DRAFT CWHHE CLINICAL COMMISSIONING GROUPS COLLABORATIVE

DRAFT CWHHE CLINICAL COMMISSIONING GROUPS COLLABORATIVE Members in attendance Ben Westmancott (BW) John Riordan (JR) Jonathan Webster () Michael Morton (MMo) Mohini Parmar (MP) Nicola Burbidge (NB) Trish Longdon (TL) Alison Baker (AB) Quality & Patient Safety Committee Thursday 30 th October 2014 15 Marylebone Road Director of Compliance, CWHHE CCGs Secondary Care Consultant, Ealing CCG Director of Quality and Patient Safety, CWHHE CCGs Lay Member, Central London CCG Chair, Ealing CCG Chair, Hounslow CCG Lay Member, Hammersmith & Fulham CCG (Chair) Lay Member, Hounslow CCG Non Members in attendance James Eaton (JE) Louise Proctor(LP) Kevin Hunter (KH) Kiran Chauhan (KC) Matthew Bazeley (MB) Lizzie Wallman (LW) Nicky Brownjohn (NB) Deborah Buckerfield(DB) Caroline Reid (CR) Steve Buckerfield (SB) Craig McGuire (CM) Head of Performance, CWHHE CCGs Managing Director, West London CCG Quality Lead, Hounslow CCG Deputy Managing Director, Central London CCG MD, Central London CCG Deputy Director of Quality & Patient Safety CWHHE CCGs Associate Director for Safeguarding, CWHHE Mental Health Manager NHSE (London) Mental Health Manager NHSE (London) Senior Commissioning Manager for CWHHE Legal & Governance Manager, CWHHE (Secretary) Minutes Business Items Action 1. Welcome/Apologies 1.1. Apologies were received from Alan Hakim, Rachel Garner, Daniel Elkes, Mary Mullix, Ruth O Hare, Tim Spicer, Phillipa Jones, Simon Tucker, Shivram Natarjam, Neville Purssell, Kathryn Magson and Fiona Butler. Page 1 of 8

2. Declaration of interests 2.1. There were no new declarations of interest. 3. Minutes of Meeting 25 September 2014 3.1 The minutes as previously circulated were approved as an accurate record of the meeting. 4.0 CAMHS tier 4 beds 4.1 The chair welcomed members of the NHSE Child and Adult Mental Health Services ( CAMHS ) team who provided a presentation on CAMHS tier 4 beds. There was a general concern that the reforms in the NHS had created fragmentation in the commissioning environment in relation to the provision of community CAMHS and tier 4 CAHMS beds. There was also concern that there was an uneven distribution of CAMHS beds across the country and that out of hours services needed to be strengthened. There had been a national task force created which is due to report in Spring 2015 and it was tasked with overhauling CAMHS. There was also a report due from a Health Select Committee of CAMHS which was expected in the next few weeks. It was reported by NHSE that there was a need for more robust case as well as risk management in relation to patients as they are admitted and discharged in and out of tier 4 CAMHS services. It was identified that there was a desire to increase capacity and work was being performed with NHS England for commissioning arrangements in relation to beds. An immediate response had been to increase tier 4 bed capacity in London. There is currently a capacity of around 280 CAMHS beds in London but approximately 50 per cent of these beds were occupied by adults and children who came from outside London. It was reported that nationally there would be an increase of around 80 additional CAMHS beds which would become available during 2014/2015 but there was a need to ensure that there was a better balance of availability of bed capacity especially for London. There was also an issue in London regarding the accessibility of beds particularly for North West London residents although it was reported that London overall was better served than other regions of the country. NHSE had reported that the priority in North West London was to work with each commissioning organisation to develop pathways for CAMHS which would include access to beds as well as transforming community care. The committee asked for details of milestones as there was a need to commission services for September 2015. 4.2 It was also identified that it was not possible to give precise information in relation to the number of London children who were in beds outside London but it was estimated to be between 20-25 children nor was it possible to currently confirm the length of stays in CAMHS beds. Clarification was sought as to whether there was any public health spend benchmarking available in relation to tier 2, 3 and 4 CAMHS beds in order that a comparative analysis could be carried out by each CCG of their spending. It was reported that these were areas that the National task force wanted to look at; however, it had been identified at the Health select committee that CAMHS data was not uniformly captured. Jackie Wilson was a member of a national task force sub group looking into the issues relating to tier 2, 3 and 4 CAMHS beds so the request for benchmarking clarification could be submitted through her. Page 2 of 8

4.3 Work had started to review the pathway through tier 4. This would lead to best practice proposals and proposals as to how pathways across the other tiers could function. The national task force proposals were due to come out in May 2015. It was identified that this area was one of Norman Lamb s priorities for resolution before the next election if not before the end of the financial year. In the next 6-12 months the CCGs and the committee should be calling the CAMHS team to account to what collaborative commissioning has been delivered. There should be consistency developed in terms of commissioning standards which could be incorporated into commissioning contracts. 4.4 The geography of North West London was a challenge; what worked in Westminster may not work in other boroughs. The number of CAMHS patients was not large so there was a problem in identifying value for money from commissioning. NHSE stated that there was shortly going to be an invitation to participate in a pilot relating to co-commissioning which NW London CCGs may wish to consider. 4.5 Rough data would be available in the next few months regarding demand but gaining a clear picture would be an iterative process. It was emphasised that there should be a desire to prevent admissions in the first place and that if there was an investment in mental health for younger people that this could lead to cost savings in the future for adult mental healthcare. It should also be the case that children should be in facilities appropriate for the age of the child and not placed in adult facilities. It was identified that DK would be the specialist in mental health representation for NHSE commissioning in relation to North West London. It was considered that Health and Wellbeing Boards should be involved in conversations about changes to services. 4.6 Action: CAMHS commissioners should call on this committee if they need any assistance or support. Action: CAMHS commissioners to come back to the committee in 2 months time with rough information in order to get a picture of what was currently going on and visibility on what commissioning can be done from September 2015. Action: CAMHS commissioners then to return in March 2015 to help with arrangements for commissioning in September 2015. 5. Matters Arising 5.1 4.1 Chronic Fatigue Services: PJ provided an update on the status of Chronic Fatigue Service. It was reported that there was ongoing working for a programme with the IFR team. 5.2 4.2 Matters Arising - CAMHS tier 4 beds: The NHSE local area team attended the committee meeting in relation to CAMHS. It was agreed that they would be invited back to the meeting in 2 months time when they could provide a further briefing. 5.3 4.3 Matters arising Clinical harm definition: It was confirmed that this was on the agenda and would be dealt with later in the business of the meeting. SB SB SB Page 3 of 8

5.4 4.4 Matters arising Lack of involvement from UCLH and out of area providers with the whole systems work: It was confirmed by that conversations with providers were ongoing with contract teams and clinicians. ACTION: MM to confirm whether UCLH and engagement with wholesystems should be on the agenda for this committee. MM 5.5 4.5 Matters arising Patient Complaints: The updated report as previously circulated was noted. 5.6 4.7 Matters arising Serious Incident report: It was agreed that the format should be changed now that this reporting had been in-housed to the CCGs in order that thematic descriptions and analysis of incidents could be provided. A new member of staff starting on 1 December 2014 would be leading on changing the format of reporting in this area. There were 6 vacancies in the quality team which when filled would lead to an enhancement in capacity for reporting. 5.7 5.1 CLCCG exception report CNWL near miss: This had been discussed at the CNWL CQG last week. ACTION: A request for an update on the CNWL near miss would be made at the next CQG meeting. MM 5.8 6.2 WLCCG exception report CQC: The chair commented that there were issues around openness from the trust and whether they were providing sufficient information to relevant CCGs. The trust has to produce an action plan to be submitted to CQC by 28 November 2014 in order to deal with issues raised in the review. There was a need to work with the trust on its action plan. The largest issue was consistency of approach across departments in the trust. It was noted that Chelsea and Westminster had been the first hospital across CWHHE to be inspected under the new inspection regime. 5.9 Action: There would be a dedicated session with representatives from all impacted CCGs and NHS England with the clinical representation from the hospital in order to help develop a joint action plan. Action: West London CCG will meet with the trust individually to discuss the remedial action plan. Action: In December 2014 the Committee would like an update on the action plan and the implications associated with it. /LP /LP 5.10 6.4 WLCCG exception report CLCH staff vacancy rate: Staff vacancy rates were escalated as an issue to the CQG. An action plan had been requested to address the issues of recruitment and retention of staff. There had been no identification of the risks that this staff shortage presented to particular patient care services. It was confirmed by BW that this issue was on the board assurance framework and that CLCH had identified the issue in public. It was reported that there was a significant problem with waiting times as well as staffing numbers. Without sufficient staffing, there were risks. It was noted that vacancy and workforce issues spanned organisations and a more holistic understanding across the health system was needed to inform plans to build a sustainable workforce. Page 4 of 8

5.11 Action: At the next meeting it should be considered what priorities and work allocations are being set for community workers and what risks are arising to the public from these priority settings. It was considered that innovative solutions would be needed as the nursing workforce staffing shortages would remain. Thirza Sawtell to be asked how this problem could be tackled. 5.12 7.3 HFCCG exception report Adult Safeguarding training for GPs. It was reported that NHS England was had still not addressed the matter of the identification of named GPs for adult safeguarding. A draft adult safeguarding strategy had been prepared which included details of online training for GPs to use. In relation to female genital mutilation (FGM) training there was a specific training package that can be delivered but there is still a query over funding to deliver the training. 5.13 10.1 Serious Incident Report: and his team introduced the report and stated that the programme of clinical visits continued along specified themes. 5.14 10.2 Serious Incident Report: reported that this arose from feedback from the monthly Trust clinical risk assessment. reported that there has been a steady improvement in the risk reporting across all parameters and as a result clinical leads in Trusts are to be advised that a clinical target of 95% is to be achieved with a view to ultimately gaining 100% for each patient. The chair confirmed that assurance had been provided. 5.15 10.3 Serious Incident Report: Following a meeting of the September CQGs further benchmarking was due to be performed in relation to maternity SI s that refer to NICU. There was particular concern regarding Chelsea and Westminster and more information was required to understand the data. 5.16 ACTION: Maternity SI s to be discussed at the November NWL maternity network meeting. 5.17 10.4 Serious Incident Report: It was thought that insertion of nasogastric feeding tubes did not occur outside of normal working hours when medical supervision was not available. In order test this assumption, agreed to collate policies of providers and report practices back to the next meeting. 5.18 ACTION: An update on providers nasogastric feeding policies to be brought back to the next meeting. MM LF 5.19 13.1 Weekend Working/111: The chair requested an update on the position from Eileen Sutton (NHSE) for clarity on GP referrals and the directory of services (DoS). It was reported that she had acknowledged the request for clarity but had not provided any further detail. NB reported that she considered that there had been improvement in terms of access by phone to patients in Hounslow but overall there was an absence of clear data about the levels of weekend access. 5.20 13.2 Weekend Working/111: The chair asked what learning was gained from Central London CCGs past patient engagement work in relation to weekend opening clinics and it was reported that the review of patient engagement work was ongoing. 5.21 13.3 Weekend Working/111: Work was ongoing in relation to linking 111 with whole systems work so that NWL CCGs are in a better position to influence the national 111 procurement. Page 5 of 8

5.22 ACTION: JE to provide an update on 111 JE 5.23 16.1 Any other Business: The draft emergency preparedness, resilience and response (EPRR) policy had been circulated for comments. No feedback had been received. The committee was content with the document as written and would present it to governing bodies for approval. ACTION: EPRR policy to be taken to governing bodies for approval. 5.24 16.2 Any other Business: A draft medical equipment policy has been prepared. No feedback had been received so reported that it would be forwarded to the Out of Hospital Group. ACTION: to send the medical equipment policy to the out of hospital group for consideration. 6 Central London CCG Highlight Report 6.1 Issues relating to London Ambulance Service were raised. It was reported that there had been poor performance against handover times. At present there was a concern regarding the 30 minute handover target and the need for assurances that this had not led to any patient risk/harm. 7 West London CCG Highlight Report 7.1 An issue was escalated around patient experience reports. The CCG was going to work with Healthwatch and the local authority to improve the way patients experiences of services are captured and interpreted to inform commissioning decisions. 8 Hammersmith and Fulham CCG Highlight Report 8.1 The highlight report was noted. It was highlighted that there was: an absence of data in the month 5 report from West London Mental Health Trust; absence of reliable data from Imperial Trust, for example relating to the maternity ward consultant coverage hours per week which was considered to be vital. It was commented that Imperial was improving the provision of data relating to maternity services. MP would discuss the issue outside of the committee to establish if this was just a reporting issue or if there were underlying safety issues. Consideration should be given to including a penalty clause in the service agreement with Imperial so that there was a disincentive not to meet service targets. 8.2 ACTION: MP to discuss consultant cover reporting (and other maternity safety data) to establish if this was just a reporting issue or if there were underlying safety issues. MP 9 Hounslow CCG Highlight Report 9.1 There was no report as the Hounslow CCG quality and safety committee meeting this month had been cancelled. 10 Ealing CCG Highlight Report Page 6 of 8

10.1 The paper as previously circulated was noted. MP highlighted that there was particular concern about cancer support volumes and how that should be addressed in next year s commissioning which MP would take up outside the meeting. The issue of care homes was identified and the fact that there had not been the development of a joint suspension policy with the council. It was reported by that for safeguarding purposes there had been a draft suspension policy created for Ealing CCG in relation to care homes. It was highlighted that a collective definition of clinical harm needed to be agreed by CWHHE which included physical as well as psychological impact and that this topic would be covered later in the meeting 11 Serious Incident Report 11.1 The paper was presented by LW. It was agreed that the content and presentation of the paper needed to be improved. reported that new staff were in place and would occur going forward. ACTION: to bring the updated format for SI report back to a subsequent meeting. 12 Clinical harm definition (18 week RTT) 12.1 The paper as previously circulated was presented by JR. The content of the update was noted and the proposed actions contained in the paper were also approved. It was also considered that there should be a duty of disclosure of clinical harm to individuals that has been caused set out in service level agreements. 13 Health and Safety update 13.1 BW gave a verbal update on health and safety matters. He stated that the office services function at Marylebone Road had transferred from the NWL CSU to the CCGs governance and compliance team from 1 October. Work was underway to instigate a reporting cycle of health and safety issues to provide assurance to this committee (the 5 CCGs health and safety committee) and governing bodies. Current issues were: testing of smoke alarms was overdue; and identification of and training for fire marshals, first aiders, and people to use the defibrillators following the organisational changes. John Riordan expressed an interest in being trained in the use of the defibrillator at Marylebone Road. BW stated that a written report would be brought to the next meeting and that all sites used by the CCGs would need to be incorporated in reporting regimes. ACTION: BW to bring a written report on health and safety to the next meeting BW 14 CQC state of healthcare 14.1 The paper as previously circulated was presented by JB and noted. 15 NW London quality surveillance group minutes 15.1 The minutes as previously circulated were noted. 16.0 Any other Business: 16.1 ACTION: to bring an update to the next meeting on issues associated with Ebola. 16.2 The chair reported that Alison Baker was retiring from the committee and the chair thanked her for her service. The meeting was then closed. 17. Date of the next meeting Page 7 of 8

17.1 27 November 2014, 10.00am Page 8 of 8