Item No: 5.3 Paper No: 24 Name of meeting FINAL MINUTES Quality and Clinical Governance Committee Date and time Tuesday 6 September 2016; 14:30-16:30 Venue Board Room, Dominion House Name Title Chair Dr Sue Tresman (ST) Lay Vice Chair (Lay Member Quality and Governance) Members Dr Darren Watts (DW) Vice Chair (Clinical)/ GP member In Attendance Apologies Members Jagadish Chakraborty (JC) Helen Collins (HC) Dr Jonathan Inglesfield (JI) Elaine Newton (EN) Dr Geoff Watson (GW) Jane Williams (JW) (Substitute for Leah Moss) Anna Vigurs (AV) Philip Tremewan (PT) For item 7 Julie George (JG) For item 8 Debbie Hustings (DH) For item 12 Natasha Moore (NM) Leah Moss (LM) Phelim Brady (PB) Carol Dunnett (CD) Vicky Stobbart (VS) Patient Representative Associate Director of Quality and Improvement Medical Director (Commissioning) Director of Governance & Compliance Medical Director (Acute)/ Secondary Care Consultant Head of Clinical Commissioning for Unplanned Care Senior Quality and Performance Analyst Designated Nurse for Safeguarding Adults Consultant in Public Health, Surrey County Council Partnership Manager for Carers Note Taker, PA to CCG Directors Deputy Director of Clinical Commissioning Lay Member Patient and Public Engagement Patient Representative Executive Director of Nursing, Quality & Safeguarding 1
Discussion and new actions 1 Welcome, Introductions and Apologies The Chair welcomed attendees and apologies were received as detailed above. Arrangements for a restricted part 2 section of the meeting were outlined. The Chair reminded members and those in attendance that confidential papers should be handed in to NM after the meeting for secure disposal. The Chair also reminded attendees that the meeting would be recorded for administration purposes only and that the recording would be deleted once the minutes had been approved. By whom Deadline 2 Declarations of Interest The Chair reviewed the subset of interests relevant to the Committee membership and then invited members to declare any further interests relevant to the agenda. No further interests were declared. 3 Quorum As the required quorum was met, the Chair declared the meeting open. 4 Minutes of Previous Meeting The minutes from the 5 July 2016 were agreed as an accurate record of the meeting. 5 Matters Arising from last meeting: Action Log The Chair advised the areas shaded grey on the Action Log were complete and would not be discussed unless members had any comment or feedback. Incomplete actions were reviewed as followed: Stroke service redesign: Agreed to close as on the agenda for this meeting. Actions relating to obtaining data regarding uptake of annual health checks for patients with learning disabilities and promotion of this service: HC confirmed still in progress. Awaiting quantitative data to confirm anecdotal feedback that rates for these were low. Carers budgets: Agreed to mark as complete as conversation had between LM and Brian Mayers to ensure Commissioning Finance and Performance Committee of Clinical Forum have sight of any future changes. Re-alignment of PPG groups with localities model: JW to take this forward and obtain an update. 2
6 Quality a) Quality and Safety Report (by exception only) with focus on RSCH and including the following specific data: latest stroke service data; and breakdown for emergency readmissions within 30 days by speciality. HC outlined the following by exception: Latest available stroke data was published for July 2014 from SNAP. More recent stroke data was un-validated and so had not been released. RSCH being monitored on 5 areas as part of the remedial action plans through fortnightly telecons. Although there had been some progress in certain areas (for example, performance for cancer waits; and workforce), the CCG was not sufficiently assured of the impact of the plan in improving performance. For example, A&E was proving to be a challenging area and the action plan was due to be revised following the EIST visit (report to be released week commencing 12/09/16). RSCH had employed an A&E Turnaround Director for a 6 month period to improve flow. JW flagged that the main issues were in relation to out of hours provision and handover, adding that there was a new executive level A&E Delivery Board, with 5 workstreams feeding into it, replacing the Systems Resilience Group. Members recognised the CCG was limited in terms of exercising financial levers, but questioned what more could be done contractually. HC confirmed that she had raised this with the contracts team and agreed to follow up with NB. To review quality performance. To discuss additional actions required for areas of particular sub-optimal performance. Agreed to continue quality surveillance. Agreed to seek assurance where specified in report. Agreed to correlate areas of sub-optimal performance with risk register. Agreed for RSCH remedial action plan improvements and possible future options, for example contractual leverage, to be discussed outside of the meeting. HC/ NB 30/09/16 b) Pressure Damage work update PT outlined that G&W CCG were working closely with both the Patient Safety Collaborative (PSC), Virgin Care and Quality workstream Surrey-wide to help to identify risks to individuals, particularly those not previously known to services. This was identified as an area for further work. Note the contents of the paper. 3
Agreed that the Designated Nurse for Safeguarding Adults in Guildford & Waverley will continue to work closely with key partners to ensure that effective pressure area care remains integral to patient safety. c) Update on Mazar s recommendations update PT confirmed that he had updated the action plan and that they were on progress with implementing the recommendations. Review and note the contents of the paper. Agreed that the CCG will continue to have oversight of the recommendations made in the Mazars report. Agreed that a further update should be presented to the Committee at the January meeting. NM to add to the work plan. NM 30/09/16 d) RSCH NHS Foundation Trust Staff Survey Feedback Action Framework HC stated that workforce is one of the areas covered by the remedial action plans for RSCH with improvement against the metrics being achieved since the notice was given. She also highlighted that the response rate for the staff survey was good, considering the wider issues that RSCH were facing. Note the action framework. Noted the action framework and agrees to continue the review of compliance to actions through the remedial action plan fortnightly meeting. 7 Annual Report of the Director of Public Health and Joint Strategic Needs Assessment Annual Report of the Director of Public Health JG presented the Annual Report, with a focus on children and young people, with main themes and findings as follows: In general, children s health locally is good compared to nationally, however there were geographical pockets of deprivation. For example, average figure across Surrey for children living in poverty was 8.3%; for Stoke ward in Guildford, this was 25%. Differences were flagged in teenage pregnancy rates; school readiness ; A&E attendance for 0-4 year olds; free school meals eligibility; and emotional wellbeing, for example, self-harm. An error on page 10 of the report was noted; the correct version would be circulated electronically. 4
Joint Strategic Needs Assessment JG confirmed that this was a statutory requirement of the Health and Wellbeing Board and that CCGs and local authorities are equally as responsible for delivery. She highlighted the following key changes to the process for assessments going forward, due to be fully embedded in working by December 2016: An overall reduction in number of chapters; Taking a life course approach; Linking each chapter to a Partnership Board (where relevant) to assign ownership - agree scope and sign off on the chapter; Shifting towards using more dynamic infographics on Surreyi for CCGs for more localised approach; and Develop some prevalent projects for some long-term conditions, e.g. diabetes. Note the contents of the Annual Report of the Director of Public Health for Surrey and to consider ways in which the CCG can respond to the recommendations of the report in commissioning intentions and other strategies. Note progress on development of revitalised approach to the Joint Strategic Needs Assessment and on-going support of CCG officers in developing specific chapters. Agreed that G&W CCG representative, David Howell, continues to support the development of the Joint Strategic Needs Assessment Strategic Development Group. Agreed for a similar update to the G&W CCG Commissioning, Finance and Performance Committee. Agreed that the CCGs should continue to be informed as chapters are published so they can use the information in them as they become available. Agreed that should the CCG want a seminar or workshop on the revised Joint Strategic Needs Assessment when it is published, Public Health will be happy to provide. JG to send the amended Annual Report to NM for circulation to members. JG/ NM 30/09/16 8 Quality and Clinical Risks Report HC highlighted that ratings for the 10 risks relating to Quality, the majority being held by the Director of Nursing, Quality and Safeguarding, have reduced towards their targets. However, she had identified 2 risks relating to workforce and constitutional targets for which more could be done to help to reduce their rating (as of 03/08/16) and that recommendations relating to this were highlighted in the paper. EN suggested that the deep dive audit template could be used to facilitate this and that this should be presented to the December Audit Committee. She also flagged that risk R0033, regarding continuing healthcare transformation (If the existing CHC services do not deliver the agreed collaborative change action plan, service transformation will fail) had surpassed its target score and so should be considered for closure. 5
EN confirmed that the closure of this risk had been recommended to Audit Committee on 13/09/16. To note current position of clinical and quality risks and their movement since last reporting. To note the progress against previous report s recommendations and the new recommendations devised from the analysis of the current risk register. To note the financial, quality and safety impact of risks not being reduced or meeting their target score. Agreed for the recommendations of paper to be implemented, including for the risk handlers to meet with VS and HC to review the mitigation, controls, assurances for risks R0164 and R0202. This should then be presented to the Audit Committee meeting in December. Agreed to review risks movement in January 2016. VS/ HC/ Risk owners 30/09/16 9 Complaints Summary Report- Q1 April 2016- June 2016 EN highlighted the following in regards to the report: There had been a decrease in complaints due to better signposting regarding who/ where to complain to and that the overall number of complaints received was relatively low. A number of themes had been identified as outlined in the report and that these had been followed up with the relevant organisations and individuals. HC flagged one particular complaint that may be subject to a serious incident investigation regarding a 999 response time. HC currently awaiting status report from the provider and agreed to follow this up. Note the Complaints Summary and its recommendations as set out in Section 7 of the Report. Agreed that the quarterly report will contribute to the Annual Complaints Report, which will be presented to the Committee in May 2017 and published on the CCG s website. Agreed for HC to follow up on the potential serious incident case. HC 16/09/16 10 Information Governance Update Report EN highlighted the following from the paper presented: Two IG incident breaches had occurred, associated with invoice validation. The CCG was liaising with the relevant GP practices to investigate and identify remedial actions. In addition to the oversight of compliance with the IG toolkit, the IG sub-committee have agreed to highlight where information governance can act as a positive enabler to the delivery of strategic projects across agencies, for example, the multi-agency safeguarding hub (MASH) and integrated care. 6
Note the update with respect to the CCG s management of IG related activities and risks. Approve the 2016/17 IG Improvement Programme (for on-going monitoring by the IG Sub Committee). Note the approval of the following items by the IG Sub Committee, in accordance with its remit: o Caldicott Function Assurance Plan o Information Security & Cyber Security Assurance Plan o Base-lined Key Performance Indicators o Base-lined Risk Register Noted the update with respect to the CCG s management of IG related activities and risks and the approval of the above items by the IG Sub Committee, in accordance with its remit. Approved the 2016/17 IG Improvement Programme. 11 Carers: a) Carers Q1 Report 2016-17 DH presented the Carers report for Quarter 1. Review and note and continue to promote the Carers Prescription especially where this leads to a young carers referral. Noted the report. b) Together for Carers: A Memorandum of Understanding between Health and Social Care Partners within Surrey and Local Carers Organisations DH outlined the following key points of the MoU: Aims to meet statutory duties under the Care Act and Childrens and Families Act. Outlined key principals as part of the MoU as a Surrey-specific model and also identified the following areas for improvement: o Black and minority ethnic groups; o traveller groups; and o military families. DH also agreed to send slides to NM for circulation and also to send through details regarding a Surrey-wide workshop on 07/11/16 for NM to forward to G&W CCG integration leads. DH/ NM 30/09/16 Attendees raised concerns regarding the level of language used and questioned its suitability for children. DH agreed that language may present a barrier for accessibility and agreed to be mindful of this going forward. Approve the paper for formal sign off. 7
Noted the report and endorses the principles as outlined in the report. Formal approval would be sought from VS as the executive lead for this area on behalf of the CCG, so it can be presented to the Surrey Health and Wellbeing Board on 03/11/16. VS/ NM 14/10/16 12 Minutes to note from sub-committees Members noted the minutes from: CAMHS CQRM and Contract meeting, 26 May & 23 June; CQUIN Working Group, 8 August; IG sub-committee, 3 August; PPE Group, 5 July; Primary Care Clinical Academic Group, 5 July; RSCH CQRM, 14 June; and Serious Incident sub-committee, 5 July & 2 August. 13 AOB HC reported that The Mill Medical Practice had received an outstanding CQC rating following an inspection. Members offered their congratulations. 14 Top Three Risks The top three risks were agreed as follows: SECAmb/ A&E/ Urgent Care at RSCH Stroke service redesign RSCH workforce These would be assessed and reflected on the CCG s risk registers if appropriate (and if not already featured). HC 30/09/16 15 Overall review of papers submitted to the meeting Agreed all papers satisfactory. Date of next meeting: Thursday 3 November 2016, 14:30-17:00; Board Room, Dominion House (This was later rescheduled to Thursday 17 November, 9:30-12:00) Signature of Chair: Date: 18/11/16 Signature of Lead Director (Approval for public website): Date: 21/11/16 8