NHS SOUTH WARWICKSHIRE CLINICAL COMMISSIONING GROUP CLINICAL QUALITY AND GOVERNANCE COMMITTEE

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1 NHS SOUTH WARWICKSHIRE CLINICAL COMMISSIONING GROUP CLINICAL QUALITY AND GOVERNANCE COMMITTEE Minutes of held on Wednesday 23 rd October 2013 at Westgate House, Warwick Present: Dr Mark Hunter Secondary Care Doctor (Meeting Chair) Dr Richard Lambert GP Member and Assistant Clinical Chair Dr. Sukhi Dhesi GP Member Safeguarding Lead Dr Tim Coker GP Member Clinical Governance Lead Dr Karen Clarke GP Member Development Lead Dr John Linnane Warwickshire County Council Alison Walshe Director of Quality and Performance Anna Burns - Director of Strategy and Engagement Elaine Strachan-Hall Governing Body Nurse Claire Johnson Quality & Safety Manager Bee Collins - Associate Clinical Quality, Safety and Governance Helen Bunter Equality & Diversity Specialist Mary Mansfield Head of patient safety Michelle Gorrell Infection Control Nurse for Coventry Sharon Stuart Infection Control Nurse for Warwick Martine Sands Personal Assistant Note taker MH RL SD TC KC JL AW AB ESH CJ BC HB MM MG SS MS Minutes of 23 October 2013 Page 1 of 11

2 Apologies: Apologies were received from Wendy Fabbro and Charles Goody. Minutes of previous meeting The minutes of the previous meeting held on 26 June 2013 were agreed as a true and accurate record of the meeting. Matters Arising None were recorded Action Log Action 13 SD to send practices a further reminder via to establish where individual practices were with regards to safeguarding training. CCG was aware of all GP practices status. Extra training sessions set up. Action complete. Action 14 TC to present mortality audit report - on the meeting agenda. Action complete. Action 15 AW agreed to share the suicide prevention work that had been completed with SWFT with ESH. Action to remain open Notification of Any Other Business Information Governance issue raised by TC. Review of Rheumatology Drugs AW advised that an audit had been undertaken in respect of rheumatology prescribing. A detailed audit report had been shared with the Trust and a meeting would be held between the CCG s Assistant GP Chair (who undertook some of the audit work) and Director of Quality and Performance, and the Trust s Nurse Director and Medical Director during early November Minutes of 23 October 2013 Page 2 of 11

3 to agree actions A further detailed update, including the full report and the Trust s response would be presented at the next meeting. Quality Management Structure. AW explained that the CCG had undertaken a review of its Quality Management Structure to ensure robustness and would be putting in further senior level nursing input to ensure sufficient Nursing Voice within the CCG. The Committee noted the update Systematic Approach to Quality AW talked through a presentation on its proposed systematic approach to quality. AW stated that the overall aim of the Clinical Commissioning Group s approach was to improve patient safety, patient experience and clinical outcomes through a systematic approach to quality improvement across primary, secondary and community services. The Committee had a discussion around planning, performance outcomes, integrated services and quality monitoring. The Committee expressed the need to bring this back for further discussion at future meetings but supported the approach. The Committee noted the presentation. Keogh Report AW presented the Keogh report and informed the group that the report aimed to outline the findings of investigations into 14 hospital trusts in England with high mortality rates. The report included proposals for review visits for NHS South Warwickshire Clinical Commissioning Group, as well as specific issues to be included within the CCG s systematic approach to quality. AW reported that the Keogh reviews adopted a visit methodology that would both be transparent and comprehensive and which would be adopted by the Chief Inspector of Hospitals. Minutes of 23 October 2013 Page 3 of 11

4 The group had a discussion around unannounced visits to A&E at SWFT and ESH explained that SWFT was very welcoming of unannounced visits. The group had a further discussion around unannounced visits in the community and felt there was a need for another process for assessing community services. It was also highlighted that communication between the CCG, CQC and Monitor needed to take place to ensure they were not duplicating. The Committee endorsed the approach South Warwickshire Foundation Trust Quality Dashboard AW presented the SWFT Quality Dashboard report and stated that this paper provided a copy of the current SWFT Quality Schedule dashboard and identified exceptions and resulting actions. Dashboard exceptions were discussed during the monthly Contract Operational Meetings and were escalated to the Clinical Quality Review Group meetings with SWFT as necessary AW highlighted the following key points: Delayed Transfers of Care showed improved performance. Safer Surgery Checklist performance remained below target; actions were in place to improve performance. 1 case of MRSA (August 2013) had been assigned to SWFT following a Post Infection Review. MRSA Screening performance remained below target. Continued under delivery of the stroke swallow screen assessment in A&E at SWFT. Breast Feeding Initiation rates were below the expected level. Caesarean section rate sits at 28% which was higher than the agreed maximum level of 25%. Standards for Emergency General Surgery the audit scheduled for June 2013 had been delayed whilst awaiting reporting requirements. There were 2 Never Events during July 2013 both of which were currently being reviewed via Root Cause Analysis (RCA). The resulting action plans would be monitored through CQRG. Minutes of 23 October 2013 Page 4 of 11

5 There were no overdue serious incidents. September CQRG was stood-down at short notice due to apologies received from SWFT Directors Safeguarding Monthly Reports Adults and Children SD presented the Committee with an overview of Adults and Children s' Safeguarding activities during the past quarter. SD confirmed that there were no current serious case reviews for either adults or children for South Warwickshire CCG AW confirmed that a breech in a nursing home was a privacy breech, not a data breech. ESH expressed her concern regarding the potential impact of placement stops on quality of patient care. AW responded that regular visits to the nursing home were undertaken during the period of placement stops and confirmed that patients were being cared for in a safe environment South Warwickshire Trust Hospital Mortality TC presented an update on SWFT s mortality and highlighted the difference between Summary Hospital Level Mortality Indicator (SHMI) and The Risk Adjusted Mortality Index (RAMI)as being: The Summary Hospital-level Mortality Indicator (SHMI) compared the actual number of patients who die following treatment at a trust with the number who would be expected to die, given the characteristics of the patients treated there. It considered all deaths that take place both in hospital and within 30 days of discharge, offering a more comprehensive picture of deaths following hospital care. The SHMI showed mortality rates for every acute non-specialist trust in England - providing a single comprehensive indicator used consistently across the NHS Minutes of 23 October 2013 Page 5 of 11

6 TC reported that the quarterly SHMI figures would suggest that mortality at SWFT was within expected levels. TC added that the report provided data relating to organisation-wide and specialty level. JL highlighted that Warwickshire County Council were looking at deaths from heart failure and the effects of pollution across Warwickshire. Patient Safety Report MM presented an overview of the patient safety report and advised the Committee of the number and nature of incidents for the period 1 st July - 30 th September and highlighted the following key points: Serious Incidents, a total of 187 Serious incidents were reported in the 2 nd quarter Never Events, four were reported in the 2 nd quarter Pressure Ulcers continued to be the most frequently reported category Falls the number of falls reported continued to increase year on year MM reported that to address the need for wider learning across the Health Economy, thus completing the incident reporting loop, a quarterly Health Economy Serious Incident Learning Forum had been set up. This group included representatives from all CCG s, each of our local provider units and the Local Area Team (LAT). This group provided a formal mechanism to facilitate the cascade and sharing of information on trends and learning following SI s. MM added that discussion relating to SI s and the learning outcomes following Never Events also formed part of the monthly Clinical Quality Review (CQR) meetings held between the various Commissioners and each provider organisation. MM further added that NHS South Warwickshire CCG was committed to activities supporting the delivery and achievement of the NHS collective ambition to eliminate avoidable grade 2, 3 and 4 pressure ulcers. Minutes of 23 October 2013 Page 6 of 11

7 AW reported that the Area Team had highlighted concerns with regards to the Community SI reporting backlog. AW proposed a deep dive into SIs and this was agreed by the Committee. ESH highlighted the lack of a Safety Thermometer in the report and stated that if the report included a section on safety reporting, a Safety Thermometer should be included. AW responded that currently the Safety Thermometer is included in her monthly quality report but would review the appropriateness in light of ES-H s comments. Infection Control Update AW advised the Committee of current activity relating to healthcare associated infections (HCAI s) and infection prevention. AW AW 14.2 AW stated that with regards to MRSA there had been 3 MRSA bacteraemias this year for the South Warwickshire population With regards to C Difficile AW explained that there would be a detailed update at a future meeting. With regards to Norovirus, AW reported that SWFT had undertaken significant work during the spring and summer to prepare for this winter. This work included: Provision of hand washbasins outside wards; Refurbishment of the medical assessment wards (male and female) to enhance infection control; Review and revision of cleaning standards; Update of the Diarrhoea and Vomiting Policy, including Lockdown and Visiting. JL reported that social care had agreed that carers in residential or nursing homes would be required to obtain free flu vaccines. Quality Safety and Governance Report re Nursing Homes AW presented the report in the absence of Sheila Peacock. Minutes of 23 October 2013 Page 7 of 11

8 AW highlighted that the key points were: The Care Quality Commission (CQC) identified nursing homes that did not meet the essential quality care standards. Commissioners, contract monitoring and safeguarding teams across health and social care escalated poor performing care providers to the Warwickshire Serious Escalation Panel (SEP) or sister committee in Coventry PEP (placement escalation panel) A Quality Dashboard for independent providers was launched in August The Arden Clinical Support Team has appointed four nurses to work with Warwickshire care homes. On quality improvements. Quality improvement projects and staff training activities were identified in the report. GP Feedback Pilot CJ updated the Committee on the GP feedback pilot and reported that the pilot stage of the GP Feedback System was launched on June 28th 2013 with 3 GP practices joining the programme, 3 further practices joined on July 5th with the last practice launching on July 17th. For the pilot phase feedback relating to services provided by South Warwickshire NHS Foundation Trust (SWFT) only had been sought. Stage 2 of the launch programme of the GP Feedback System which included roll-out to all the CCG GP practices was currently on-going and due to be completed by the end of October CJ reported that following guidance from NHS England no identifiable information could be recorded. CJ further reported that evaluation of the pilot stage with practices had shown that the operating process was working well. Future reports to Executive Team, Members Council and Clinical Quality and Governance Committee would contain more detailed quantitative and qualitative information, enabling themes to be more explicitly identified. On-going discussions relating to feedback themes would take place with SWFT at Clinical Quality Review Meetings (CQRG), ensuring that appropriate actions were taken by the Trust. Future reports would incorporate these agreed actions, clarifying where any changes had Minutes of 23 October 2013 Page 8 of 11

9 been made; they would also identify any shared learning and demonstrating how the feedback had been triangulated with other appropriate data to develop and improve services Quarter 2 Information Governance Report 1. Data Sharing Agreement AB updated the Committee on the Data Sharing Agreement. The group had a discussion with regards to what information should be accessible to GPs on a need to know basis and expressed the need for an audit to be carried out. AB stated that she would request the information governance team to look into this. The Committee noted the Agreement and recommended the Agreement to Governing Body for approval. 2. Risk Stratification Policy AB presented the Risk Stratification Policy to the Committee and reported that in June 2013, NHS England published a document: Information Governance and Risk Stratification; Advice and Options for CCGs and GPs. Risk Stratification was a process that looked to identify patients who were at most risk of admission to hospital in the future. The Committee noted the Policy and recommended the Policy to Governing Body for approval. Corporate Risk Register AW provided an update on the Corporate Risk Register and flagged up the QIPP S117 with regards to discharge of mental health patients. It was identified that the Coventry Warwickshire Partnership Trust may not be robustly reviewing all patients on the Care Programme Approach. AW stated that South Warwickshire was working together with Rugby and Coventry to make sure mental health patients had an annual review. AB Minutes of 23 October 2013 Page 9 of 11

10 Quarter 2 Equality and Diversity Report HB presented the report and highlighted the following key points: Based on the CCG s organisational values and the equality impact assessment of the Integrated Plan, Equality objectives had been produced and the Equality Delivery System (EDS) Plan had been drafted. The EDS plan was currently being finalised before a consultation draft was circulated to stakeholders in November. A revised Equality Delivery System (EDS2) would be launched by NHS England later this year, to which the CCG would respond in due course. HB informed the Committee that the CCG was fully compliant with its duties Quarter 2 complaints and Enquiries Report Aw stated that the purpose of this report was to provide the Committee with an overview of the complaints and enquiries received by the CCG for Quarter 2. The Committee noted the report Quarter 2 Communications and Engagement AB provided the Committee with a summary of communications and engagement activities undertaken during Quarter2. AB highlighted that Quarter 2 had seen an increase in website page views and certain key themes had emerged from the CCG s engagement. Development of the Communications and Engagement Plan for 2014/15 AB provided the Committee with a high level summary of the work that would be undertaken to develop the Communications and Engagement Plan for 2014/15 and explained that the plan took its strategic direction Minutes of 23 October 2013 Page 10 of 11

11 from the SWCCG Integrated Plan AB added that the plan would be brought back in December for evaluation Quarter 2 Organisational Development Report 23.1 AB explained that this report provided an outline proposal for the development of an Organisational Development Strategy agreed by the CCG prior to authorisation in March 2013 and agree a new strategy for implementation from January Any Other Business 17.1 Budbrook Surgery Press coverage AW provided the Committee with a brief update on the Budbrook Surgery Press coverage Schedule of Future Committee Meetings/Frequency of Meetings 17.4 AW informed the Committee that due to the amount of material that needed to be covered in the CQ&G meetings, the meetings would now take place bi-monthly instead of quarterly. The Committee would be informed of the new dates. Date of next meeting: 18 th December 2013, am 1.30pm, Committee Meeting Room, Westgate House, Warwick Confirmed as a true and accurate record of the meeting: Signature of Chair: Print Name: Date: Minutes of 23 October 2013 Page 11 of 11