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Title: NHS Bristol CCG Quality Report May 2016

Reporting on April 2016 performance unless stated

Agenda Item: 14

1 Purpose

The Quality Monitoring Report provides the committee with performance information on quality measures and outcomes for Bristol CCG and across local provider services. The report is supported by quality dashboards and provider quality reports for University Hospitals Bristol (UH Bristol), North Bristol Trust (NBT), Bristol Community Health (BCH), Avon Wiltshire Partnership (AWP) and Recovery Bristol Partnership (RBP) for community mental services.

The narrative in the report provides analysis and focus on those areas of performance outside the acceptable benchmarks. The report and dashboards are structured under the headings of the NHS Outcomes Framework.

2 Summary of operational quality issues and harm free care during escalation for the month of May 2016

During May 2016, the Bristol, North Somerset and South Gloucestershire (BNSSG) urgent care system has remained under significant pressure and additional System Management calls continued to be scheduled as required (including weekends). Both UH Bristol and NBT experienced periods of black escalation and needed to utilise additional escalation capacity. Efforts continued to focus on discharging complex discharges and maximising community capacity. The ambulance Standard Operating Procedure (SOP) frequently remained in place at both Trusts.

UH Bristol’s 4 hour Emergency Department (ED) performance fluctuated between red, amber and green status (dipping on one occasion to 66.1%). High attendance and low discharge numbers continued throughout May. Mid-month saw one mental health patient breach (delayed assessment and bed availability). On 26 May the upcoming “Love Saves the Day” festival was noted and it was envisaged there maybe additional pressures through increased attendances (similar to last year). UH Bristol also expressed some concerns pertaining to patients waiting over 14 days in hospital. NBT frequently remained in a very challenged position. 4 hour ED performance was rated red for the majority of the month (reaching a low point of 57.3%). Green status was only achieved twice. NBT declared an internal critical incident on the 8 May 2016 and all partners considered as to how to help bring forward discharge dates. On several occasions there were an excessive number of breaches which was attributed to high

Meeting of Bristol Clinical Commissioning Group Quality and Governance Committee

To be held on Tuesday 21st June 2016 commencing at 8.45 in Bristol CCG Conference Room

Meeting of Bristol CCG Quality and Governance Committee 21 June 2016

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attendance and low discharge numbers. The Trust continuously struggled with capacity within ITU. On occasions elective admissions were reviewed and cancelled if required to help manage capacity. Concern was expressed regarding the high number of Delayed Transfers of Care (DTOC) patients (those awaiting completion of assessments and the complexity of the discharges). Towards the end of the month, one long waiting patient with mental health needs required escalation. Both Trusts held ‘Breaking the Cycle’ events during the weekend of 20/21 May and learning is being collated. Cases of Norovirus were reported by both Trusts. NBT’s Trauma ward was closed early in the month and UHB conveyed they had 2 bays closed on11 May. Mid-month UHB also reported affected with diarrhoea symptoms (which were being assessed by the Infection Prevention and Control Team). It was noted at the end May that the police would no longer be taking section 136 patients to their custody suites. Though additional beds were put in place in response to this, it was highlighted that there was an element of risk that patients would be admitted to ED.

3 Areas of notable improvement Following issuing of a Contract Performance Notice in January 2016, UH Bristol’s FFT inpatient response rate increased in April 2016 to 32.2% and the Trust is currently on course to meet its trajectory of a 30% response rate by June 2016. The CCG has agreed to review again in July 2016 prior to making a decision on whether to close the Contract Performance Notice (CPN).

The Trust has now completed all actions within the Remedial Action Plan (RAP) pertaining to Serious Incident (SI) timelines. It was noted that there was an outstanding Root Cause Analysis (RCA) from 2015/16 and the Trust was actively looking into this. On the basis that the Trust is achieving compliance with submission on RCAs and 72 hour reports and the completion of all actions in the RAP, the CCG agreed to close the CPN and agreed to monitor compliance on a quarterly basis going forward. The Trust has also included SI reporting compliance as part of its monthly quality and performance report to the Board. The Quality Sub Group reviewed the progress made on national and local CQUINs in 2015/16 and commended the Trust on achievement of 2.42% (including specialised CQUINs) achievement against a possible 2.5% CQUIN payment. Work was continuing on the 2016/17 CQUINs in preparation for contract sign off by 13 June 2016. UHB has achieved the RRT national standard despite ongoing emergency pressures and activity lost due to junior doctor industrial action; there has also been a reduction in the level of last-minute cancelled operations. NBT’s Friends and Family Test (FFT) ED response rate improved to 27% in April 2016, exceeding the 15% target for the second time in the last 12 months. The positive increase has followed the implementation of the new FFT collection system. Following the publication of NBT’s Care Quality Commission (CQC) inspection report, the CQC action plan has been completed and submitted to the CQC on the 17 May 2016. Delivery against the action plan will be monitored internally by the Trust (via their Trust Board, Integrated Performance Report, Quality Committee and the Quality and


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Risk Management Committee) and also externally (CQC, CCG Quality Sub Group, System Flow Partnership and other relevant stake holders) to ensure progress is on track. NBT have 6 ‘Must do’ actions (compared to 34 in the 2014 report). The 3 key areas are internal patient flow, admissions avoidance & reducing attendance and discharge from hospital. The CAMHS actions have been formally handed over to AWP and the patient records is a corporate theme. NBT have reported zero cases of both MRSA and C.Difficile for the second consecutive month. BCH has seen a reduction in the numbers of serious incidents reported. BCH has a higher than national average harm free care (93.88%). Care UK NHS 111 rates for weekday and weekend calls abandoned after 30 seconds has reduced. The weekday indicator remains within target, the weekend target, previously rated amber has returned to green status.

4 Quality Key Messages

Below is a summary of the reported position in April 2016 (with the exception of serious incidents which includes May 2016 data):

UH Bristol: The Emergency Department (ED) Friends and Family (FFT) response rate has decreased this month (12.3%) and is below the required 15% threshold. 71.5% of patients say they would recommend ED to a friend or family for care and treatment which is below the 87% national average of all NHS Trusts. The FFT Contract Performance Notice (CPN) for low response rates in inpatients and day cases continues to be in place and will be reviewed again in July 2016 by the quality sub group. The response time to complaints within the agreed timescale deteriorated from 86.1% in March to 81.6%. This is due to increased internal quality assurance processes introduced within the Trust. Complaint response times will continue to be monitored via the UH Bristol Quality Sub Group. In April 2016 performance pertaining to the National Early Warning System (NEWS) was 87% against a three year improvement goal of 95% (similar to the previous three months 86% to 88%). Close monitoring will continue via the UH Bristol Quality Sub Group to ensure improvement. NEWS is included within the 2016/17 Quality Schedule. Fractured Neck of Femur – There has been some improvement in the percentage of patients seeing an Ortho-geriatrician within 72 hours (83.3%). The percentage achieving best practice tariff showed a slight improvement at 70.8%. The percentage of patients treated within 36 hours has improved slightly to 87.5% but all remain below the 90% threshold. The CCG is expecting the report in mid-June following an external review by British Orthopaedic Association. The report pertaining to the Paediatric Cardiac Review is due to be published on 30 June 2016 and will be available on the Trust website. Whilst the content of the review is not yet known, the report is likely to attract media attention. The CCG has asked if the report could be made available in advance of the publication date in order to allow the CCG to prepare. The Trust has commissioned Veritas, a health and social care consultancy specialising in the review, commissioning and mobilisation of services, to undertake an independent investigation into the management of a compliant about into paediatric services. NBT: the Trust are at risk of not achieving the Quarter 1 target for VTE assessment contained within the Remedial Action Plan (RAP), with 91.5% VTE Assessment compliance reported in April


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2016 and only 50% of RCAs completed for hospital acquired thrombosis (HATs). There continues to be a backlog of notes and the Trust to look at changing the way they capture VTE data. NBT are revising the RAP to take this into account. The Trust continues to remain below the locally agreed 30% threshold (Quality Schedule 2015/16 target) for the FFT inpatient response rate. The Trust developed an Action Plan and trajectory for improvement; a Contract Performance Notice (CPN) will be issued if the response rate drops in June 2016. The number of overdue complaints continues to remains high with 47 overdue complaints reported in April 2016. NBT continue to progress an action plan and trajectory to reduce overdue complaints through a combination of support and development work with the Patients Association, targeting directorates with specific issues. NBT are confident in their ability to reduce the complaints backlog to less than 10 by July 2016. Nutrition screening compliance continues to fall below the national 90% target, reported at 81.7% in April 2016. An action plan and driver diagram is in place and significant training is underway to improve the screening rate. Nutrition screening remains part of NBT’s Quality Improvement Drive. Staff sickness has consistently remained above the 4% target throughout 2015/16; NBT will update the NBT Quality Sub Group in June on their actions in relation to the figures. One ‘Never Event’ relating to wrong site anaesthesia was reported by NBT in May 2016. The procedure was for a left cemented hip hemiarthroplasty. Another anaesthesia block was placed on the correct side and the operation progressed unremarkably. A full RCA investigation is currently underway. BCH has reported a rise in information governance incidents in April 2016. These are described as being attributable to the TUPE of children’s services into BCH as there have been some issues with the transfer across of information. It was noted that a review of incidents for the service has identified that information governance incidents are the highest reported incident for this group. BCH have ensured that all 500 staff transferring from Children’s services have undergone information governance training as part of their induction to the service. This has raised awareness amongst staff and has also facilitated (positively) the increase in reporting of incidents. AWP: the CQC completed a full inspection early in June 2016 and the draft report will be shared with the Trust in July. Commissioners have not yet received feedback. Commissioners issued a Contract Performance Notice in August 2015 based on increasing concerns related to quality assurance and governance. A full review of the associated action plan took place in April 2016 to measure outcomes against agreed deadlines. A decision regarding next steps is pending subject to commissioner discussions and is expected to be finalised at the AWP Quality Sub Group meeting in June 2016. During March 2016, Laurel and Lime Wards were closed to admissions and discharges due to an infection outbreak (suspected Norovirus). An action plan is in place including involvement of both AWP and UH Bristol Infection Control teams. A report has been requested to be reviewed at the Quality Sub Group meeting in June 2016. Following discussions with the CQC regarding the interpretation of single sex accommodation guidance, the Trust has implemented a revised protocol removing the flexible use of beds. This means that wards can no longer admit both genders to the same corridor except in emergencies, resulting in some Bristol patients not being able to return to a local bed from out of area. Discussions are ongoing via the Quality Sub Group and a decision regarding application of the guidelines is expected in June 2016. The complete CQC report relating to the unannounced inspection in December 2015, including the outcomes of a follow up visit in February 2016 has been published. The report notes some


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improvements since December. The associated action plan is closely monitored via the local contract meeting and the dedicated Quality Improvement Group co-chaired by the TDA and NHS England. The CQC completed a Trust-wide full inspection last week; no feedback has as yet been shared with commissioners (the draft report is due in July 2016). Referral to treatment breaches have been fully reviewed following the CQC visit. This is monitored daily by the Trust and shared with commissioners. The situation has improved but pressures remain. An action plan is in progress. Place of Safety/136 - As from the 1st June police colleagues will no longer accommodate service users in cells. An interim arrangement has been agreed including use of ED with extra support when no other options are available. Street triage has been extended until the end of September and will be evaluated at the end of June. Issues and action plans are closely monitored via the Crisis Concordat Group, the local contract and performance meeting and the Quality Sub Group. A potential safety issue has been identified pertaining to some GPs declining to take bloods for service users within the community being treated with Clozapine. It is possible that further GPs will also decline. Discussions are ongoing in order to seek a contractual solution (being managed by the commissioning team). RBP: services continue to struggle with demand and a comprehensive review of the community model is in progress. Commissioners expect receipt of the report in July 2016. SWAST: April performance has been challenging with the implementation of the ‘Ambulance Response Programme’ (ARP), a major change to deployment, which has led to two reporting mechanisms. Pre-ARP Trust-wide Red 1 performance was 72.73% and Red 2 was 56.87% (up until 19 April 2016). Post ARP the overall Red performance is 66.79%. Commissioners expressed concern at the SWAST IQPMG as regards to the amount of information contained within their submitted 72 hour reports for Serious Incidents (SIs). Key issues are the lack of context and immediate mitigating actions. The previously identified “spinal” incident trend continues to be managed under the SI process; links have been made with the receiving Acute hospitals and it is hoped aggregate learning will be cascaded. The potential trend of “making clinical decisions in isolation/non-clinician decision making” has been discussed at the IQPMG; there will be further discussion with SWAST regarding this topic. SCWCSU is undertaking a review of “Long Waiters” and the potential impact delays may cause. Terms of reference are being drawn up. A progress update will be provided by the next SWAST IQPMG. BrisDoc 3 key performance indicators (KPIs) were rated as amber, including clinical advice within 2 hours (92%) and urgent visits within 2 hours (93%). Despite the volume of calls reducing, they continue to struggle with clinical advice given within 2 hours. At times of high volume, BrisDoc are reviewing the calls received to get a better understanding of priority. BrisDoc continue to report non-compliance against their 95% target for clinician hours filled (was reported as 89% for April 2016). BrisDoc have recruited pharmacists to improve performance against this measure and will be reviewed at the end of May. Bristol CCG has asked to have sight of this report when it becomes available. Care UK NHS 111: the majority of KPIs remain red rated however some improvements have been made from the previous month. Performance for call backs within 10 minutes when transferred to a Clinical Advisor (CA) deteriorated to 42.9% against the 95% target. Performance relating to calls referred to ED remains unchanged and red rated. Ambulances dispatched have increased to 10.6% (rated amber). The KPIs are monitored at the monthly IQPMG meetings and Care UK is subject to Contract Performance Notices. The CCG is looking into the contractual arrangements with Care UK.


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Contents

Page Section

1 Purpose

1 Summary of operational quality issues and harm free care

2 Areas of Notable achievement

3 Quality Key Messages

9 Section 1. Quality and Outcomes Measures Exception Reports for UH Bristol, NBT, BCH, AWP and RBP

33 Section 2. Serious Incidents UH Bristol, NBT, BCH and AWP

38 Section 3. Urgent Care Section Quality and Outcome Measures Exception Reports for BrisDoc, Care UK NHS 111 and SWAST

58 Section 4. Horizon scanning

64 Section 5. Conclusions and Recommendations

List of Supporting Annexes – Those not listed for inclusion within the Governing Body Papers are available on request through [email protected] or in writing to Bristol CCG, South Plaza, Marlborough Street, Bristol BS1 3NX.

Annex Title QAG Gov Body

1.1 UH Bristol Quality Dashboard June 2016

1.2 NBT Quality Dashboard June 2016

1.3 BCH Quality Dashboard June 2016

1.4 Glossary of Terms and Abbreviations

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SECTION 1. Local Quality and Outcome Exceptions

Treatment for fractured neck of femur operated on within 36hrs (April)

National Standard UH Bristol NBT

90% 87.5% 80%

UH Bristol April 2016 data demonstrated some improvement in the percentage of patients seeing an Ortho-geriatrician within 72 hours (83.3%). The percentage achieving best practice tariff showed a slight improvement at 70.8%. The percentage of patients treated within 36 hours has improved slightly to 87.5% but all remain below the 90% threshold and demonstrate red performance. A clinical review by the British Orthopaedic Association has now been completed and the report will be available mid-June 2016.

NBT NBT reported 80% of patients with a fractured neck of femur were operated on within 36hrs in April 2016, a decrease from March’s figure of 91% (and is now below the 90% threshold).

Mitigations This has a continued focus at the monthly UH Bristol Quality Sub Group and IQPM meetings. The British Orthopaedic Association’s report will be discussed at the July 2016 UH Bristol Quality Sub Group. Fracture Neck of Femur is included in the Quality Schedule 2016/17 with the inclusion of local thresholds and contractual terms to ensure there are stronger contract management arrangements going forward. The CCG will continue to monitor performance against fractured neck of femur treatment targets via the NBT Quality Sub Group.


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Issue Highlighted: April 2013 Recovery Expected March 2017

CCG Director: Alison Moon CSU Lead: Emma Savage

Mixed Sex Accommodation Breaches (April)

UH Bristol

There have been no reported cases of mixed sex accommodation breaches reported by UH Bristol.

NBT There were a total of 6 mixed sex accommodation (MSA) breaches reported by NBT in April 2016, a significant decrease from the 34 breaches reported in February and a further reduction on the 8 reported in March. The breaches occurred on one occasion in the ED Observational Unit (EDOU), due to insufficient availability of cubicles. All approval for Gender Breaching is via the executives and validated against the Service Level Agreement for Mixed Sex Accommodation and CQC Guidance. All breaches are reported to the CCG and TDA.

Mitigations The CCG previously undertook an observational visit and provided NBT with further guidance and support and will undertake a quarterly audit of MSA breaches. The CCG will continue to monitor MSA breaches through the NBT Quality Sub Group and the ICQPM as required. The MSA contract schedule 2016/17 has been formally signed off by both UH Bristol and NBT. Issue Highlighted January 2016 Recovery Expected - to be reviewed for 2016/17

CCG Director Alison Moon CSU Lead Emma Savage

Friends and Family Test Inpatient Response Rate (April)

Locally Agreed Response Rate UH Bristol NBT 30% 35.2% 21.3%


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UHB

The FFT inpatient response rate has increased from 26% in March 2016 to 35.2% in April (exceeding its trajectory of a 30% response rate by June 2016). The Trust has explored alternative ways to gather patient experience information, including the use of text message and possibly changing their supplier to provide real time patient feedback. The Trust has rolled out a poster campaign to help improve the response rate for outpatients. The percentage of patients in April 2016 who would recommend the service remains high at 97.1%. These results are shared with ward staff and are displayed publically on the wards.

NBT The FFT inpatient response rate has increased from 16.7% in March to 21.3% in April 2016, although a positive increase it continues below the locally agreed target of 30% for the tenth consecutive month. Inpatients continue to use the FFT cards for feedback (unlike the other areas implementing the new interactive system). Inpatients will however trial using tablets, text messaging and interactive voice messaging in September. NBT have produced a detailed action plan with a trajectory for improvement. 97% of responders reported that they would recommend the NBT inpatient service. This has remained a consistent high percentage over the last 9 months.

AWP & RBP The FFT inpatient response rate has improved again from 24% in March to 26% in April 2016 (was 20% in January and 23% in February). 86% of patients said they would recommend the service and 9% of patients said they would not recommend the service. The FFT community response rate for RBP decreased slightly from 9.4% in March to 8.2% in April 2016. 82% of respondents stated that they would recommend the service and 2% said they would not (improved from 8.3%).

Mitigations The CCG will continue to monitor UH Bristol’s progress against the Remedial Action Plan (RAP) and trajectory until completion in June 2016 (information available end of July 2016). South Gloucestershire CCG monitors the FFT response rates for NBT through the monthly Quality Sub Group meetings. Improvement will be monitored following the appointment of the new supplier. South Gloucestershire CCG will consider issuing a Contract Performance Notice if no improvement is made. Both AWP and RBP have an improvement trajectory plan in place that is reviewed and monitored by the CCG. Commissioners have decided not to apply targeted measures via the Quality and Reporting Schedule for 2016/17 due to required focus on other


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priorities. However, AWP have committed in their draft Quality Account to improve FFT scores to over 20% with 90% recommendation rate. Issue Highlighted June 2015 Recovery Expected July 2016


Friends and Family Test Emergency Department (ED) Response Rate (April)

Locally Agreed Response Rate UH Bristol NBT

15% 14.7% 27.0%

UH Bristol

The Trust’s ED FFT response rate has improved this month to 14.7% (remaining slightly below the required 15% threshold). 80.2% of patients say they would recommend ED to a friend or family for care and treatment which is below the 87% national average of all NHS Trusts. To help increase the response rate, the Trust is exploring alternative ways to gather patient experience information, including the use of text message and possibly changing their supplier to provide real time patient feedback.

NBT The ED FFT response rate increased from 13.7% in March to 27% in April 2016, well above the target of 15%. The Trust has recently implemented a new system (Healthcare Communications) to capture FFT responses in the ED, Outpatients, day cases and Maternity. Patients can submit their responses via text messaging and interactive voice messaging. This has already had a positive effect and is yielding good responses and increasing the response rate. 95% of the patients who responded would recommend NBT’s ED.


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Mitigations

The response rate and patient feedback for the FFT is monitored by the CCGs through the monthly Quality Sub-Group meetings. Issue Highlighted April 2015 Recovery Expected September 2016


Friends and Family Test Outpatients Response Rate (April)

Locally Agreed Response Rate UH Bristol NBT NA 1.0% 3.6%

UH Bristol UH Bristol’s FFT response rate for outpatients in April 2016 was 1.0% and below the 6.2% average response rate for all NHS providers. This is a decrease on March 2016 performance (1.72%). The Trust is rolling out a poster campaign to help improve the response rate for outpatients.

NBT NBTs FFT response rate for outpatients improved from 0.96% March to 3.6% in April 2016, however remains below the national average response rate of 6.2%. 91% of responders would recommend the outpatient service at NBT and 3% would not recommend the service (9% in March) against a national average of 92%.


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Mitigations

A 6% response rate has been included in the 2016/17 Quality Schedule and SCWCSU is waiting final sign off by UH Bristol. Outpatient FFT will be monitored through the quality sub group. Outpatient FFT response rate will continue to be monitored by South Gloucestershire CCG through the NBT Quality Sub Group. Issue Highlighted December 2016 Recovery Expected March 2017


BCH - FFT Patients seen at home or in clinic (April)

During April 2016, 370 patients who were seen at home or in a clinic responded to the FFT question. 97% of patients would recommend services to friends and family should they require similar care or treatment. Only 1 patient responded that they would not recommend services.


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BCH –FFT Patients seen in Urgent Care Centre (UCC)/Walk in Centre (WIC) (April)

During April 2016, 202 patients seen at the Urgent Care Centre and Walk in Centre responded to the FFT question. This is above the rolling average of the previous 6 month period (126). 84% of patients seen in the UCC / WIC services would recommend services to friends and family should they require similar care or treatment, with 6% of patients who said they would not recommend services. Themes arising from patient experience feedback continue to pertain to the need for:

Improved access and appointments

Better understanding and increased confidence

Clear and comprehensible information

Emotional support, empathy and respect

Involvement in decisions and respect for preferences

Mitigations

The FFT will continue to be monitored in the IQPM. The CCG has included an expected target response rate for the Urgent Care Centre BCH in the Quality Schedule for 2016/2017.

National Early Warning Scores (April)

National Target UH Bristol NBT 95% 87% TBC

UH Bristol

In April 2016 performance pertaining to the National Early Warning System (NEWS) is 87% against a three year improvement goal of 95% (similar to the previous three months 86% to 88%). The deterioration has been attributed to the introduction of a new adult observation chart incorporating NEWS in December 2015 which meant a change for staff in how


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Early Warning Scores are calculated and in the escalation of deteriorating patients for senior clinical review.

Mitigations NEWS acted upon will be closely monitored at UHB Quality Sub Group to ensure improvement. The CCG has included within the 2016/17 Quality Schedule measures to ensure providers have a unified approach to scoring patient observations to indicate severity of acute illness, deterioration and the need for escalation of treatment by:

Use of the NEWS

Monitoring compliance with use of NEWS

VTE Assessment (April)

National Target UH Bristol NBT 95% 99.3% 91.5%

*VTE data not available for NBT for January 2016 due to notes backlog

UH Bristol Compliance with VTE risk assessment increased from 96.9% in March to 99.3% in April 2016 which is above the national threshold of 95% and the Trust’s internal target of 98%. The Trust is due to send to the CCG the Quarter 3 RCAs for all Hospital Acquired Thrombosis for commissioner review. It is intended to extend the time in the fortnightly CCG Serious Incident Review Panel to review these RCAs. Key themes will be included in June’s quality report.


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NBT

VTE Assessment compliance reduced from 94.2% in March to 91.5% in April 2016, continuing below the 95% target. NBT report a compliance risk in relation to the RAP for Quarter 1, 2016/17 and are unlikely to reach the 95% target for VTE Assessment. They also only achieved 50% of the 100% target for completing Root Cause Analysis (RCA) reports for HATs. The Trust is expected to consistently achieve 95% standard for VTE risk assessment from July 2016 onwards. NBT continues to report that the primary issue with poor performance relates to the timeliness of coding rather than the clinical completion of risk assessments. NBT continue to work to resolve the issue in order to give a true representation of assessment compliance.

Mitigations The CCG is monitoring the Root Cause Analysis reports for all confirmed cases of hospital acquired VTE at the fortnightly SI Review Panel. NBT will revise and update the current RAP to reflect the risk and include actions relating to RCAs for HATs. Compliance to VTE assessment, RAP progress and the completion of RCAs continue to be monitored through the NBT Quality Sub Group and are included within the Quality Schedule for 2016/17 for all providers. The Trust is also considering an alternative way of monitoring VTE performance. Issue Highlighted July 2014 Recovery Expected July 2016 (to be reviewed for 2016/17)


Nutritional Screening (April) National Target UH Bristol NBT*

90% 74% (Quarter 3) 81.7%


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UH Bristol

UH Bristol audits nutritional screening data on a quarterly basis rather than monthly. This is not currently reported within their Trust scorecard, however UH Bristol were asked to provide their quarterly data for nutritional screening on admission. This is reported as follows 85% for Quarter 1, 77% for Quarter 2 and 74% for Quarter 3 and 71% for Quarter 4.

NBT NBT nutritional screening compliance increased from 75% in March to 81.7% in April 2016, although the figure consistently remains below the national target of 90%. NBT have achieved the 90% target just once in the last 12 months (in June 2015). As part of NBTs Quality Improvement drive, a second audit has been completed and a daily 5 patient snap shot audit is underway. Nutrition assessments are completed within 12 hours (previously 48 hours) and focused training continues. A Nutrition Driver Diagram has been developed which incorporates nutrition screening and shared with all ward sisters. Implementation will be managed through NBTs Ward Nutrition Group and the Trust’s multi professional Nutrition Working Group. Significant training for senior nurses on the completion of nursing assessments on Lorenzo has taken place over the last two months and it is hoped that this will have a positive impact on the planned trajectory.

Mitigations The CCG will continue to monitor nutritional screening on a quarterly basis at UHB Quality Sub Group. South Gloucestershire CCG will continue to monitor nutritional screening assessment and receive assurances on improvement through the NBT Quality Sub Group. NBT will be providing an updated action plan with trajectory for when the 90% target will be achieved to the Quality Sub Group in June 2016. Ensuring good nutrition and hydration is included in the Quality Schedules for 2016/17.

Pressure Ulcer Rate (April)

National Target UH Bristol NBT NA 0.275 6.1

*Per 1,000 bed days


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UH Bristol

The Trust continues to have low levels of incidence of pressure ulcers reporting 0.275 per 1,000 bed days in April 2016.

NBT NBT’s rate of pressure ulcers per 10,000 bed days reduced slightly from 6.7 in March to 6.1 in April 2016. A total of twenty two grade 2 pressure ulcers were reported in April, no grade 3 or grade 4 pressure ulcers were reported in the month, continuing NBTs internal trust target of zero Grade 4 pressure ulcer cases. Continuing the drive to reduce pressure ulcer incidence, NBT Directorates are informed of pressure ulcer occurrence within their clinical area by grade and location. The pressure ulcer prevention training programme continues across the Trust supported by the Trust-wide newsletter and Pressure Ulcer Steering Group.

Mitigations The BNSSG Stop the Pressure work continues as a collaborative approach to prevent and manage pressure ulcers. Grade 3 and 4 Pressure Ulcers continue to be raised as SIs and reviewed on a regular basis by the CCG.

Pressure ulcer incidence will continue to be monitored through the Quality Sub Groups. Issue Highlighted October 2014 Recovery Expected September 2016


BCH Pressure Ulcer Rate (April)

BCH reported 74 pressure ulcers in April 2016, which is a continued increase from 61 in February and 64 in March and is due to an increase in reporting grade 2 pressure ulcers.


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The Tissue Viability Specialist Nurse validated 20 pressure ulcer incidents during April 2016. Seven incidents were found to be incorrectly categorised as pressure ulcers; six of these incidents were attributable to friction or moisture. The seventh incident was related to trauma caused by footwear and therefore would not be reported via NRLS. BCH has started work on a new pressure ulcer prevention strategy. The wound care service team have visited every community team to discuss SSKIN and pressure ulcer prevention. All staff are being asked to handover about SSKIN for every patient and complete the SSKIN EMIS template for every patient for every visit. Three teams have a wound care specialist nurse working with them every week to promote proactive pressure ulcer prevention.

Mitigations Discussions between the CCG and BCH at the Quality Sub Group have focused on improving the analysis of RCA’s to identify learning. A CQUIN has been agreed to address pressure ulcer prevention for 2016/17. It has been agreed that the Quality Teams will meet to jointly review an RCA. Issue Highlighted April 2015 Recovery Expected September 2016


Complaints Response Rate (April)

National Target UH Bristol NBT NA 81.6% 85% (Sept)

UH Bristol

The response time to complaints within the agreed timescale deteriorated from 86.1% in March to 81.6% in April 2016. The Trust agrees the timescale for response with each individual complainant and monitors rates against this and has no backlog of complaints. There is a thorough checking process in place to improve the quality of response letters, whereby all letters are firstly checked by the case-worker handling the complaint, then by the Patient Support & Complaints Manager. The Head of Quality for Patient Experience & Clinical Effectiveness also checks a selection of response letters each week.

NBT NBT has not published data pertaining to complaints response rates since September 2015. NBT received a total of 52 complaints and 48 concerns in April 2016, continuing the decrease from February 2016. NBT reported 100% compliance with the NHS 3 day acknowledgement target and no complaints opened since April 2015 exceeded the 6 month target. There were 47 overdue complaints in April, the largest number reported in Anaesthesia, Surgery and Critical Care (40%). NBT continue to work towards reducing overdue


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complaints through a combination of support and development work with the Patients Association and targeting directorates with specific issues. NBT have provided the CCG with an action plan and trajectory for the complaints backlog (aiming to be less than 10 by the end of July 2016). Clearing the backlog remains a priority for NBT.

Mitigations The CCG notes that performance continues to be on an upward trajectory for UH Bristol but will be keeping a close oversight on complaint response times through monitoring of the quarterly patient experience and complaint report at the Quality Sub Group. South Gloucestershire CCG will continue to monitor all aspects of complaints through the Quality Sub Group. NBT will provide a trajectory to May’s Quality Sub Group as to when the complaints backlog will reduce below 10. South Gloucestershire CCG will continue to monitor all aspects of complaints (including the Trust’s progress against their action plan for backlog reduction via the NBT) Quality Sub Group. Issue Highlighted October 2015 Recovery Expected - to be reviewed for 2016/17


Section 136 Suite (April)

National Target AWP

NA 25 admissions (March)

AWP AWP reported 25 Bristol admissions (equating to 46% of the total) to the Place of Safety in April 2016. This is a further decrease from the ‘spike’ of 51 admissions (70% of the total) noted in January 2016. Of the Bristol service users, 91% were white British, with only 2 service users from other ethnic groups. The gender split was 52% male and 48% female. There were no service users under the age of 16, 16% were aged 18-25. The most common age range was 26–45 (68%). 12% were 46-64 and 4% were over 65 years.


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The most recent statistics pertaining to 136 admissions to police cells shows that there were 3 such admissions of Bristol residents in April 2016. Ambulance services transported 35% of patients to the Place of Safety (challenges remain but this is an improvement from 18% in January 2016). Waiting times for assessment increased in April 2016 with only 20% of service users assessed within the 4 hour target, 48% were assessed within 12 hours, 48% were assessed within 24-36 hours and the longest wait was more than 60 hours. The most common reasons for delays continue to relate to Approved Mental Health Professional (AMPH) availability (50%), intoxication (20%) and availability of other teams (10%). The most common reason for patients remaining on the unit after their assessment was completed was due to the unavailability of mental health beds (92%). Of the patients who were assessed in April, 20% were followed up by the Crisis Team, 48% were admitted, 12% were followed up by community services and 20% required no follow up. The majority of Bristol admissions were seen outside of 9am to 5pm working hours and spread across the week.

Mitigations The issues relating to the whole system are monitored at all contract meetings. Revised arrangements are in place to mitigate the changes to police procedures from 1 June 2016. In addition control room triage support will commence from 1 August which is expected to provide further mitigation. Issue Highlighted October 2014 Recovery Expected March 2017

CCG Director Jill Shepherd CSU Lead Bernadette Knight


22

AWP & RBP Unallocated Cases (May)

The graph below shows the weekly summary of unallocated cases across Bristol and by locality, please note some weeks are missing.

With the continued high volumes of referral for all three assessments and recovery teams the timely allocation of cases remains challenging. However, the new tracking system appears to be working well giving a daily, detailed analysis of all breaches. Numbers are monitored on a daily basis and shared weekly with CCG via SCWCSU. Overall numbers have reduced since January 2016. There remains a smaller number of referral to assessment breaches, largely due to DNAs or service user choice.

Mitigations The CCG is working closely with the Trust and is closely monitoring performance pertaining to unallocated cases via the RBP LCQPM. Issue Highlighted July 2015 Recovery Expected September 2016


Infection Control

Clostridium difficile (April) The number of C. difficile infection cases for Bristol CCG was below the threshold for April 2016. There were 8 cases against a threshold of 18. Bristol CCG position for 2016/17 April May June July Aug. Sept Oct Nov Dec Jan Feb Mar Total Acute Cases

6 (6) 6

Non-acute Cases

2 (8) 2

Total cases

8 (14) 8

Objective 18 8 11 16 13 11 9 9 7 10 9 10 131


23

Trust position for 2016/17

UH Bristol annual

threshold

UH Bristol (monthly figure)

NBT annual threshold

NBT (monthly figure)

45 2 43 0

UH Bristol Two cases of C. Difficile infection were identified at UH Bristol in April 2016. The number of C. Difficile cases against the objective of 45 for the April 2016 is 2 cases of which 0 were due to lapses of care. The Trust has put in place an action plan for ward A508 as there have been 3 cases of C difficile on the ward and lapses in care had been identified.

NBT For the second consecutive month NBT reported zero cases of C. Difficile in the month of April 2016. The annual target is set at a maximum of 43 cases for the year 2016/17. NBT continue to focus on reducing the incidence of C.Difficile and undertook a thematic review of lapses in care cases for 2015/16. Themes identified included environmental and point of care equipment cleanliness and prompt patient sampling.

Mitigations The CCGs continue to work with the Trusts reviewing all C. difficile cases to identify lapses in care and review action plans. Governance is in place to review all healthcare associated cases. The action plan for Ward A508 is being monitored by the CCG through the C Difficle RCA meeting and HCAI group. Bristol CCG has put in place an action plan to reduce the numbers of C Difficile cases. Progress against the action plan is discussed monthly at the HCAI group. Cases of C.Difficile will continue to be monitored via the Quality Sub Groups. Issue Highlighted April 2015 Recovery Expected - Sept for 2016/17



24

MRSA (April)

The number of MRSA pre 48 hour bacteraemia cases assigned to Bristol CCG from April 2016 to March 2017 is as follows: April May June July Aug Sept Oct Nov Dec Jan Feb March Total 1 (1) 1

The number of MRSA cases assigned to third party from April 2016 to March 2017 is as follows: April May June July Aug Sept Oct Nov Dec Jan Feb March Total 0 (1) 0

National threshold UH Bristol NBT

0 0 1

UH Bristol There were no cases of MRSA reported by UHB in April 2016.

NBT There were no cases of MRSA reported by NBT in April 2016.

Mitigations Every case of MRSA blood stream infection assigned to a provider incurs a £10,000 financial penalty and it forms part of the NHS Constitutional Standards. The CCGs monitor cases of MRSA via the monthly Healthcare Associated Infection (HCAI) meetings. These are held with providers of acute and community care to share learning to reduce HCAIs including MRSA. The CCG will continue to monitor MRSA incidence through the Quality Sub-Groups and undertake MRSA Bacteraemia Post Infection reviews (PIRs) when required. Issue Highlighted April 2015 Recovery Expected - NA


AWP - Suspected Norovirus in Laurel Ward and Lime Ward (March)

During March 2106, Laurel Ward and later Lime Ward, were closed to admissions and discharges due to an infection outbreak (suspected Norovirus). An action plan is in place including involvement of both AWP and UH Bristol infection control teams. The wards have now reopened. AWP have instigated their policy and procedures for control of infection and a report will be received at the next Quality Sub Group meeting in June 2016.


25

Mitigations

The CCG is in close contact with the Trust and monitors status via the local contract and Quality Sub Group meetings. The Trust regularly updates the CCG via communication with SCWCSU.

Staff Turnover (April)

Local target UH Bristol NBT BCH See below 13.6% 9.8% 24.47%

NB: local thresholds

UH Bristol Staff turnover increased from 13.4% in March to 13.6% in April 2016. The biggest increase was in Trust Services. The largest rise was among professional /scientific and administrative / clerical staff groups. Programmes to support staff recruitment remain a key priority for the Divisions and the Trust. Increased turnover is due in part to increased retirements which have doubled compared with the April 2015.

NBT Staff turnover at NBT in April 2016 was reported at 9.8%, largely unchanged since August 2015 and below the 12% threshold. There were 306 (244 WTE) leavers in April 2016 compared to 799 (583 WTE) leavers in March, predominantly the final transfer of CHHP staff accounting for 207 of the 306 leavers.


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BCH

There has been a decrease in staff turnover from 25.16% in March to 24.47% in April 2016. The three month voluntary turnover figure for clinical staff has remained at around 4% for the third month in a row indicating a period of lower turnover than that experienced in the summer months of 2015. BCH’s three year Staff Wellbeing Strategy has been launched and shared with GP colleagues. The strategy supports staff with their physical, mental and general wellbeing at work, aims to reduce turnover, improve recruitment and retention and staff morale and create a more resilient workforce. BCH have launched a staff benefits platform giving staff access to a wide range of benefits, many of which save them money through salary sacrifice. It also provides an extended Employee Assistance Programme giving staff free access to a range of support services such as counselling, financial advice and legal advice.

AWP & RBP (March) The Trust’s HR department has not provided the usual staffing report this month due to pressures with the CQC inspection.

Turnover of AWP staff working within inpatient services 2015/16

April May June July Aug Sept Oct Nov Dec Jan Feb March

% posts vacant

14.86 16.48 15.47 13.99 14.31 11.85 12.74 12.31 14.51 14.75 11.44 13.29

% FTE turnover

18.01 19.36 18.17 17.91 15.09 14.40 13.26 12.91 13.94 12.74 11.74 12.69

The overall turnover rate for AWP staff working in RBP (community services) was largely unchanged in March 2016 at 14.93%. The monthly turnover is detailed in the table below:

Turnover of AWP staff working in RBP (community services) 2015/16

2015/16 April May June July August

Sept Oct Nov Dec Jan Feb Mar

% posts vacant

-4.04 -4.03 -2.89 1.16 1.54 -2.50 -3.98 0.54 -0.39 -0.45 -8.82 -5.70

% FTE turnover

6.86 8.10 9.65 12.53 14.05 17.26 16.54 15.40 14.80 14.69 14.47 14.93

Currently data pertaining to the turnover of Voluntary Care Sector (VCS) staff working within the RBP services is reported differently – the VCS organisations report annual rolling rates rather than monthly figures. The turnover of VCS staff since April 2015 is detailed in the table below: VCS organisation Overall organisational turnover

since April 2015 Turnover of VCS staff working for RBP since April 2015

Second Step 24.43% 32%

Missing link 15% 35%

Off the Record TBC TBC

Nilaari TBC 66%

Brunel Care NA (recruiting from Jan 2016) NA


27

These figures have increased from January 2016, particularly for Second Step. A wide ranging Trust strategy is ongoing to try to improve recruitment and retention but challenges persist. Discussions are on-going with the VCS organisations to try to standardise reporting.

Mitigations Workforce issues are discussed in depth on a quarterly basis at the UH Bristol, NBT and BCH Quality Sub Groups. The Director of Human Resources often attends these meetings to respond to specific questions posed by the CCG. AWP issues are closely monitored on a monthly basis via locality meetings, the CQPM and also through the CQC work programme monitored by the TDA/NHSE/ Commissioners/Trust via the bi-monthly Quality Improvement Group. Issue Highlighted July 2014 Recovery Expected March 2017


Staff Vacancies (April)

Local Target UH Bristol NBT BCH 5% WTE 3.8% 6.5% 11.05%

UH Bristol

UH Bristol vacancies reduced to 3.8% (305.8 FTE) against a target of 5%. Nursing vacancies reduced partly due to the end of winter pressures funding in Women’s & Children’s Division. Also nursing vacancies reduced by 10.4 WTE in the Division of Medicine. Registered nursing vacancies are the lowest since April 2015.

The Trust’s programme of recruitment activities is on-going. They are closely monitoring specialist nursing and theatre vacancies. Additional investment is in place


28

for Heygroves Theatres, Ward D703 and the Coronary Intensive Care Unit to support recruitment and retention.

NBT

NBTs vacancies slightly decreased from 6.9% in March to 6.5% in April 2016, equating to 484 WTEs. An increase in starters (111 WTE) was reported in the month of April, a net gain of 30 WTE. 41 Registered Nurses and 39 Non-Registered Nurses started in April with an additional 144 Registered Nurses due to start in August/September. NBT continues to work on their recruitment project with an upcoming open day planned in June.

BCH The overall vacancy rate for April was 11.05% (including bank staff) and 13.57% (excluding bank staff) compared to the March rate of 6.14% and 8.72% respectively. The increase in vacancy rate is due to the rebase lining due to the new financial year and revised budgets from 1 April 2016.

AWP & RBP The Trust’s HR department has not provided the usual staffing report this month due to pressures with the CQC inspection. For AWP inpatient services the vacancy rate in March 2016 was 13.29% - down from 14.75% in January but slightly increased on last month (11.44%). A wide ranging Trust strategy is on-going to try to improve recruitment and retention. The vacancy rates for VCS staff working in RBP are not yet standardised to report as a monthly percentage but across all VCS organisations 14.4 WTE posts were reported as vacant in March equating to 17%. The vacancy rate for AWP staff working in RBP services for March 2016 was minus 5.70% (.i.e. they are over established).

Mitigations Bristol CCG continues to monitor recruitment and retention strategies through the IQPM and Quality Sub Group meetings. The Directors of HR are invited to attend on a quarterly basis to present an update on actions being taken to address workforce issues. Issue Highlighted June 2015 Recovery Expected March 2017



29

Staff Sickness (April) Average all Health Education Regions England

UH Bristol NBT* BCH

3.99% 3.93% 4.5% (March) 3.51%

* AWP has not provided the usual staffing report this month due to pressures with the CQC inspection

UH Bristol

Sickness absence has reduced from 4.6% to 3.93% (against the Trust target of 3.9%), achieving the green status in 4 out of 7 Divisions. There were reductions in all Divisions, the greatest being nearly 25% in Diagnostics & Therapies. Trust-wide, days lost due to colds and flu reduced by 42% and gastrointestinal by 20%. The Trust’s programme of work to address sickness absence is on-going.

NBT NBT’s sickness absence reduced from 4.78 in February to 4.5% in March 2016 (reported one month in arrears), remaining above the Trust’s 2015/16 set target of 3.8%. The Trust target for 2016/17 is 4.2%. There were 150 long term sickness cases and 34 short term cases logged in April, with the number of cases being managed via HR gradually increasing. In addition to NBT’s work to address sickness absence figures (a new Sickness Absence Policy and training for managers), a plan is currently being formulated to achieve a new Health and Wellbeing CQUIN, introducing a range of physical activity, mental health initiatives and increased physiotherapy schemes for staff. NBT anticipate that these initiatives will support the work currently underway and help improve staff attendance.


30

BCH

BCH’s April 2016 sickness absence rate is 3.51% compared to March’s rate of 3.46% and is still below the recently published average for public services of 4.1% and for not for profit of 4.0% (as per CIPD Absence Management Survey 2015). Sickness levels continue to benchmark well against the national NHS average of 4.33% and community providers of 4.64% for the 12 month period to July 2015 (this is the latest data available). The corresponding BCH figure for this period is 3.13%, putting the organisation fourth out of 41 in the community provider rankings. The increase in sickness absence in part relates to cough / colds and flu. Mental health related absence is lower than the same period last year. The rest of the increase is due to proportionately lower absence months dropping out of the rolling year.

AWP & RBP (March) Please note that sickness rates are reported one month in arrears. AWP’s inpatient staff sickness rate improved in March 2016 to 5.29% from 5.48% in February against a threshold of 4.6% - short term sickness was impacted by the Norovirus outbreak on Laurel Ward. Sickness absence rates in RBP are reported as 3.6% for AWP staff and 2.8% for VCS staff. AWP/RBP staff sickness rates are monitored monthly and managed by local managers (with HR support as required).

Mitigations The CCG discuss staff sickness at monthly Quality Sub-Groups and IQPM. The Directors of HR are invited to attend on a quarterly basis to present an update on actions being taken to address workforce issues. Issue Highlighted December 2014 Recovery Expected March 2017


RBP Supervision and Appraisal (April) Supervision and appraisal rates for April 2016 are:

Service Supervision Appraisal

AWP RBP staff 87% 92%

VCS RBP staff Incomplete data 66%

Supervision and appraisals were included within the 2015-16 Service Development and Improvement Plan with trajectories set as follows:

Supervision: September 85% and October 85%

Appraisal: September 80%, October 85%, November 90% and December 95%. No further trajectories have been set. As part of the CQC action plan the Trust is reviewing automated systems to accurately record VCS HR activity. Work continues to ensure an accurate, automated system is in


31

place to record rates for VCS community staff but data is incomplete so not yet reliable. Appraisal for VCS staff is now starting as staff become due for annual review.

Mitigations The CCG closely monitors supervision and appraisal performance via the IQPM. Issue Highlighted April 2015 Recovery Expected March 2017


BCH Information Governance and Safeguarding Training (April) Information Governance training has been reported as 90% for April 2016 (rated green). BCH has reported a rise in information governance incidents in April 2016. These are described as being attributable to the TUPE of children’s services into BCH as there have been some issues with the transfer across of information. It was noted that a review of incidents for the service has identified that information governance incidents are the highest reported incident for this group. BCH have ensured that all 500 staff transferring from Children’s services have undergone information governance training as part of their induction to the service. This has raised awareness amongst staff and has also facilitated (positively) the increase in reporting of incidents. Safeguarding adult training compliance is 96% for April 2016 (rated green). Safeguarding children’s training stands at 92% for Level 1, 95% for Level 2, 83% for Level 3 (amber status) and 100% for Level 4. The Safeguarding Children Lead and Learning and Development team are currently reviewing both the delivery and administration of the Safeguarding Level 3 programme.

Mitigations The CCG closely monitors progress on all aspect of training via the IQPM.

AWP & RBP Safeguarding training (April) The AWP RBP safeguarding training rate continues to improve with 92.1% for level 1, 89.4% for level 2 and 88.8% for level 3. VCS staff training is now aligned to mirror AWP level 3 safeguarding training but the figures for this month need to be validated so will be updated in full next month. For AWP inpatient teams, safeguarding training compliance for the month of April was 92.8% for level 1, 87.1% for level 2 and 100% for level 3.

Mitigations The CCG closely monitors progress with Safeguarding training via the IQPM. The Adult & Children’s Safeguarding Leads have been asked for their view regarding the efficacy of the VCS level 3 training meeting the level 1 & 2 requirements.


32

Issue Highlighted April 2015 Recovery Expected: to be reviewed for 2016/17


al Health Services

Patient Advice and Liaison (PALS) (April)

In April 2016 a total of 74 new cases were recorded; of these 26 (35%) were Bristol

cases.

Themes and Actions PALS have taken the opportunity of the beginning of a new reporting year to amend

some of the categories to better reflect the work of the CCG as it has progressed. The

Provider/community category is now labelled ‘Community’ this covers feedback around

the community services provided by Bristol Community Health. ‘Connecting Care etc’

refers to the data sharing projects of Summary Care Record, care data and Connecting

Care as numbers of each of these are down to one or two a month so they have been


33

merged into one category. The ISTC category has been changed to ‘Independent

sector’ to recognise the change in contracts for the ISTCs to the same as other

independent sector contracts and includes all AQP contracts.

With a relatively low number of contacts in April, it is difficult to identify any themes

other than the recurring problem of people contacting PALS thinking they are calling

LIFT. During March, PALS liaised with the commissioning manager regarding a

publicity drive with GPs to ensure they are using the current literature rather than old

copies from their drawer. However, it is too soon for this to have taken effect so PALS

will continue to monitor the situation and to identify the practices that are giving their

patients incorrect contact details whilst expecting these contacts to reduce over time.

One GP practice and a crisis team member contacted PALS to request further copies of

the ‘LIFT’ leaflet. PALS advised on the changes to the service and passed the

requestors’ details to IAPT to provide new leaflets.

The two members of the PALS team have enrolled on a transgender awareness

workshop and the ASIST training day designed to give confidence when dealing with

people who are expressing suicidal thoughts.

Compliments

One compliment was received this month from Bristol service users regarding the help and support in making a complaint about services at NBT in November 2015. The complainant has been granted a resolution meeting that will take place in May.


34

SECTION 2. Serious Incidents (May)

UH Bristol For the month of May 2016, UH Bristol reported 8 Serious Incidents (SIs). These pertained to a child death, a medication incident, a pressure ulcer, three falls, a sub-optimal care case and a 12 hour trolley breach. This bring the total number of incidents for the year to 11 SIs, a slight increase on the same time last year where UH Bristol had reported 10 SIs up until the end of May 2015. The table below shows the break-down of all reported SIs entered onto STEIS for UH Bristol as from April 2016. UH Bristol Serious Incidents for April to May 2016/17

2016/2017

Serious Incident Type

Ap

r

May

Ju

n

Ju

l

Au

g

Sep

Oct

No

v

Dec

Jan

Feb

Mar

To

tal

%

Child Death 1 1

2 18%

Medication Incident

1

1 9%

Pressure Ulcer grade 3

1

1 9%

Slip, trips, and falls

3

3 27%

Sub-optimal care for deteriorating patient

1

1 9%

Trolley breach

1

1 9%

VTE 1

1 9%

Unexpected Death (general) 1

1 9%

Never Events

0

Total (excluding Never

Events) 3 8 0 0 0 0 0 0 0 0 0 0 11 100%

Slips/trips/falls currently represent the most common type of incident for the year to date with 3 cases; child deaths were the highest reported type of incident for the same time period last year with 2 cases. The table below represents the breakdown of the number of SIs involving Bristol CCG patients this year to date. Most of the incidents reported in May 2016 related to patients from the Bristol area, however, two cases involved Somerset patients (pressure ulcer and medication incident) and one from North Somerset (a child death).

2016/2017

UH Bristol

Ap

r

May

Ju

n

Ju

l

Au

g

Sep

Oct

No

v

Dec

Jan

Feb

Mar

To

tal

%

Bristol CCG 1 5

6 55%

South Gloucestershire CCG

1

1 9%

North Somerset CCG

1

1 9%

CCG OTHER 1 2

3 27%

Total 3 8

11 100%


35

In May 2016, the Trust had a 100% compliance rate for reporting SIs within the expected timeframe, in accordance to national policy. The Trust also achieved 67% compliance with 72 hour reports. From the beginning of April 2016 to date, the Trust’s SI reporting compliance stands at 91% and 100% for 72 hour report submissions. For this reason the CPN relating to serious incidents has been closed.

NBT For the month of May 2016, NBT reported 11 SIs. These pertained to slips/ trips/ falls (4 incidents), surgical/invasive procedures (2 incidents), treatment delays (2 incidents), a medical equipment failure, a sub-optimal care and a diagnostic incident. The table below shows the break-down of all reported SIs entered onto STEIS for NBT from April to May 2016. NBT Serious Incidents for April to May 2016/17

2016/2017

Serious Incident Type

Ap

r

May

Ju

n

Ju

l

Au

g

Sep

Oct

No

v

Dec

Jan

Feb

Mar

To

tal

%

Diagnostic Incident 0 1 1 5%

Sub-optimal Care of Deteriorating Patient 0 1 1 5%

Medical Equipment Failure 0 1 1 5%

Medication Incident 1 0

1 5%

Slip, Trips, and Falls 4 4

8 42%

Surgical/Invasive procedure incident 2 2

4 21%

Treatment Delay 1 2

3 16%

Never Events 0 1

1 Total (excluding Never

Events) 8 11

19 100%

One ‘Never Event’ relating to wrong site anaesthesia was reported by NBT in May 2016. The procedure was for a left cemented hip hemiarthroplasty. Another anaesthesia block was placed on the correct side and the operation progressed unremarkably. In light of the patient’s cognitive impairment, both the patient and his wife were informed the following day. A full RCA investigation is currently underway. Slips/trips/falls currently represent the most common type of incident for the year to date with 8 cases (similarly to the same time period last year with 4 cases reported). The CCG was asked by SGCCG to comment on an NBT SI that occurred in April and involved primary care, relating to antenatal blood sugar screening results not being acted upon. Review of the incident identified that whilst results had been acted upon there was a lack of communication between the GP and Midwives to confirm that the blood results had been acted upon. The table below indicates the breakdown of SIs by CCG. To date, 32% of reported incidents involved patients from the Bristol area (a diagnostic incident, 3 falls and a surgical/ invasive procedure case).


36

2016/2017

NBT

Ap

r

May

Ju

n

Ju

l

Au

g

Sep

Oct

No

v

Dec

Jan

Feb

Mar

To

tal

% South Gloucestershire CCG

6 4

10 53%

North Somerset CCG 0 1

1 5%

Bristol CCG 1 5

6 32%

Other CCG 1 1

2 10%

Total 8 11 0 0 0 9 0 0 0 0 0 0 19 100%

In May 2016, the Trust had an 82% compliance rate for reporting SIs within the expected timeframe. The Trust also achieved 50% compliance with 72 hour reports, with one report not yet due. From the beginning of April 2016 to date, the Trust’s SI reporting compliance is at 84% and 35% for 72 hour report submissions.

BCH For the month of May 2016, BCH reported 4 SIs, all of which were pressure ulcers. This brings the total number of incidents for the year to 6 (one of April’s incidents was approved for removal/downgrading). This is an increase in comparison to the same reporting period last year where 5 SIs were reported (all pressure ulcers).

BCH Serious Incidents for April to May 2016/17

2016/2017

Serious Incident Type A

pr

Ma

y

Ju

n

Ju

l

Au

g

Se

p

Oc

t

No

v

De

c

Jan

Feb

Ma

r

To

tal

%

Pressure Ulcer 2 4

6 100%

Never Events

0 0%

Total (excluding

Never Events) 2 4

6 100%

For the month of May 2016, BCH had a 75% SI reporting compliance rate and achieved 75% compliance with 72 hour reports. From the beginning of April 2016 to date, compliance with both SI reporting and 72 hour report submission stands at 83%.

St Peters Hospice St Peter’s Hospice did not report any SIs in May 2016, leaving the total number of incidents from April 2016 to date at 2 cases (both of which pertained to pressure ulcers). From 1st April 2016 to date, St Peter’s Hospice had a 100% SI reporting compliance rate.

AWP For the month of May 2016, AWP reported 14 SIs (an increase from 5 in April). These pertained to a number of different CCGs, including 5 new cases relating to Bristol patients (4 apparent/ actual/ suspected self-harm incidents and a disruptive/ aggressive behaviour case). This brings the total number of incidents year to date, for all CCGs, to 19 cases; in comparison 18 were reported for the same time period in 2015/16. From


37

April to date, AWP reported 6 incidents relating to Bristol patients, in comparison to 4 incidents for the same time period in 2015/16. AWP Serious Incidents for April to May 2016/17 – Bristol Cases

Serious Incident category

2016/2017

Ap

r

Ma

y

Ju

n

Ju

l

Au

g

Se

p

Oc

t

No

v

De

c

Ja

n

Fe

b

Ma

r

To

tal

%

Apparent/actual/suspected self-inflicted harm

4

4 67%

Disruptive/ aggressive/ violent behaviour meeting SI criteria

1

1 17%

Slip Trips & Falls 1

1 17%

Never Events 0 0%

Total 1 5 0 0 0 0 0 0 0 0 0 0 6 100%

The table below shows the break down in accordance to incident category of all reported SIs for AWP to date for 2016/17 (all CCGs).

2016/2017

AWP

Ap

r

Ma

y

Ju

n

Ju

l

Au

g

Se

p

Oc

t

No

v

De

c

Ja

n

Fe

b

Ma

r

To

tal

%

BANES CCG 1 2

3 16%

Bristol CCG 1 5

6 32%

North Somerset CCG 3

3 16%

South Gloucester CCG

0 0%

Swindon CCG

4

4 21%

Wiltshire CCG

3

3 16%

NHS England

0 0%

Cygnet

0 0%

Never Events

0 0%

Total 5 14 19 100%

From 1st April 2016 to date, for all CCG areas, AWP’s SI reporting compliance stands at 95% due to a Swindon case not being reported within the expected 48 hours of incident identification. AWP also achieved 95% compliance with 72 hour reports, with a Bristol case 72 hour report received after the deadline.

RBP For the month of May 2016, no RBP SIs have been reported.

Mitigations The CCG is utilising an SI tracker to ensure provider compliance with the national serious incident framework 2015 for the reporting of incidents and submission of 72 hour, RCA reports and action plans. Compliance is monitored and discussed at the monthly Quality Sub Groups and IQPM. Close monitoring of AWP / RPB SI reports is being undertaken by the CCG to identify any incidents relating to patients in the unallocated cases group. An independent review of suicides in Bristol is being commissioned by the CCG. Bids have been received from a number of potential providers and these are currently


38

subject to CCG review. A shortlist has been agreed pending decision regarding which provider will proceed and report. The CCG has gained assurance at the IQPM from the discussion of the key theme analysis of pressure ulcer incidents completed by BCH. The CCG is also arranging a meeting with BCH to jointly review an RCA report with the aim of improving the analysis of SIs to identify learning and also reduce the number of requests for additional assurance made by the CCG to be able to close an incident on STEIS.

SECTION 3. Urgent Care Quality and Outcome Measures Exception Reports for SWAST, BrisDoc and Care UK NHS 111

SWAST – Serious Incidents (May) For the month of May 2016, SWASFT reported 3 SIs (all of which pertain to treatment delays). None of the incidents related to patients from the Bristol area. The table below shows the break down in accordance to CCG of all reported SIs for AWP to date for 2016/17.

2016/2017

SWAST

Ap

r

Ma

y

Ju

n

Ju

l

Au

g

Se

p

Oc

t

No

v

Dec

Ja

n

Fe

b

Ma

r

To

tal %

BANES CCG 1 1 11%

Bristol CCG 1 1 11%

North Somerset CCG 1 1 11%

Gloucestershire CCG 1 1 11%

Wiltshire CCG 1 1 11%

Somerset CCG 1 1 2 22%

Dorset CCG 1 1 11%

South Devon & Torbay CCG 1 1 11%

NEVER EVENTS 0 0%

Total 6 3 9 100%

SWAST reported 1 SI pertaining to Bristol CCG in February 2016. This related to a delayed diagnosis (traumatic fracture cervical spine). The investigation is currently on-going and is being reported on at the next IQPMG as it has been identified as a potential “theme”. SWAST reported one case relating to Bristol CCG in April 2016 which pertained to treatment delay. The investigation is currently ongoing with the RCA report due at the beginning of July 2016. Comparatively, SWASFT had reported 5 SIs for the same time period in 2015/16, with no Bristol related cases. From 1 April 2016 to date, for all CCGs, SWAST’s SI reporting compliance stands at 100% and achieved 67% compliance with 72 hour report submissions.

Mitigations

The CCG has requested that the brevity of the SWAST 72 hour reports and the lack of context and immediate actions to mitigate further risk has been discussed at the IQPM.


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SWAST – Vehicle Deep Cleaning An update has not been received from SWAST regarding this issue.

Mitigations An update pertaining to vehicle deep cleaning compliance is expected from SWAST at the next IQPMG which will be reported on in July’s Quality Report. Issue Highlighted December 2015 Recovery Expected - to be reviewed for 2016/17

CCG Director Alison Moon CSU Lead Daryl Fitzgerald

SWAST – Friends and Family Test (April) SWASFT publishes the FFT results on the safety netting leaflet which is left with patients who are not conveyed, and also on the Trust’s website. SWAST continues to consider as to how the question can be provided to other patients, including the potential for incorporation onto the electronic patient record. All quantitative responses are being provided to NHS England via Unify 2 in line with FFT guidance. Both quantitative and qualitative feedback is compiled onto a power point presentation which is shared with managers on a monthly basis. Feedback from patients continues to be very positive. Response rates remain low. However, this picture is replicated for all ambulance services nationally and the issue is a regular feature of the National Ambulance Service Patient Experience Group (NASPEG). Consideration has been given to employing a system to proactively text eligible patients the FFT; however it has been felt that this activity presents a risk of intruding on patient lives during what might be a traumatic time. The engagement team is small but currently being developed; thus some activities may be limited. An action plan has been created by a team of managers, with allocated responsibilities. Based on the responses from patients in April 2016, 87% would recommend the service and 10% would not recommend. In comparison, 86% recommended in February and 91% in March. Patient Opinion

The Trust regularly reviews and, where possible, responds to feedback from patients via the Patient Opinion website. A breakdown of the Patient Opinion stories received during February and March is as follows (April information is unavailable):

*Primary Service Line No. of stories

Positive Negative Mixed

Accident & Emergency (A&E)

11 8 2 1

*First Point of contact with the service as identified by the feedback

Mitigations

Progress with efforts to improve the FFT response rates will continue to be monitored via the SWAST IQPMG.


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Issue Highlighted December 2015 Recovery Expected March 2017


SWAST – Staff Sickness (March) Trust-wide sickness absence was previously reported as 5.42% in March 2016, with the end of year figure for 2015/16 standing at 5.35%. Trust-wide sickness absence for April 2016 is unavailable at this time. The table below reflects year rolling data (up until March 2016).

Mitigations An update pertaining to sickness absence is expected from SWAST at the next IQPMG which will be reported on in July’s Quality Report. Issue Highlighted April 2013 Recovery Expected March 2017


SWAST – Recruitment and workforce planning (March) SWAST’s Trust-wide frontline establishment is as follows:

Establishment detail as at 31 March 2016

East Division Budget ESR Variance

Qualified Staff 419.27 392.62 -26.65

Non-Qualified Staff (incl ACA and PSV) 274.53 267.60 -6.93

East Division Total 693.80 660.22 -33.58

West Division Budget ESR Variance

Qualified Staff 538.37 523.76 -14.61

Non-Qualified Staff (incl ACA and PSV) 347.50 346.91 -0.59

West Division Total 885.87 870.67 -15.20

North Division Budget ESR Variance

Qualified Staff (inc Advanced Practitioners)

648.11 612.21 -35.90

Non-Qualified Staff 266.18 270.45 4.27

North Division Total 914.29 882.66 -31.63


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Trust-wide Budget ESR Var

Qualified Staff (incl North Advanced Practitioner)

1605.75 1528.58 -77.17

Non Qualified Staff (incl ACA and PSV) 888.21 884.96 -3.25

Trust-wide total 2493.96 2413.54 -80.42 ACA- Ambulance care assistant, PSV - Patient Support Vehicle (essentially both non-clinicians in similar roles, one working in PTS and one within A & E).

SWAST previously reported staff turnover for the end of March 2016 as 14.10% (up from 13.87% in November). There was no information available pertaining to recruitment/vacancy breakdown by division/service line. Staff turnover pertaining to April 2016 is currently unavailable. The table below presents the rolling turnover from April 2015 to March 2016.

An update pertaining to staff turnover is expected from SWAST at the next IQPMG which will be reported on in July’s Quality Report. SWAST provides commissioners with quarterly briefings to provide assurance on recruitment and retention of staff. Issue Highlighted April 2013 Recovery Expected March 2017


Mitigations


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SWAST – Staff appraisals (March)

*Data for December, February and April is unavailable

SWAST previously reported that appraisal compliance remained low at 51.36% for the end of March 2016 (though a slight increase from January’s figure of 48.71%). The low compliance is attributed to increased demand on the 4th quarter leading to cancellation of appraisals due to patient safety issues and decreased staffing leading to increased demand and cancellation of pre-planned appraisals. ‘My career conversations’ (a new appraisal system) is being promoted by SWAST human resources and all non-operational staff appraisals are being prioritised. The new appraisal system is much simpler to use and aids a natural conversation. Information pertaining to April 2016 is currently unavailable

Mitigations An update pertaining to appraisal compliance is expected from SWAST at the next IQPMG which will be reported on in July’s Quality Report. Issue Highlighted February 2015 Recovery Expected September 2016


SWAST - Safeguarding (March) SWAST’s 2015/16 end of year Safeguarding training figures for the A&E service line which includes Prevent and Mental Capacity Assessment (MCA) is as follows:


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Reporting Unit

Module Staff Group Target Actual Total number

West Division Safeguarding Level 2 Clinical Staff 95% 99% 1002 West Division Safeguarding Level 1 Support staff - no

patient contact 95% 81% 16

East Division Safeguarding Level 2 Clinical Staff 95% 99% 746

East Division Safeguarding Level 1 Support staff - no patient contact

95% 36% 17

North Division Safeguarding Level 2 Clinical Staff 95% 98% 1075

North Division Safeguarding Level 1 Support staff - no patient contact

95% 67% 15

SWAST have not provided further information pertaining to Safeguarding training for April 2016. SWASFT had 1 Prevent referral in February 2016 in Taunton. There have been 1079 safeguarding referrals in February 2016 and 1042 in March. SWAST previously reported their recognition of the rise in the number of Safeguarding referrals which meant that the current referral process was becoming untenable. The Trust had reported a risk on the Trust risk register related to their current inability to report on Safeguarding training completed in some areas. Remedial action had been undertaken for Heads of Service to confirm training progress and the current position. The Trust was appointing a Learning Development Officer to facilitate and coordinate improvement efforts in relation to the recording of training. An End to End call review was conducted on the 5 May 2016 around the subject of “safeguarding” however SWAST did not participate.

Mitigations An update pertaining to appraisal compliance is expected from SWAST at the next IQPMG which will be reported on in July’s Quality Report. Commissioners have requested that SWASFT participates in the End to End call reviews that are taking place with NHS 111 to review the patient journey. Issue Highlighted December 2015 Recovery Expected - to be reviewed for 2016/17


BrisDoc – Serious incidents (May) BrisDoc reported no SIs involving Bristol patients in May 2016.

BrisDoc – Key Performance Indicators (April) As previously reported, concern was voiced at the BrisDoc GP Support Unit (GP SU) Contract Monitoring meeting regarding the light content of their Quality and Performance report. It was conveyed that commissioners expect reporting on all KPIs accompanied with robust and meaningful analysis of data. BrisDoc were also asked to


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provide data and supporting information pertaining to quality requirements such as mandatory/Safeguarding training and appraisals. As from April 2016 BrisDoc are now submitting a combined GPSU and Out of Hours (OOH) Quality and Performance report and aim to enhance the level of information provided. Though graphs pertaining to Health & Safety, Fire, Information Governance, Safeguarding children and adults, infection prevention & control, manual handing and equality & diversity have been included, data presented is unclear and is not supported by narrative analysing the activity and providing assurances to Commissioners.

The table below details performance against the Key Performance Indicators (KPIs).

Urgent Response Indicator (percentage)

May 15

Jun 15

July 15

Aug 15

Sept 15

Oct 15

Nov 15

Dec 15

Jan 16

Feb 16

Mar 16

Year End

Apr 16

To meet a minimum of 95% clinical advice within 2 hours

94 97 91 97 92 91 85 86 82 84 79 89 90%

Emergency Consultation within 1 hour

100 94 95 100 88 90 92 100 100 89 100 95 100

Urgent Consultations NHS 111 breaches excluded

95 92 94 92 90 90 93 91 88 93 87 92 90

Clinical Advice BrisDoc reports that April had been a challenging month, despite the volume of calls reducing they continue to struggle with clinical advice given within 2 hours, achieving 92% performance. With challenges around clinical resourcing and a high degree of variability in the accuracy of the dispositions provided by NHS111, BrisDoc is prioritising patient safety by ensuring a designated clinician is able to identify the high risk patients for expediting (and conversely the low risk patients). At times of high volume, BrisDoc are reviewing the calls received to get a better understanding of priority. At the weekend, at times of high demand, a meeting room close to the control centre is used for triaging. The recruitment of Pharmacists has helped but performance indicators remain a challenge. BrisDoc have recruited 4 new GPs on a fixed term basis to cover maternity leave (due to start work in June 2016). The use of the non-clinical safety call backs protocol is used to manage patient expectations during busy periods and also to maintain safety by identifying worsening symptoms and capturing any additional information. The protocol is now well embedded with more clarity of role definition with the call handling team and the process is managed at the weekend by the Assistant Shift manager.


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0

10

20

30

40

50

60

70

80

December January February March april

% of cases safety called

Urgent Face to Face Appointments BrisDoc monitor the performance against this KPI as the number of patients who have an appointment booked within two hours and who wait no longer than 30 minutes past the appointment time. The results against this standard are shown below: March 2016 April 2016

Number of patients with a two hour F2F disposition 1097 866

Number of patients seen by a clinician within two hours 960 (87%) 779 (90%)

Number of patients with an appointment booked and arrived at base within 2 hours and waited less than 30 minutes to see a clinician.(ie maximum wait time 2.5 hours but appointment MUST have been made within 2 hour window)

987 (90%) 823 (95%)

BrisDoc assured the CCG at the last Contract Board meeting that all patients are given appointments within the 2 hour target, all patients are reviewed within 30 minutes of arrival and urgent patients are prioritised.

Mitigations Performance against the KPIs are discussed and monitored at the Contract Board meetings. SCWCSU has drafted a letter, on behalf of Bristol CCG, to send to BrisDoc regarding the insufficient standard of information contained within their Quality and Performance report (requirement for reports to be more comprehensive to ensure the CCG is assured regarding service provision). Issue Highlighted November 2015 Recovery Expected: to be reviewed for 2016/17

CCG Director Alison Moon CSU Lead Jane Jacobi


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BrisDoc – Clinical Hours Filled (April)

May 15

Jun 15

July 15

Aug 15

Sept 15

Oct 15

Nov 15

Dec 15

Jan 16

Feb 16

Mar 16

Year End

Apr 16

Clinician hours filled

95% 93% 84% 92% 92% 95% 93% 82% 89% 85% 100% 91% 89%

Performance for clinician hours filled deteriorated from 100% in March to 89% in April 2016. Clinical resourcing remains a challenge nationally. BrisDoc has advised of several on-going work streams to optimise clinician activity and ensure patient safety is maintained:

Dedicating resource within the control room when demand is very high to pick out the very high priority cases

Dedicating resource to identifying low acuity patients who can be provided with self-care advice. Using a non-clinician to support contacting these patients

Implementation of prescribing pharmacists in the control room on Saturday and Sunday to manage repeat medications (working between 10.00 – 16.00hrs)

BrisDoc will be evaluating the implementation of the pharmacist role at the end of May; early analysis of the work carried out is shown in the graph below. During the time period shown 260 consultations were carried out with an average consultation time of 15 minutes. Patients of all ages were consulted.


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BrisDoc is staging an engagement event to target ST3 trainees qualifying in the summer with a view to offering employed roles working across several services. Interviews are being held at the end of May.

Mitigations Commissioners previously requested and were awaiting a further briefing paper highlighting the pertinent issues relating to clinician indemnity resourcing to facilitate discussion. The CCG has requested sight of the review paper pertaining to implementation of the pharmacist role once completed. The issues pertaining to the filling of clinical hours is discussed at the Contract Board meetings. Issue Highlighted April 2015 Recovery Expected: to be reviewed for 2016/17


BrisDoc - Patient Experience (April) The following graphs show the Patient Satisfaction Questionnaire Response rates and FFT scores/response rates.


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BrisDoc reported that they continue to meet their target for patient experience satisfaction; 62% of patients in April were very satisfied and 26% were satisified.


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The following graph details the number of complaints received on a monthly basis.

Themes primarily pertain to waiting times, in particular for telephone call back during busy Bank Holiday periods. The non-clinical safety calling protocol aims to minimise these complaints by managing patient expectations. BrisDoc are liaising with Care UK as some patients are calling back within their disposition time to complain about the need for the provision of accurate information at the point of direction to the out of hours service.

Mitigations Themes from complaints and patient experience will continue to be monitored and addressed through the bi-monthly Contract Board meetings. The CCG has asked for more accurate reporting and increased narrative to be provided within the BrisDoc Quality and Performance report. Reporting requirements are included within the Quality Schedule for 2016/17. Issue Highlighted September 2015 Recovery Expected: to be reviewed for 2016/17


C

Care UK NHS 111 – Serious Incidents (May) Care UK NHS 111 reported one SI in May 2016. The pertained to an environmental incident relating to telephony outage across numerous call centres, affecting BrisDoc OOH, Bristol 111 Call Centre, Worcester Call Centre, Emerson’s Green Treatment Centre and the East of England Call Centre. This investigation is currently on-going with the full report due in August 2016.


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CARE UK NHS 111 – Activity Key Performance Indicators (April) Care UK NHS 111 performance against KPIs is as follows:

BNSSG Activity (%)

Targ

et

May

15

Ju

n

Ju

ly

Au

g

Sep

t

Oct

No

v

Dec

Jan

Feb

Mar

Ap

ril

16

Weekdays calls answered within 60 seconds

≥95 98.4 96.8 96.3 96.8 93.7 95.6 95.9 98.1 97.1 94.5 81.1 89.7

Weekend calls answered within 60 seconds

≥95 95.0 94.0 91.9 96.4 82.6 88.4 93.9 92.5 91.5 84.9 71.7 79.7

Warm transferred calls to Clinical Advisor (CA)

≥98 38.0 38.0 31.0 41.0 37.0 41.0 41.5 46.8 40.2 30.6 30.3 40.8

CA call backs within 10 minutes

≥95 31.0 38.0 40.0 47.0 43.0 46.7 51.9 61.3 53.6 41.6 48.6 42.9

Care UK has reported that April has been a difficult month for performance relating to answering calls in 60 seconds. Whilst they had anticipated achievement of this KPI, Care UK experienced IT issues and a general increase in call handling time which has inhibited improvement. When benchmarking the service against national results, Care UK did exceed the national average for the month. Care UK are undertaking the following actions to mitigate against this:

Induction training for all new supervisors and shift leads is to include floor management training

On an on-going basis, the Call Centre Manager is reviewing and coaching individual performance for outliers and new staff (as it is known new starters initially have a higher call handling time)

Use of the operational support line is being reviewed to identify any persistent users or outliers where training may be needed

In parallel with the above actions, analysis is underway to try to ascertain the root cause of the increase in handling times. Care UK hope to be able to identify any patterns i.e. process, acuity, system or staff behaviour which may be underpinning this; once known they will take appropriate mitigating actions. Ambulance dispatch rates increased slightly in April 2016 which as per a trend over previous months, this is attributed to the increased number of hours they are able to source a validation Clinical Advisor (CA). The ED dispositions remain similar to previous months.


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Care UK were involved in a training event in March with the leads for the Calderdale Framework which will underpin the work with the NHS 111 Integrated Urgent Care Workforce Development Programme. At this event it was mentioned that the initial focus would be on the workforce aspect. Care UK will gain a better understanding as regards to what’s involved in the project pilot their meeting with the Calderdale Framework team on 12 May. Performance data from April 2015 to April 2016 is shown in the graphs below.

Calls referred to ED have remained consistant with previous months (achieving 6.7% in April 2016). Care UK continues to see a lower percentage of patients referred to ED at


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the weekend. They continue to use their ambulance validation line which will result in some patients being refered to ED rather than an ambulance dispatched. Care UK cites referral to ED is the third most frequent disposition in hours and the fourth out of hours as being the reason for the difficulty in achieving this target

For the month of April 2016, the ambulance dispatch rate has seen a downward trend. Care UK continues to use their ambulance validation line to identify any inappropriate green ambulances.

Mitigations The activity and performance KPIs are monitored at the monthly IQPMG meetings. Commissioners have previously expressed concern regarding Care UK’s failure to make adequate improvements to their Integrated Performance and Quality Report despite numerous requests. Quality reporting requirements have been included within the Quality Schedule for 2016/17 (which encompasses the need for evidence of analysis and learning). Issue Highlighted: April 2015 Recovery Expected: March 2017


NHS 111 – Workforce and Attrition Care UK NHS 111- Patient Experience (April)

A total of 13 complaints were received in April 2016, 6 of which pertained to BNSSG patients. Care UK reported that 0 complaints breached the requirement to be acknowledged within 3 days. The graph below details the reasons for complaints.


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The graphs below show key results for patient experience via FFT for April 2016 (for the Bristol locality):


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Mitigation Patient experience will continue to be monitored at the monthly IQPMG.

CARE UK NHS 111 – Workforce (April) For Health Advisors (HAs) Care UK are currently recruiting for predominantly part time shifts; (20 shifts vacant on a Saturday, 15 on a Sunday and 8 shifts between Monday to Friday). The shift lengths that are vacant are between 4 and 6 hours. Care UK is currently recruiting for 2 full time night staff. For both HA & CA roles, Care UK is finding it challenging to recruit to the required shifts as the majority of their vacancies are working every weekend. CA’s have expressed a preference for full time rotas. Care UK received 9 HA resignations during April 2016. The majority of these are starting new roles with other organisations with regular working patterns.

During the month of April, 2 CA were promoted to CA Supervisor roles, 1 CA resigned as they felt the role was not for them. Care UK continues to recruit for both part and full-time CAs.

Care UK holds a bi-monthly employee representative meeting to gain an understanding of the issues impacting their team and improvements have been implemented following feedback from employee representatives (including the adoption of ‘free fruit Friday’ and the launch of the Cycle to Work Scheme).

Each month staff can nominate their chosen ‘Healthcare Hero’ (their peers who demonstrate exceptional service to patients or the organisation). Recipients receive vouchers and a recognition pin.


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Mitigations Commissioners continue to monitor workforce planning at the monthly IQPMG. Issue Highlighted: April 2014 Recovery Expected: to be reviewed for 2016/17


Care UK NHS 111 – Clinical effectiveness via clinical audit (April) Calls managed by both HAs and CAs are regularly audited using the 111 standard Audit Tool. Audits are carried out by Pathways trained HAs and CAs. Any audit which scores below 86% is considered a fail and is reviewed by a Pathways Trainer or a Supervisor. Each is then discussed with the HA or CA.


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The following tables detail the number/% of audits undertaken for HAs and CAs.

Month

Health Advisors (Live more than 3 months)

Number of

staff

requiring

audit

Number

of staff

audited

Number

of audits

required

Number of

audits

completed

Percentage

of audits

completed

Passes %

passes

Average

score %

Feb- 16 105 105 390 390 100% 328 84% 93%

Mar-16 104 104 386 386 100% 334 86% 93%

Apr-16 106 28 393 64 16.28% 52 81% 89%

Month

Health Advisors (Live less than 3 months)

Number of staff

requiring audit

Number

of staff

audited

Number

of

audits

required

Number of

audits

completed

Percentage

of audits

completed

Passes %

passes

Average

score %

Feb-16 14 14 70 70 100% 51 73% 90%

Mar-6 21 21 105 105 100% 77 74% 91%

Apr-16 13 7 65 31 47.69% 24 77.41% 83%

Month

Clinical Advisors

Number of

staff

requiring

audit

Number of

staff

audited

number of

audits

required

Number of

audits

completed

Percentage

of audits

completed

%

Passes % Average

score %

Feb 34 34 159 159 100 91.36 96.89

March 31 25 134 95 64.92% 90% 94.47%

April 35 6 137 22 16.05% 100% 95.59%

Month

Clinical Advisors in first 3 months since training

Number of

staff

requiring

audit

Number

of staff

audited

Number of

audits

required

Number of

audits

completed

Percentage

of audits

completed

%

Passes

%

Average

score %

Feb 11 11 55 55 100% 94.54% 96.67%

March 11 11 55 55 100% 94.54% 96.67%

April 8 4 40 22 55% 100% 95.59%


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Care UK reported poor audit compliance for April 2016: - audits were completed by 16.28% of HAs live for more than 3 months and 47.69%

of HAs live less than 3 months - 16.05% of CAs completed audits and 55% of CAs within the first 3 months since

training. 5 new HAs all passed their first audits and will continue to be coached during their first few weeks on the phones.

Care UK has trained a further 4 clinical staff to assist in completing audit requirements. During April some of their auditing resource was used to audit these new auditors for levelling purposes and resource was also concentrated on auditing staff who failed audits during the previous month. Care UK made progress with catching up on audit figures in March and they assure that they will continue to catch up to achieve the required audits (reporting one month ‘in arrears’).

Over the next month 10 new coaches will be trained; their role will be to focus on HAs who either new to the role or those who are struggling (providing one on one coaching).

Mitigations Commissioners have previously highlighted their concerns at the Contract Board Meeting regarding the poor compliance with call audit. Care UK has been asked to include the dates of when audit data is pulled to provide context relation to when the completed Quality & Performance Report has been released. Audit compliance continues to be monitored via the monthly IQPMG. Issue Highlighted: August 2015 Recovery Expected: to be determined for 2016/17


Care UK NHS 111 Safeguarding (April) Care UK has advised they will provide Safeguarding data with analysis and commentary as from May 2016.

The graph below shows that there was a slight increase in referrals for adults and a decrease in children’s referrals. The rise in adult safeguarding referrals continues to predominantly pertain to referrals relating to Care Packages.


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Mitigations Safeguarding will be closely monitored at the monthly IQPMG. Commissioners will await receipt of information pertaining to training which will be contained within Care UK’s next Integrated Quality and Performance Report. Issue Highlighted: October 2015 Recovery Expected: to be reviewed for 2016/17


SECTION 4. Horizon Scanning Below is a summary of recently published documents and guidance which will be of significance in commissioning for quality. Where possible electronic links to the relevant document have been provided: Stroke in Adults - update https://www.nice.org.uk/guidance/qs2 This quality standard covers diagnosis and initial management, acute-phase care, rehabilitation and long-term management of stroke in adults (aged over 16 years). The annual review of quality standards in 2014 identified that there had been changes in the areas for improvement for stroke and therefore this quality standard has been updated. Statement 1. Adults presenting at an accident and emergency (A&E) department with suspected stroke are admitted to a specialist acute stroke unit within 4 hours of arrival. [2010, updated 2016] Statement 2. Adults having stroke rehabilitation in hospital or in the community are offered at least 45 minutes of each relevant therapy for a minimum of 5 days a week. [2010, updated 2016] Statement 3. Adults who have had a stroke have access to a clinical psychologist with expertise in stroke rehabilitation who is part of the core multidisciplinary stroke rehabilitation team. [new 2016] Statement 4. Adults who have had a stroke are offered early supported discharge if the core multidisciplinary stroke team assess that it is suitable for them. [new 2016]

https://www.nice.org.uk/guidance/qs2


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Statement 5. Adults who have had a stroke are offered active management to return to work if they wish to do so. [new 2016] Statement 6. Adults who have had a stroke have their rehabilitation goals reviewed at regular intervals. [2010, updated 2016] Statement 7. Adults who have had a stroke have a structured health and social care review at 6 months and 1 year after the stroke, and then annually. [new 2016]

Antenatal Care- update https://www.nice.org.uk/guidance/qs22 The source recommendations and definitions for statement 6 on risk assessment (gestational diabetes) have been updated to reflect changes to the NICE guideline on antenatal care in March 2016: Antenatal care for uncomplicated pregnancies NICE guidelines CG62 Statement 6: Pregnant women are offered testing for gestational diabetes if they are identified as at risk of gestational diabetes at the booking appointment. Definitions: Risk factors are taken from NICE guideline NG3: - body mass index above 30 kg/m2

- previous macrosomic baby weighing 4.5 kg or above

- previous gestational diabetes

- family history of diabetes (first-degree relative with diabetes)

- minority ethnic family origin with a high prevalence of diabetes. Women with any 1 of these risk factors should be offered testing for gestational diabetes. Testing for gestational diabetes should be carried out in accordance with NG3 Diabetes in pregnancy management from preconception to the postnatal period. NICE suggest that current practice is highly variable and the guideline might have resource implications at a local level. Early diagnosis of gestational diabetes can lead to improved care for the woman and baby and fewer complications during pregnancy and labour. Organisations are encouraged to evaluate their own practice against the recommendations in the NICE guideline and assess costs and savings locally. Venous Thromboembolism in Adults: Diagnosis and Management - update https://www.nice.org.uk/guidance/qs29

This quality standard covers the diagnosis and treatment of venous thromboembolic diseases in adults, excluding pregnant women and has been updated to remove statement 4 pertaining to mechanical interventions in order to reflect an update of NICE's guideline on venous thromboembolic diseases: diagnosis, management and thrombophilia testing, due to the advice on using compression stockings changing. NICE advise is not to offer elastic graduated compression stockings to prevent post-thrombotic syndrome or VTE recurrence after a proximal DVT. This recommendation does not cover the use of elastic stockings for the management of leg symptoms after DVT.

Routine Preoperative Tests for Elective Surgery https://www.nice.org.uk/guidance/ng45 This guideline covers routine preoperative tests for people aged over 16 who are having elective surgery. It aims to reduce unnecessary testing by advising which tests to offer people before minor, intermediate and major or complex surgery, taking into account specific comorbidities (cardiovascular, renal and respiratory conditions and diabetes and obesity). It does not cover pregnant women or people having cardiothoracic procedures or neurosurgery. This guideline includes recommendations on communication, pregnancy testing, sickle cell testing, HBA1c testing, tests for



https://www.nice.org.uk/guidance/ng45


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people having minor surgery, tests for people having intermediate surgery and tests for people having complex and major surgery. NICE provided an implementation resources for this guidance (baseline assessment tool) Controlled drugs: safe use and management https://www.nice.org.uk/guidance/ng46 This guideline covers systems and processes for using and managing controlled drugs safely in all NHS settings except care homes. It aims to improve working practices to comply with legislation and have robust governance arrangements. It also aims to reduce the safety risks associated with controlled drugs. It includes recommendations for organisations on: - developing systems and processes, including governance arrangements, storage,

stock checks, transportation and destruction and disposal,

- record keeping, risk assessment and reporting controlled drug-related incidents, for health professionals on prescribing, obtaining and supplying, administering and handling controlled drugs

- for health professionals monitoring use, including governance and systems for reporting concerns and incidents.

Depression in Adults: Recognition and Management – update https://www.nice.org.uk/guidance/cg90 This updated guideline covers identifying and managing depression in adults aged 18 years and older, in primary and secondary care. It aims to improve care for people with depression by promoting improved recognition and treatment. The recommendation on transcranial magnetic stimulation has been replaced with a link to the NICE interventional procedure guidance on repetitive transcranial magnetic stimulation for depression published in December 2015. NICE states that repetitive transcranial magnetic stimulation for depression may be used with normal arrangements for clinical governance and audit. New Early Access to Medicines Scheme (EAMS) In April 2014, the Government announced the launch of the Early Access to Medicines Scheme (EAMS). This scheme is operated by the Medicines and Healthcare products Regulatory Agency (MHRA) and aims to give patients with life threatening or seriously debilitating conditions access to medicines that do not yet have a licence when there is a clear unmet medical need. It does not replace the normal licensing systems but will mean that a small number of medicines will be available to patients earlier than normally anticipated. Under the scheme, the MHRA will give a scientific opinion on the benefit/risk balance of the medicine, based on the data available when the EAMS submission was made. The opinion lasts for a year and can be renewed.

NHS England: Quick Guide to Elective Care https://www.england.nhs.uk/wp-content/uploads/2016/01/elective-care-summary-actions-ccgs.pdf NHS England has published a quick guide containing ideas and examples that will help commissioners and providers to effectively manage the increasing demand for elective care services. The guide will also help ensure that those patients who need surgical treatment are seen as quickly as possible in line with their right under the NHS Constitution. The guide sets out a checklist that commissioners can use with providers to ensure existing best practice is in place. These high-impact interventions particularly focus on areas that impact on demand management and are supported by existing resources, including case studies, protocols and toolkits.

NHS England: Quick Guide: Supporting Patients’ Choices to Avoid Long Hospital Stays http://www.nhs.uk/NHSEngland/keogh-review/Documents/quick-guides/Quick-Guide-supporting-patients-choices.pdf

https://www.nice.org.uk/guidance/ng46

https://www.nice.org.uk/guidance/cg90

https://www.england.nhs.uk/wp-content/uploads/2016/01/elective-care-summary-actions-ccgs.pdf

https://www.england.nhs.uk/wp-content/uploads/2016/01/elective-care-summary-actions-ccgs.pdf

http://www.nhs.uk/NHSEngland/keogh-review/Documents/quick-guides/Quick-Guide-supporting-patients-choices.pdf

http://www.nhs.uk/NHSEngland/keogh-review/Documents/quick-guides/Quick-Guide-supporting-patients-choices.pdf


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NHS England has published a quick guide to support local health and social care systems to reduce the time people spend in hospital, when they are ready to depart and no longer need acute care, but are delayed whilst making decisions about or making arrangements for their ongoing care. This should be read alongside the 2015 NICE guidance ‘Transition between inpatient hospital settings and community or care home settings for adults with social care needs’.

NHS England: Avoiding Unplanned Admissions Enhanced Service Specification https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2016/04/aua-serv-spec.pdf

NHS England has published the Avoiding Unplanned Admissions (AUA): proactive case finding and patient review for vulnerable people 2016/17 enhanced service specification, which has now been updated to reflect the 2016/17 contract changes.

NHS England: Quick Guide to Healthy Caring https://www.england.nhs.uk/resources/resources-for-ccgs/out-frwrk/dom-2/healthy-caring/ NHS England in partnership with Carers UK, Carers Trust Age UK, Public Health England, and older carers themselves, has published a quick guide which provides information and advice to carers about staying healthy whilst caring and identifies the support available to help carers maintain their health and wellbeing.

NHS England: Implementing the Cancer Taskforce Recommendations: Commissioning Person Centred Care for People Affected by Cancer https://www.england.nhs.uk/wp-content/uploads/2016/04/cancer-guid-v1.pdf NHS England has published guidance to ensure every person affected by cancer will have access to a recovery package and follow-up pathways by 2020 as set out in the cancer strategy. This guidance is intended to support commissioners and strategic clinical networks to take the actions necessary to drive improved outcomes for person centred care through cancer commissioning. It describes the actions necessary to deliver this including checklists for developing service specifications, practical examples and templates to use and adapt locally. Public Health England: Strategic Plan for the Next Four Years: Better Outcomes by 2020 https://www.gov.uk/government/publications/public-health-england-strategic-plan This document sets out how Public Health England intends to achieve its aims over the next 4 years and outlines the key actions for the year ahead.

DH: NHS Outcomes Framework 2016 to 2017 https://www.gov.uk/government/publications/nhs-outcomes-framework-2016-to-2017 A policy paper which sets out the framework and indicators that will be used to hold NHS England to account for improvements in health outcomes.

NHS England: 2016/17 Quality and Outcomes Framework Guidance

http://www.nhsemployers.org/QOF201617 The Quality and Outcomes Framework (QOF) guidance has now been updated to reflect the 2016/17 General Medical Services (GMS) contract changes. The guidance has been jointly published by NHS England, NHS Employers and the General Practitioners Committee of the British Medical Association.

NHS England: eContract system and supporting publications https://www.econtract.england.nhs.uk/Home/ This is the NHS Standard Contract eContract system, for use by commissioners and providers when generating an NHS Standard Contract in the full-length or shorter-form versions. By the selection of the relevant service categories and contract options, the eContract system allows the contract content to be tailored to reflect the different

https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2016/04/aua-serv-spec.pdf

https://www.england.nhs.uk/resources/resources-for-ccgs/out-frwrk/dom-2/healthy-caring/

https://www.england.nhs.uk/resources/resources-for-ccgs/out-frwrk/dom-2/healthy-caring/

https://www.england.nhs.uk/wp-content/uploads/2016/04/cancer-guid-v1.pdf

https://www.gov.uk/government/publications/public-health-england-strategic-plan

https://www.gov.uk/government/publications/nhs-outcomes-framework-2016-to-2017

http://www.nhsemployers.org/QOF201617

https://www.econtract.england.nhs.uk/Home/


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services being provided (thus producing shorter, more relevant contracts), and makes the contract production process more efficient. NHS England strongly recommends that commissioners and providers use the eContract system. A user guide is available.

DH: The NHS Choice Framework https://www.gov.uk/government/publications/the-nhs-choice-framework This document sets out patients’ rights to choice in healthcare, where to find information to help choose, and how to complain if choice is not offered. NHS England: General Practice Forward View https://www.england.nhs.uk/2016/04/gpfv/ NHS England has set out a multi-billion plan designed to get general practice back on its feet, improve patient care and access, and invest in new ways of providing primary care. The plan was developed with Health Education England and in discussion with the Royal College of GPs and other GP representatives. The report states that the NHS would now earmark an extra £2.4 billion a year for general practice services by 2020/21. This means spending will rise from £9.6 billion in 2016/17 to over £12 billion by 2021 – a 14 percent real terms increase. This investment will be supplemented by a £500 million national ‘turnaround’ package to support GP practices, and additional funds from local CCGs. The plan also contains specific, practical and funded steps to strengthen workforce, drive efficiencies in workload, modernise infrastructure and technology, and redesign the way modern primary care is offered to patients. NHS England: Patient and public participation in primary care commissioning https://www.england.nhs.uk/commissioning/primary-care-comm/involving-the-public/ NHS England has developed a new framework for patient and public participation in primary care commissioning which includes guidance for CCGs, particularly those that are co-commissioning primary care services. The framework builds on NHS England’s Patient and Public Participation Policy and provides practical information and resources, including case studies. In addition, NHS England has published information for patients and the public around how to get involved in primary care commissioning. NHS England: CCG Improvement and Assessment Framework 2016/17 https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2016/03/ccg-iaf-mar16.pdf NHS England has published a new CCG Improvement and Assessment Framework for 2016/17 to align with its Mandate and planning guidance. This replaces the existing assurance framework and CCG dashboard, and aims to reach beyond CCGs, enabling local health systems and communities to assess their own progress. NHS England: Improving Palliative and End of Life Care https://www.england.nhs.uk/wp-content/uploads/2016/04/nhsiq-comms-eolc-tlkit-.pdf NHS England has published a refreshed toolkit on commissioning person centred end of life care, which provides a valuable supporting resource for the commissioning process. To complement this, NHS England’s Specialist Level Palliative Care: information for commissioners outlines a key part of the strategic and responsive commissioning system for delivering palliative and end of life care in any care setting. NHS Confederation: Developing MSK Networks: A Resource Pack http://www.nhsconfed.org/resources/2016/03/developing-msk-networks-a-resource-pack This resource pack provides healthcare professionals as well as commissioners and providers of MSK services with a framework for planning and developing a local MSK network, and signposts to a wide range of additional materials which may be useful as they undertake this task. This resource has been developed as part of the Arthritis and Musculoskeletal Alliance (ARMA) MSK Clinical Networks Project.

https://www.gov.uk/government/publications/the-nhs-choice-framework

https://www.england.nhs.uk/2016/04/gpfv/

https://www.england.nhs.uk/commissioning/primary-care-comm/involving-the-public/

https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2016/03/ccg-iaf-mar16.pdf

https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2016/03/ccg-iaf-mar16.pdf

https://www.england.nhs.uk/wp-content/uploads/2016/04/nhsiq-comms-eolc-tlkit-.pdf

http://www.nhsconfed.org/resources/2016/03/developing-msk-networks-a-resource-pack

http://www.nhsconfed.org/resources/2016/03/developing-msk-networks-a-resource-pack


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NHS England: Cardiovascular Disease (CVD) Primary Care Intelligence Packs https://www.england.nhs.uk/2016/04/matt-kearney-6/ The second edition of the CVD Primary Care Intelligence Packs has been launched by the National Cardiovascular Intelligence Network (NCVIN). This resource aims to help CCGs and practices drive improved outcomes in cardiovascular disease, by identifying key gaps and opportunities in primary care. NHS England: Nearly two million patients to receive person-centred support to manage their own care https://www.england.nhs.uk/2016/04/person-centred-support/ People with long-term conditions will be supported to better manage their own health and care needs, following the roll-out of an evidence-based tool over the next five years. NHS England has agreed a deal which will grant nearly two million people access to more person-centred care as part of its developing Self Care programme. Local NHS organisations and their partners are being invited to apply for free access to patient activation licences, which will help them assess and build their patients’ knowledge, skills and confidence, empowering people to make decisions about their own health and care. The Patient Activation Measure (PAM) is a validated tool which captures the extent to which people feel engaged and confident in taking care of their health and wellbeing. Locally, it is expected that measuring and improving patient activation will lead to patients enjoying better experiences of care and outcomes, making more positive choices about their health and wellbeing, and experiencing fewer unplanned hospital admissions. Building on well-received trials in six areas, NHS England has now agreed a five-year licence to expand the use of the PAM tool with up to 1.8 million people, as a core component of the Self Care programme. NHS England: Rehabilitation Commissioning Guidance https://www.england.nhs.uk/ourwork/qual-clin-lead/ahp/improving-rehabilitation/ NHS England has published new guidance for commissioning rehabilitation services. Responding to requests from NHS commissioners, the guidance contains links to the latest evidence and examples of good practice, including practical advice to commission good quality rehabilitation, describing what good looks like from the perspective of patients and their families. It is focused on helping people remain as independent as possible, continuing to live their lives and, wherever possible, returning to work and occupation. The work supports commissioners, services users, providers and clinicians to develop and improve rehabilitation services that respond to local needs.

NHS Improvement: Choice in Mental Health: How It Can Work for you https://improvement.nhs.uk/resources/choice-mental-health A guide for people using mental health services on their legal right to choose a provider that best suits their individual needs and preferences. NHS England: National Congenital Heart Disease Audit https://www.england.nhs.uk/2016/04/chd-nicor-report/ The National Congenital Heart Disease Audit has been published by The National Institute for Cardiovascular Outcomes Research (NICOR) and shows very good outcomes for congenital heart surgical operations as well as improvements in antenatal detection of infant heart problems. In the 3 year period 2012 -2015, there were 75 fewer deaths than predicted, demonstrating the continuing rise in the quality of congenital cardiac surgery in the UK. Survival 30 days after heart surgery for children was also good or better than predicted in each of the paediatric centres providing care.

https://www.england.nhs.uk/2016/04/matt-kearney-6/

https://www.england.nhs.uk/2016/04/person-centred-support/

https://www.england.nhs.uk/ourwork/qual-clin-lead/ahp/improving-rehabilitation/

https://improvement.nhs.uk/resources/choice-mental-health

https://www.england.nhs.uk/2016/04/chd-nicor-report/


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NHS England: Wheelchair Services Data Collection: Quarter 3 Dataset https://www.england.nhs.uk/ourwork/pe/wheelchair-services/nhse-role/ NHS England has now published the Q3 wheelchair services dataset. 57% of CCGs have provided data in this round and commissioners can use the dataset to review the results for their own CCG. CHIMAT: Childhood Mortality in England and Wales: 2014 http://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/childhoodmortalityinenglandandwales/2014 This statistical bulletin presents final statistics on infant deaths and childhood deaths that occurred in England and Wales in 2014. It also contains additional statistics on some of the main risk factors affecting infant deaths, including age of mother and birthweight. Public Health England: Child Health Profiles http://fingertips.phe.org.uk/profile/child-health-profiles Part of the PHE Fingertips series, Child Health Profiles provide a snapshot of child health and wellbeing for each local authority and CCG in England using key health indicators, which enables comparison locally, regionally and nationally. Paediatric Care Online (PCO UK) http://pcouk.org/ This is a new online decision support system designed for healthcare professionals who see children at the point of presentation. This tool provides immediate access to clinically assured information to inform decisions, together with a repository of reference material and patient information. PCO UK requires subscription. Cost of an annual subscription is £50 plus VAT, most members of the Royal College of Paediatrics and Child Health members have access to PCO UK as part of their annual membership. Twenty new innovative projects selected to improve the quality of health care http://www.health.org.uk/news/twenty-new-innovative-projects-are-selected-improve-quality-health-care The Health Foundation has selected twenty new projects to be part of the third round of its £1.5 million innovation programme, Innovating for Improvement which aims to improve health care delivery and/or the way people manage their own health care by testing and developing innovative ideas and approaches and putting them into practice. The innovative ideas will be tested in health care settings around the around the UK including primary and community care, secondary care, and mental health services. Seven teams selected to scale up health care improvement http://www.health.org.uk/news/seven-teams-selected-scale-health-care-improvement Seven health care projects have been selected by the Health Foundation to be part of its £3.5 million improvement programme, Scaling Up Improvement. The Scaling Up Improvement programme aims to improve health care delivery and/or the way people manage their own care through the delivery of successful health care improvement interventions at scale. The selected projects will each be led by one organisation working in partnership with a wide range of organisations including acute hospitals, Clinical Commissioning Groups, Royal Colleges, Academic Health Science Networks, Collaborations for Leadership in Applied Health Research and Care (CLAHRCs), universities, charities, national bodies and local government. NECS e-learning: antibiotic prescribing and antimicrobial stewardship in primary care https://www.nice.org.uk/sharedlearning/necs-e-learning-antibiotic-prescribing-and-antimicrobial-stewardship-in-primary-care

https://www.england.nhs.uk/ourwork/pe/wheelchair-services/nhse-role/

http://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/childhoodmortalityinenglandandwales/2014

http://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/childhoodmortalityinenglandandwales/2014

http://fingertips.phe.org.uk/profile/child-health-profiles

http://pcouk.org/

http://www.health.org.uk/news/twenty-new-innovative-projects-are-selected-improve-quality-health-care

http://www.health.org.uk/news/twenty-new-innovative-projects-are-selected-improve-quality-health-care

http://www.health.org.uk/news/seven-teams-selected-scale-health-care-improvement

https://www.nice.org.uk/sharedlearning/necs-e-learning-antibiotic-prescribing-and-antimicrobial-stewardship-in-primary-care

https://www.nice.org.uk/sharedlearning/necs-e-learning-antibiotic-prescribing-and-antimicrobial-stewardship-in-primary-care


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The North of England Commissioning Support (NECS) team developed an e-learning package to promote antimicrobial stewardship and prudent prescribing amongst primary care clinicians. The package was developed in order to reach a wider audience, and also to allow clinicians to work at their own pace, and explore issues in more detail if needed. The e-learning has been completed by over 570 primary care clinicians over the North East & Cumbria and has coincided with a reduction in total antibiotic prescribing and level of broad spectrum antibiotic prescribing in line with national Quality Premium targets.

SECTION 5. Conclusions and Recommendations

Conclusions

The Quality Monitoring Report provides the committee with an overview of the current quality performance within the local provider services. Key issues have been highlighted at the start of the paper including a narrative on the mitigating actions being taken to improve the quality of care for patients.

Recommendations

The Quality and Governance Committee is asked

To note the contents of this report and the mitigations that is being put in place by providers to improve the quality of care for patients.

Emma Savage Lizanne Harland Head of Commissioning for Quality Head Of Community Commissioning South, Central and West CSU Bristol Clinical Commissioning Group 9 June 2016