Meeting title STCCG Governing Body Date: Report title Commissioned Services Assurance Report Enclosure: 02 Lead director: Report author:

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1 Meeting title STCCG Governing Body Date: Report title Commissioned Services Assurance Report Enclosure: 02 Lead director: Report author: Name/Title: Ann Fox, Director of Nursing Quality and Safety. Tel/ Name/Title: Kirstie Hesketh, Senior Clinical Quality Manager, North of England Sponsor(s): Commissioning Support Unit Tel/ / F.o.I status Short summary of key issues The primary areas of concern/interest for South Tyneside CCG are: South Tyneside Foundation Trust (STFT) In June, STFT reported 4 SIs, all of which are reviewed against a standard root cause analysis process. This is a decrease on previous month where 8 were reported. In July, STFT reported 3 SI s, a slight reduction on June figures. The governance risk rating for ST Foundation Trust was amended from red to amber-red in May 2013 due to the trust delivering a finance risk rating of '3' at year end. The last national quality dashboard indicates that STFT is over trajectory on their MRSA target. Friends and Family Test results for the month of June 2013 indicated that 210 out of 253 in-patient respondents would highly recommend South Tyneside District Hospital. Q1 results, STFT combined score 81, England average 64. Inpatient rate 21.5%, England average 24.4%, A&E rate 0.9%, England average 7.8%. Unfortunately this means the STFT combined rate is 6.3% compared with the England average of 13.3%. City Hospitals Sunderland Foundation Trust (CHSFT) In June, CHSFT reported 15 SIs, all of which are reviewed against a standard root cause analysis process. This is a slight increase on the previous month where 14 incidents were reported. There was one Never Event reported in June. This related to wrong site surgery. The governance risk rating for CHSFT was amended from amber-red to amber-green in May 2013 The last national quality dashboard indicates that CHSFT is over trajectory on their MRSA target. Friends and Family Test results for the month of June indicated that 813 out of 1051 in-patient respondents would highly recommend Sunderland Royal Hospital. Northumberland Tyne and Wear NHS Foundation Trust (NTWFT) In June, NTWFT reported 14 SIs in total, 2 of which related to South Tyneside patients. In July, NTWFT reported 17 SI s, 5 of which related to South Tyneside residents. 1

2 Concerns were highlighted in a report published by the mental health charity Mind about the use of face down physical restraint which is considered to be a life threatening form of physical restraint because of the severe impact it can have on breathing. NTWFT reported they had 2660 incidents of restraint against a national average of 455 the Trust also highlighted that 923 of these incidents involved face down restraints compared to a national average of 65. North East Ambulance Service (NEAS) The governance risk rating for NEAS was amended from amber-green to green in May 2013 due to the Trust achieving all targets in Q4 2012/13. A Clinical Quality Review has now been established which will monitor the quality aspects of the service provided by NEAS for both 999 and 111 services. Report summary Purpose (tick one only) Recommendation To provide the governing body with a Quality and Patient Safety highlight report on any issues and concerns that have arisen since 1 st June, Information Approval To note Decision This item is provided for information and discussion at the CCG governing body. Strategic objectives links Identified risks & risk management actions Resource implications Legal implications Including equality & diversity assessment Process for Report history Next steps Appendices Commissioners are required to ensure that there are robust systems in place for the delivery and monitoring of clinical quality in commissioned services. Clinical Quality support from the 1 st April is provided by NECS Clinical Quality Team Francis 2 Complaints legislation This is the first monthly highlight report. Clinical quality representatives from the North of England Commissioning Support Unit will be working closely with the CCG Director of Nursing and Head of Quality and Patient Safety on the content of future reports. Not applicable 2

3 1. Introduction South Tyneside Clinical Commissioning Group Clinical Quality and Safety Highlight Report - June 2013 The purpose of this report is to provide South Tyneside Clinical Commissioning Group (STCCG) governing body with a monthly briefing of the headlines relating to clinical quality and assurance. This initial report highlights quality and safety issues and concerns received in June It is anticipated that this report will evolve over forthcoming months as clinical quality representatives from the North of England Commissioning Support Unit work closely with the CCG Director of Nursing and Head of Quality and Patient Safety, to ensure the report meets CCG requirements. The increasing escalation and focus on the quality of commissioned services following Mid Staffordshire and Morecombe Bay Foundation Trusts has meant that CCGs need to ensure systems and processes are in place to monitor and seek assurances from their commissioned providers. The CCG needs to act on local concerns to ensure that patients are safe, treated with dignity and respect and have a positive experience with the best possible outcomes. This report will ensure that the CCG Governing body is made aware of any potential risks that may compromise the delivery of high quality care to South Tyneside patients. 2. Complaints No new complaints were received in June from South Tyneside residents. However, in June STCCG sent a written response which was co-ordinated by NECS to a complainant whose complaint was initially received in April. This related to the outcome of an individual funding request made to the former NHS South of Tyne and Wear. First received Location 16/04/2013 Pemberton House Description Complainant raised concerns about the independent funding review process followed by the former PCT regarding his wife's breast implant surgery. Complaint investigated and response provided on 14 June 2013 by NHS South Tyneside CCG. However, the complainant has further concerns which are currently under consideration. Current status Ongoing 3. Acute & Community Services This report provides, where known, the quality intelligence for South Tyneside NHS Foundation Trust (STFT) and City Hospitals Sunderland NHS Foundation Trust (CHS) acute providers. It is pertinent to highlight that the providers only provide quality reports on a quarterly basis, therefore the monthly reports focus on the information owned and monitored by the clinical quality team in NECS. 3.1 South Tyneside NHS Foundation Trust (STFT) Serious Incidents (SI) In June, STFT reported 4 SIs, all of which are reviewed against a standard root cause analysis process. This is a decrease on previous month where 8 were reported. The reported cases are listed below: 3

4 Incident Type Number of Incidents Delayed Diagnosis 1 Slips/Trips/Falls 2 Suicide 1 The provider currently has 33 legacy cases carried over from the PCT, a recent meeting between the trust and NECS has identified that the majority of cases can be considered for closure at forthcoming panels Monitor Ratings The governance risk rating for this Foundation Trust was amended from red to amber-red in May 2013 due to the trust delivering a finance risk rating of '3' at year end Mortality No concerns identified for Summary Hospital-level Mortality Indicator (SHMI) or Hospital Standardised Mortality Ratio (HSMR) Healthcare Associated Infections (HCAI) The last national quality dashboard indicates that STFT is over trajectory on their MRSA target Friends and Family Test (FFT) The FFT aims to provide a simple, headline metric which, when combined with follow-up questions, can be used to drive cultural change and continuous improvements in the quality of the care received by NHS patients. The test asks the following standardised question: How likely are you to recommend our ward/a&e department to friends and family if they needed similar care or treatment? The FFT was launched nationally in April 2013 and the first results were published on 30 July The chart below shows the ratings given by in-patients at South Tyneside District Hospital during the month of June patients participated in the FFT in the month. Data relating to A&E results is not currently available. Don't know Extremely unlikely Unlikely Neither likely nor unlikely Likely Extremely likely City Hospitals Sunderland (CHSFT) 4

5 3.2.1 Serious Incidents In June, CHSFT reported 15 SIs, all of which are reviewed against a standard root cause analysis process. This is a slight increase on the previous month where 14 incidents were reported. The incidents reported relate to: Incident Type Number of Incidents Pressure Ulcer Grade 3/4 4 Drug Incident 2 Unexpected Neo Natal Death 3 Intrapartum death 1 Slips/Trips/Falls 1 Sub optimal care of deteriorating patient 1 Other 1 Wrong site surgery 1 Delayed Diagnosis 1 TOTAL Never Events There was one Never Event reported in June. This related to wrong site surgery Monitor Ratings The governance risk rating for this Foundation Trust was amended from amber-red to amber-green in May 2013 due to the trust meeting the A&E target in Q4 2012/13 (previously failed in Q3). However, the trust has continued to breach the annual C. Difficile target Mortality No concerns identified for SHMI or HSMR Healthcare Associated Infections The last national quality dashboard indicates that CHSFT is over trajectory on MRSA and C. Difficile targets Friends and Family Test (FFT) As previously highlighted in section 3.1.5, results are now available nationally in relation to the FFT. The chart below shows the ratings given by in-patients at Sunderland Royal Hospital during the month of June patients participated in the FFT in the month. Data relating to A&E results is not currently available. 5

6 Don't know Extremely unlikely Unlikely Neither likely nor unlikely Likely Extremely likely Northumberland Tyne and Wear Mental Health Foundation Trust (NTWFT) 4.1 Serious Incidents In June, NTWFT reported 14 SIs in total, 2 of which related to South Tyneside patients. These are reviewed against a standard root cause analysis process. The incidents involving South Tyneside patients relate to: Incident Type Number of Incidents Unexpected Death of Community Patient (In receipt) 1 Assault by Outpatient in Receipt Mind Report on Physical restraint in crisis In June 2013, the mental health charity Mind issued their report on Mental Health Crisis care: Physical restraint in crisis. The report sets out Mind s findings on the use and impact of physical restraint in mental healthcare settings in England. Face down physical restraint is a life threatening form of physical restraint because of the severe impact it can have on breathing. It is a disproportionate and dangerous response to someone s behaviour when they are in a mental health crisis. Mind claim that face down physical restraint has no place in healthcare settings and are campaigning for an immediate end to its use and for it to become a never event. NTWFT reported they had 2660 incidents of restraint against a national average of 455 they also highlighted that 923 of these incidents involved face down restraints compared to a national average of 65. NTWFT incidents of physical injury following restraint were higher than most other trusts in England. Referral rates to crisis resolution and home treatment teams were very high compared with the rest of the country. These areas will need discussion and explanation by NTWFT at the quality review group. 6

7 4.3 Monitor Ratings Green - no governance risks identified. 5 North East Ambulance Service (NEAS) 5.1 Serious Incidents NEAS reported 3 SIs in June, all of which related to patient deaths and possible failures in the 999 triage process. The Trust is currently investigating these incidents. 5.2 Monitor Ratings The governance risk rating for NEAS was amended from amber-green to green in May 2013 due to the trust achieving all targets in Q4 2012/ Clinical Quality Review Group A Clinical Quality Review has now been established which will monitor the quality aspects of the service provided by NEAS for both 999 and 111 services. The Group is chaired by the Executive nurses and clinical leads from each of the 4 lead CCGs, Northumberland, Sunderland, DDES and HAST on rotation. The terms of reference include a process for reporting between 111 governance groups and representation on the group also includes clinical leads for 111 from the CCGs. 6 Other Assurances 6.1 Walkabouts A plan is in development to inform discussions in order to agree the principles of the unannounced visits programme for the CCG and STFT. A timetable has been shared by STFT of their Director walkabout visits and a plan is in development as to who will attend these from the CCG. HealthWatch has also agreed a process under their statutory right to enter FT premises and the CCG s Director of Nursing, Quality and Safety is exploring whether a CCG rep can also attend these visits. 6.2 Healthcare Associated Infections A report was presented to the Quality, Patient Safety and Risk Committee (QPS&R) in June 2013 which explained that targets for HCAI MRSA had exceeded the zero tolerance in South Tyneside. A monthly joint South Tyneside and Sunderland HCAI improvement group has been established with good levels of attendance. The group will work to develop an integrated action plan showing progress against plan which will be reported to the QPS&R Committee. 6.3 Safeguarding Adults and Children A report was presented to the June QPS&R Committee presenting the current position, key achievements and progress in relation to safeguarding adults and children. Key issues highlighted in the report were as follows: A serious case panel was convened to review the case of a child who had sustained multiple fractures and further meeting was held in order to develop the Terms of Reference for the review. 7

8 A judgement of adequate was given following an Ofsted unannounced inspection in May 2013 the focus of which was a child s journey though the child protection system. This was achieved through speaking to partners and examining case files. One of the recommendations of this inspection to be completed within 6 months was the appointment of a named GP for South Tyneside CCG. An had been sent out to practices with an outline of the post: the named GP for Gateshead had offered to be a named contact for any inquiries in regard to the post. In response to a query around the 6 month timescale from Ofsted, the Local Authority were required to complete any action requested within the timescale set. The post had been on the Risk Register for some time and, by not appointing to the post, the CCG was not discharging its duty in this regard. A named GP for Adults is also required. 6.4 Continuing Health Care (CHC) The nurse assessment team are based within South Tyneside Foundation Trust. The present SLA has been looked at and a recommendation was made that this is reviewed to reflect the present service delivery and how this needs to be developed in the future. The ratification of CHC is in the process of being developed to ensure full clinical governance processes are in place thus reducing the risk of legal challenge to the CCG. To ensure the robust evidencing of decisions a form has been developed that reflects the full consideration made and identifies why any challenges are made. The ratification process will include a random selection of an agreed number of cases to be presented to the CCG to ensure standard of delivery. NECS CHC staff are reviewing all recommendations and providing supporting information to the CCG where required. The agreement for finances will be separated from the ratification process to ensure all decisions are clinically based and not financially driven. The fast track process for CHC is being reviewed to ensure that: a) The standard of information is adequate for supporting CHC b) Identify where appropriate funding is provided c) Reviews are in place at the 3 month period 8