Members Position Voting Rights Alison Lewis-Smith Chair, Lay member, Quality and Safety

Minutes (confirmed) Subject Quality Committee Date 4 April 2017 Time 10.00am 12.30pm Venue Goodwood Room Chair Alison Lewis-Smith Members Position Voting Rights Alison Lewis-Smith Chair, Lay member, Quality and Safety (AL-S) Jenny Kay (JK) Vice Chair, Independent Nurse Governing Body Ralph Beard (RB) Secondary Care Clinician Jayam Dalal (JD) Lay Member Patient & Public Involvement Frances Russell (FR) Chair, Healthwatch X Marie Dodd (MD) Acting Chief Officer and Chief Operating Officer Amy Dissanayake Quality Clinical Lead (AD) Carol Harris (CH) Acting Deputy Head of Quality & Nursing/Quality Assurance Manager Alison Young (AY) Quality Assurance Manager & Infection Control Specialist Nurse Debbie Robertson Quality Manager, Primary Care (DR) Faye Murphy (FM) Quality Manager X Present In attendance Philip Pragnall (PR) Kieran Stigant (KS) Maria Souter (MS) Position Senior Commissioning Manager, Learning Disabilities, West Sussex County Council Chair, CWS CCG - observing Note taking Action 1. Welcome and Apologies AL-S opened the meeting with introductions and welcomed PR to the meeting. Apologies noted from, FM and FR. The Committee were advised David Mannings, Independent GP member had resigned with immediate effect and David Whitehead, Clinical Director had retired. 2. Declarations of Interests No declarations of interest other than those already recorded with Coastal West Sussex Clinical Commissioning Group (CWS CCG). 3. Minutes of the last meeting: 7 March 2017 Page 6, IC24: Amendment to last sentence to read: High Weald Lewes and Haven are arranging and co-ordinating a meeting for all parties to meet and discuss these issues. Decision: Based on the above changes the minutes were approved as an accurate record. Page 1 of 8

4. CWS CCG Quality Briefing Papers CH assumed all had read the papers and asked if there were any questions, starting with IC24. IC24 DR advised the Committee there is on-going work in relation to the remedial action plan. IC24 have agreed to share the Surrey and Sussex board papers to enhance monitoring and assurance. The professional judgement based on information available to date for the Quality team continues to be not assured. MD advised the issue of training within IC24 was specific to Safeguarding however, the overall delivery of service is stable and work is taking place to gain insight to daily services to link with the urgent care pathway. JK queried the reporting of data, specifically where there may be discrepancy and or inaccurate recording for areas of concern. Discussion centred on the accuracy of the reporting and clarity of phrasing to be considered. It was agreed to undertake a further review and provide an update in the May briefing paper. Action 488 Primary Care DR referred to the completed CQC inspection data chart, noting the safety domains were rated as good. Two GP Practices were rated as requiring improvement. It was agreed to ascertain if there were any quality issues noted. Action 489 DR AD The Committee noted St Lawrence surgery had received Primary Care provider of the Year award and should be commended for their achievement. DR advised the Committee the quality team have access to the National Reporting Learning System (NRLS). This is a voluntary system and some GPs are using the system. Western Sussex Hospital Foundation Trust (WSHFT) CH advised of the newly appointed Director of Nursing and a meeting arranged to meet in the near future. The Committee raised the issue of ward moves, CH advised the audit continues. CH advised of the notable engagement from the Dementia Matron, WSHFT. It is anticipated the findings will be reported to the May Quality Committee. Decision: to include within the May Quality overview report. The Committee raised the issue of disparity between the two WSHFT sites in relation to clinical effectiveness. It was agreed to review this issue and feedback to the May Quality Committee. Decision: to include within the May Quality overview report. Discussion took place in relation to Hospital Standardised mortality Ratio (HSMR) and JK asked if deeper analysis took place. The Committee were referred to Serious Incidents (SIs) reporting criteria and missing patients within acute settings and how this is managed. The Committee noted the Patient Experience data chart and the number of complaints relating to nursing. CH advised there were no specific themes or trends and will raise with the Director of Nursing at the scheduled meeting. Action: 490 CH Page 2 of 8

The Committee noted the Friends and Family response rate was low. Sussex Partnership Foundation NHS Trust (SPFT) The committee noted the out of area placements information and data chart; there had been improvement in relation to SIs. CH advised on average 15-20 (SIs) are reviewed each week. Sussex Community NHS Foundation Trust (SCFT) The Committee noted Referral to Treatment and MSK partnership. MD advised of the anticipated move to a contractual position and agreement by end of Quarter 1. Discussions continue to agree the patient pathway to ensure effective work both in the Community and Acute sectors. RB noted the need to consider budgets and expectation of the system. MD agreed there was a need as a CCG to work within compliance parameters and to monitor progress going forward. Brighton Sussex University Hospitals (BSUH) The Committee noted the monitoring of quality and improvement within the Trust. Concordia ENT AY advised there was a remedial action plan in place. Further meetings have been scheduled week commencing 3 April 2017 to enhance monitoring and ensure quality aspects are fully considered. Decision: To update at the May Quality Committee. Sussex Healthcare The Committee noted the work taking place and further update to be provided at the May Quality Committee. Sussex Medical Chambers The Committee noted the work taking place. Decision: Further update to be provided at the May Quality Committee. HealthCare Associated Infections (HCAI) AY advised the Committee of a methicillin-resistant staphylococcus aureus (MRSA) in March. This had been assigned to BSUH and will form part of the quality process together with advised learning outcomes. RB asked of the line of management for infection control type queries. AY advised this would be the Head of Quality, Chief Operating Officer, WSHFT Microbiology team and colleagues within the Provider setting. There is a good working relationship. AY advised CWS CCG was 10 over objective for Clostridium Difficile infections (CDI) for year-end; WSHFT are also over objective, however there is a downward trend. 5. Learning Disabilities/Transforming care AD assumed all had read the paper and asked if there were any questions. AL-S noted in relation to health checks people aged 14 or over with a learning disability have an annual health check. However, numbers appeared low and noted plans in place to improve this during 2017/18. PP advised this is part of the life pathway and the work is trying to deliver a more seamless transition into adulthood. Page 3 of 8

AL-S noted the care and treatment reviews whereby there is an NHS England requirement as part of transforming the care programme to reduce admission and length of stay which West Sussex are currently not meeting. Currently West Sussex County Council (WSCC) has designed a matrix and local protocols to prioritise clients. The Committee noted the paper covers a large remit of work and was informative. The risks highlighted quality continuing healthcare concerns in relation to Sussex Healthcare who provide funded nursing care for coastal West Sussex clients. AD advised the organisation provides in-house services e.g. dieticians. CH advised the Safeguarding team are fully involved with monitoring placements and have attended a whole system meeting involving other providers e.g. SCFT, to discuss issues raised. PP advised there is a range of issues including safeguarding incidents and concerns raised by family members. There are patients commissioned from other areas within the country. PP recognised there are pressures placed on specialists, local and community services. The concern is delivery of care on a large scale. JD asked if an equality impact assessment could be provided to understand the groups of people affected as it is important to be aware of the issues and needs of the community together with accessing the hard to reach groups. AD advised there is a review taking place with regard to access of services for parent and carers, the first line of contact would be the GP. AL-S reminded the Committee of the full update at the June meeting in relation to Children and Young People and Joint Commissioning services. The Committee agreed it was important to understand the interfaces to ensure correct patient pathways. Discussion centred on how the reduction of in-patient to community care was beneficial. AD advised of the transforming care programme and CWS meeting the objective despite not being a suitable match to the template. PP advised there is focus on prevention and community service delivery to ensure the correct setting. Some placements are outside of CWS and there may be an issue to increase beds for care despite a focus to reduce in-patient numbers. Discussion centred on patient pathways and utilising specialist contacts within the organisation, the key factor to ensure quality care and monitoring in acute settings. AD advised of a Learning Disability liaison post holder at WSHFT and regular audits undertaken. PP advised of the key issues involving the working interface clarity around the role for commissioned work streams and wider services the need to evidence value of commissioning service providing clear information to ensure all aspects are captured within the commissioning round focus on re-design of specialist services going to tender in July KS stated the paper was very helpful and asked of support for carers and availability of carers for patients. PP advised there is a range of support, e.g. respite, direct payments, voluntary sector and domiciliary care. Engagement takes place with families and carers to review and enhance services. Page 4 of 8

AL-S noted CWS has 1845 patients registered with GP practices with learning disabilities and 1148 of these are known to the community teams. It was recognised there may be some families that do not access or register with GPs as they do not feel the need to. AD informed the Committee of benchmarking data improving and on-going work in relation to SIs and all mortality data being collected from 1 st April 2017 via the Learning Disabilities Mortality Review Programme (LeDeR). It was agreed to review and consider the annual report Action 491 The Committee requested an update at the May Quality Committee in relation to Sussex Healthcare. Action 492 The Committee requested the health check assessment template be cascaded to primary care. Action 493 AD CH AD AL-S thanked PP for attending and requested an update in October. 6. Primary Care Assurance Framework ALS noted the paper was for information and the Committee to note. DR assumed all had read the papers and asked if there were any questions. The Committee noted the work will take a unified approach and forms part of the development process for Primary Care and Quality. DR advised of a Task and Finish group commencing to undertake planning together with terms of reference being developed. It was important to note that a GP should be part of the membership and to consider the changes taking place within the local health services. JK noted it was important to link with local community networks, form a strategic overview applying a consistent and co-ordinated approach for all groups and members together with defined key performance indicators and linking with the local medical committees. It was agreed to submit the framework to the Primary Care Commissioning Committee prior to submission to Clinical Commissioning Executive and Governing Body Committees. Action 494 DR 7. Pressure Ulcers, WSHFT The Committee noted the high level of assurance provided by WSHFT. CH advised of the collaborative working group which also includes SCFT and SPFT. All providers report pressure ulcers but in different ways. WSHFT hold an internal scrutiny review, CH attends on an ad hoc basis e.g. if there is a grade 3 pressure ulcer and a deep dive takes place. There is high level attendance at meetings. SCFT adopted the WSHFT model and are actively encouraging promotion of work. SPFT are linking and working with all Providers. JK asked about the link with primary care and noted in January 2017, 147 patients were admitted to the Trust from the community with existing pressure damage. JK asked if GPs undertake risk assessments for pressure ulcers. AL-S asked if there is Tissue Viability Nurse resource. CH advised work is in progress with regard to the service specification and KPIs have been agreed. AL-S asked about mattress availability. CH advised there is a working group which is reviewing the care home beds matrix. Equipment is funded through the Better Care Fund. Page 5 of 8

Quality team to consider and develop a system within primary care to review patients and provide educational skill updates. Action: 495 CH/DR 8. Vaccination and Immunisation report AY assumed all had read the paper and asked if there were any questions. AL-S noted the paper was for information and also to highlight the issue within CWS locality. AY advised there appears to be a downward trend for pre-school vaccinations and immunisations and this is below the national trend. CWS CCG does not commission the service however, Public Health England who do commission the services wish to engage with CWS CCG and primary care to raise awareness. AY informed the Committee practice level data has been requested to ascertain themes, trends and any areas that may need support. Decision: to escalate to Clinical Commissioning Executive 9. Quality Risk Register CH wished the Committee to note: One new risk had been identified; Risk 32: Provider Sussex Healthcare high level of concern about the safety of care provided in their care homes in West Sussex [Safeguarding intervention]. Risk 4: MSK The Committee agreed to close the risk. The quality team agreed to provide feedback at a later date. Post review note: Quality team to report back at the July Quality Committee meeting. Risk 32: Provider Sussex healthcare to provide an update at May Quality Committee meeting Risk 11: SECAMB [Swale CCG lead CCG] to provide an update at May Quality Committee meeting Risk 12: amend wording services to domains Risks 25, 26, 27, 28, 29 & 30: Update to be provided at May Quality Committee meeting CH Action: 496 Eight risks had been identified as scoring greater than twelve post mitigation. The Committee agreed to monitor the risks and the mitigations in place. 10. Quality Impact Assessment (QIA) >8 only and exceptions There were none to report to the Quality Committee. AY advised the Committee there had been A total of 13 QIAs to date, submitted to Quality Committee with a risk score >12. A total of 21 QIAs risk scored <8 had been submitted to the programme board/projects teams to date There is a robust QIA process and there is a planned meeting with the Chief Operating Officer who will sit on the review panels in the interim period following the retirement of the Clinical Director. Page 6 of 8

MD updated the Committee in relation to the collaborative working with Horsham and Mid Sussex CCG in relation to similar or same QIAs and ensuring a high level of scrutiny and adherence to process. 11. For information questions to Interim Head of Quality or Chair outside of meeting Serious incident report (SIs): The Committee noted the paper for information and await the annual report provided by the Patient Safety team. Review of QIA policy update: The Committee accepted the revised policy. CWS CCG Verification of expected death: MD advised a formal response will be sent. CH advised of a robust SI scrutiny process in place and lessons learnt are fedback to providers for cascade to staff. SIs are reported on provider board papers which appear on provider websites and the information is shared with families. 12. Review of Action log Action 456: Closed. Action completed Action 458: Closed. Action completed Action 460: Open. In progress Action 472: Closed. Action completed Action 473: Closed. Action completed Action 474: Closed. Action completed Action 479: Closed. Action completed Action 480: Closed. Open Action 481: Closed. Action completed Action 482: Closed. Action completed Action 483: Closed. Action completed Action 484: Closed. Action completed Action 485: Closed. Action completed Action 486: Closed. Action completed Action 487: Closed. Action completed 13. Feedback from Clinical Commissioning Executive (CCE) AL-S advised the Committee of the issue re: Looked After Children (LAC) resources that don t meet the minimum recommendations for CWS population and escalated to CCE together with the quality team mitigations as detailed on the risk register. AL-S advised of CWS CCG financial position being discussed of which staff had been briefed. The issue of safeguarding training for Governing Body members was noted and plans are in progress to schedule training. AL-S advised of the Governance review currently underway through NHSE to include a capacity and capability audit in preparation for the future, of which staff had been briefed. 14. Items to be escalated to Clinical Commissioning Executive (CCE) The Committee wish the CCE to note and respond to information provided by Public Health England to CWS CCG advising that many of the specific immunisation rates reported for the West Sussex populations are below 95% (the national target) and some types are amongst the lowest in England. Action 497 AL-S 15. Evaluation of meeting KS advised the Committee of the excellent work and papers which were a credit Page 7 of 8

to the Quality Committee. CH advised there was a clear focus and this ensured any actions were relevant to the quality assurance remit and also part of the CWS CCG process. Working relationships have been forged with all CCG teams and providers and this enables productivity. The Quality team stated that quality is a strand through every piece of work and all teams are engaged and refer to the quality team as required. MD stated there is a need to remain focussed and work within the assurance remit. Both AL-S and RB are part of the clinical effectiveness group and clinical effectiveness will be scheduled into the Quality Committee work plan 16. Date of next meeting: 2 May 2017, Goring room, 10am 12.30pm. Alison Lewis-Smith, Chair Quality Committee, Coastal West Sussex CCG Page 8 of 8