Clinical Commissioning Group (CCG) Governing Body Meeting

Transcription

1 Clinical Commissioning Group (CCG) Governing Body Meeting Date of Meeting: Agenda Item: Subject: Reporting Officer: Friday 21st September Paper 18(ii) Quality in the new health system - Maintaining and improving quality from April 2013: A draft report from the National Quality Board and update on recommendations about transition arrangements Susan Savage, CCG Executive Nurse Purpose of the Paper: This paper outlines the recommendations of Quality in the new health system - Maintaining and improving quality from April 2013 (NQB, August 2012). It also updates the CCG Governing Body on transition arrangements in response to the NQB recommendations in Maintaining and Improving Quality during the Transition (NQB, March 2011). Governance: Link to CCG Strategic Objectives Development of Commissioning for Quality Framework Ensure robust quality monitoring of contracts Governing Body Resolution: To approve To support Recommendation The Governing Body is requested to consider the NQB recommendations and identify any further actions required to ensure these are met. 1

2 Key implications for the following: Financial Value for Money Risk Legal Workforce Developments will need to be undertaken within existing resource and capacity. - There is potential risk to patient safety if the recommendations are not fulfilled and robust quality assurance is not attained. - - Equality Impact Assessment: Included in Committee Paper Comments Patient and Public Involvement Clinical Engagement Parties/ Committees consulted prior to Committee n/a The work of the Patient Experience Team and the Patient Experience Assurance Group will inform this work stream Engagement from CCG is required to progress this work stream Quality and Safety Committee 2

3 Maintaining and improving quality during the transition and beyond Purpose of the report 1.1 This paper outlines the recommendations of Quality in the new health system - Maintaining and improving quality from April 2013 (NQB, August 2012). It also updates the CCG Governing Body on transition arrangements in response to the NQB recommendations in Maintaining and Improving Quality during the Transition (NQB, March 2011). 2. Executive Summary 2.1 The National Quality Board published its draft report Quality in the new health system - Maintaining and improving quality from April 2013 (NQB, August 2012). This builds on its previous publications Maintaining and Improving Quality during the Transition (NQB, March 2011) and Review of early warning systems in the NHS (NQB 2010), which were reported to the PCT Quality Committee in October The NHS Commissioning Board (NCB) will establish local Quality Surveillance Groups (QSGs), based on the footprint of NCB local area teams by April The CCG is expected to be a member of the QSG. 2.3 Actions have been taken to ensure NQB recommendations for transitional arrangements are met. 2.4 Areas for further development by the CCG include: Completion of the Commissioning for Quality Framework to support the CCG in its development of its quality assurance The recommendations of the public inquiry into Mid Staffordshire NHS Foundation Trust Francis report, due in Autumn 2012, will need to be reviewed to ensure ongoing compliance as a commissioner The risk register needs to be reviewed to ensure that quality risks are explicit A system is required to ensure the legacy document is maintained and updated three monthly 2.5 This work will be monitored by the Quality and Safety Committee on behalf of the CCG Governing Body. 3. Introduction 3.1 The National Quality Board published its review Maintaining and Improving Quality during the Transition in March It considered the mechanisms that should be in place to ensure resilience in maintaining patient safety and quality throughout service and organisational reconfigurations. 3.2 The report built on the previous publication Review of early warning systems in the NHS (NQB 2010). In June 2010 the PCT Board considered the issues raised in relation to early warning systems during its review of the Mid Staffordshire recommendations and its future development of quality assurance. 3

4 3.3 In August 2012 the NQB published its report outlining arrangements for maintaining quality and safety beyond April The NQB report is in draft in order for recommendations from the Mid Staffordshire NHS Foundation Trust Public Inquiry to be included when published in Autumn This paper outlines the key aspects of the report and implications for HMR CCG. The full report can be accessed on the DH website. 4. Key features of the NQB draft report 4.1 The NQB draft report emphasises the importance of culture that puts patients first and openness in an organisation; sharing information and intelligence; patient and service users involvement in oversight and scrutiny of design and measurement of services. It outlines the distinct responsibilities of different organisations in relation to quality, for example the NHS Commissioning Board; regulators such as the CQC, Monitor, and professional regulators; commissioners such as CCGs and local authority; and providers. It also describes the establishment of Quality Resilience Groups operating on two levels: across the footprint of the NCB Local Area Team and regionally on the footprint of the NCB regional teams. This is described in more detail in paragraphs 4.3 to With regard to commissioning, the report states the following: Commissioners must assure themselves of the quality of care they have commissioned, with providers being CQC registered for regulated activities as a minimum standard for quality and safety There should be a mature and constructive relationship between providers and commissioners so that the provider can raise concerns with commissioners and any quality problems are addressed as soon as possible CCGs should identify improvements and use the commissioning process to drive continuous quality improvement CCGs should utilise CQC Quality and Risk Profiles with local intelligence, collected throigh contract monitoring, engagement with patients and the public, and general interaction in the local economy CCGs need to work collaboratively with other CCGs and local partners to collectively specify services and monitor quality CCGs will be part of the new local Quality Surveillance Group where information and intelligence is shared across the local system 4.3 Local Quality Surveillance Groups (QSGs), based on the NCB Local Area Team footprint, will meet monthly initially to provide a forum for local health economies to realise the cultures and values of open and honest cooperation. It will also operate as a virtual team, creating a network to maintain quality in the system. Membership will include all local commissioners (NHS Commissioning Board, CCGS, local authorities); NHS Trust Development Authority, Local Education and Training Board, local HealthWatch, Monitor and the CQC. Such membership will be mirrored in the regional QSGs. 4.4 QSGs will be established by the NHSCB local area teams by April In the event of a serious concern being raised in relation to an actual or potential serious quality failure, a Risk Summit may be triggered. Concerns may be raised from local intelligence, whistleblower, a patient, or media exposure. The CQC will make an independent regulatory judgement with regard to whether there has been a breach of the essential standards for quality and safety, and where required, regulatory action taken. 4

5 5. Action required from the NQB draft report 5.1 The NQB expects each organisation to consider the report to commit to the principles and behaviours that underpin it. It presents key questions in relation to the organisation s readiness for its responsibilities in relation to safeguarding quality in health services. These include: Has the Chief Executive and Chair taken a lead on the application of the report? Are we clear about our distinct roles and responsibilities with regard to quality and identifying, responding and learning from failure? What further steps need to be taken to between now and April 2013 to ensure we are able to fulfil our responsibilities? Are we clear within the health care economy what we expect of each other? Do we have good relationships with our local/ national and regional partners, built on open and honest cooperation, and how can these be strengthened? Are there reliable processes in place for staff and member engagement? How can we ensure that the values and principles of the NHS Constitution are a reality within and between organisations? How can we ensure that we adhere not just to legislation but exercise common sense and judgement in the interest of the patients who use the NHS and the public who pay for it? How can we engage patients and carers, LINks and HealthWatch locally to help understanding of the report and the role of the organisation? What contribution can they make? 6. Action to date to meet NQB recommendations for transitional arrangements 6.1 The CCG Executive Nurse has been identified as the CCG executive lead for quality and safety for NHS HMR CCG. This postholder also has responsibility for ensuring the coordination of quality assurance activity across the north east sector and is a member of the North East Sector Commissioning Board. The CCG Executive Nurse role will be supported by a quality and safety lead within the CCG structure, and support services from the Commissioning Support Unit. 6.2 A north east sector approach to quality assurance and improvement is being fostered across HMR, Oldham, Bury and North Manchester CCGs. Quality monitoring of contracts is undertaken through north east sector quality groups for each major contract, each led by the respective CCG acting as lead commissioner (ie NHS Oldham CCG for Pennine Acute Hospitals Trust (PAHT); NHS HMR CCG for Pennine Care Foundation Trust (PCFT)- mental health and BMI Highfield; NHS HMR CCG has adopted the lead role quality monitoring of for PCFT- community services). Monthly meetings are held with providers to review performance against quality indicators, which incorporates information sources including, for example, the CQC QRP, patient experience data, serious incident reports and quality dashboards. Site visits are also undertaken. There has been significant GP involvement with quality contract monitoring for PCFT- mental health, with increasing involvement of GPs in the PAHT contract monitoring process, in particular the local CQUINs. 6.3 Terms of reference for quality monitoring groups have been reviewed and governance arrangements have been strengthened across the north east sector. Quality monitoring is reported to the Quality and Safety Committee bimonthly with exception reporting to the Governing Body bimonthly. Updates from the Quality and Safety Committee are also provided at the Audit Committee and will be formalised with the Clinical Commissioning Committee from October This will support the embedding of quality in all areas of business for the CCG. The PCT Quality Committee reviewed and commented on provider Quality Accounts for 2011/12. The CCG Quality and Safety Committee will review 2012/13 5

6 accounts, which are prepared in Spring/Summer. 6.4 The Governing Body has delegated responsibility for quality assurance to the Quality and Safety Committee. In addition to quality assurance of contracts, the Quality and Safety Committee seeks assurance with regard to patient experience and patient and public engagement. Both the Quality and Safety Committee and the Governing Body receive reports in relation to complaints, PALS, patient engagement, to ensure that the patient voice is heard. The Patient Experience Team ensure that commissioning teams are alerted to issues and concerns raised by patients in relation to commissioned services. NHS HMR CCG is also committed to upholding the principles of Being Open. 6.5 NHS Greater Manchester undertook an audit of the implementation of recommendations following the report on Mid Staffordshire NHS Foundation Trust (Francis report). This showed the CCG to be maturing in relation to its responsibilities for quality and safety. However the outcome of the public inquiry (again led by R Francis QC) is due to be published in Autumn 2012, the recommendations of which will need to be considered for implications for the CCG and the providers from whom it commissions services. 6.6 The governance arrangements for the management of serious untoward incidents (including StEIS) have been reviewed across the north east sector. Greater collaboration and effective use of capacity has been promoted across the north east sector. The CCG Executive Nurse has responsibility for the oversight and sign off of incidents being performance managed by the CCGs in the north east sector on behalf of the North East Sector Commissioning Board. The policy has been updated to reflect this. 7. Areas for further development 7.1 The following areas require further development to ensure the recommendations of the NQB draft reports, Maintaining and Improving Quality from April 2013, Early Warning Systems in the NHS and Maintaining and Improving Quality during transition are met: To ensure that the Governing Body is aware of and understands the implications of the NQB draft report (August 2012) To consider how patients and service users, LINks and HealthWatch can be supported in understanding their contribution to the recommendations of the NQB draft report To ensure appropriate reporting to receiving organisations regarding quality and safety issues in commissioned services To complete the CCG Commissioning for Quality Framework to set out the strategic approach to further develop quality assurance systems and quality improvement programmes to be fit for purpose in the new NHS infrastructure The recommendations of the second Francis report, due to be published in Autumn 2012, need to be reviewed to ensure ongoing compliance as a commissioner To review the CCG resource and Commissioning Support Unit offer in relation to quality to ensure CCG responsibilities can be met A system is required to ensure the legacy document is maintained and updated three monthly. 6

7 8. Assessment of risk 8.1 Patients may be placed at risk if quality assurance is not robust and transitional arrangements have not addressed potential gaps created by the organisational changes. 8.2 The CCG will not be able to fulfil the authorisation process requirements if unable to demonstrate understanding of quality assurance, quality improvement and that effective processes are in place. 9. Recommendations/Resolution required 9.1 The Governing Body is requested to consider the NQB recommendations and identify any further actions required to ensure these are met. 10. Next steps 10.1 The actions will be overseen by the Quality and Safety Committee and updates will be reported to the Governing Body through the Quality and Safety Committee Highlight reports. Reporting Officer: Susan Savage, CCG Executive Nurse 7