Report of North & West Reading CCG Governing Body 19 September 2017

Agenda Item 15: NWR17.09.14 Report of North & West Reading CCG Governing Body 19 September 2017 Title Sponsoring Director Author(s) Purpose Previously considered by Risk and Assurance Financial and resource implications Legal implications/regulatory requirements Consultation, public engagement & partnership working implications/impact Public Sector Equality Duty Chairs report from the Berkshire West Joint Quality Committee held on 11 th July 2017 Debbie Simmons, Nurse Director, BW CCGs Wendy Bower, Chair of Berkshire West Joint Quality Committee To provide the Governing Body with the key issues arising from the Berkshire West Joint Quality Committee held on 11 th July 2017 Berkshire West Joint Quality Committee 11 th July 2017 Assurance provided to Governing Body from Berkshire West Joint Quality Committee None identified None identified Not applicable Not applicable Executive Summary The Berkshire West Joint Quality Committee met on 11 th July 2017: The minutes from the meeting held on 9 th May 2017 were approved; The Integrated Quality and Performance Report was discussed and noted; A HCAI update was received ; The Primary Care Quality report was discussed; Provider Quality Assurance visit reports were noted; The Committee discussed the Corporate Risk Register including issues from the Quality Committee that create significant risks for the attention of the Audit Committee; Updated Quality Strategy and Quality Policy were presented and approved; Care home Quality Assurance was presented; CQUIN 16/17 achievements were noted; The Provider Risk rating, SI Quarter 1 2017/18, Clinical Concerns Quarter 1 2017/18, Primary Care Incidents Quarter 1 2017/18 and PACT Annual reports were received; The Safeguarding Committee Chairs report and Commissioning Checklist were received; Recommendation The Governing Body notes the report and gains assurance that the Berkshire West Joint Quality Committee is discharging its responsibilities effectively. 1

Berkshire West Quality Committee Meeting 11 th July 2017 Chairs Report 1.1 The meeting of the Berkshire West Quality Committee was held on 11 th July 2017. 1.2 The members in attendance were: Present: Wendy Bower Lay Member (CHAIR) Andy Ciecierski North and West Reading CCG Chair Ashmita Chandra Head of Performance, BW CCGs Bal Bahia GP, Newbury & District CCG Debbie Simmons Nurse Director, BW CCGs Jane Thomson Assistant Director Quality, BW CCGs Jo Jefferies Consultant in Public Health, Bracknell Forest Council Johan Zylstra Berkshire West CCGs Chair Kajal Patel GP Clinical Lead, South Reading CCG Saima Hussain-Sheikh Quality Improvement Support Officer, BW CCGs Simon Hawkins Quality Improvement Lead, BW CCGs Terri Brunne Primary Care Co Commissioning Manager Julie Parsons PA to Debbie Simmons, BW CCGs (MINUTES) Apologies: Abid Irfan Newbury & District CCG Chair Eleanor Mitchell Operations Director, South Reading CCG Kathy Kelly Head of Safeguarding Adults, BW CCGs Katie Summers Operations Director, Wokingham CCG Liz Stead Head of Safeguarding Children, BW CCGs Mandeep Sira Healthwatch representative (apologies received Maureen McCartney Operations Director, North & West Reading CCG Michaela Hooper Infection Prevention & Control Nurse, BW CCGs Raju Reddy Secondary Care Consultant Shairoz Claridge Operations Director, Newbury & District CCG 2. Key Actions and Decisions 2.1. Minutes of meeting held on 9 th May 2017 These Minutes were approved as an accurate record and the Action Log was updated accordingly. 2.2. Integrated Quality & Performance report The Integrated Quality & Performance report was discussed in detail. Patient Safety CDiff: 4 cases in May, 3 of which were a lapse in care. Will keep an eye on. There seems to be a spike across the system and was the same this time last year too. Patient Experience Mixed sex accommodation: DS reported a conversation with Caroline Ainslie re this most important is for privacy and dignity to be maintained and Caroline assured DS that it is. Mixed sex accommodation is not an issue in AMU but it is in the Obs unit and it is being

monitored so as to not have frail elderly left in the unit overnight. DS has also written to NHS England about RBH reporting differently. Clinical Effectiveness Fractured Neck of Femur: RBH, on the whole, performing well. Vacancies: Recruitment continues to be a challenge 218 offers were made during the Philippines recruitment drive, 9 of which have passed their International English Language Testing System. SH reported that Hampshire have a Nursing 200 project which is focussing on return to practice nurses. GWH have an issue with overseas recruitment and level of English-speaking abilities and so are stopping overseas recruitment. Safeguarding training: RBH remains under the compliance threshold but CCG leads are supporting with an action plan. Maternity DS reported all going well. DS is now the Chair of the BOB LMS and it s really highlighted how ahead of the game in Berks with a very clear, simple plan on how to cope with an increase in population. Rushey Ward will be redeveloped to a 6-bed unit and work on HDU will commence in Oct. The Home Birth service is working well, with 2% of births in the first month. On the whole, April was a very good month. SCAS Asthma Care bundle: SH reported this is still below programming is needed to change EPR and with this, a vast improvement is expected. Funds have been raised and signed off SCAS Board are really positive. Falls: Dip in May but we are assured due to engagement. Clinical Concerns: THE CPN issues in Jan 2017 has had a huge impact and performance is already noticeable improved. Urgent Care Performance 4 hours A&E: GWH are struggling to achieve, trying to get some support. Red 1: Very positive. 111 calls answered within 60 secs: increase in performance but still not on target remedial action re this will be discussed further at SCAS CQRM. Delayed Transfers of Care: A draft DToC plan is being revised to improve performance from current 3.5% - it will be considered again in July. Long Term Conditions New denominator has had a positive effect on all but Newbury CCG the Dementia Steering Group is looking on ways to remedy this. CMMV: Improve access rate to CYPMH: a new standard currently voluntary and third sector activity is not being captured. Children waiting >18weeks for a wheelchair: Need to find a Lead Commissioner for this. 62-day wait: RBH not achieving KP reported that the Thames Valley Network are getting funding to achieve. 2.3. HCAI report The MRSA case provisionally assigned to South Reading CCG has now officially been assigned to third party (as requested). JJ stated that bacteraemia were being reviewed across the system, and best practice shared. 2.4. Primary Care Quality report TB presented this report in the new format. There is an ongoing issue over data availability and accuracy but the report is 80% there TB is working with CSU to resolve. DS very good report, gives assurance.

Digital transformation: needs lots of development to bring in line with GP IT Committee. Immunisations & Vaccines: JJ queried the 90% target for childhood imms as nationally this target is 95%. This percentage will be checked as TB thought this was a local target but the committee wanted assurance that we are compliant with the national target. The committee also asked for the numbers to be included as well as percentage. CQC inspections: DS informed all that CQC will be re-inspecting 10% of all the practices previously rated as Good this year practices might be able to put themselves forward to be re-inspected to potentially improve rating to Outstanding. 2.5. Provider Quality Assurance Visits Gynae, RBFT (27 th April 2017): A very positive visit which included a walk-through of the whole system. Campion House, BHFT (25 th May 2017): A very important visit as the Unit had previously had three QA visits which hadn t shown the Unit in a good light and CQC had not been impressed. The ward is now totally different and vastly improved, with new leadership; new décor, beds and a garden; Speech & Language input; and an overall improvement in the environment. CQC have revisited and have noted the improvements. DS felt the visit was excellent and has conveyed thoughts to Helen Mackenzie. AQP Physio (31 st May 2017): This visit was undertaken as a result of GP clinical concerns. Conversations focussed on basic governance. Discussion re potential opportunity to set up one clinic, in one area in order to improve the efficiency of the service. Pathology, RBFT (6 th June 2017): This visit was due to recent issues. JT met with the wider team and scrutinised and analysed processes. Further assurance will be gained in Sept. 2.6. Corporate Risk Register Nothing to add. CMMV7: DS has requested closure of this risk as now fully compliant within 20 mile radius (out of 20 mile radius is still an ongoing issue nationally). This is backed up by the recent OFSTED inspection in West Berks. 2.7. Updated Quality Strategy DS presented this rewritten document WB agreed it was very good but others need a chance to read and review. DS has liaised with the other Nurse Directors across the ACS and agreed to keep the Quality Strategies legally separate but to ensure they all align, with a front section outlining overarching and shared visions and priorities. ACS Quality Committee: DS informed all that there will be ACS Quality Committees scheduled from Sept 2017 onwards these meetings will not replace the Berks West Quality Committee at this stage but will replace the CQRM meetings from next year. It has been agreed that, from Oct 2017, SI Panels will be shared which is very positive as this means proactive and shared learning. WB added that this is a testament to the good relationship between the Nurse Directors. 2.8. Updated Quality Policy JT presented this policy which is an overarching view of statutory obligations and governance processes. WB felt this was a very good document. All to review and comment if no comments, take as approved by the Committee; if it needs to be amended, bring amended version to September meeting to note changes and approve.

2.9. Care homes quality assurance Terms of Reference: all agreed very good and to approve. Response awaited from BHFT re their involvement; JZ queried if a GP is to be involved; AC suggested SCAS (they have been asked). 2.10. CQUIN 16/17 Achievements Achievements noted. DS noted that this has been as a result of the CQUINs being National CQUINs and there is no negotiation on these. 2.11. Provider risk rating DS & WB stated this was a very helpful report. SH added it backs up what the Quality team have been doing anyway. 2.12. SI Quarter 1 2017/18 SH presented this report and stated this was a quiet quarter. STEIS 2017/13671: Linking with Sanjay Desai in Medicines Management re this (for specialist knowledge) and awaiting RCA report. Post meeting note: Due to an error when compiling the Serious Incident report, a Never Event for RBFT was not highlighted. The details for this case are below: STEIS Reference Number: 2017/11127 Date of incident: 01/04/2017 Type of incident: Retained foreign object post-procedure Outline of Incident: 61 year old patient who had emergency surgery on the 01/04/2017. Two further admissions to the Trust with a poorly healing wound. On last admission to the Trust an X-ray revealed a retained swab and the patient was taken back to Theatre to have the object removed. SI inpatient, BHFT: DS reported that an in-patient on Bluebell Ward had committed suicide using a pillowcase. A recent CQC inspection at Bluebell Ward had raised some concerns. The Coroner s inquest is due shortly and DS will update. The patient had been on 15 minute observation and the incident is extremely sad. JZ queried why five beds on Bluebell Ward were closed DS responded that the beds were closed whilst the Trust reviewed capacity and the mix of patients (large number of complex/personality disorder patients). 2.13. Clinical Concerns Quarter 1 2017/18 update SH reported that Clinical Concerns was relaunched in Feb 2017. RBH Clinical concerns not included (as go direct to RBH) DS suggested adding these as an appendices. WB stated this is a very helpful report. DS added that Newbury & District and South Reading CCGs are not using Clinical Concerns as effectively as others. SH reinforced we can help with GWH/HHFT hospitals too.

2.14. Primary Care Incidents Quarter 1 2017/18 update April 2017 fully delegated. Numbers reported low. All four GP Councils 3 of 4 Practice Manager forums. Reiterated weekly newsletter re process, remind often of what needs reporting. SCAS Meds Optimisation Committee for drug issues. WB/DS again, very helpful. Culture is for shared learning and highest reporting organisations are safest. 2.15. PACT Annual Report 2016/17 No comments from the Committee. WB stated this report had improved greatly in the last couple of drafts. DS added that it was a good report and sets out themes. WB expressed her thanks to the Complaints team. 2.16. QIA/EIA any for consideration None for consideration currently. DS has requested a summary of all QIAs (even those scoring under 8) to review. THE QIA process has been revised to ensure it s more robust and the policy has been rewritten as it s unlikely that there have been no QIAs scoring over 8 in the last 12 months. 2.17. Safeguarding Berkshire Safeguarding Committee Chairs Report (5 th July 2017) DS presented this report and highlighted the following: o West Berks SCR: 19 week old baby twin died, other injured, father arrested and charged. Lots of media interest. Police report will take priority. From a health perspective there will be some learning for the Poppy Team (an issue of newly qualified midwives being on the team had already been flagged). o West Berks Local Authority OFTSED inspection: Resulted in the Local Authority going from inadequate/in need of special measures to Good. This demonstrated good partnership working and, from a health perspective, LAC health assessments were highly praised. Concerns were raised over accessibility of CAMHs. One recommendation is for Liz Stead, BHFT and the Local Authority to review the cases looked at in the inspections. Commissioning Checklist All agreed it was good to have an audit trail and the checklist was approved. 2.18. AOB AGM SLIDES: DS suggested doing a video (or photos) to celebrate the achievements of the Quality Committee/Team at the CCG AGM. All agreed. Q4 assurance: The recent Q4 assurance rated Berks West CCGs as outstanding in some areas (leadership/quality) but Good overall due to some improvements being needed in sustainability. This rating was then changed to Outstanding overall which is a fantastic achievement. Berks West CCGs have been issued a Green Star. Q2 assurance will focus on ACS. THANK YOU: WB thanked the Quality Team as they have upped their game even more and just keep getting better and better.

3. Conclusion The Chair provides this report from the Berkshire West Joint Quality Committee to the CCG Governing Bodies and Clinical Commissioning Committee. It will be presented by the Nurse Director. Wendy Bower, Lay Member (Patient and Public Involvement) North and West Reading CCG, Berkshire West Joint Quality Committee Chair, July 2017