Quality & Assurance Group Meeting Kathy Headdon Chair Held on Tuesday 27 th May 2014 In Castlewood Room G11 Minutes Present: Kathy Headdon Chair of the Governing Body KAH Julie Kell Head of Joint Commissioning JK Lindsey Perryman Corporate Manager LP Julian Simcox Lay Volunteer JS Liam Williams Interim Chief Nursing Officer from Q&A/14/ - Q&A/14/ Mary Backhouse Chief Clinical Officer MB In Attendance: Jeanette George Chief Operating Officer JG Present for Agenda Items Q&A/14/ Tiana Filby Note Taker TF Q&A/14/031 Welcome Kathy Headdon welcomed everyone to the meeting. Action Q&A/14/032 Apologies : Debbie Campbell Jeremy maynard Q&A/14/033 Minutes of the meeting held 20 th March 2014 The Minutes of the meeting held on 16 th January 2014 were approved as an accurate record. Q&A/14/034 Action Log Q&A/13/098 Open - Change to rebate scheme required and then policy to be present at QAG in July. Q&A/14/006 Open OD Plan will be finalised after sign off of 5 year plan and presented at QAG in July. Q&A/14/019 Closed The outcome will be included in the Workforce report and presented at QAG in July. Q&A/14/021 Open Work on-going Q&A/14/021 Closed to upload to CCG website Q&A/14/021 Closed Q&A/14/024 Open - There is a working practice already in place and a formal policy will be developed by HR as part of their 2014/15 objectives. Need to check that CCG staff are aware of the current working practice. Q&A/14/025 Closed - Evaluation and Evidence based practice is being built into plan and will be presented at QAG Quality & Assurance Group 20.03.14 Page 1 of 9 JG
in July. Q&A/14/027 Closed No Comments received. Q&A/14/035 Matters Arising There were no matters arising. Q&A/14/036 Work Programme Kathy Headdon invited comments on the Draft Work Programme for the Quality and Assurance Group, and highlighted that it is an evolving document on which work is being undertaken by Liam Williams and Lindsey Perryman. The Group recognised that as the Patient Insight/experience report was being developed further,the timing of its reporting cycle to QAG would need to be confirmed and amended in the work programme. Action: Liam Williams to discuss development of the patient insight/ experience report, and reporting cycle with CSU. Julian Simcox asked whether the seminar programme should be included in the work programme and it was explained that a seminar programme across the whole CCG was being developed and that any QAG specific seminars would be reflected in the work plan. Mary Backhouse expressed concern that the members of the Quality and Assurance Group may not be receiving invitations to all appropriate seminars and it was agreed that in future this would be arranged. Q&A/14/037 Annual Report 2013/14 for Quality and Assurance Group Kathy Headdon invited comments on the Quality and Assurance Group Annual report for 2013/14, which will be presented at the Governing Body meeting on 3 rd June 2014. Julian Simcox commented that the word improvement is not included in the document but it was recognised that the role of the group in improvement is covered in the Terms of Reference which is an appendix to the report. The members of the Quality and Assurance group approved the Annual Report for presentation at the Governing Body. Q&A/14/038 BNSSG Access Policy This item has been deferred until the July meeting of the Quality and Assurance group. Q&A/14/039 BNSSG CCG Incident Response Plan Kathy Headdon explained that the BNSSG CCG Incident Response Plan is being presented at QAG for information and will be approved by Mary Backhouse as Chief Clinical Officer. Quality & Assurance Group 20.03.14 Page 2 of 9
Mary highlighted that the on-going commitment to this work is significant for the CCG. Kathy Headdon highlighted that contact details for escalation are included in the document and for this reason suggested that staff be made aware that this is a restricted access document. The Group agreed that a recommended approval process for updates to the plan should be in place. Kathy Headdon proposed that updates to the plan be given directly to Mary Backhouse for approval, Mary will then advise the Quality and Assurance Group as necessary. If an update is considered to be significant or requiring QAG attention then these would be brought to the Group. Action: Kathy Headdon to ensure that Debbie Campbell is aware of the approval process for updates to the plan. KH Q&A/14/040 Declarations of interest 2014/15 QAG received the schedule of declarations of interest from QAG members. Action:Liam Williams needs to add Executive Member of Community Hospital Association Board to his declarations of interest. Liam advised that in his role on the Community Hospital Association Board he will have no involvement with issues relating to Clevedon Community Hospital, therefore there will be no conflict of interest. Q&A/14/041 APCRC Quarterly Report for January-March 2014 The Quality and Assurance Group were asked to note the APCRC reports for January to March 2014. A brief discussion followed around how the CCG should provide appendices to the reports. Mary Backhouse commented that APCRC are taking their role of supporting the CCG seriously, and they have advised that additional support will be provided to CCGs going forward but it was noted that the CCG will require further clarity on what form the additional support will take. It was noted that the Cochrane Review, on keeping people out of hospital, will shortly be published and this will be the baseline document for future evidence based decisions. The APCRC Quarterly reports were received and noted by the Quality and Assurance Group. Quality & Assurance Group 20.03.14 Page 3 of 9
Q&A/14/042 Serious Incidents Requiring Investigation Policy Liam Williams introduced the paper requesting QAG to approve the Serious Incidents Requiring Reporting Policy. Liam invited comments. Lindsey Perryman pointed out an error in section 5 of the policy. Information Governance incidents have previously been reported to the Quality Team via an online form and not to the quality manager as stated in the document. Action: Liam Williams to review section 5 and ensure it reflects the processes and systems used to report information governance incidents. Kathy Headdon commented that the document meets NHS England s requirements. Julian Simcox queried the way that Incident Reports are recorded and presented for learning purposes in a tabular format. Julian believes that timeline plotting would add value. Liam Williams responded that the reports are a mechanism for providing information, the reports are reviewed by Liam and he will look into any highlighted concerns. Incident reporting was noted as an area for development with the CSU quality team. Jeanette George commented that the policy does not cover the internal process for incidents involving CCG staff. Following a recent incident, which was reported through CSU but not passed to CCG straight away, Jeanette would like assurance that there are no other staff incidents of which the CCG is unaware. Action: Liam Williams to with CSU the current level of CCG staff incidents and ensure they are all being managed in the system as required. Quality Assurance Group members approved the Serious Incidents Requiring Reporting Policy with one amendment to Section 5 (to be made by Liam Williams). Q&A/14/043 NSCCG staff survey results and action plan Jeanette George introduce the Staff Survey management report and asked the Quality and Assurance Group to discuss the report, agree priorities and endorse the action plan. Jeanette stated that the action plan has been developed and agreed with CCG officers and managers. Mary Backhouse suggested that staff be kept up to date Quality & Assurance Group 20.03.14 Page 4 of 9
regarding the Operational Plan via the CCG Business meeting. Julie Kell gave some feedback from her recent team away day, around ways of encouraging staff engagement, and recognising good work. Kathy Headdon believes the CCG managers should be encouraged to try new approaches with their teams and share the learning. Liam Williams believes that improvements have been made since the staff survey was undertaken, and that staff are now feeling more positive. Jeanette George highlighted that the Staff Forum meetings are commencing this week. The Quality and Assurance Group confirmed that they are happy with the recommendations made in this report and endorsed the action plan. Action :Jeanette George will bring the Organisational development Plan to the Quality and Assurance Group meeting in July. JG Q&A/14/044 Quality of Care of Local Health Services The Quality and Assurance Group noted particular concerns around SWAST performance: SWASFT s continued maintenance of a Trust-wide green RAG rating score for Category Red 1 Performance. However performance within North Somerset has continues to be a challenge and remains below target (scored 61.67%) Mary Backhouse questioned if the transition into Brunel Building had impacted negatively on the Ambulance Service Liam Williams advised that he and Mike Vaughton had agreed not to sign the South West Ambulance Service Contract (SWAS) at present. Liam highlighted some of the main areas of concern: Trajectory not sufficient to give improvements Poor red performance against 111 calls There was ongoing negotiation being undertaken with the ambulance trust. Mary Backhouse confirmed she had met with the Chief Executive of SWAS last month who reported that their quarter four recovery plan is not on track. Quality & Assurance Group 20.03.14 Page 5 of 9
Kathy Headdon asked if the CCG can take assurance that the outcome for patients has not been materially damaged by poor response times. Liam Williams responded that there have been serious incidents reported in which ambulance response times were cited as a contributing factor. The CCG can take assurance from the fact that these have been investigated and learning implemented. Liam feels confident that CSU are engaged with patient complaints. Mary Backhouse advised that a patient opinion survey has been being promoted by the Ambulance service and the feedback is largely positive. The Quality and Assurance Group noted: Public concerns regarding capacity in the paediatric service at Weston Liam Williams advised that: there is a national shortage of Paediatric doctors. A solution for the provision of community paediatric cover has been put in place following the service not being sustainable at WAHT. the consultant waiting list is down but this has impacted on follow up appointments. Current areas of focus for Dali Sidebottom and her team are shared caseload review and improved communications with families of patients. The Quality and Assurance Group noted: The never event at NBT and UHB in April 2014 due to wrong site surgery The Quality and Assurance Group noted: The significant improvement made by Weston to VTE risk assessment 100% of all patients in April 2014 Kathy Headdon observed that there had been press interest in the inappropriate discharge of vulnerable patients at night. Action: Liam Williams will include a comment on night discharges in the next QAG report to assure the Group. Q&A/14/045 Participation Insight and Feedback Report This item was withdrawn from the agenda. Quality & Assurance Group 20.03.14 Page 6 of 9
Q&A/14/046 Annual Quality accounts from provider organisations The reports for Weston Area Health Trust and Avon and Wiltshire Partnership were received and noted by the Quality and Assurance Group. The responses sent from the CCG to each were noted and discussed. The reports for South West Ambulance Service and North Somerset Community Partnership were not circulated with the meeting papers. Action :Liam Williams will circulate these and Kathy Headdon requested that any comments are sent directly to Liam via email. ALL Q&A/14/047 Co-commissioning of Primary Care Liam Williams presented this paper and the Quality Assurance Group noted the NHS England requirements for a cocommissioning proposal to be developed and submitted. The current separation of duties between CCGs and NHS England is not working well in the commissioning of primary care and the GPs and Practice Managers are keen for the CCGS to have a more active role. Liam Williams invited comments on the proposed Terms of Reference for the North Somerset Primary Care Joint Planning Group. Kathy Headdon commented that NS Community Partnership is not listed in the membership. Lindsey Perryman commented on point 11 (Papers will need to be sent to the secretariat at least ten working days prior to the meeting date) and highlighted it is more important to state when the committee members should receive the papers. Kathy Headdon advised that the relationships for reporting need to be stated. The minutes of this group will be taken to the Clinical Commissioning Leadership Group. It should also be added to the terms of reference that NS CCG will hold the chair for the meeting. The Quality & Assurance approve the Terms of Reference for the North Somerset Primary Care Joint Planning Group with the stated amendments. Q&A/14/048 Safeguarding year end reports 2013/14 Safeguarding adults at risk or experiencing abuse Areas of focus: Quality & Assurance Group 20.03.14 Page 7 of 9
Work on training package and mental capacity assessments. Care Home improvements with the Local Authority Julie Kell requested that roles and responsibilities on page 10 are clarified and it be made explicit CCG are not responsible. Kathy Headdon referred to Prevent on page 17 and asked if the P&C board will monitor. Liam Williams responded that it will be monitored by individual CCGs. Julian Simcox referred to the Increase in Safeguard alerts for Nursing Homes mentioned on page 5 Liam Williams advised that work is currently being undertaken on thresholds. The Nursing Home system is generating a lot of activity at the moment and some homes are on complete reviews. Julie Kell asked if Winterbourne returns should be included page 11. Action :Liam Williams will look into this and amend if required. The report for Safeguarding Adults was endorsed and approved by the Quality and Assurance Group with the above comments. Thanks were given to Pippa Lucas for her work in safeguarding and for producing this report. Report for Safeguarding and Looked After Children The following were highlighted as areas for concern: WAHT Primary Care (This will be reviewed by Sue Masters when she is in post) There have been positive outcomes with engaging GPs and raising the profile of Safeguarding. The report for Safeguarding and Looked After Children was endorsed and approved by the Quality and Assurance Group. Thanks were given to Sarah Tyndall for her work in safeguarding and for producing this report. Q&A/14/049 Equality Impact Assessment (EIA) Safeguarding Adults Policy Liam Williams acknowledged all the hard work that Pippa Lucas has put into the EIA for Safeguarding Adults Policy. The Group recognised the issues raised by management around carrying out effective public engagement relating to such a complex subject area and document. The document has been completed to comply with statutory requirements but Quality & Assurance Group 20.03.14 Page 8 of 9
will need to be made more proportionate. Kathy Headdon stated that shared learning could be drawn from other parts of the system/national EIAs. The Quality and Assurance Group received and endorsed the EIA for the safeguarding adults Policy. Q&A/14/050 Any Other Business There was no other business to discuss. Q&A/14/051 Date of Next Meeting: Thursday 17 th July 2014 at 9.00am in Castlewood, Room 2.07 Quality & Assurance Group 20.03.14 Page 9 of 9