: 2016-002.a QUALITY IMPROVEMENT COMMITTEE Minutes of the meeting held on 11 th February 2016, Conference Room D, 1829 Building Present: Faulkner, Sarah (SF) (Chair) Lay Member, NHS West Cheshire CCG Cavanagh, Hayley (HC) Quality and Performance Manager, NHS West Cheshire CCG Eccles, Anne (AE) Designated Nurse Safeguarding Children, NHS West Cheshire CCG Green, Brian (BG) Head of Quality and Safety, NHS West Cheshire CCG Hawksworth, Lee (LH) Director of Operations, NHS West Cheshire CCG Jefcoate-Malam, Tanya Primary Care Manager, NHS West Cheshire CCG (TJM) Dr McAlavey, Andy (AMcA) Medical Director, NHS West Cheshire CCG (Deputy Chair) Dr Riley, Julia (JR) Clinical Lead Quality and Safety, NHS West Cheshire CCG Smith, Debbie (DS) Patient Experience Manager, NHS West Cheshire CCG Also in Attendance: For : Warren, Karen (KW) Organisational Development Manager, NHS West Cheshire 2015-073 CCG Walsh, Cathy (CW) Programme Manager for Mental Health, Learning Disabilities 2015-075 and Dementia, NHS West Cheshire CCG Milner, Louise (LM) Clinical Quality & Performance Co-ordinator, Continuing HealthCare/Complex Care, NHS West Cheshire CCG 2015-076 Roberts, Pauline (PR) Pharmacy Advisor, Medicines Management Team 2015-077 Clare Jones (CJ) Governing Body and Committees Coordinator, NHS West Cheshire CCG 15-068 Welcome and apologies The Chair welcomed everyone to the meeting and noted that apologies have been received on behalf of Pam Smith and Barbara Perry. 15-069 a. Minutes of the previous meeting 10th December 2015 It was agreed that PW and CJ would revise the minutes outside of the meeting and circulate them to committee members for comment/amendment. PW/CJ b. Matters Arising There were no matters arising to be discussed. 14 th April 2016 Page 1 of 10
: 2016-002.a c. Tracker The updated action tracker was agreed as accurate, and it was noted that all items have been completed, are included upon the agenda or within reports, or are updated as follows: 2015-043.a Primary Care Quality Update Report Controlled Drugs Result of Peer Review of ADHD drugs to be requested through CWP quality and performance meeting. BG provided details of progress in relation to the ADHD pathway. PR noted that GPs had previously been expected to prescribe controlled drugs outside of approved guidelines, which had been a significant area of concern. However, a new drug has been included on the local formulary and GPs should no longer be required to prescribe the high levels of the drug previously used. There remain a small number of patients receiving the previously prescribed drug and it has been suggested that the Consultant could be asked to retain prescribing responsibilities for these patients, or to provide a letter to the patient s GP citing why this level of prescribing is required. It was agreed that HC will coordinate work with JR, PR and Dr Tim Saunders, to ensure the required information is shared with the patients GPs and that patient management plans are in place. 2015-061 End of Life Care Issues raised in relation to End of Life care to be raised with project manager AMcA and LH have discussed this issue with the project manager and details of those discussions were provided. It has been agreed that a briefing paper will be provided to the committee. 2015-064 Quality Improvement Report b. Hospital@Home CoCH consultants to review pathways for agreement This issue has progressed and Trust consultants have reviewed and provided feedback. It has been agreed that the Trust s medical director will provide details of the process required for future pathway consultation, to ensure that the Trust s governance process is met. 2015-065 Nurse Revalidation This paper is to be presented at the clinical commissioning group s governing body meeting in March 2016 and details were provided on the work being undertaken in relation to revalidation. It was noted that: The Nursing and Midwifery Council has launched a microsite which outlines the exact requirements for revalidation. SF is attending the Practice Managers forum on the 11 th February 2016 to provide an update and to identify whether any potential risks have been noted. The Nursing and Midwifery Council requires payment for re-registration to be received before the first day of the month in which it is due. and this will be highlighted at the Practice Managers forum. LM and SF will discuss the revalidation process in relation to care and nursing homes to ensure that robust processes are in place. 2015-067 Vascular Service b. Published NICE Guidelines E-mail to be sent to PW, LH and BG outlining intention to include guidelines within quality schedules for 2015/17. This work is currently underway and an update will be provided to the April 2016 meeting of the committee. HC/PR LH LM/SF HC 14 th April 2016 Page 2 of 10
: 2016-002.a 15-070 Declarations of Interest The Chair declared her role as Director of Quality for the North West Ambulance Service. 15-071 Terms of Reference The terms of reference were presented for annual review, as a part of the committee s annual workplan. The following point was discussed: a. Section 9.a Ensuring quality and clinical standards are integrated into the organisation objectives, strategy and annual commissioning plan The Chair queried how assurance will be provided that the quality and clinical standards are integrated as stated. PW responded that this will be achieved through quality impact assessments and ensuring integration in to the 2 and 5 year plans, and further details were provided. PW and LH are currently working on the quality impact assessment template and it was agreed that an assurance paper will be provided to this committee, once this work is complete. The 2 and 5 year plan will be included upon the committee s annual workplan and will be scheduled for the June 2016 meeting. PW/LH PW 15-072 Quality Improvement Committee Work Plan The committee s annual workplan was presented for discussion and approval, and the following points were noted: a. The 2 and 5 year operational and strategic plans will be added b. The extraordinary meeting to receive annual reports will be added as an additional annual meeting c. The Quality Impact Assessment was discussed and it was noted that the Clinical Commissioning Group is not required to undertake the assessment as it is not a provider. It was agreed that PW will review this issue and determine the level of risk that would be identified to this committee. This will be placed on the workplan for each meeting and will be reported exception. d. The scheduling of the equality and diversity updates will be reviewed and updated on the workplan. CJ/KW 15-073 Equality and Diversity Update KW provided an overview of the draft equality and diversity annual report and thanked Andy Woods for the support he has provided to ensure an appropriate level of assurance is provided to the committee. The main issues highlighted from the report were discussed and the following points were noted: a. Further consideration may be required in relation to commissioner decision making and decommissioning guidance sessions. b. The equality and diversity function for West Cheshire will transfer to the Midlands and Lancashire Commissioning Support Unit from the 1st March 2016. 14 th April 2016 Page 3 of 10
: 2016-002.a c. An updated version of the clinical commissioning group s Workforce Equality and Diversity policy has been developed and the committee is asked to recommend to the governing body that this policy is ratified. The committee agreed to recommend that the governing body ratifies the updated policy at the May 2016 governing body meeting. d. A revised draft 3 year Equality Objectives Plan was presented for in approval and the committee approved the plan. It was noted that HC will provide the metrics for the quality schedule to BG. AMcA thanked KW for the work undertaken as this issue is especially important in relation to patients and GPs need to be aware of this. KW provided details of the implications of failure to comply with the quality and diversity duty and noted that work is commencing in March 2016 to raise awareness around this issue. In response to queries raised, the following points were noted: Workforce data work will be undertaken to compare the clinical commissioning group s profile against the population profile, and this will be included in future update reports. Annual Report It would be beneficial if a list of the agencies involved in the annual report could be included as an appendix, as well as the Stakeholder Plan. PW noted that the outcomes of the plan are reported to the committee within the scheduled updates. It was agreed that PW and KW will discuss the document further outside of this meeting. The quality improvement committee: a. Noted the equality and diversity annual report b. Noted the clinical commissioning group s approach to Equality Delivery Systems 2 assessment c. Approved the 3 year Equality Objectives Plan in light of the Equality Delivery Systems 2 assessment, subject to the committee s comments and further discussions with Paula Wedd d. Noted the NHS England EDS summary report e. Agreed to recommend that the governing body ratifies the revised Equality and Diversity Workforce Policy CJ HC PW/ KW 15-074 Quality Improvement in General Practice AMcA noted that this report provides details on the wealth of work undertaken in relation to primary care and highlights the main themes for consideration the committee. TJM provided an update to the committee and the following points were highlighted: The terms of reference for the GP Quality Group were reviewed. The terms of reference for the Primary Care Working Group were also reviewed, to ensure that there are clear lines of work and responsibility, 14 th April 2016 Page 4 of 10
: 2016-002.a and that representation at both groups is appropriate. The GP Quality Group has instigated a workplan to ensure that work being undertaken the group is progressed to the quality improvement committee appropriately. An example of a GP s report to the Coroner was discussed as an example of good practice. The example contained a great deal of information and analysis and the group discussed what action needed to be taken to ensure GP reports to the Coroner are appropriately detailed and submitted expediently. It is intended that this issue will be discussed further at a later meeting of the group. Primary care Commissioning for Quality and Innovation (CQUIN) scheme 2015/16 3 GP clusters did not achieve the milestones for Quarter 3. A decision on the Quarter 3 payment has been referred to the finance, performance and commissioning committee for decision, which will then be communicated to the affected clusters. A number of GP practices are working together to address issues in relation to indemnity for seeing other practice s patients and the recruitment of practice staff. The Acute Visiting Service has not commenced in three GP practices and this is having a negative impact on patient care and finances. A meeting has taken place with the provider, Primary Care Cheshire, to resolve this issue from April 2016. Primary Care Commissioning for Quality and Innovation scheme 2016/17 Vanguard work has been currently been placed on hold due to concerns raised the Local Medical Council and clinical leads, and further details were provided. Key performance indicators have been drafted for the practices who are currently receiving additional funding in their contract via Personal Medical Services. These will now be shared with the practices to negotiate an agreed position from April 2016, for one year. GP Survey Results discussions took place in relation to creating a GP practice report, similar to the nursing home report presented at this committee. A number of measures for inclusion within the report were discussed, including Care Quality Commission data, the GP dashboard, and patient experience data at practice level. It was agreed that the report should cover safety, quality and patient experience. The GP practice report will be developed initially with the Quality Improvement Committee and can then be shared with the clinical commissioning group s governing body. It was agreed that BG and TJM will create a draft GP practice report to be brought to this committee. The Quality Improvement Committee noted the progress made the GP Quality Group and Primary Care working group. BG/ TJM 15-075 Transforming Care Cathy Walsh provided the background to this item, noting that that this work is in relation to national, regional and local programmes relating to transforming care for people with learning disabilities. 14 th April 2016 Page 5 of 10
: 2016-002.a It has been agreed that there will be one Transforming Care Partnership or unit of planning across the Cheshire & Merseyside footprint, comprising of three geographical collaborative commissioning delivery hubs. Details were provided on the issues experienced locally and the ongoing work to improve the quality of care for people with learning disabilities and autism. The report was discussed and the following points were noted: Each clinical commissioning group will be required to have a list of patients at risk due to learning disabilities or autism. A recognised risk will trigger a blue light meeting, and which will require that a treatment review is undertaken within two weeks and is Chaired the commissioner, and further details were provided. The initial focus of the work will be around patients who have been in long-term hospital care, and working to return these patients to their own homes. A new learning disabilities commissioner is now in place within the clinical commissioning group, who will support the mental health and learning disabilities programme lead with this work. West Cheshire is currently seen to have one of the highest admission rates across the footprint, although it has been noted that it is also one of the highest reporters. The level of reporting varies across the footprint and work will be undertaken to ensure that the reporting process to aligned across the hubs. It is important to ensure that learning disabilities remain as a priority across the local footprint and that all involved organisations continue to manage this as one of their responsibilities. Once the care model is in place, this will enable families and patients to be supported on a 24hour/7day basis and will assist to prevent unnecessary admissions to general hospital, which would not trigger a blue light meeting. 15-076 Nursing Home Update LM provided an update to the committee and the following points were highlighted: Atherton Lodge The voluntary suspension of admissions is no longer in place. Assurance has been received from the new manager in relation to the prioritisation and sustainability of improvements, and a review of the home will be scheduled to ensure improvements continue. Orchard Manor Details were provided in relation to an ongoing safeguarding issue within the home. It is expected that the home s RAG rating will have changed to Amber for the next meeting. Chester Lodge The Care Quality Commission has published its report of the inspection carried out at the end of October and the start of November 2015, which took place at the same time as the initial safeguarding investigation at the home. The report will be discussed as part of a review meeting with the home week commencing 15 th February 2016. 14 th April 2016 Page 6 of 10
: 2016-002.a Aaron Court There is an ongoing safeguarding investigation relating to pressure sore development and a suspension on new placements has been agreed. A further visit to the home is planned for February 2016 and it is expected that the home will be rated as Amber for the next report. Old Rectory A recent Care Quality Commission visit to the home has rated the home as inadequate, and a review meeting will be arranged to identify any issues and to agree a way forward with the home. The areas of concern are currently unclear, although patient care and staff responsiveness were rated as good. PW noted that the home is now in special measures and the home will be closed if improvements are not made and monitoring at the home will continue. The Quality Improvement Committee discussed the information provided in the home home provider report and identified any further assurance or actions required. 15-077 Quality Improvement Report The Quality Improvement Report was discussed and the following points were noted: Serious Incidents Themes and trend The Countess of Chester Hospital had not previously been reporting level one incidents through StEIS, and this has now been instigated. As a result of this, it is likely the Trust s reported numbers are likely to increase going forward. Safer staffing This item is now a standing item upon the agenda for the quality and performance meeting with Cheshire and Wirral Partnership NHS Foundation Trust, as it is noted that this may be a contributing factor to the occurrence of incidents. Pressure Ulcers work is being undertaken to drill down in to cases classed as unavoidable for both local Trusts, to ensure that there is no further action that could have been taken to avoid the pressure ulcer incident. The Countess of Chester Hospital NHS Foundation Trust thematic review shows that a change in practice has resulted in a change in the number of reported incidents and details were provided of the action taken around this issue. Violent and aggressive patients There have been six reported incidents in GP practices, which the incidents team have been shared with NHS England. NHS England has provided the incidents team with all relevant documentation, which has subsequently been circulated to all West Cheshire practice managers for their information. Positive feedback was received as the documents had not been previously distributed to some practices. GP practices have been requested to report these incidents to the clinical commissioning group, as well as continuing to report them to NHS England. Care Home Incidents There have been seven incidents reported from care homes, which is a 133% increase on the previous reporting period. When a care home reports an incident as unavoidable, the home undertakes a Root Cause Analysis, which is then discussed at 14 th April 2016 Page 7 of 10
: 2016-002.a the clinical commissioning group s Serious Incident Review Group. A pilot is currently being undertaken at three care homes for direct Datix reporting and the pilot will be fully functional week commencing 15th February 2016. The reported numbers are being monitored with the prospect of rolling out direct Datix reporting to care homes throughout the West Cheshire patch. Safe Staffing Countess of Chester Hospital NHS Foundation Trust and Cheshire and Wirral Partnership NHS Foundation Trust have a continuous ongoing recruitment process in place to ensure that appropriate staffing levels are maintained within the Trusts. Sutton Beeches The voluntary suspension of admissions to the home has now been lifted, although a decision has been taken that GP's will transcribe all medication for residents on admission to the discharge to assess beds. Details were provided in relation to the work undertaken to resolve the issues at the home and to ensure that there is a service level agreement and contract in place with Cheshire West and Chester Council, who is essentially both commissioner and provider for Sutton Beeches. Safeguarding Serious Case Review 01 / 2014 Child A a decision is awaited in relation to the publication date of the report. However, the action plan is ongoing, with the involved GP having their own action plan, and the action plans will continue to be monitored the Local Safeguarding Children Board. Serious Case Review 01 / 2015 Child B the publication of this report has been delayed, at the request of the parents, until the inquest has been completed. This case will be discussed at the next meeting of the Local Safeguarding Children Board. Unannounced Ofsted Inspection of Children's Services the report from the inspection that took place during November 2015 is awaited and it is expected that this will be published on 19 th February 2016. Ofsted briefings for partners have been arranged to take place on 26 th February 2016. Children s Social Care Contact and Referral Team and Early Support Integrated model significant work has been undertaken to bring both teams together to provide a single front door model from 1 st April 2016. It has been agreed that the local authority will ensure that information on the new model is made available to all providers. Safeguarding Assurance Framework The Countess of Chester Hospital NHS Foundation Trust and Cheshire and Wirral Partnership NHS Foundation Trust have not met the 80% training target for Quarter 3. This issue has been escalated to the quality and performance meeting for each Trust and an action plan is awaited from each organisations. GPs and Child Protection Case Conferences NHS England has written to GP practices to advise that, from the 31st December 2015, they will no longer reimburse GP practices for attendance at case conferences. Two GP practices will be the most affected this decision and the clinical commissioning group will support these practices as much as possible. A meeting has been scheduled for 11 th February 2016 to discuss this issue with practice managers. AMcA suggested that the local authority is approached one more in 14 th April 2016 Page 8 of 10
: 2016-002.a relation to the possibility of using teleconferencing and other technological solutions to allow GPs to virtually attend at case conferences and it was agreed that AE will follow up on this suggestion. Children in Care Timescales and quality of health assessments are monitored regularly and reported on the Countess of Chester Hospital NHS Foundation Trust and the Cheshire and Wirral Partnership NHS Foundation Trust Safeguarding Assurance Frameworks. There is an escalation process in place for any arising issues and Cheshire and Wirral Partnership NHS Foundation Trust report any exceptions at the scheduled quality and performance meetings. Advancing Quality Countess of Chester Hospital NHS Foundation Trust was advised in September 2015 that the clinical commissioning group would issue a contract query in December 2015 if there was no improvement against four particular pathways that were performing poorly. However, the Director of Quality Improvement discussed this issue with colleagues and subsequently made a decision to delay issuing the contract query as the Trust has limited capacity to respond as they are experiencing challenges around urgent care capacity. Never event the Countess of Chester Hospital NHS Foundation Trust recorded a surgical Never Event in November 2015. The incident occurred in the central labour suite and is categorised as a retained swab. There is a clearly documented procedure that is used in theatres to manage and record swab usage and the Trust is now reviewing all areas outside of theatres where theatre procedures should be used, The Quality Improvement Committee: a. Scrutinised the issues and concerns highlighted and identified any further actions for members b. Identified any exceptions and concerns that need reporting to the governing body c. Reviewed the Infection Control Update and identified any further actions for escalation to Director of Infection Prevention and Control d. Noted the performance at Quarter 2 against the 2015-16 secondary care commissioning for quality and innovation schemes e. Reviewed the current position reported the Designated Nurses for Safeguarding Children and Children in Care and identified any further assurances required against the actions taken to mitigate exceptions. f. Noted the information provided Medicines Management team AE 15-078 Patient Experience Report DS noted that the patient experience team was brought back in-house to the clinical commissioning group during September 2015, to ensure the provision of an effective patient advice and liaison service and complaints service. During quarter 3, 1st October 2015 to 31 st December 2015, the patient experience team handled a total of 74 patient advice and liaison service enquiries, which is similar to the number received during quarter 2. 83% of the enquiries were closed within 48 hours. Delays in those not resolved within this time were due to awaiting responses from providers, and time taken to investigate more complex queries. 14 th April 2016 Page 9 of 10
: 2016-002.a The most enquiries related to patient transport or continuing healthcare, and examples of enquires received were provided. Details were also provided on the process of how the continuing healthcare issues are feedback to that team. Work is being undertaken to improve the response rate, while maintaining the quality of responses, and this work will be ongoing. The Complaints Policy and Standard Operating Procedure have been reviewed and updated, and were provided to the committee for comments and feedback. The committee endorsed both documents and will recommend to the governing body that the Complaints Policy is ratified. CJ The quality improvement committee: a. Noted the work of the NHS West Cheshire Patient Experience Team. b. Reviewed and endorsed the draft Complaints Policy and Standard Operating Procedures and agreed to recommend that the governing body ratifies the Complaints Policy. c. Noted the feedback on patient experience from the Patient Advice and Liaison Service data, and noted the wider themes from the data impact on quality of care. 15-079 Any Other Business There was no other business to be discussed. Date of next meeting: Thursday, 14 th April 2016 Time: 9.30am 12.00pm Venue: Conference Room D, 1829 Building 14 th April 2016 Page 10 of 10