GOVERNING BODY MEETING: Governing Body Meeting Papers/13... · AGENDA ITEM NO: 047/17 Quality...

AGENDA ITEM NO: 047/17

Quality Report Warrington CCG Governing Body Meeting 13

th September 2017

GOVERNING BODY MEETING:

Governing Body Meeting

DATE OF MEETING:

13

th September 2017

REPORT AUTHOR AND JOB TITLE:

John Wharton, Chief Nurse & Quality Lead Dawn Chalmers, Deputy Chief Nurse

REPORT TITLE:

Quality Report

STRATEGIC OBJECTIVES:

Please tick which strategic objectives the paper relates to

Improve quality of services

Sustained financial balance

Build an effective and motivated whole system workforce

Sound governance arrangements

Ensure integration and joint working arrangements

OUTCOME REQUIRED (tick)

Approval

Assurance

Discussion

Information

EXECUTIVE SUMMARY

To provide information to the Governing Body on the quality of services commissioned by NHS Warrington Clinical Commissioning Group by identifying areas where performance falls below expected standards.

To seek scrutiny of the assurance provided by the Quality Committee in relation to the risks and concerns managed by the committee that may impact on patient safety, experience and outcomes in this health economy.

RECOMMENDATIONS

Note and discuss the work being carried out with the providers to address concerns regarding areas of quality provision where the provider may be experiencing difficulties.

Note the assurances regarding NHS Health Education England report and the supporting work to ensure improved synergy between provider and commissioner to ensure potential workforce issues are addressed.



th September 2017

Acknowledge the pro-active work being recognised at local and national level by the CHC team in ensuring that patients influence and receive the care from the people / organisations they wish to deliver it.

Outline any engagement – staff, clinical, stakeholder and patient / public

Not applicable

Are there any conflicts of interest which may be associated with this paper?

None identified

Does this paper address any existing risks which are included on the Assurance Framework or Risk Register?

Have the following areas been considered whilst producing this report?

Yes

N/A

Equality Impact Assessment (if yes, attach to paper)

Quality Impact Assessment (if yes, attach to paper)

Regulation, legal, governance and assurance implications (reference in the report if applicable)

Procurement process (reference in the report if applicable)

Document development

Has this document been presented to any other Committee or Forum? If yes, please list which meeting, date and outcome of presentation



th September 2017

Strategic Objectives and Risks 2017/18

A1 Failure to performance manage to ensure continuous improvement

A2 Failure to agree and measure outcomes

A3 Failure to ensure clear arrangements are in place for quality management of non-commissioned providers in the independent sector

B1 Failure to implement the financial strategy

B2 Failure to ensure sound business practices are at the heart of running the CCG

B3 Failure to secure best value

B4 Failure to adequately provide for external factors, which impact on financial sustainability

C1 Failure to continuously develop the organisational culture that meets the needs of the changing needs of the workforce

C2 Failure of delivery by outsourced critical business functions

C3 Failure to establish primary care capacity

D1 Failure to ensure that we are compliant with our statutory duties

D2 Failure to demonstrate patient and public engagement

E1 Failure to provide appropriate reporting, for joint working arrangements

E2 Failure to describe benefit of integration and joint working arrangements to local people



th September 2017

WARRINGTON CLINICAL COMMISSIONING GROUP QUALITY REPORT SEPTEMBER 2017

PURPOSE

1. To provide information to the Governing Body on the quality of services commissioned by NHS Warrington Clinical Commissioning Group by identifying areas where performance falls below expected standards.

2. To seek scrutiny of the assurance provided by the Quality Committee in relation to the risks and concerns managed by the committee that may impact on patient safety, experience and outcomes in this health economy.

NEVER EVENTS

3. Spire Cheshire have informed the CCG that there has been a never event regarding a ‘wrong site’ procedure. This was quickly recognised by the organisation and no harm was caused to the patient.

4. The provider adhered to the agreed procedure for reporting to the commissioner and will be submitting a report which will be scrutinised by the Serious Untoward Incident (SUI) group in the coming weeks.

WARRINGTON & HALTON HOSPITAL NHS FOUNDATION TRUST

5. The Clinical Commissioning Group is still awaiting the Care Quality Commission report from the trust; it is anticipated that the trust will be providing detailed feedback at the next Clinical Quality Focus Group.

6. Health Education England have kept the trust on Enhanced Monitoring due to concerns regarding the experience and supervision of trainees working in acute medicine, and concerns have been raised regarding the student experience with the trust in anaesthetics

7. The report by NHS Health Education England offers assurances that following a focused visit earlier in the year small improvements have been made. The trust is looking at ways to increase the numbers of supervisors. This is also backed up by the submission of regular monitoring reports from the trust to Health Education England.

8. The report confirms that improvements have been made in cardiology but the trust will need to strengthen their work particularly around acute medicine and elderly care if their current monitoring status is to be improved upon.

9. The CCG will be working with both organisations to ensure that patient safety is not compromised and that students and trainees are supported appropriately.



th September 2017

10. The CCG has not been informed of any issues which may have

impacted of patient care and safety following the recent industrial action by staff members covering the Operating Theatre Department.

BRIDGEWATER COMMUNITY HEALTH NHS FOUNATION TRUST

11. The Clinical Commissioning Group continues to have concerns regarding the organisations governance/risk management processes. Since the last Governing Body a number of serious incidents have been raised and not all have been reported via the correct mechanisms.

12. The Quality Team is working closely with the contracts team to manage both these and other commissioner concerns with respect to delivery of services.

13. The Quality Team will be undertaking an unannounced quality visit

during September to the trusts leg ulcer clinics in response to the outcome of the trusts clinical audit report on compliance against leg ulcer standards

CONTINUING HEALTH CARE ASSURANCE

14. NHS England undertook a CCG assurance deep dive review into NHS Continuing Healthcare in Warrington.

15. The review looked at three domains:- Assessment & Decision Making - lawful, high quality & timely Fast Track Care & Support Planning

16. NHS England has assessed the CCG as OUTSTANDING across all

three domains.

17. Please see Appendix 1 for further information

18. The work of the CHC team has also been acknowledged in NHS England’s recently published Annual Report (2016-17) with reference to the team’s significant work regarding personal health budgets (PHBs) for patients receiving end of life care.

19. Hospice staff identify suitable recipients for PHBs through the Fast Track funding process and have been trained to co-develop personalised support plans and identify health outcomes with patients.

20. Four months into the pilot, 17 people have received PHBs, which have

been used for a range of services to support health outcomes, such as



th September 2017

pain management and mental health care. Traditionally, the home care and support package consists of four visits per day and three overnight stays. All recipients of PHBs in the pilot have opted for alternative care and support to this traditional offer, with a fully tailored package and plan put in place that includes services and support the individual may be accessing in the community.

21. Each of the PHBs has resulted in a more efficient use of resources. Work is now in progress to offer PHBs to people not accessing the hospice service, in order to secure equity of access and support across the locality.

PATIENT EXPERIENCE ENGLAND

22. It is nearly ten years since the publication of the Darzi Review, High Quality Care for All. Chapter 4 of that review, “Quality at the heart of everything we do” said, “If quality is to be at the heart of everything we do, it must be understood from the perspective of patients.” It went on to list the three cornerstones of high quality care as patient safety, patient experience and effectiveness of care.

23. A great deal of time and money is now spent on efforts to understand patient experience. Hundreds of organisations produce thousands of reports every year. It can be hard for health professionals and the general public to make sense of it all. This report provides an overview and set out to answer three basic questions:

How is patient experience evidence gathered and disseminated? What are we learning? Are we acting on the learning?

24. The report explains how patient experience evidence is gathered and

disseminated. It shows what has been learnt about patient experience in England over the last year. And importantly, it looks at whether health service providers are acting on the learning.

25. The report highlights positive experiences for cancer patients and an increase in confidence and trust in clinical staff from hospital inpatients.

26. However the report also flags "significant declines" in key areas of

person-centred care.

27. "Substantial concerns" remain about the quality of care some people using community mental health services receive. In maternity services, some women were left alone at a time that worried them during early labour, and of those who raised concerns, not all felt that their concerns were taken seriously.



th September 2017

28. A copy of the full report can be found by following the link below https://www.patientlibrary.net/tempgen/162496.pdf

The Governing Body is asked to:

a) Note and discuss the work being carried out with the providers

to address concerns regarding areas of quality provision where the provider may be experiencing difficulties.

b) Note the assurances regarding NHS Health Education England report and the supporting work to ensure improved synergy between provider and commissioner to ensure potential workforce issues are addressed.

c) Acknowledge the pro-active work being recognised at local and

national level by the CHC team in ensuring that patients influence and receive the care from the people / organisations they wish to deliver it.

John Wharton Chief Nurse & Quality Lead Dawn Chalmers Deputy Chief Nurse & Quality Lead September 2017

https://www.patientlibrary.net/tempgen/162496.pdf

Dear Chief Nurse CCG Assurance Deep Dive Review into NHS Continuing Healthcare – Warrington

Thank you for your recent participation in the NHS England deep dive review of NHS Continuing Healthcare as part of the assurance process for CCGs in 2017/18, which was presented by Johnathon Murray-Seddon and Louise Long.

We have now completed the process using the evidence submitted, the discussion at the deep dive meeting in addition we considered performance data for 15/16 and 16/17. As part of the Assurance process, NHS England need to understand and evaluate CCGs processes and governance for Continuing Healthcare. This falls out of the need to seek assurance that organisations are well led and review performance including NHS Continuing Healthcare (CHC). The NHS England Continuing Healthcare Operating Model states NHS England needs to be assured that arrangements are in place to meet the overall strategic challenges for NHS Continuing Healthcare in terms of:

• the delivery of the National Framework; • assessment processes that achieve a consistent approach to eligibility

throughout England; • decision making that is sound and legally complaint; and • high quality care being delivered to those found eligible for NHS Continuing

Healthcare. NHS England has assessed the CCG as OUTSTANDING across all three domains.

Continuing Healthcare Priorities for Assurance

Outcome

Assessment & Decision Making - lawful, high quality & timely

Assured Outstanding

Fast Track Assured Outstanding

Care & Support Planning Assured Outstanding

Cheshire & Merseyside Regatta Place

Brunswick Business Park Summers Road

Liverpool L3 4BL

14th July 2017

047/17 Quality Report - Appendix

This was a very good submission with evidence to support compliance against all standards, with good practise described. The discussion at the meeting highlighted the journey the CCG has been on, the model in place currently and future priorities. NHS England was impressed with the comprehensive picture provided of control and insight into managing CHC across Warrington CCG, both in terms of organisational responsibilities and in terms of system leadership.

We would like to thank Johnathon for his continued engagement with the Cheshire and Merseyside network and the contribution made to sharing good practise across and the team, for their professionalism when liaising with NHS England and requests for information.

Next Steps

We will be collating the findings from the Continuing Healthcare deep dives to report at regional and national level. As stated at meetings individual CCG performance will not be shared with wider stakeholders.

The outcome of this deep dive will feed into the overall CCG assurance process. Can I take this opportunity to thank you again for your positive engagement with this process and for your use of the CHAT tool which can be updated and used locally to demonstrate your compliance to the National Framework.

If you have any questions please do not hesitate in contacting me.

Yours sincerely,

Michelle Cox Continuing Health Care Manager – NHS England - North

Julie McGregor Regional Lead Continuing Healthcare – NHS England North

047/17 Quality Report - Appendix

of 42

North Region Nursing Assurance Framework

Version 6

NHS England North Nursing Team "Everyone Deserves Great Care"

Agenda Item No: 047/17 - Appendix

of 42

Domain Name: Continuing Healthcare

Outstanding

- The CHC process is fully compliant with the National Framework & is MCA Compliant - The CHC Team has strong senior leadership - A documented operational policy is in place - The CCG Board / SMT are cited on complex cases / quality issues & performance data on at

least a monthly basis - CHC is included in the CCG’s Strategic Plans - A contract monitoring process is in place for providers of CHC care - A CCG assurance process is in place for the review process, fast track process, and to audit

the number of patients receiving CHC and for those in need of fast track - All CHC Staff are trained in MCA / DoLS - Partnership arrangements are in place with all of the acute, social care and community

providers to ensure that patients are cared for safely - A CHC training programme is in place for all of the acute, social care and community

providers - There are strong links and intelligence sharing with the Safeguarding Team - MDT assessments involve the minimum of a nurse, social care and patient/representative - Clear information is provided to patients/representatives about the assessment process and

support available - Information is provided to patients/representatives about personal health budgets - There are clearly documented dispute procedures in place - There are timely 3 month reviews and annual reviews thereafter - All patients have a written care plan - Each person in receipt of CHC has a named Case Manager - The CHC Team work with care providers to ensure quality care - There are whistleblowing procedures in place in provider organisations

Good

- The CHC process is compliant with the National Framework & is MCA Compliant - The CHC Team has senior leadership - A documented operational policy is in place - The CCG Board / SMT are cited on performance data and quality issues but this may not be

monthly - CHC is included in the CCG’s Strategic Plans - A contract monitoring process is in place for providers of CHC care - A CCG assurance process is in place for the review process, fast track process, and to audit

the number of patients receiving CHC and for those in need of fast track - Over 80% of CHC Staff are trained in MCA / DoLS - Partnership arrangements are in place with 90% or more of the acute, social care and

community providers to ensure that patients are cared for safely - A CHC training programme is in place for 90% or more of the acute, social care and

community providers - There are strong links and intelligence sharing with the Safeguarding Team - MDT assessments involve the minimum of a nurse, social care and patient/representative - Clear information is provided to patients/representatives about the assessment process - Information is provided to patients/representatives about personal health budgets - There are dispute procedures in place - There are 3 month reviews and annual reviews thereafter


of 42

- Over 80% of patients have a care plan - Over 80% of people in receipt of CHC have a Case Manager - The CHC Team work with care providers to ensure quality care

Requires Improvement

- The CHC process is compliant with the National Framework - The CHC Team has leadership although this may not be senior - An operational policy is in place - The CCG Board / SMT are not cited on performance data - CHC is not clearly included in the CCG’s Strategic Plans - A limited contract monitoring process is in place for providers of CHC care - A CCG assurance process is in place for the review process & fast track process - Between 70% & 80% of CHC Staff are trained in MCA / DoLS - Partnership arrangements are in place with over 80% of the acute, social care and

community providers - A CHC training programme is in place for 80% or more of the acute, social care and

community providers - There are some links with the Safeguarding Team - MDT assessments involve the minimum of a nurse, social care and patient/representative - Some information is provided to patients/representatives about the assessment process - There are dispute procedures in place although these may not be clear - There are 3 month reviews and annual reviews thereafter although these may not be timely - Over 70% of patients have a care plan - Over 70% of people in receipt of CHC have a Case Manager - The CHC Team work with care providers to ensure quality care although this is limited

Inadequate

- The CHC process is not fully compliant with the National Framework - The CHC Team has a lack of senior leadership - There is no clear operational policy is in place - The CCG Board / SMT are not cited on performance data - CHC is not included in the CCG’s Strategic Plans - No contract monitoring process is in place for providers of CHC care - No CCG assurance process is in place for the review process & fast track process - Less than 70% of CHC Staff are trained in MCA / DoLS - Partnership arrangements are in place with less than 80% of the acute, social care and

community providers - A CHC training programme is in place for less than 80% of the acute, social care and

community providers - There are limited or no links with the Safeguarding Team - MDT assessments do not involve the minimum of a nurse, social care and

patient/representative - Little information is provided to patients/representatives about the assessment process - There are no clear dispute procedures in place - 3 month reviews and annual reviews thereafter are not routinely undertaken - Less than 70% of patients have a care plan - Less than 70% of people in receipt of CHC have a Case Manager - The CHC Team do not work with care providers to ensure quality care

Completed by: Rick Holden / Marie Boles

Job Title: Project Officer, Quality & Safety / Deputy Director of Nursing Greater Manchester


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