Quality and Safety in South Tyneside NHS CCG

Ann FoxDirector of Nursing, Quality & Safety

Aim of the presentation

• To provide an overview of the response to the Francis Inquiry and what this means for South Tyneside NHS CCG community.

Findings from the first inquiry(published February 2010)

• Lack of basic care across a number of wards and departments• Trust culture was not conducive to providing good care or a

supportive environment for staff• Too high a priority on targets• Consultant body disassociated itself from management• Acceptance of poor standards• Management and Board thinking dominated by financial targets• Absence of effective governance• Lack or urgency to Board response to problems• Statistics and reports preferred to patient experience• Focus on systems and not outcomes• Lack of internal and external transparency

Learning from 1st Inquiry resulted in publication of:

Review of Early Warning Systems in the NHS

Assuring the Quality of Senior NHS Managers

The Healthy NHS Board

NQB – Managing Safety and Quality during in the transition

Scope of the Francis 2 inquiry

To build on the evidence of the first inquiry and examine the operation of:

• Commissioning

• Supervisory and regulatory organisations :

DoH, SHA, PCT’s, Monitor, CQC, HSE

• Other agencies

Local scrutiny and public engagement bodies, Coroner

To identify lessons to be learned for the future NHS and make recommendations to the Secretary of State for Health

Findings from 2nd Inquiry• A lack of openness to criticism• A lack of consideration for patients• Defensiveness• Looking inwards and not outwards• Secrecy• Misplaced assumptions about the judgements and

actions of others• An acceptance of poor standards• A failure to put the patient first in everything that is done

Key Recommendations•Governance and trust boards•Monitor and authorisation of Foundation Trusts•New fundamental and enhanced standards of quality•Duty of candour, complaints and clinical risk•Enhancements to provision of information, inspection and monitoring•Workforce issues•Commissioning for quality•Role for regulators

Expectations from Francis 2

• How lessons learned might be applied to other parts of the health economy

• All healthcare organisations should consider the findings and recommendations and decide how to apply them to their own areas of work.

• Each organisation should announce its progress against planned actions ( no less than once a year).

• DoH should publish collective progress• House of Commons select committee on Health should

consider incorporating update on actions from those organisations responsible to parliament.

The whole enquiry has been focussed relentlessly on the need to protect patients from unacceptable and unsafe care.

“The extent of the failure of the system shown in this report suggests that a fundamental culture change is

needed. This does not require a root and branch reorganisation – the system has had many of those –

but it requires changes which can largely be implemented within the system that has now been

created by the new reforms.

I hope that the recommendations in this report can contribute to that end and put patients where they are entitled to be – the first and foremost consideration of

the system and everyone who works in it.”

• Sir Robert Francis QC (February 2013)

Initial Government Response to Mid Staffs Inquiry

Statement of Common Purpose:•Renew and reaffirm NHS Constitution•Putting patients first- listening carefully and responding quickly to patients, especially the most vulnerable.•Collaborating on behalf of patients – rooting out poor care and promoting excellent care.•Outward facing – do the business of the patient, not the system or organisation.

Continued• Reduced bureaucracy- freeing up time to care

and to lead. Rewarding staff for their care as well as for skills.

• Single set of measures of success – focussing on what matters to patients.

• Duty of candour- challenge ourselves and each other on behalf of patients. Culture of humility, openness and honesty.

• Commitment to change – set out plans to make this a reality

Five Point Plan – Putting Patients First

A. Preventing problemsB. Detecting problems quicklyC. Taking action promptlyD. Ensuring robust accountabilityE. Ensuring staff are trained and motivated

Learning from Mid Staffs Inquiry

• Francis is an opportunity to reassess what we (commissioners) are doing and why!

• Quality and the Patient First• Getting the basics right• An open culture• Contracts that work for patients and clinicians

Headline considerations for South Tyneside CCG

Issues to consider:

•Performance and standards

•Information

•Professional regulation

•Values and accountability

•Openness and candour

•Leadership

•Care and compassion

•Organisational culture and staff engagement

•Learning from Keogh Review

Next Steps

• Key organisations across health and social care will take the action needed to make the document a reality for patients.

• Government will report on progress annually.• Developing NHS ST CCG action plan by

September 2013 ( aligned with findings from Keogh Reviews)

• Build on assurance from Providers

Themes from draft action plan……

REC NO THEME

Commissioning for standards 123 Responsibility for monitoring delivery of standards and quality

124 Duty to require and monitor delivery of fundamental standards

125 Responsibility for requiring and monitoring delivery of Enhanced standards

126 Preserving corporate memory 127 Resources for scrutiny 128 Expert support

129 Ensuring assessment and enforcement of fundamental standards Through contracts

130 Relative position of commissioner and provider 131 Development of alternative sources of provision132 Monitoring tools 133 Role of Commissioners in complaints 134 Role of commissioners in provision of support for complainants

135 & 136

Public accountability Of commissioners and public engagement

137 Interventions and sanctions for substandard or unsafe services

Local Scrutiny 138 Local Scrutiny Performance management and strategic oversight139 The need to put patients first at all times 140 Performance Managers working constructively with regulators

141 Taking responsibility for quality 142 Clear lines of responsibility supported by good information flows

143 Clear metrics on quality 144 Need of ownership of quality metrics at a strategic level

Questions/Comments?