Quality report July 2013 1.0 Quality Directorate update 1.1 Staffing The following key posts will be filled over the summer period. Board Support Officer Communications Support Officer Head of Quality and Performance 1.2 Infection control In the absence of a designated resource, the management of infection control and co-ordination of post infection review investigations continues to be led by the Director of Quality and integrated Governance. Options for securing a resource remain under review. 1.3 Nurse Member s activities In addition to chairing the Quality Committee and attending key CCG meetings, the Nurse Member has undertaken the following visits to local acute Trusts: Meeting with the Director of Nursing, Whittington Health NHS Trust, which included a visit to four inpatient wards. Topics discussed included vacancy management, establishment of nurse pool, standards of nurses on qualification and meeting quality measures. Meeting with Director of Nursing and Deputy Director of Nursing, Camden and Islington Mental Health Foundation Trust, to discuss the pan London training programme for practice nurses. 2.0 Haringey CCG Quality Committee The Quality Committee met on 22 May 2013 and 19 June 2013 receiving minutes and supplementary reports from the CQRGs relating to Whittington Health NHS Trust (WH); Barnet, Enfield and Haringey Mental Health NHS Trust (BEH); North Middlesex University Hospital NHS Trust (NMUH). The committee also received minutes from the communication and engagement group and the medicines management committee. The six monthly update on Communications and Engagement is presented to the Governing Body in a separate report. Minutes of the Quality Committee meetings are attached separately under item 7.1. 2.1 Development/review of policies The committee continues to oversee the development and review of CCG policies and guidelines. Since the last Quality Report the Quality Committee has approved the following policies: Anti-Fraud and Bribery Policy Policy on Policies Policy for Development and Management of Patient Group Directions. 2.2 Concerns and queries A log of concerns and queries has been placed on the CCG shared drive to ensure contemporaneous records are made of concerns/queries received from members of the public, any actions taken.
During June NHS England referred a complex query relating to individual funding requests (IFR) to the DQIG. This case led to the CCG improving the IFR section of HCCG website to ensure information about how the IFR process is clear. Two queries were received from women seeking clarity on the CCG s commissioning of infertility treatment. In both cases the Director of Commissioning responded within ten working days. 2.3 Complaints As previously reported, the majority of complaints received during 2012/13 by North Central London PCT Cluster on behalf of Haringey PCT, related to primary care services. Since 1 April 2013 complaints relating to primary care have been handled by NHS England. On 1 April 2013 four legacy cases were received by North East London CSU (NELCSU) on behalf of Haringey CCG. These included some of the most complex complaints handled by the former PCTs. At the time of writing, there is one legacy complaint open which relates to a complex adult safeguarding continuing healthcare case. It is anticipated this will be responded to within quarter 2 2013/14. During quarter 1 one a complaint was received about a provider service from a Haringey CCG resident. This related to a GP practice and 111 services and is being co-ordinated by NHS England. Haringey CCG received no complaints about its commissioning function for during quarter1. However, it is expected that the figure will increase as improved sign posting takes place across the health community. 2.4 HCCG incidents An incident log has been developed on the CCG shared drive to ensure timely recording and investigation of incidents. There have been no reported incidents during quarter 1. 2.5 HCCG serious incidents (SI) The CCG is required to report internal SIs and serious case reviews on the Strategic Executive Information System (STEIS). The Designated Nurse for Child Protection reported one serious case review (SCR) on STEIS during June 2013. 2.6 Child safeguarding The 2012/13 annual report was approved by Quality Committee in June 2013. There are three SCRs currently in progress one of which is expected to be published in July 2013. In advance of publication the CCG has contributed to a statement being prepared by the Local Safeguarding Children Board. On 17 th June 2013 the Designated Nurse for Safeguarding Children updated the Quality Committee on the status of each case as part of the monthly briefing.
The Safeguarding Children Commissioning Group chaired by the Governing Body Lead for Children held its inaugural meeting on 28 June 2013. The group will meet quarterly and report to the Quality Committee. Membership includes the Designated Nurse for Safeguarding Children and the Designate Doctors for Safeguarding and Looked After Children. 2.7 Adult safeguarding The Adult Safeguarding Lead continues to support safeguarding adults training within primary care. A safeguarding adults e-learning module has recently been made available to GPs via the Skills For Health resource. The 2012/13 annual report was approved by the Quality Committee in June 2013. The Launch of the Haringey Local Authority and CCG Establishment Concerns Policy (ECP) took place in June 2013. The ECP will further strengthen collaborative work with the local authority to ensure swift action is taken when establishment concerns are raised about a provider. 3.0 North Central London Clinical Quality Review Meetings (CQRG) As part of the contractual requirements, commissioners hold monthly Clinical Quality Review Group (CQRG) with each of the local acute NHS providers. The purpose of the CQRG is to discuss quality issues and to hold Providers to account for quality of the services they are commissioned to provide. The Director of Quality and Integrated Governance attends CQRG meetings for North Middlesex University Hospital NHS Trust, Whittington Health NHS Trust, Barnet Enfield and Haringey Mental Health Trust. The Nurse Member continues to deputise when the Haringey GP clinical lead is unable to attend. 3.1 Review of local acute Trust quality accounts against DH guidance A technical review of the Quality Accounts has been conducted by NELCSU on behalf of North Central London CCGs. During June 2013 NCL CCGs provided a statement to the Trust(s) for which they are lead commissioners. Due to the lack of wider engagement, the Quality Account will in future be discussed at CQRG to facilitate early CCG input. 3.2 Quality impact assessments of local acute Trust cost improvement programmes (CIP) On behalf of North Central London (NCL) CCGs, NELCSU has reviewed the evidence submitted by local acute Trusts with regard to the governance process of their Cost Improvement Programme (CIP), including Quality Impact Assessments. NCL CQRGs will provide the on-going monitoring of the implementation of CIP schemes, particularly those that present a high risk of reducing service quality. HCCG has requested further information from North Middlesex University Hospital (NMUH) regarding the management of CIPS and on-going plans for monitoring and assessing the quality impact on provision of services in CIP areas.
3.3 Local implementation of the Friends and Family Test (FTT) NCL acute Trusts are performing well for inpatient response rates but continue to be challenged for securing responses to patents attending A&E departments. NCL CQRGs monitor performance on a monthly basis and recovery plans are being requested where appropriate. Maternity services will be required to implement FFT in October 2013. NHS England is providing support to Trusts and NCL CQRGs are monitoring roll out plans. FTT data for all acute Trusts in England will be published on the NHS Choices website at the end of July 2014 with Maternity FTT due to be published in January 2014. 4.0 Quality and safety headlines by provider. 4.1 North Middlesex University Hospital Trust (NMUH) In May 2013 the Trusts score for FFT was 19.18% and A&E 3.33%, against a target of 15%. The aggregated score of 6.52% places the Trust in group of lowest performers within North Central London. CQRG continues to focus on FFT performance and has asked the Trust to confirm key challenges and actions planned to address the low response rates in A&E. The Trust has confirmed that plans are in hand to implement FTT within maternity services in accordance with NHS England guidance. The Trust continues to be above the monthly tolerance level of 1.5 per month, with two cases of Clostridium difficile (C.Diff) reported in May 2013. In addition to this the zero tolerance for MRSA blood stream infection (BSI) has been breached on two occasions. Both cases were confirmed as contaminated blood samples. In October 2012 a challenge and confirm meeting was held to discuss the Trust s progress with implementing recommendations from a peer review of healthcare associated infections (HCAI). Progress against the plan during 2012/13 was slow. CQRG has requested an overarching remedial action plan to be presented at the July meeting and a contract query notice has been issued by the CCG. The Trust has reported 4 mixed sex accommodation (MSA) breaches for May 2013. The Director of Nursing at NMUH has confirmed that the issue of male and female patients crossing the entrance to bays in the A&E department has been addressed. Appendix 1 provides a summary of performance on serious incidents and additional issues/ actions for May 2013. 4.2 Whittington Health NHS Trust The Trust is committing resources to a programme of work aimed at reducing the incidence of community and hospital acquired pressure ulcers. This will coincide with the launch of a Trust wide Pressure Ulcer Strategy.
The Trust confirmed that there had been 3 cases of C Diff since the 1st April 2013 which were not related (the threshold is 10 for 2013/14). There was a Norovirus outbreak in April which was contained. The Trust action plan and further update from the Trust infection control lead has been requested for July CQR. A hospital acquired incident of MRSA BSI was notified by the Trust on 3rd June 2013.Further information about the case is being clarified. There have been a cluster of neonate cases colonised with MRSA. This is thought to be a pseudo outbreak due to testing errors and false positive results from using a point of care testing system (PCR). The Trust is currently investigating this issue. The Trust continues progress the work to validate patient pathways. Highlight reports on the Trust position are received at the Trust Executive Board. NEL CSU performance team and local CCG accountable officers are provided with regular updates The Trust expects to clear the Endoscopy 6 week wait back log by early July 2013.The position as at 5 th June 2013 was that 24 patients were still waiting to be seen. One incident of serious harm (against the national SI criteria) has been identified and will be discussed at the Trust Clinical Review Group. The SI investigation is in progress. NEL CSU performance team and local CCG accountable officers are provided with regular updates. Appendix 2 provides a summary of performance on serious incidents and additional issues/ actions for May 2013. 4.3 University College London Hospitals NHS Foundation Trust (UCLH) May Inpatient response rate for the Friends and family test (FFT) was 29.51% and A&E 0.14% against a 15% target. The aggregated score was 7.78%. FFT will be monitored at CQR until the 15% threshold is achieved. The Trust advised that they are reviewing ways to improve on the A&E response rate. The Trust s Inpatient Survey Action Plan 2013 was shared with CQRG. The Trust Inpatient Service group meets regularly to review progress on the action plan. Individual Divisions also monitor their own sections of the action plan. The main focus for 2013/14 will be on pain management. The Trust s ambition is to achieve better results than the national average. Appendix 3 provides a summary of performance on serious incidents and additional issues/ actions for May 2013
4.4 Barnet, Enfield and Haringey Mental Health NHS Trust Between March and June 2013 the Care Quality Commission (CQC) made a number of unannounced inspection visits to BEH services. The Oaks Unit Chase Farm on 27 March 2013. The inspection team highlighted concerns about care and record keeping. In June 2013 the London Borough of Enfield (LBE) convened a Provider Concerns Group in response to a series of safeguarding alerts and also commissioned a separate independent review of the services provided. In order to address these issues and provide assurance about the quality and safety of the service, the Trust has developed an overarching improvement plan. Enfield CCG will oversee the implementation of the plan via CQRG. Further to this, the Trust intends to place an interim suspension on new admissions to the Oaks during July 2013 to enable the staff and senior leadership team to implement the required improvements. At the time of writing, the Trust is making preparations to ensure the interim suspension causes minimum disruption to patient care and service continuity. LBE continues to lead the investigation into the safeguarding concerns supported by Enfield, Barnet and Haringey CCG quality and safeguarding leads. Inpatient mental health acute wards on 19 June 2013. The Trust received informal feedback on at the time of the visit and awaits the final report. CQRG will request an update on 18 July 2013. The Haringey home treatment team (HTT) Enfield recovery team and Barnet Primary Care Mental Health Team in May 2013. The Trust received informal feedback at the time of the visits and awaits the final report. CQRG will request an update on 18 July 2013. Enfield Community Services (District nurses, Paediatric Occupational Therapy, and Tissue Viability Services) on 8 May 2013. No concerns were raised at the time of the visit, although caseload allocation was highlighted as a potential issue. CQRG will request an update on 18 July 2013. Appendix 4 provides a summary of performance on serious incidents and additional issues/ actions for May 2013.