liam Edwards and lizzie Wallman advised the committee that these concerns will be addressed the CQG meeting. This again highlighted the need to improve the reporting line from the CQG which must include a sensible feedback loop; this issue will be covered by Michael Roach and James Eaton’s paper that will be presented to the committee in July.

6. West London CCG Highlight Report

6.1 Nothing to escalate.

7. Hammersmith and Fulham CCG Highlight Report

8.1 West London CCGs Quality and Safety Committee raised concerns that the assurance given in relation to workforce planning is not sufficient, for example; LAS recruitment across London and watching brief required on maternity recruitment at imperial. The committee discussed the differences between assurances that had been provided on workforce planning against the situation in reality. Imperial College Healthcare Trsut had repeatedly assured around the recruiting of midwives, but this has been protracted. The committee concluded that as the theme of workforce planning is being encountered across the 5 CCGs that the collaboration board are to request an update paper about the workforce plan and strategy to allow scrutiny across NWL. ACTION – Jonathan Webster to coordinate the CWHHE Quality & Safety committee’s request for an update paper in relation to workforce planning and strategy across NWL from the collaboration board.

(JW)


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8. Hounslow CCG Highlight Report

9.1 Nothing to escalate.

9. Ealing CCG Highlight Report

10.1 Leigh Forsyth informed the committee on behalf of Ealing CCG of 2 suicides relating to Increasing Access to Physiological Therapies (IAPT). He advised work will be undertaken to review all suicides to find the root cause and the contributing factors. ACTION – Leigh Forsyth to present a review of the root causes of all suicides relating to IAPT to the committee in July.

(LF)

10. NHSE CAMHS Tier 4 Update


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10.1 Steve Buckerfield and Deborah Kingsbury introduced the NHSE CAHMS Tier 4 Paper which contained the in-patient provisions for young people with mental health needs and the strength of pathways between CAHMS in- patient and community health services. The following updates were provided to the committee;

a) The national CAMHS Taskforce Report, ‘Future in Mind’ expects CCGs to submit a CAMHS ‘Transformation Plan’ for September explaining how the new promised government investment (£1.25 billion over 5 years) in young people’s mental health services will be spent. The intention is to submit a NWL Transformation Plan, with NHSE involvement, which will capture high level common priorities but be flexible enough to allow local CCG flexibility.

b) CQUINs are in place at West London Mental Health Trust and Central & North West London NHS Foundation Trust to ensure contact between local providers and Tier 4 in patient units and NHS E have a locum Case Manager in post.

c) 3 contentious cases where young people are waiting for beds were reported. In these situations the number of professions, clinicians and commissioners increases and there is a strong risk of losing sight of the patient’s needs. A Memorandum of Understanding is needed that explains the detail so that all involved can be assured of what steps can be taken, when and by whom;

d) 10-15 cases where the patient was treated outside of London. The only admission to provision in the of north England was a very specific learning disabilities case where this was judged an appropriate admission;

e) Work is being undertaken nationally on a procurement strategy for Tier 4 beds. This is still in the pre-procurement stage and is due to be completed next year;

f) There is a need to recruit additional clinical case managers for London (and elsewhere); who perform two roles; 1 – advise and facilitate problematic cases and 2 - Quality assurance to all providers and report back to NHSE;

g) All referrals passing through the system noted as part of the 8 CCGs (BHH & CWHHE) area to build a clearer NW London picture.

The committee agreed that there is a need to arrange a meeting between CCG & NHSE London commissioners in relation to how they can work together effectively. A Memorandum of Understanding that outlines the most efficient way of working would begin to address this. The committee invited Steve Buckerfield and Deborah Kingsbury to present back to the committee in September. ACTION – A meeting to be arranged between CCG & NHSE London commissioners in relation to how they can best work together effectively. ACTION - CAHMS to be an agenda item for the September CWHHE Quality & Patient Safety Committee.

(SB)

(RH)


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11. Ealing Maternity transition

12.1 Sam Burrows presented the Ealing maternity transition report which detailed; the outcome of ealing CCG GB meeting on 20th May, the implementation plan including timelines and the outcomes of the NSHE TDA stage 1 assurance. Further to this the report described the TDA stage 2 requirements.

a) Ealing CCG Governing Body confirmed that the date set for the transition of Ealing maternity services as 1 July, with Paediatric services closing on 30 June 2016;

b) The transition assurance processes had been undertaken with NHSE and TDA and are on track to meet all TDA stage 2 requirements;

c) Maternity diverts are being monitored and no further diverts will be sent to Ealing. The level of diverts being reported are no higher than usual;

d) HSE stage 2 assurances confirmed that the estates are ready, with site visits being undertaken at Imperial, Hillingdon and the Ealing hub. The West Middlesex site visit was already completed. David Finch and Juliet Brown are leading on this.

The committee noted the resolutions made by the Governing Body, the outcomes of the NHSE TDA stage 1 assurance and the TDA stage 2 requirements.

12. Patient safety report

12.1 Nicola Clark presented the Patient Safety report including the national SI and Never Event framework. The report contained the following summary;

a) Commissioners and Providers are reminded of the importance of timely reporting and investigation of Serious Incidents, with reporting numbers on an upward trajectory and learning being reflected in reduction in repeated root causes;

b) Considerable efforts required across the commissioned services on the transparency and candour in reports, including the use of accessible language;

c) Pressure Ulcers continue to reflect a high level of human and financial cost. All providers must concentrate on investing in prevention of category 2 Pressure Ulcers. This would have a dramatic impact on the overall burden of harm to people;

d) A concerning number of reports which, when returned to trusts for quality improvement, are not returned to the CCG Quality & Patient Safety team within 10 days. Commissioners need to ensure that providers have plans in place to respond to requests for improvements in a timely manner;

e) New metrics will provide data on repeat causes and contributory factors to Serious Incidents in future reports, the new system will be implemented from June 2015.


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The following points emerged in discussion;

f) Work with providers needs to be undertaken to change the commissioner’s culture to support the providers in changing their own culture. There is a need to create an environment where it is encouraged to report errors, and secondly where investigations are carried out openly. The issue of a lack of investment across the system to train people appropriately has been raised with NHSE who advised they plan to explore what the appropriate level is;

g) The committee would like to receive assurances that the system is working and that learning is taking place.

ACTION : Nicola Clark to present back to the committee in July, specifically addressing the learning around how to prevent reoccurrences of Serious incidents

13. Pressure ulcer improvement plan

13.1 Nicola Clark introduced the pressure ulcer improvement plan which contained the following summary;

h) Pressure Ulcers are largely preventable, but rates of those occurring in patients known to health services continue to rise. There is little new learning for healthcare professionals in the science of prevention and treatment of pressure ulcers, and the salient question to be posed might be; given that we know how to prevent and treat pressure ulcers, what organisational and human factors impede care being delivered effectively?

i) The proposed programme requires a suspension of blame and attribution of harm, honest and accountable leadership, with buy-in from senior staff from all healthcare organisations. The programme will require a Collaborative-wide agreement between providers and commissioners about what improvements are sought and how this will be measured. It will require a system-wide buy in to transparent and candid measurement.

The committee discussed the need for the information being provided to be less process based as the main concern is the cause of the pressure ulcers and what work can be done to prevent them. ACTION: Nicola Clark to track the pressure ulcer prevalence over the past 12 months and present the findings back to the committee in July.

(NC)

14. Health and safety end of year report


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14.1 Helen Christodoulou presented the 14/15 annual Health & Safety report. The report covers the five CCGs within the NW London Collaborative and focuses on the period 1st April 2014 to 31st March 2015. The report outlined that many property management aspects are compliant with current legislation, the re-shape and redirection of the management system in its broadest sense is what is required and a careful analysis of a full Health and Safety audit should be undertaken within the next 12 months to ensure ongoing compliance. Helen Christodoulou highlighted the need to have standard reporting systems across the 5 CCGS and that a health and safety contract also needs to be procured.

15. Patient experience update

15.1 Samira Ben Omar presented a proposal which was in response to action 4.7 of the March meeting of the CWHHE Collaborative Quality & Safety Committee, where it was requested that a reporting structure is created to ensure data is presented and reported, including thematic and accessible formats, to be delivered in a more systematic way to the appropriate forums. The new model will bring together CCG Engagement leads and Quality leads on a quarterly basis to help:

a) Create a timely and efficient reporting process for NHSE Assurance meetings, PPE Committees, Quality and Safety Committees and other key decision making bodies;

b) providers to effectively complete their quarterly patient experience reports in reference to the quality schedule;

c) share patient experience data and good practice across the CWHHE CCGs; d) Demonstrate that across CWHHE we are pro-active in using our data and

intelligence reports (especially data from our local communities) to help shape and influence our commissioning intentions.

Conversations with providers were had requesting that good practice should be shared. A template has been produced for the providers to prescribe the information that is being received. The focus of this is largely positive, requesting themes and trends of what patients have said, what work has been done in response and how this benefits patients. Feedback from providers has been positive. The committee were content that Samira had articulated the need, but requested that the report is further worked up outlining what can and can’t be prioritised. Formulating a business case showing the minimum amount that needs to be invested. ACTION: Samira Ben Omar to write a business case on equalities resourcing that is to be present at the business meeting of the SMT for approval.

(SB)

16.1 Any other business


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16.1 Jonathan Webster informed the committee that work is being done with CQC about the quality of care homes, with a number being classed as inadequate and where this had happened they have been put in to special measures. ACTION: Jonathan Webster to report back to the committee in July, detailing what care homes being put in special measures looks like in reality.

(JW)

17. For Noting

17.1 Building User Group minutes.

18. Date of the next meeting

30 July 2015

CWHHE Clinical Commissioning Group ... - Ealing CCG · 6.2 The Committee discuss the implications...

Documents

Transcript of CWHHE Clinical Commissioning Group ... - Ealing CCG · 6.2 The Committee discuss the implications...