AGENDA ITEM NO: 002/17

Transcription

1 AGENDA ITEM NO: 002/17 GOVERNING BODY MEETING: Governing Body Meeting DATE OF MEETING: 10 th January 2018 REPORT AUTHOR AND JOB TITLE: John Wharton, Chief Nurse & Quality Lead Dawn Chalmers, Deputy Chief Nurse & Quality Lead REPORT TITLE: Quality Report STRATEGIC OBJECTIVES: Please tick which strategic objectives the paper relates to Improve quality of services Build an effective and motivated whole system workforce Sustained financial balance 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 the concerns raised regarding areas of quality where the provider may be experiencing difficulties. Note the contents of the Care Quality Commission report. Note the contents of the Getting to Grips with the Human Factor report. Quality Report January 2018 NHS Warrington CCG Governing Body Meeting 10 th January 2018

2 AGENDA ITEM NO: 002/17 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 Quality Report January 2018 NHS Warrington CCG Governing Body Meeting 10 th January 2018

3 AGENDA ITEM NO: 002/17 Strategic Objectives and Risks 2017/18 A1 A2 A3 B1 B2 B3 B4 C1 C2 C3 D1 D2 E1 E2 Failure to performance manage to ensure continuous improvement Failure to agree and measure outcomes Failure to ensure clear arrangements are in place for quality management of noncommissioned providers in the independent sector Failure to implement the financial strategy Failure to ensure sound business practices are at the heart of running the CCG Failure to secure best value Failure to adequately provide for external factors, which impact on financial sustainability Failure to continuously develop the organisational culture that meets the needs of the changing needs of the workforce Failure of delivery by outsourced critical business functions Failure to establish primary care capacity Failure to ensure that we are compliant with our statutory duties Failure to demonstrate patient and public engagement Failure to provide appropriate reporting, for joint working arrangements Failure to describe benefit of integration and joint working arrangements to local people Quality Report January 2018 NHS Warrington CCG Governing Body Meeting 10 th January 2018

4 NHS WARRINGTON CLINICAL COMMISSIONING GROUP QUALITY REPORT JANUARY 2018 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. At the time of writing this report there has been no never events reported from any of our providers. WARRINGTON & HALTON HOSPITAL NHS FOUNDATION TRUST CARE QUALITY COMMISSION 4. The CQC carried out an announced inspection of Warrington Hospital between the 7 th and 10 th of March 2017, and published the report 1 on 27 th November In addition to the announced inspection, they carried out an unannounced inspection between 3pm and 9pm on the 23 rd March This inspection was to follow up on the findings of the previous inspections in January and February 2015, when the trust was rated as requires improvement overall. The inspection team also looked at the governance and risk management support for all of the core services inspected. 5. The table below provides a comparison of the overall ratings between the 2015 & 2017 inspections Are services at this trust safe? Requires Improvement Requires Improvement Are services at this trust effective? Requires Improvement Good Are services at this trust caring? Good Good Are services at this trust responsive? Requires Improvement Requires Improvement Are services at this trust well-led? Requires Improvement Requires Improvement 6. At the March inspection CQC inspected the following services at the hospital: Urgent and Emergency Care Critical Care Services Services for Children and Young People Maternity and Gynaecology Services Medical Services [Including the care of older people] Surgery 1 Quality Report January 2018 NHS Warrington CCG Governing Body Meeting 10 th January 2018

5 End of Life Services Outpatient and Diagnostic Services 7. Overall the trust was rated as requires improvement with Medicine [including older people s care] Critical Care, Outpatient and Diagnostic services and Maternity and Gynaecology Services as requires improvement. CQC rated Urgent and Emergency, Surgery, End of Life Services and Services for Children and Young People as good. A comparisons between 2015/17 for each areas can be found in appendix 1 8. The CQC acknowledged progress since their previous inspection with, improvements noted in urgent and emergency care, maternity, surgery, outpatient and diagnostic services and critical care. 9. However, the trust continues to require improvement in the following key areas:- The hospital must ensure that staff receive training on the Mental Capacity Act (2005) and that staff work in accordance with The Act. The hospital must ensure that paper and electronic records are stored securely and are a complete and accurate record of patient care and treatment. The hospital must ensure that staff receive the appropriate level of safeguarding training. Critical care services must improve compliance with advanced life support training updates and ensure that there is an appropriately trained member of staff available on every shift. The hospital must ensure that the formal escalation plan to support staff in managing occupancy levels in critical care is fully implemented. The hospital must ensure that there are appropriate numbers of staff available to match the dependency of patients on all occasions. The hospital must ensure that all risks are formally identified and mitigated in a timely way as part of the risk management process. The hospital must take action to ensure that all safety and quality assurance checks are completed and documented for all radiology equipment, in accordance with Ionising Radiations Regulations. The hospital must ensure midwifery, nursing and medical support staffing levels and skill mix are sufficient in order for staff to carry out all the tasks required for them to work within their code of practice and meet the needs of the patient. The hospital must ensure all necessary staff completes mandatory training, including Level 3 safeguarding training. The hospital must ensure that the assessment and mitigation of risk and the delivery of safe patient care is in the most appropriate place. The hospital must review the impact of the triage system on access and flow and the appropriate assessment of patient safety. The hospital must review the safety of the induction bay environment to ensure patient safety is maintained at all times and that the premises are safe to use for the purpose intended. The hospital must ensure that all staff receives medical devices training and this is recorded appropriately. The hospital must ensure that that the risk register and action plans are comprehensive, robust and adequate to improve patient safety, risk management and quality of care. The hospital must ensure staffing levels are maintained in accordance with national professional standards. The hospital must ensure that there is one nurse on duty on the children s unit trained in Advanced Paediatric Life Support on each shift 10. The CQC did identify areas of outstanding practice:- The trust had developed the Paediatric Acute Response team to deliver care in a Health and Wellbeing Centre in central Warrington. This allowed children and young people to access procedures such as wound checks and administration of intravenous antibiotics in a more convenient location. It also allowed nurse-led review of a range of conditions such as Quality Report January 2018 NHS Warrington CCG Governing Body Meeting 10 th January 2018

6 neonatal jaundice and respiratory conditions in a community setting that would have previously necessitated attendance at hospital. Within the urgent and emergency care division, the use of the Edmonton frailty tool in the treatment of older people in the department and the wider health economy. The training of all the consultants within the accident and emergency department in the use of ultrasound for timely diagnosis of urgent conditions. The trust had direct access to electronic information held by community services, including GPs. This meant that hospital staff could access up-to-date information about patients, for example, details of their current medicine. The environment on the Forget Me Not ward had been designed using the recommendations set out by The Kings Fund to be dementia friendly. The ward was designed to appear less like a hospital ward and featured colour coded bay areas and a lounge and dining area designed to look like a home environment. There was access to an enclosed garden and a quiet room 11. There has been no formal presentation from the CQC of the outcome of the visit, and the CCG are disappointed that they have been unable to formally respond to the report. ACCIDENT & EMERGEMCY DEPARTMENT QUALITY REVIEW 12. The Clinical Commissioning Group undertook a quality review of the front of house aspect of the AED at Warrington & Halton Hospitals NHS Trust on 13 th December 2017 in order to get assurance that care at the Trust met the required standards. The visit consisted of a tour of the department, explanation of processes and observation of triage and streaming. 13. The department matron and manager walk us through the front of house processes and we visited Primary Care streaming, Minors, Paediatric AED and Ambulatory Care as well as Majors and the hub. 14. The CCG staff spent an hour with the staff on duty undertaking triage and streaming and witnessed the process and follow up activity 15. At the December Quality Committee the outcome of the visit was shared and a formal report is being completed to go to the trust SPINAL SERVICES 16. As reported at the November Quality Committee, a full suspension of all spinal surgery services delivered by Warrington and Halton Hospitals NHS Foundation Trust has been in place since 2 nd December This suspension notice means that the Trust can no longer provide spinal surgery services to all patients whether they are both inpatients, outpatients (new or follow up) or patients for spinal injections. All patients have been or are being transferred to alternative providers. 17. The CCG agreed with the trust and the new providers a staged process to transfer patients according to their scheduled appointment date and the new provider has offered a new consultation date as near to the original date as possible. 18. The CCG has established monthly contract meetings with The Walton Centre, where the majority of non-complex cases and follow up patients have been transferred; this is enabling the CCG to work closely with them to ensure patients receive timely consultations and to monitor patient outcomes. 19. Salford Royal NHS Foundation Trust continue to accept ers referrals and Pioneer Health Care continue to provide consultations for those patients requiring spinal injections. 20. The Spinal Surgery Services Specification has been rewritten and it has been made clear that providers are to provide treatment in line with NICE guidance. Quality Report January 2018 NHS Warrington CCG Governing Body Meeting 10 th January 2018

7 21. No decision will be taken with respect to lifting the suspension notice until the Royal College of Surgeons full report is published, it is anticipated that the report will be available in January The trust has completed their root cause analysis (RCA) in respect of the incident involving the patient from NHS Knowsley CCG. The report has been shared with the family who are in discussions with the Trust regarding further actions. 23. During December 2017 The trust reported a further serious incident relating to a spinal patient BRIDGEWATER COMMUNITY HEALTH NHS FOUNATION TRUST 24. The CCG continues to monitor the performance notice and action plans that the trust developed following the concerns raised that were reported at the last Governing Body. Progress in relation to the action plans has been steady and the trust is working with the CCG to ensure the quality, safety and resilience of the services. 25. A remedial action plan has been put in place, following the issue of the performance notice in relation to the management of serious incidents. The first meeting has taken place with the Trust to obtain an update on the action plan, including appropriate evidence and these meetings will continue until such a time that all necessary actions have been completed to demonstrate the required improvements 26. The CCG has received a letter from the trust about capacity within their safeguarding team. The trust is experiencing a number of absences due to long term sickness and vacancies that have yet to be filled. They have included the capacity concerns on their corporate risk register and have put in some measures to mitigate the difficulties. NORTH WEST BOROUGH PARTNESHIP NHS FOUNDATION TRUST 27. The CCG issued a Contract Performance Notice on 22 nd September 2017 due to the commissioners not receiving sufficient assurance from the trust in response to a number of queries raised relating to the quality and safety of the Attention Deficit Hyperactivity Disorder (ADHD) service, the concerns relate to:- Staffing resilience of the service Waiting list management Issues relating to shared care 28. An action plan has been agreed and is being monitored via the Clinical Quality Focus Group**** 29. The Deputy Chief Nurse & Quality Lead has contacted the trusts Chief Nurse and Executive Director of Operational Clinical Services to arrange a joint quality visit to get a better understanding of the quality & safety concerns. Quality Report January 2018 NHS Warrington CCG Governing Body Meeting 10 th January 2018

8 COMMISSIONING for QUALITY & INNOVATION National indicators 2 have been defined which aim to improve quality and outcomes for patients including reducing health inequalities and of those 11 relate to the providers/services that the Clinical Commissioning Group (CCG) commission. 31. Of the 11 schemes five have several elements to them creating complex monitoring. 32. The CCG has agreed 7 local schemes with a number of smaller providers. 33. The Clinical Commissioning Group is working in collaboration with other co-ordinating CCGs to manage and monitor North West Borough Partnership NHS Foundation Trust s. The collaborative meet quarterly to review the milestones and evidence offered by the trust. 34. There are currently two schemes that require organisations to work together:- Improving services for people with mental health needs who present to A&E Supporting proactive and safe discharge The Q2 milestones for both these schemes have not been met, although Warrington and Halton Hospitals NHS Foundation Trust has supplied further information that the CCG is reviewing. 35. Details of all the schemes can be seen in appendix 2 SAFEGUARDING 36. The Department for Education is consulting on Working Together to Safeguard Children: changes to statutory guidance and new regulations largely being made to reflect the legislative changes introduced through the Children and Social Work Act There are some minor changes in a number of areas to improve clarity, however there are significant changes relating to Multi Agency Safeguarding arrangements. 38. The Children and Social Work Act 2017 (the Act) replaces Local Safeguarding Children Boards with new local safeguarding arrangements, led by three safeguarding partners (local authorities, chief officers of police, and clinical commissioning groups). The Act places a duty on those partners to make arrangements for themselves and relevant agencies they deem appropriate, to work together for the purpose of safeguarding and promoting the welfare of children in their area. 39. It is the responsibility of each safeguarding partner to identify a senior officer in their agency to have responsibility and authority for ensuring full collaboration with the arrangements. 40. The representative should be able to; Speak with authority for their organisation Commit their organisation on policy and practice matters Hold their organisation to account and hold others to account Quality Report January 2018 NHS Warrington CCG Governing Body Meeting 10 th January 2018

9 41. All three partners have equal and joint responsibility for local arrangements in relation to safeguarding 42. Discussions are taking place within Warrington to establish the impact of these new requirements 43. For further information please see appendix 3 GETTING TO GRIPS WITH THE HUMAN FACTOR Strategic actions for safer care 44. Ensuring effective, compassionate care and treatment, while keeping patients free from avoidable harm is the essence of any healthcare system. The vast majority of patients using NHS services experience great care but the evidence is clear that there are still too many occasions where care and treatment falls below an acceptable standard. 45. Delivering healthcare is becoming increasingly challenging and complex. Inevitably things will go wrong and we have to accept that errors will occur because staff are human. Staff often achieve, remarkable results in spite of, rather than because of their organisation s systems and processes. Healthcare systems are often poorly designed, or prone to failure when overloaded. 46. Our collective challenge is to recognise the human factors and skilfully apply proven approaches that simultaneously improve system and individual performance, tackle variation and improve the reliability of patient care. 47. The board plays a key role in creating an organisational culture that supports front line clinical teams to do the right thing, first time, every time. 48. Executive and Non-Executive Directors, have a part to play in taking strategic actions for safer care. This guide is intended to help get to grips with the human factor that is a natural phenomenon, increase awareness and understanding of the science, and prepare individuals for the actions that they will want to take to fulfil their responsibilities. 49. The Clinical Human factors Group has developed a learning resource for the Boards of health organisations in order to: Raise awareness and stimulate dialogue about human factors Demonstrate how human factors impact on quality, safety and productivity in healthcare Encourage Boards to invest time and resource in human factors Identify the contribution Boards and their individual members can and should be making in this area Act as a signpost to additional resources. 50. The learning resource has been designed to be succinct and accessible. It offers questions for Board members to ask of themselves and their organisation and suggests learning activities for Boards and individual directors to undertake. It includes real case studies and signposts other useful resources. 51. Further reading please follow the link below Quality Report January 2018 NHS Warrington CCG Governing Body Meeting 10 th January 2018

10 The Governing Body is asked to: a) Note and discuss the work being carried out with the providers to address the concerns raised regarding areas of quality where the provider may be experiencing difficulties. b) Note the contents of the Care Quality Commission report. c) Note the contents of the Getting to Grips with the Human Factor report. John Wharton Chief Nurse & Quality Lead Dawn Chalmers Deputy Chief Nurse & Quality Lead January 2018 Quality Report January 2018 NHS Warrington CCG Governing Body Meeting 10 th January 2018

11 002/18 Quality Report Appendix 1 Care Quality Commission Report Comparison Overall Rating - Requires Improvement Are services at this trust safe Requires Improvement Requires Improvement Are services at this trust effective Requires Improvement Good Are services at this trust caring Good Good Are services at this trust responsive Requires Improvement Requires Improvement Are services at this trust well-led Requires Improvement Requires Improvement Service Urgent & emergency services Good Good Medical care( including older Requires Improvement Requires Improvement people s care) Surgery Good Good Critical care Requires Improvement Requires Improvement Maternity & gynaecology Requires Improvement Requires Improvement Services for children & young Good Good people End of life Good Good Outpatients & diagnostic imaging Requires Improvement Requires Improvement Urgent and Emergency Services Safe Good Good Effective Good Good Caring Good Good Responsive Requires Improvement Requires Improvement Well-led Good Good Medical Care Safe Requires Improvement Requires Improvement Effective Requires Improvement Good Caring Good Good Responsive Requires Improvement Requires Improvement Well-led Requires Improvement Good Surgery Safe Good Good Effective Good Good Caring Good Good Responsive Good Good Well-led Good Good

12 002/18 Quality Report Appendix 1 Critical Care Safe Requires Improvement Requires Improvement Effective Good Good Caring Good Good Responsive Requires Improvement Requires Improvement Well-led Good Good Maternity & gynaecology Safe Requires Improvement Requires Improvement Effective Requires Improvement Good Caring Good Good Responsive Requires Improvement Requires Improvement Well-led Requires Improvement Requires Improvement Services for Children & Young People Safe Good Requires Improvement Effective Good Good Caring Good Good Responsive Good Good Well-led Good Good End of Life care Safe Good Good Effective Good Good Caring Good Good Responsive Good Good Well-led Good Good Outpatients and diagnostic imaging Safe Requires Improvement Requires Improvement Effective Not rated Not rated Caring Good Good Responsive Good Good Well-led Requires Improvement Requires Improvement

13 Agenda Item 002/18 Quality Report Appendix 2 National Indicator Indicator weighting (% of scheme available) Reporting Provider Comments RAG 1a Improvement of health and wellbeing of NHS staff 33.3% of 0.25% (0.0834%) Q4 NWB BCHT Reporting Q4 update provided in Q2 on track 1b Healthy food for NHS staff, visitors and patients 33.3% of 0.25% (0.0833%) Q4 NWB Reporting Q4 update provided in Q2 on track 1c Improving the uptake of flu vaccinations for front line staff within Providers 33.3% of 0.25% (0.0833%) Q4 NWB BCHT Reporting Q4 update provided in Q2 on track 2a 2b 2c Timely identification of sepsis in emergency departments and acute inpatient settings Timely treatment for sepsis in emergency departments and acute inpatient 25% of 0.25% (0.0625%) 25% of 0.25% (0.0625%) settings Antibiotic review 25% of 0.25% (0.0625%) audit 2d 3a Reduction in antibiotic consumption per 1,000 admissions Improving physical healthcare to reduce premature mortality in people with SMI: 25% of 0.25% (0.0625%) 80% of 0.25% (0.20%) Q4 Reporting Q4 Q1 & Q4 NWB Reporting Q4 Cardio metabolic assessment and treatment for patients with

14 Agenda Item 002/18 Quality Report Appendix 2 psychoses 3b Collaborating with primary care clinicians 20% of 0.25% (0.05%) Q2,Q3 & Q4 NWB Build on primary care interface work 4 Improving services for people with mental health needs who present to A&E 0.25% NWB Governance Group established some concern with regards to the cohort identified. CCG member of the group 5 6 Transitions out of Children and Young People s Mental Health Services (CYPMHS) Offering advice and Guidance (A&G) 0.25% NWB 0.25% 7 NHS e-referrals 0.25% monthly 8a 8b 8c 9 - Tobacco Supporting proactive and safe discharge Acute Supporting proactive and safe discharge Community Supporting proactive and safe discharge Care Homes Preventing ill health by risky behaviours alcohol and tobacco 0.25% Group established to support this Commissioning for Quality & Innovation, CCG a member of the group and both community and care reps are present 0.25% BCHT 0.25% Q2 & Q4 Care Homes 5% of 0.25% (0.0125%) NWB BCHT (2018 only) Data submitted via unify

15 Agenda Item 002/18 Quality Report Appendix 2 9a Tobacco screening 9b Tobacco brief advice 20% of 0.25% (0.05%) NWB BCHT (2018 only Data submitted via unify 9c Tobacco referral and medication offer 25% of 0.25% (0.0625%) NWB BCHT (2018 only) Data submitted via unify 9 Alcohol 9d Alcohol screening 25% of 0.25% (0.0625%) NWB BCHT (2018 only Data submitted via unify 9e Alcohol brief advice or referral 25% of 0.25% (0.0625%) NWB BCHT (2018 only Data submitted via unify Improving the assessment of wounds Personalised care and support planning 0.25% BCHT 0.25% Q2,Q3 & Q4 BCHT Local Indicator Indicator weighting (% of scheme available) Reporting Provider Comments Local Local Local Reducing Risky Behaviour 1.1 Smoke Free 1.2 Tobacco Screening Management of Service Users with potential Risky behaviours and keeping them within service. (2017/18 only) IAPT for service users with comorbid common mental health disorders and 2.00% 0.50% AFG 0.25% MHM 2.5% MHM Potential options

16 Agenda Item 002/18 Quality Report Appendix 2 long standing emotional difficulties Local Preventing Ill Health Spire Improving Staff Health and Wellbeing Spire NHS E-referrals Spire Local Collaboration with primary clinicians 2.5% St. Rocco s Did not meet Q2 milestones

17 002/18 Quality Report Appendix 3 Briefing Paper; On The New Working Together 2018 and CCG Responsibilities. 1.0 Introduction The Department for is consulting on Working Together to Safeguard Children: changes to statutory guidance and new regulations largely being made to reflect the legislative changes introduced through the Children and Social Work Act The core requirements in Working Together to Safeguard Children in Chapter 1: Assessing need and providing help. There are some minor changes in a number of areas to improve clarity, references to the Children and Social Work Act 2017, remind practitioners of an important focus of work and to include areas of safeguarding concern that have become more prominent since the publication of Working Together to Safeguard Children 2015 and their responsibilities for Children in Care. 2.0 Chapter 1: Assessing need and providing help Additions to Early Help focus to include; Gang involvement and association with organised crime groups, is frequently missing/absent from home, is misusing drugs or alcohol themselves and radicalisation. Protection: to be protected against all forms of abuse and discrimination and the right to special protection and help if a refugee. Have added to the responsibilities of Local Agencies to have a response to CSE, FGM and radicalisation this statement should also include services for disabled children and be aligned with the short breaks services statement. Information sharing is also essential for the identification of patterns of behaviour when a child has gone missing or in relation to children in the secure estate where there may be multiple local authorities involved in a child s care. All practitioners should be particularly alert to the importance of sharing information when a child moves from one local authority into another, due to the risk that knowledge pertinent to keeping a child safe. Assessment of young carers added as a section. Assessment of young people in secure youth establishments added as a section. 3. significant changes The significant changes relate to chapters 3 to 5 they include; Chapter 3: Multi-agency safeguarding arrangements 1

18 002/18 Quality Report Appendix 3 This details the replacement of Local Children Safeguarding Boards (LCSBs) with local safeguarding partners with the purpose of creating new flexible local safeguarding arrangements led by three safeguarding partners (local authorities, chief officers of police, and clinical commissioning groups). It places a duty on those partners to make arrangements to work together and with any relevant agencies for the purpose of safeguarding and promoting the welfare of children in their area. The Local Safeguarding Partner (Relevant Agencies) (England) Regulations details the specific agencies which safeguarding partners can choose from which are shown in Annex A of the consultation document. Working Together to Safeguard Children.pdf Local agencies should develop processes that promote; the commissioning of services in a co-ordinated way; co-operation and integration between universal services such as schools, GP practices, adult services, early years settings, youth services and colleges, voluntary and community and specialist support services. This includes determining how best to ensure that clear criteria for taking action are made available to relevant agencies and others in a transparent, accessible and well-understood way. Currently, Local Safeguarding Children Boards are required to produce a threshold document. They are not proposing to specify in statutory guidance how, and in what format, the safeguarding partners should make their criteria for action available. Safeguarding partners can choose specific agencies which they believe to be relevant to the work of safeguarding and promoting the welfare of children in their area. All agencies need to cooperate in the local safeguarding arrangements, although the duty to make local arrangements rests with the three safeguarding partners. Leadership; It is the responsibility of each safeguarding partner to identify a senior officer in their agency to have responsibility and authority for ensuring full collaboration with the arrangements. The representative should be able to; Speak with authority for their organisation Commit their organisation on policy and practice matters Hold their organisation to account and hold others to account. All three partners have equal and joint responsibility for local arrangements in relation to safeguarding. 2

19 002/18 Quality Report Appendix 3 The Safeguarding Partners have to publish their safeguarding arrangements. They must report annually on these arrangements and how effective the arrangements have been. They must include any updates to the published arrangements and the proposed timescale for implementation of any changes. Local arrangements can cover two or more local authorities, and safeguarding partners can join and collaborate on their arrangements, providing this has been agreed by the relevant safeguarding partners. A single local authority area must not be covered by two separate safeguarding partnerships. The local safeguarding partners must ensure there is independent scrutiny of the effectiveness of the arrangements. It will be a local decision how best to implement a robust system of independent scrutiny. Safeguarding partners should agree the level of funding secured from each partner and relevant agency, to support the new safeguarding arrangements. Decisions on funding are for local determination; however, contributions should be equitable and proportionate to the needs of the local population. 4.0 Transition arrangements The Safeguarding Partners will have up to 12 months from the commencements of the provisions laid out in the Children and Social Work Act 2017 to agree the arrangements for themselves, and any relevant agencies they consider appropriate, to work together to safeguard and promote the welfare of children in their area. They must publish their arrangements, and should notify the Secretary of State for Education when they have done so. Following the publication of their arrangements, safeguarding partners will have up to three months to implement the new arrangements. The consultation document shows April 2018 suggesting that will be the start of the process but this is not stated. 5.0 Chapter 5: Child death reviews This covers the transfer of responsibility for child death reviews from Local Safeguarding Children Boards to new Child Death Review Partners. This will give clinical commissioning groups and local authorities joint responsibility for child death reviews, and enable a wider geographical footprint for these partnerships in order for them to gain a better understanding of the causes of child deaths. The changes to this area in Working Together to Safeguard Children - - April 2018 are wide ranging and Involve a separate consultation Child Death Review - Statutory Guidance October 2017 which proposes a new approach, that allows each 3

20 002/18 Quality Report Appendix 3 individual death to be responded to appropriately, rather than determining whether or not a death meets certain criteria for investigation. Some of the key areas include:- Chapter 4 of the Child Death Review October 2017 Consultation document requires that every Child s death is reviewed at a child death review meeting involving practitioners directly involved in the child s care, prior to being discussed anonymously by the Child Death Overview Panel (CDOP). The nature of this meeting will vary according to the circumstances of the child s death and the practitioners involved. The purpose of the child death review meeting is to ensure local learning and reflection. All child death review meetings should routinely send a report to the CDOP, to inform its independent review of the case. Chapter 5 of the Child Death Review October 2017 Consultation document, sets out the expectations and purpose of the CDOP to provide independent scrutiny of each case from a multi-agency perspective. Chapter 7 of the Child Death Review Consultation outlines expectations in a number of specific circumstances, including: deaths of UK-resident children overseas; deaths of children with learning disabilities; deaths of children in adult healthcare settings; suicide and self-harm; deaths in inpatient mental health settings and deaths in custody. Child_death_review_stat_guidance.pdf 6.0 Conclusion Whilst local authorities play a lead role, safeguarding children, promoting their welfare and protecting them from harm is everyone s responsibility. The CCG has specific responsibilities and duties under section 11 of the Children Act 2004 to ensure that they consider the need to safeguard and promote the welfare of children when carrying out their functions. The CCG Under section 10 of the same Act, are required to co-operate with local authorities to promote the wellbeing of children in our area. It is paramount that the CCG work in partnership with the Local Authority and the police to ensure they are an equal partner in the planning and implementation of the new safeguarding arrangements. 4