Meeting of Bristol, North Somerset and South Gloucestershire Clinical Commissioning Group Governing Body Meeting In-Common Date: Tuesday 9 January 2017 Time: 13.30 Location: Christchurch, Chapel Hill, Clevedon, BS21 7LL Agenda item: 8.4 Report title: Quality Assurance Report 1. Purpose The purpose of this report is to provide the Governing Body with the key issues of quality work discussed at the BNSSG Quality Committee in December 2017 and areas of emerging quality issues. 2. Recommendations To note the area of work undertaken; note assurances received and actions agreed. 3. Background The first Joint Quality Committee of the Bristol, North Somerset and South Gloucestershire (BNSSG) Clinical Commissioning Groups (CCGs) took place on the 12 December 2017. The Quality Committee was established in accordance with the BNSSG Clinical Commissioning Groups Constitutions, Standing Orders and Schemes of Reservation and Delegation. BNSSG CCGs are responsible for ensuring that there is a cohesive and comprehensive structure in place for the oversight and monitoring of: The quality of commissioned services including patient safety, patient experience and clinical effectiveness The clinical effectiveness of commissioned services Performance against constitutional standards
4. Quality Committee Assurance 4.1 Joint targeted area inspection of the multi-agency response to abuse and neglect in Bristol City Council. Jackie Mathers, Designated Nurse for Safeguarding children presented this item. Between 16 and 20 October 2017, Ofsted, the Care Quality Commission (CQC), HMI Constabulary (HMICFRS) and HMI Probation (HMI Prob) undertook a joint inspection of the multi-agency response to abuse and neglect in Bristol City Council. This JTAI included an evaluation of the multi-agency front door for child protection, when children at risk become known to local services. In this inspection, the evaluation of the multi-agency front door focused on children of all ages who are being or have been neglected. The JTAI also included a deep dive focus on children between seven and 15 years old who have been neglected. It was noted that the partnership had a strong commitment to protecting children in Bristol, with solid foundations for further improvement and that it was evident that self-awareness in the partnership was improving and that the vast majority of the areas for improvement identified during the inspection had already been identified, with action being taken to address these deficits. An action plan to address areas of concern is currently being formulated. The lack of an information system for Health Visiting was noted and a bid has been made to NHS England. 4.2 Workforce Marie Davies, Head of Commissioning for Quality presented this item and a presentation in regard to Primary Care Workforce was undertaken by Rosemary York, Primary Care Workforce Lead. Health Education England (HEE) has established Local Workforce Advisory Boards(LWAB) to support collective delivery of the workforce agenda, building on the National Workforce Advisory Board. The aim of the LWAB is to bring together health and care organisations and key stakeholders across a broad range of workforce issues, current and future, and deliver a work programme to support the STP. Areas discussed included an update on the STP refresh and stocktake; a Workforce Strategic Priorities Workshop that is being arranged for the 15 January 2018; an update on the re-establishment of an Agency Controls Group, aimed at reducing temporary staffing through agencies and apprenticeships. It was noted that the National Workforce strategy was due for publication and the consultation is now live and the relevant documents can be accessed through 2
the following hyperlink. https://hee.nhs.uk/sites/default/files/documents/facing%20the%20facts%20sha ping%20the%20future%20a%20draft%20health%20and%20care%20workforce %20strategy%20for%20England%20to%202027_0.pdf Ro York presented data in regard to the current primary care workforce and possible approaches to developing apprenticeships within primary care. It was agreed that an update to the Quality Committee would be provided once the data had had further analysis. 4.3 Avon Wiltshire Mental Health Partnership The Quality Committee discussed the quality concerns relating to medication issues, the backlog of Serious Incident investigations and the delivery of a Contract Performance Notice in relation to the management of serious incidents. It was noted that the Committee requested a deep dive into quality metrics for AWP and that this would be scheduled for discussion for a future meeting. 5 Emerging Quality Issues This section identifies emerging issues and concerns and the work undertaken to address this. 5.1 North Bristol Trust Area of Concern In the week commencing 3 December 2017, North Bristol Trust reported that their Emergency Department(ED) was under significant pressure and Opel 4 was declared. The Trust reported breaches in 4 hour wait performance including un-validated 12 hour trolley breaches and queuing patients in the corridor. The situation was compounded by cases of Norovirus being brought into the hospital from the community. Actions Being Taken In response to the increase in demand and to manage patient safety, the Trust has implemented the following actions: NHS Improvement trolley breach process to report all trolley breaches within 24 hours and complete a 14 day review for patient harm. Zero patient harm has been identified from the 14 day review of the cases of trolley breach that occurred on 3 and 4 December 2017. Deployment of agency staff has been undertaken by the Trust to support patient care. Additional medical staff have been deployed to support nurses in managing corridor overflow of patients. All non-urgent electives have been cancelled by the Trust. An ambulance divert was put in operation. The Trust identified capacity for additional beds within physio outpatients. 3
A critical incident was declared on the 7 December 2017 and twice daily escalation meetings were put in place. The Trust has requested that communications are issued from the CCG to the public regarding the approaching cold weather and the need to keep well and warm and stock up on medications and food. Expected Outcomes and Timescales The CCG undertook a patient safety visit to the ED on 7 December 2017 to assess the situation and gain assurance of the action being taken to keep patients safe from harm. The CCG was assured that actions had been put in place to ensure that patients were safe and being managed. The crossroads area was again noted to be cold and diversion of ambulance admissions through the decontamination area was put in place to close the entrance doors during the cold weather. Since the CCG visit, the Trust has advised that heaters and blankets have been provided within the Crossroads area. The CCG monitors monthly ED safety metrics at the quality sub group. Daily Sitrep reporting is in place through the BNSSG systems call. A proposed plan for patient safety visits, including a report on visits undertaken this year, across all providers will be presented to the Governing Body for the February meeting. Owner/Position in BNSSG CCGs Cecily Cook, Interim Associate Director of Nursing and Quality 5.2 Weston Area Healthcare Trust Area of Concern An outbreak of Norovirus occurred at Weston Hospital in the week commencing 11 December 2017 resulting in the closure of 4 wards and 2 ITU beds. WAHT report that the outbreak had arisen in the community and was affecting people of all ages. At the beginning of the week commencing 18 December 2017, the hospital reports 3 wards closed with an expectation that Kewstoke ward will open by Wednesday 20 December. Berrow ward will be reviewed on Wednesday 20 December with a view to reopening on Thursday 21 December. The Trust is reporting that staff sickness has increased with 10 staff absent from work with diarrhoea and vomiting (D&V). Concern has also been raised that Care Homes are refusing to accept non-symptomatic patients discharged from affected wards and this is to be escalated to North Somerset Council. 4
Actions Being Taken The Trust has put in a series of actions to contain and manage the outbreak of Norovirus including daily escalation meetings. Actions have included ensuring all symptomatic admissions to ED are swabbed and patients are not transferred into wards until results are known. Communications to the public have been put in place including website, twitter feed, newspaper and phone messages as well as placing a conference style banner in the entrance to the hospital. Visiting times to the wards have been restricted and championship of hand hygiene amongst staff is in place. The issue regarding Care Homes not accepting patients was escalated to North Somerset Council through the BNSSG system management call. Expected Outcomes and Timescales The CCG instigated daily infection, prevention and control sitrep reports in order to be kept informed of the position in relation to actions being taken and ward closure position. Minutes of the daily escalation meetings held at Weston Hospital are shared with the CCG and the CCG is assured that appropriate action to manage the outbreak has been put in place. The CCG is receiving community outbreak information from Public Health England that provides updates on Norovirus outbreaks within the community. NHS England held a webinar in relation to Norovirus on the 14 December 2017 and the slides from this webinar have been shared with the Trust. The CCG quality team will plan to undertake an observational visit in the New Year to review infection prevention control within the Trust Owner/Position in BNSSG CCGs Cecily Cook, Interim Associate Director of Nursing and Quality 7 Recommendations The Governing Body is asked to note this update and emerging issues of quality provision within the BNSSG providers 8 Financial/Resource implications There are no direct financial implications for the CCGs in this paper 5
9 Legal implications There are no legal implications to the CCGs from this paper. 10 Risks/mitigations Risks and mitigation where required are described in this paper. 11 Implications for health inequalities High quality care is a requirement for all. 12 Implications for equalities (Black and Other Minority Ethnic/Disability/Age Issues) Not applicable 13 Consultation and Communication including Public Involvement Not applicable Marie Davies Head of Commissioning for Quality Anne Morris Director of Nursing and Quality 20 December 2017 6