patient safety/quality assurance report nhs … body papers/may 2… · 2015 casey report published...

Public Session

PATIENT SAFETY/QUALITY

ASSURANCE REPORT

NHS ROTHERHAM CCG

6th

MAY 2015

CONTENTS

1. PATIENT SAFETY ................................................................................................................................... Error! Bookmark not defined.

2. MORTALITY RATES .................................................................................................. 3

3. SERIOUS INCIDENTS (SI) AND NEVER EVENTS (NE) ............................................ 4

4. CHILDREN'S SAFEGUARDING ................................................................................ 4

5. ADULT SAFEGUARDING .......................................................................................... 8

6. ADULT CONTINUING HEALTHCARE ....................................................................... 9

7. CHILDREN’S CONTINUING HEALTHCARE ............................................................. 10

8. PERSONAL HEALTH BUDGETS (PHB) ................................................................... 11

9. FRACTURED NECK OF FEMUR INDICATOR .......................................................... 12

10. STROKE ..................................................................................................................... 12

11. CQUIN UPDATE ........................................................................................................ 12

12. COMPLAINTS ............................................................................................................ 12

13. ELIMINATING MIXED SEX ACCOMMODATION ....................................................... 13

14. CQC INSPECTIONS ................................................................................................... 13

15. ASSURANCE REPORTS ........................................................................................... 15

16. CARE AND TREATMENT REVIEWS ......................................................................... 16

17. WINTERBOURNE SUBMISSION ............................................................................... 16

APPENDIX A – QUALITY IN GP PRACTICES END OF YEAR REPORT 2014/15 ................ 17

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NHS ROTHERHAM

1. HEALTHCARE ASSOCIATED INFECTION

RDaSH:

There has been 1 case of C-Diff in June, which was acquired in the community. In addition, there has been 1 outbreak of Norovirus in the Ferns, Woodlands OPMHS.

Hospice:

As at the end of Quarter 3, there was 1 patient admitted to the Hospice who already had MRSA and 1 patient who already had C-Diff.

TRFT :

MRSA – 0 (Monthly) 0 (YTD)

MSSA – 0 (Monthly) 6 (YTD)

E Coli – 2 (Monthly) 174 (YTD)

C-Difficile:

TRFT

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

2014/15 Target = 24

Monthly Actual 2 3 3 2 2 1 3 3 3 3 1 1

Monthly Plan 3 3 1 2 2 3 2 1 2 2 2 2

YTD Actual 2 5 8 10 12 13 16 19 22 25 26 31

YTD Plan 3 6 7 9 11 14 16 17 18 20 22 24

NHSR C-Difficile - (YTD) 82 (Planned) 66

NHSR

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

2014/15 Target = 66

Monthly Actual 5 8 11 7 4 2 6 7 5 8 11 8

YTD actual 5 13 24 31 35 37 43 50 55 63 74 82

YTD Plan 7 13 19 25 31 36 41 46 51 56 61 66

The above tables represent the cases to date which have been signed off (14th of each Month) on the MESS database. Please note the above figures may not exactly match the C.Diff figures which are discussed at the Post Infection Review meetings with TRFT which was last held on the 20th April 2015.

Post Infection Review – Overview Panel (C.Diff cases)

Following discussion at the Operational Risk, Governance and Quality Management Group it was agreed that RCCG would strengthen the reporting arrangements for HCAI with TRFT and other providers. The following actions have therefore been implemented:

Changes to the Post Infection Review Overview Panels (PIROP) terms of reference, strengthening the lead from the CCG with additional input from Medicines Management and Patient Quality

All Root Cause Analysis (RCA) to be reviewed prior to the monthly PIROP and documenting key areas for follow up using a shared action log

Reviewing community acquired C.Diff cases to take account of the whole patient pathway

These revised processes will be kept under constant review over the next three months.

In addition, a deep dive on the 2014/2015 C.Diff cases has been undertaken. This will inform the HCAI reduction plan for 2015/16 and findings and recommendations will be reported to the next Operational Risk, Governance and Quality Management Group in July.

2. MORTALITY RATES

The latest data (as at December 2014) submitted from TRFT in Dr Foster shows the HSMR performance measure to be at 94.92 which is within the ‘expected’ banding. It is noted that there is an

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upward trend from the 12 month rolling figure, year on, which is being carefully monitored. However, this is still within the expected range.

The SHMI performance now stands at 105.88 which is also within 'expected' banding.

The mortality review process is on-going with the uptake of the electronic death summary document improving from 62% to over 90% which enables the trust to be assured that the requirements set from the CCG to inform the primary care teams of the admission summary is being upheld.

TRFT have undertaken a review of the top ten diagnosis groups from Dr Foster and have subsequently commenced a number of audits to determine whether there are any underlying concerns around care. The top ten diagnoses include acute and unspecified renal failure and liver disease alcohol related. This programme of work is being overseen by the Associate Medical Director for Standards of Medical Care with a view to developing an action plan depending on the findings. The CCG Contract Quality Group review this data.

3. SERIOUS INCIDENTS (SI) AND NEVER EVENTS (NE)

SI Position 16.03.2015 – 20.04.2015

TRFT RDASH NHSR CCG

Ind. Contractors

Roth residents out of area

Rotherham Hospice

YAS PHE/ NHSE

Open at start of period 48 15 1 0 2 2 1 0

Closed during period 10 3 0 0 0 2 0 0

De-logged during period 0 1 0 0 0 0 0 0

New during period 8 4 0 0 0 0 0 0

Open at end of period 46 15 1 0 2 0 1 0

Never Events (New) 0 0 0 0 0 0 0 0

New Trends and themes 0 0 0 0 0 0 0 0

4. CHILDREN'S SAFEGUARDING

Date Discussion Outcome Follow up

April 2013 to present.

Following two suicides (Nov 2012, Feb 2013) children and young people at a local school also had to contend with the tragic expected death of a young person (April 2013).

RLSCB have published multi agency practice guidance on handling potential suicide clusters. This document has been shared with other areas as the incidence of adolescents suicide is increasing. The document has been discussed with the national NHS England Safeguarding Lead as good practice guidance.

An Independent Author was commissioned to publish a lessons learnt document.

February 2015

The All-Party Parliamentary Group (APPG) on Suicide and Self-Harm Prevention was published.

The rate of suicides in Rotherham is recorded as 8.9 with the national rate for England of 8.8 per 100,000

Rotherham is credited as hosting a suicide prevention conference in 2013 and producing a resource for workers and the public called ‘CARE’ which encourages them to act on Concerns, Ask about Suicide, Respond and Explain their actions to help a person at risk.

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Aug 2014/ Jan 2015

Child Sexual Exploitation (CSE) Report published Aug 2014.

Report published August 2014, media interest immense. Negative press received for LA and Police.

Front line staff undertaking ‘Stop the Shift awareness raising’

62% of CCG staff responded to the follow up questionnaire. The level of awareness raising was significant.

National training on CSE commissioned for senior health professionals – September 2014.

A bi-monthly ‘health’ focus group has been set up to co-ordinate a health economy response to national recommendations and the Alexis Jay Health recommendation. This group has completed the work and will present a paper to LSCB Quality Sub Group.

Second tier of CSE training for front line staff commissioned to consider victimolgy took place in February just under 800 participants attended and the CSE pocket guide was launched. Next steps is for RCCG to provide financial support training within all comprehensive schools as a preventative measure. RMBC Public Health have agreed to match fund.

January 2015 Attendance by RCCG at CSE Gold and Silver Group has established a process for capturing local CSE issues.

RCCG has set up a data base to map information on high risk CSE children

CCG Named GP highlights high risk cases to individual GP Practices for them to flag concerns

Named GP/RCCG alert GP Practices and/or other health related organisations of areas of concern.

The data base is accessible to the RCCG Executive Lead for Safeguarding if further information is required. Future plan will be to monitor any themes and trends.

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4.1 Drivers for Change:


23 – 27 Feb 2015

CQC Inspection of Children Looked After and Safeguarding (CLAS) undertaken.

The final day feedback provided lots of positives and several challenges. Each provider has written an immediate action plan to support taking forward the initial feedback.

Looked After Children (LAC) require a written summary of their health care.

Several issues raised with regard to CAMHS. A number of workstreams have been taken forward.

Maternity in-patients required work with LA social care. Initial meetings held and appear to be working through challenges.

CCG have subsequently provided a non-recurrent fund to purchase appropriate tools to enable health care to be summarised.

23 – 16 Feb 2015

TRFT had their CQC Essential Standards inspection which included Outcome 7 (safeguarding)

Feedback restricted to verbal. Written report due.

June 2014 Independent Review of NHS and Dept of Health into matters relating to Jimmy Savile. Monitor letter for a response by Foundation Trust 15.6.15

Rotherham health providers are undertaking a review of the recommendations and will report their findings to the CCG as well as Monitor.

October 2014 Ofsted Inspection of Local Authority completed. Rotherham received an Inadequate Grade.

Feedback – the government have appointed a number of independent commissioners to oversee improvements and new DCS appointed.

LA has set up an improvement panel to consider implications and drive forward changes. RCCG Chief Officer and Chief Nurse attending.

Rotherham health economy is fully committed to safeguarding (one of four priorities in the Commissioning Plan)

Deputy Designated Nurse commenced post 12 January 2015 same day as an independent manager to drive forward multi agency input into the Multi Agency Safeguarding Hub (MASH) and therefore support on-going improvements in safeguarding children

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March 2015 Rotherham CCG has commissioned 2 health secondees to work within the Rotherham Multi Agency Safeguarding Hub (MASH)

Commissioners of health services in Rotherham will work within the MASH to ensure that an evidence base is established to support future commissioning whilst supporting all agencies, including health providers, in developing an effective MASH.

An interim review presented to OE 16 March 2015.

A follow up report due in Sept/October 2015 to support and provide evidence for commissioning health care 2016/2017 with a final report to be published January 2016.

4 February 2015

Casey Report Published

100% of RCCG staff have received a generic briefing on CSE. 62% positive response to CSE awareness.

CSE is included in all safeguarding children training in providers

CSE Pocket Guide to circulated with payslips February 2015

NHS Choices sexual exploitation guidelines to be included internet for public information

The details for the various support agencies and the helplines in Rotherham have been circulated to all staff and ‘hard copies are to be provided to all Practice Managers.

RCCG significantly contributed to facilitating the CSE events held on 12th and 13th February. 33 RCCG staff attended.

Bespoke training Feb 2015 just short of 800 participants attended.

Next steps CCG working in partnership to support prevention work within all comprehensive schools.

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4.2 Learning Review

Area Discussion Outcome Output

May 2013 Croydon

TRFT and RDaSH have completed an Individual Managements Report (IMR) for an external LSCB, namely Croydon.

The methodology used is Significant Incident Learning Process (SILP).

Letter sent from RLSCB (31.12.2013) regarding closure of Rotherham actions to Croydon LSCB.

Rotherham LSCB is following up local recommendations to ensure compliance via the SCR Panel December 2013, completed actions sent to Croydon LSCB.

May 2014 Update from Croydon with regards to publication, it was agreed by Croydon LSCB that the Overview Report required further work.

The report was scrutinised (Jan 2014) and dependent on the outcome will be published after the Coroner’s Inquest. This date has yet to be set.

6.3.2014 19.2.2014 SCR Panel met to discuss injuries sustained by a Rotherham infant. The injuries were potentially non-accidental and whilst under investigation the infant sustained further bruising.

SCR Panel has agreed the methodology and terms of reference of the SCR.

The methodology to be utilised is a Significant Incident Learning Process (SILP).

Media reporting following court case to restrict access by father - highlights child injured whilst in hospital.

SCR Panel meeting to discuss publication 16 April 2015

5. ADULT SAFEGUARDING

5.1 Headlines

A number of changes have occurred at RMBC:

Director of Adult Services and Neighbourhoods (Shona MacFarlane) left at the end of March

Graeme Betts - appointed as the Interim Director of Adult Social Services (6 months)

Sam Newton – appointed Interim Head of Adult Services (6 months)

Rotherham Safeguarding Adult Board (RSAB) – Board meeting cancelled in April. Next meeting May 2015 and the Independent Chair (Professor Pat Cantrill) has agreed to remain the chair for the next 12 months.

Rotherham Safeguarding Adult Sub Group - met for the first time in over 6 months on the 14th April. Terms of reference and agenda discussed with future meeting dates arrange for bi monthly. Next meeting the 2nd June 2015.

The Care Act 2014 - came into force on the 1st April 2015 and is the most significant reform of care in 60 years. The Act is to deliver the key elements following on from the Governments response to the Francis inquiry from the events at The Mid Staffordshire hospital. A core concept to the Act is a focus on wellbeing and for Making Safeguarding Personal – “no decision about me without me” and is focused on the individual, their families and carers working together with agencies for outcomes.

The Act also takes into account the right to support carers and to put them on the same footing as the individuals they care for. All carers will be entitled to an assessment – if the assessment highlights an eligible need for support for a need, the carer will have a legal right to receive support for that need like the individuals that they care for.

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The Act now has a number of statutory roles that include:

Safeguarding Adult boards – and must have the 3 key partners of Local Authorities, Police and Health.

Serious case reviews to be mandatory.

Three new categories for abuse have been added to The Act – Domestic Abuse, Self-neglect and Modern Slavery.

The Care Act 2014 has recognised that local authorities cannot independently safeguard individuals but that this is to be a process achieved by working with the Police, NHS and other key organisations.

The Vulnerable Adults Panel (VAP) - met on the 20th April to discuss the terms of reference. Due to the amount of client indefinable information within the meeting RCCG as commissioners will only attend this meeting for specific agenda items as appropriate and agreed”.

Browne Jacobson – health lawyers invited RCCG’s Adult Safeguarding Lead as their guest to the “Elderly Care Conference – reducing legal risk in an ageing Britain” in Manchester on the 21st April 2015. The conference covered a number of subjects ranging from Deprivation of Liberty (DoL), Court of Protection (CoP) and their liabilities, Hospital Care of the Elderly and Criminal liabilities. There were a number of guest speakers including Sir Neil McKay, Professor Martin Green- Chief Executive, Care of England, Nicholas Paines QC from the Law Commission and Moya Sutton – Head of Safeguarding, NHS Leeds.

5.2 Care Home update

Care Home - The suspension still remains in place however feedback from Aprils CQC meeting is that improvements and positives are evident.

Care Home – Meeting held last week to discuss contracting and previous safeguarding concerns. Agree action is for RMBC contract officer to continue to visit and to complete a final review in eight weeks and feedback due to the positive actions and engagement of the home.

Care Home – RMBC have a number of low level contract concerns in relation to the care home and have arranged a meeting to discuss an action plan.

5.3 Delayed Transfers Of Care (DTOC)

RDaSH - RCCG continue to work with RMBC and RDaSH Inpatient services to develop systems to minimise the current increase in DTOC.

RDaSH are meeting with Monitor auditors following the concerns regarding the significant rise in reported delays over the past 12 months. This should help shape the discussions regarding future reporting and performance.

Further joint meetings have been arranged for early May, at which we would hope to finalise the definitions used to declare delays.

6. ADULT CONTINUING HEALTHCARE

6.1 Headlines

The recent publication of the draft national statistics for CHC (quarter 3 - 2014/15) has noted a further improvement for Rotherham in activity associated with the number of patients eligible for CHC funding, Quarter 2 has identified that Rotherham were ranked at 48 while quarter 3 identified that Rotherham are ranked 51, which highlights Rotherham are continuing to improve to achieve a more average rank amongst the 211 CCGs.

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6.2 Reports

W/C 16 Mar 2015 13 Apr 2015

Total Number Eligible Patients 648 638

Total % Outstanding Reviews 46.30% 49.22%

Total Number of Outstanding Reviews 300 314

Number of LD Team patients Eligible 122 125

% of LD Team reviews outstanding 73.77% 68.80%

Number of outstanding LD Team reviews 90 86

Number of CHC Team Patients Eligible 526 513

% of CHC Team outstanding reviews 39.92% 44.4%

Number of CHC Team reviews outstanding 210 228

The table identifies the total number of patients eligible for funding from Rotherham NHS Continuing Health Care and the number of patients that require a review, and also identifies the patients and outstanding reviews that the CHC Team and RDASH LD Team have responsibility for reviewing.

New processes such as the completion of 1st DSTs and changes in eligibility that require 3 month reviews have continued to impact on the CHC teams ability to significantly reduce outstanding reviews, and unfortunately a nurse assessor has been on sick leave for the last month, which has again reduced the team’s ability to reduce the outstanding reviews

7. CHILDREN’S CONTINUING HEALTHCARE

7.1 Headlines:

The Children’s Continuing Care (CCC) Team have sent out journals/diaries to some of our Service Users, to gain some feedback regarding our CCC Service. We acknowledge that this could be a more lengthy process to gain such feedback, so are now working on the development of a Service Users Questionnaire and hope to have this completed soon, as we are keen to use the Service User Feedback to make any improvements to our CCC service, already provided.

7.2 Key Achievements for the Team:

Continuing to further develop our CCC service.

Establishing a good working relationship with our colleagues at RMBC.

There has been a vast reduction in outstanding reviews.

Key Targets (KPI’s) are mostly being met.

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7.3 Reports

Total number of DSTs undertaken: including reviews

88

Months January 15 February 15 March 15 April 15

Total number of Eligible patients

22 + 1 fast track

24 + 1 fast track

27 + 1 fast track

30 + 1 fast track

Total outstanding Reviews

1 (0.23%) 0 0 0

8. PERSONAL HEALTH BUDGETS (PHB)

8.1 Review and Audits

Of the cases that are “live” the feedback at reviews is very positive and all reviews are up to date. The audits on these cases are carried out by RMBC.

The feedback from the service user review was that their quality of life had much improved and would recommend a PHB as they now feel more in control. As the service continues to evolve, it is hoped that moving forward many more families will feel the same and with their PHB will produce quality outcomes for all those concerned.

8.2 Current Caseload

The Markers of progress of the time period between Oct 14 to March 15 identified

53 adults + 14 children making a total of 67 PHBs (these were transferred from the Local Authority):

11 of these have now ceased due to either moving into permanent residential care or have deceased.

7 new referrals in total have been received by the PHB team ( 3 of these referrals were received in March)

The current PHB caseload in Rotherham is 63:

20 Joint Funded PHB cases, which are in receipt of funding both from the Local Authority and Health. The Local Authority manages these 20 PHB cases

29 PHBs, 18 of these are in progress, 10 have been signed off by the Approved Person, 1 is on hold due to a family bereavement

14 children, 2 of these have been signed off by the Approved Person

8.3 Processes

As with all processes the processes underpinning PHB are always being reviewed, due to this some amendments have been made to the process. In order to make things work more effectively the sign off process and agreement has been delegated to 2 CHC senior nurse managers for signing off support plans.

All updates are added to the system, which allows all nurses to be kept informed of the process of cases and all nurses are ensuring that any action being taken on cases transferring to PHB are being fed back to the advisor. This process is working very well with both parties feeling involved.

8.4 Budget Calculations

Plans are calculated on the current care, with this in mind it is to be considered whether a new way of budgeting packages would be more beneficial to the CCG and more transparent for service users, this is to be discussed between the CHC team and the CCG.

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8.5 Moving Forward

Rotherham is relatively new to PHB; new referrals are increasing each week: training to be arranged for CHC nurses. A date has yet to be confirmed.

Rotherham CCG is aiming to support all individuals requesting a PHB. The following people have signed up to the moving forward programme to look at rolling out PHBs for Mental Health.

We are currently working on a fast track support plan and looking at future service model.

9. FRACTURED NECK OF FEMUR INDICATOR

The Q4 position is due to be submitted at the end of April. Falls and bone health indicators continue to be closely monitored and the Trust is working hard to continue to keep the numbers attending low with on-going work in the Community.

10. STROKE

The February position remains showing an underachievement against a number of Stroke targets, in particular the percentage of people who have had a stroke who are admitted to an acute stroke unit within 4 hours of arrival to hospital and the percentage of stroke patients scanned within 1 hour of hospital arrival.

There has been a significant increase in the percentage of patients spending at least 90% of their stay on a Stroke Unit from a position of 72.2% in January to a position of 89.7% in February. This improvement has been supported by the newly developed Standard Operating Procedure for protecting 2 stroke beds at all times has supported this improvement. Access to CT scan is also improving and it is anticipated that continued monitoring of the referral pathway will see continued improvement.

RCCG and TRFT are in the process of finalising a remedial action plan which incorporates the recommendations/concerns from the Stroke Annual Peer Review, the recent Clinically Led Visit and the requirements to improve performance against the national stroke indicators. Stroke Services is an area for inclusion in the Local Outcomes Framework Incentive (LOFI) Scheme for 2015/16.

11. CQUIN UPDATE

11.1 RDaSH

Final CQUINs have been agreed for 2015/16. These are ‘National Schemes’ including Improving Physical Healthcare for patients with severe mental illness (SMI) and Urgent & Emergency Care (UEC) – Improving diagnosis and re-attendance rates of patients with mental health needs in A&E.

Local Schemes being implemented are; Outcomes (in CAMHS, Personality Disorder & Learning Disability), Risk Assessment and Safeguarding.

11.2 Hospice

For 2015/16 a National CQUIN will cover ‘Dementia and Delirium’ and a Local CQUIN will relate to patient outcomes.

11.3 TRFT

The Q4 CQUIN submission is expected at the end of April.

12. COMPLAINTS

12.1 TRFT

The number of complaints reported during February was 35. The Trust is on track to be under the year-end target.

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12.2 Via RCCG

Four complaints have been received following a letter being sent out by a TRFT consultant regarding a CCG decision to limit the number of Botox sessions for Rotherham patients. One complainant states that as a result of not receiving the treatment they have had a urine infection which his GP suggested could be as a result of not receiving the Botox injection. Investigation is ongoing.

13. ELIMINATING MIXED SEX ACCOMMODATION

RDaSH/Hospice – There have been no mixed sex accommodation breaches in March.

TRFT - Eliminating Mixed Sex Accommodation was raised with the Trust as a serious concern due to breaches on the Medical Assessment Unit. The Rotherham NHS Foundation instigated a full review and has implemented the majority of the actions that were identified on the immediate action plan that was developed. The Trust has confirmed that they have held briefing sessions with key areas, escalation mechanisms are in place, the Root Cause Analysis process has been reinforced in the event of a breach and policies are currently being updated.

RCCG continue to have discussions with the Trust regarding the inclusion of Eliminating Mixed Sex Accommodation in the Local NHS Outcomes Framework Incentive Scheme for 2015/16.

14. CQC INSPECTIONS

14.1 RDaSH

The CQC made Mental Health Act Monitoring Visits to Sandpiper Ward at Swallownest Court on the 17 February 2015 and to The Glade, Woodlands on 24 February 2015. No Action Statement was required following the visit to Sandpiper Ward, but one is required for The Glade visit by the deadline of 6 May 2015 to address three actions raised. These were;

What steps the hospital managers will take to ensure that they meet their duty to provide detained patients with information about their rights as required by Section 132.

What steps the trust has taken to remind Responsible Clinician (RC) of their duties under Section 58 and to ensure that there are no similar delays in referring patients to the Second Opinion Appointed Doctor (SOAD) service.

What steps the trust has taken to address the issue that staff should consider risk to others routinely when granting Section17 leave to detained patients.

14.2 Mulberry Manor Care Home

Accommodation for individuals who require nursing or personal care, dementia, diagnostic and screening procedures, mental health conditions, treatment of disease, disorder or injury, caring for adults over 65 years of age.

CQC Inspection published on the 20th March 2015. The CQC inspection covers five main areas of; - Safe, Effective, Caring, Responsive and Well-led. The overall outcome for the service was good.

Safe - CQC found this service safe. The staff had knowledge about how to keep individuals safe from the risks of harm or abuse, and were well trained in relation to this. All medications were stored and handled safely.

Effective - The service was effective. The Mental Capacity Act was well understood by staff and the procedures to follow should someone lack the capacity to give consent undertaken appropriately.

Caring – The service was caring. CQC found that staff spoke to individuals with warmth and respect. Day to day procedures within the home took into account individuals privacy, dignity their needs and preferences.

Responsive – The service was responsive. CQC found there to be arrangements in place to regularly review individual’s needs and preferences, so that their care could be appropriately tailored.

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Well-led - CQC found the service to be well led. The home’s manager understood the responsibilities of the role, support was also provided by the deputy and senior manager. The management teams was accessible and were familiar to the individuals within the home. CQC saw that the provider had a thorough system in place for monitoring the quality of service individuals received, and a clear plan for future improvements.

14.3 Treeton Grange Care Home

Accommodation for individuals who require nursing or personal care, diagnostic and screening procedures, Treatment of disease, disorder or injury, caring for adults over 65 years of age


Safe – This service is safe. CQC were assured that staff knew how to recognise and respond to abuse correctly. Staff had a clear understanding of the homes procedures in place to safeguard vulnerable adults from abuse.

Effective – The service was effective. CQC saw evidence that each member of staff had a programme of training and were appropriately trained to care and support people who used the service safely and to a good standard. CQC spoke with a number of staff during the inspection and they understood the importance of the Mental Capacity Act in protecting people and the importance of involving people in making decisions. CQC also observed that the service was meeting the requirements of the Deprivation of Liberty Safeguards.

Caring – The service was caring. Individuals informed CQC that they were happy with the care they received. CQC observed staff to have a warm rapport with the individuals they cared for. Relatives told CQC they were more than satisfied with the care at the home and that the manager was approachable and available to answer questions. Individuals had been involved in deciding how they wanted their care to be given. This was discussed prior to moving in. CQC saw evidence that the home had a good understanding of how to support individuals at the end of their life.

Responsive – The service was responsive. CQC found that individual’s needs were thoroughly assessed prior to them moving in to this service. Family/visitors informed CQC that they had been consulted about the care of their relative before and during their admission to Treeton Grange.

Well-led - The service was well led. CQC observed that the manager listened to suggestions made by individuals and their relatives. The systems that were in place for monitoring quality were effective. CQC saw evidence that where improvements were needed, these were addressed and followed up to ensure continuous improvement.

14.4 Kinetic Domiciliary Care Services

Dementia, learning disabilities, mental health conditions, nursing care, personal care, physical disabilities, sensory impairments, substance misuse problems, caring for adults under 65 years of age, caring for adults over 65 years of age.


Safe - The service was safe. CQC saw that there were systems in place to reduce the risk of abuse and to assess and monitor potential risks to individuals. The CQC observed that the recruitment processes was thorough which enabled the employer to make safer recruitment decisions when employing new staff.

Effective – The service was effective, the CQC saw evidence that staff had completed training on the Mental Capacity Act and knew when to apply. Records also demonstrated that staff had completed a comprehensive induction and that a varied training programme was available to help staff meet the needs of the individuals they supported. CQC did not there were no records of formal supervision sessions taking place. For individuals who required assistance to prepare food and their intake to be monitored, appropriate steps were in place to ensure that this was recorded

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and that appropriate action taken when needed. Staff had received basic food hygiene training to help make sure food was prepared safely.

Caring – The service was caring. CQC found that staff demonstrated a good awareness of how they should respect people’s choices and ensure their privacy and dignity was maintained. Individuals informed CQC that staff respected their opinion and delivered care in an inclusive, caring manner. Individuals received a good quality of care from staff who understood the level of support they needed and delivered care and support accordingly.

Responsive – The service was responsive. Individuals reported to CQC that they were encouraged to be involved in planning their care. Care plans were individualized so they reflected each individuals need and preference. Care records had been reviewed and updated in a timely manner.

Well-led - The service was well led. CQC saw evidence that there were systems in place to assess if the agency was operating correctly and if individuals were satisfied with the service provided. This included surveys, meetings and regular audits. Where a concern was identified then an action plan had been put in place to address.

15. ASSURANCE REPORTS

15.1 TRFT Update

A&E

The Trust ended the 2014/15 financial year with an performance against the 4 hour quality standard of 93.04%. The Quarter 4 position was 91.08%. Therefore both the Q4 and year end targets were not achieved.

Year-to-date position as at 20th April is 93.24% against a target of 95%. RCCG, NHS England and TRFT continue to manage the A&E performance closely. Performance against the quality standard continues to be a challenge - as it continues to be a challenge nationally. However, the Trust is continuing to see some improvement month on month.

Cancer Standards

The Trust's performance against the quarterly cancer quality standards remains good with the unvalidated position showing compliance against all standards for Q4. Performance has been consistent throughout 2014/15.

52 week waits

The CCG is in a position of un-quantified risk until all 13,000 patients have been reviewed; therefore a weekly update is currently being produced by TRFT and submitted to RCCG against the validation process.

To date, 10 patients have been found to have breached the 52 week wait quality standard. No patient concerns have been reported in relation to the breaches identified and TRFT have assured RCCG that there has been no adverse clinical consequences for these patients. Six of the patient pathways have now been closed. There are 700 pathways remaining for validations which are all being worked on and notes are being pulled to review. The Trust is on trajectory to meet its objective in relation to the recovery plan and this continues to be supported by NHS England. In addition, the Trust is working with the NHS England Elective Intensive Support Team to review systems and processes for managing the 18 week Referral To Treatment (RTT) going forward. This team have been into the Trust w/c 16 March 2015 and are using their best practise tools to review TRFT processes in order to make recommendations that will improve practise and sustainability of improved performance against the 18 week RTT targets. RCCG will receive a copy of the review and associated recommendations once it has been finalised.

The formal contract query issued by RCCG remains open. RCCG will continue to receive weekly updates until assurance is given that all pathways have been validated and all identified 52 week wait breaches are successfully and appropriately closed.

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2015/16 Contract Negotiations

RCCG and TRFT successfully reached agreement and signed the 2015/16 contract with TRFT on 31st March in line with national deadlines.

Peer Review: Trauma Unit

RCCG and The Rotherham NHS Foundation Trust received formal feedback from the Peer Review of the Trauma Unit highlighting a number of serious concerns identified by the reviewers and to set out the requirement on the Trust to respond. In summary, they are as follows:

Locum doctors being trained in Advanced Trauma Life Support (ATLS) or equivalent and nursing staffing attending the Advanced Trauma Nursing Course (ATNC). In addition, lack of information available demonstrating the number of clinicians trained in Advanced Paediatric Life Support (APLS);

24/7 CT scanning availability within 30 minutes of the request;

Use of the Embrace Team, which is the specialist paediatric transport service, to provide time critical transfers for paediatric patients.

Patients with spinal cord injuries being admitted locally to non-specialist wards.

A formal response has been received from Trust including a Trust action plan which focuses on the two concerns specific to Rotherham as a Major Trauma Unit (MTU). The formal letter also includes a response from the South Yorkshire Major Trauma Operational Delivery Network which addresses and details actions to be taken relating to the two wider trauma network issues.

15.2 GP Peer review visits

Report attached at Appendix A.

16. CARE AND TREATMENT REVIEWS

There are currently no planned Care & Treatment Reviews. This applies to all LD patients in hospital irrespective of Provider.

17. WINTERBOURNE SUBMISSION

The CCG is now required to provide a weekly update on admission or discharge of Rotherham patients into an Assessment and Treatment Unit.

Week commencing

Admission Discharge Number in ATU Total number currently subject to Winterbourne

19th March 0 0 0 2

26th March 0 0 0 2

2nd April 0 0 0 2

9th April 0 0 0 2

16th April 0 0 0 4

Following information triangulation by the Health & Social Care information Centre and a review of the definitions used for identifying those thought to have a learning disability or autism, an additional two patients have been identified subject to the ‘Assuring Transformation’ cohort. Whilst there are discharge plans in place for the two additional patients, we are working with RDaSH to expedite early discharge.

One of the above original patients will be discharged on the 27th April as previously reported.

There are currently no patients in the locally commissioned Assessment and Treatment Unit (ATU) service (Sapphire Lodge). This has been the case since January of 2015.

Sue Cassin – Chief Nurse May 2015

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APPENDIX A – QUALITY IN GP PRACTICES END OF YEAR REPORT 2014/15

NHS Rotherham Clinical Commissioning Group Governing Body

Clinical Commissioning Group Governing Body - Wednesday 6th May 2015

Quality in GP Practices- End of Year Report for Peer Review Visits 1 April 2014- 31 March 2015

Lead Executive: Sue Cassin, Chief Nurse

Lead Officer: Dawn Anderson, Head of Primary Care Quality

Lead GP: Jason Page, SCE Lead for Primary Care

Purpose:

This report is to provide the CCG with an overview of the Peer Review visits undertaken in 2014-15 as part of the CCGs commitment to promoting quality in primary care.

Background:

The Functions of a Clinical Commissioning Group (March 2013) states that it is the duty of a CCG to ‘assist NHS England with securing continuous improvement in the quality of primary medical services’. One of the ways in which Rotherham has chosen to promote quality has been the development and implementation of a GP peer review process, whereby each practice is visited every 3 years. Peer review visits are intended to be an informal way for practices to have an open discussion about areas of their practice, including prescribing, elective and non-elective activity and enhanced services. This is intended to be a supportive process and part of the on-going dialogue with practices and the CCG.

These visits have been undertaken since 2013, so by the end of the financial year 2015-16 all of the practices will have been visited.

From 1st April 2015, GP contracting was fully delegated to the CCG. Whilst acknowledging that quality and contracting have a clear relationship it has been recommended for the first year of delegation at least, that the current process is continued, but that there are clear linkages to the contracting team.

At the start of the process a ‘table-top’ exercise was held with attendance from the LMC, SCE GPs, Chief Nurse and Head of Medicines Management. It was at the first of these meetings (held July 2013) that the programme of visits was agreed and the framework for the discussions. Since then there is an annual ‘table top’ where information for each practice is collated and reviewed and recommendations are also made of areas of focus for the visits. The information is looked at for all practices, so that if the group thought it was warranted a practice visit could be brought forward.

Appendix 1 shows those practices which have been visited already and those which are planned to be visited in 2015-16.

What metrics are considered when looking at each practice?

For the purpose of the visit practices are asked to look at a suite of benchmarking reports:

(these are updated quarterly):

- Unplanned admissions

- Outpatient referrals and admissions

- Prescribing indicators

- Performance against CCG Commissioned services

The size of the practice, age demographics and deprivation levels are also considered.

Following the visit a summary of the discussion and action points is sent to the practice and actions are followed up in due course.

These visits form part of the quality surveillance model which is included in Appendix 2.

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What have been the key themes for this year?

The visits have been well received by all of those practices which have been visited. GPs have been open to discussing their practice and have been keen to look at areas where they do not benchmark as well as we would expect.

It is clear that for smaller practices there is a wider variation in their performance, but this is often the result of small numbers of patients skewing the figures.

The PMS practices visited all expressed concerns about the PMS review.

Where practices performed particularly well, despite their demographics there were areas of practice that we highlighted to be shared across the CCG.

The feedback to the CCG was that they felt that engagement was good.

Have there been any exceptions for this year?

At the ‘table top’ meeting it was agreed that there was one practice, who, although a small practice (whereby we can see swings in activity as a result of only a few patients) seemed to be an outlier and also appeared to have disengaged from the other CCG enhanced services that it had signed up to. This visit was undertaken in February. There were no concerns following the visit and it was agreed that further escalation was not necessary.

One Practice has undergone a significant amount of change, which although not reflected in a change of performance has meant a change in working practices, including the introduction of GP triage and recruiting more staff. It was agreed that a visit in April would give the practice more time to embed the new ways of working.

There was a concern raised outside of the Peer Review Process about another practice. There were two strands to this concern. Firstly, that the GP had a member of his family on his practice list, which is an area of concern as this is a single-handed practice. This was referred to NHS England Medical Director. The second issue was a concern raised about the recent staff changes and that the practice management seemed to be suffering. The practice had been visited in year 2 of the visit schedule, with no areas of concern highlighted. The escalation process was followed and the other areas of performance were looked at, to see if there were any indications of a change in the service provided. There was nothing to suggest that the quality of the services being provided to patients had been affected, but this was referred to NHS England.

What changes are likely for the future?

The CCG is currently looking at the introduction of a new reporting tool - RAIDR (Reporting Analysis & Intelligence Delivering Results). This will enable us to look at up to date benchmarking for the practice at the actual visit and will be far more interactive.

The delegation of contracting will also improve links to performance against contract and it is likely that the quality indicators will feed into the metrics being captured as part of contract monitoring.

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APPENDIX 1- GP PEER REVIEW VISITS – 3 YEAR ROLLING PROGRAMME

Year 1 2013-4

PRACTICE VISITING GP DATE OF VISIT

1. WOODSTOCK BOWER JASON PAGE 05/02/14

2. BLYTH ROAD IAN TURNER 23/10/13

3. DR SHRIVASTAVA IAN TURNER 09/10/13

4. QUEENS IAN TURNER 29/01/14

5. PARKGATE JASON PAGE 24/10/13

6. MORTHEN ROAD JASON PAGE 24/10/13

7. MANORFIELD IAN TURNER 21/08/13

8. WICKERSLEY JASON PAGE 12/02/14

9. GREENSIDE JASON PAGE 28/08/13

Year 2 2014-5


1. BRINSWORTH AND SURGERY OF LIGHT

JASON PAGE 25.3.15

2. BROOM LANE JASON PAGE 26.06.14

3. CANKLOW JASON PAGE 26.11.14

4. CHANTRY BRIDGE JASON PAGE 19.02.15

5. CLIFTON JASON PAGE 22.01.15

6. CROWN STREET JASON PAGE Deferred to April 2015

7. DALTON JASON PAGE 25.06.14

8. GATE JASON PAGE 10.12.14

9. GREASBROUGH JASON PAGE 25.03.15

10. HIGH STREET JASON PAGE 08.01.14

11. RAWMARSH JASON PAGE 24.09.14

12. SWALLOWNEST JASON PAGE 20.11.14

13. THORPE HESLEY RICHARD CULLEN 13.08.14

14. TREETON JASON PAGE 5.11.15

15. THRYBERGH JASON PAGE 22.10.14

Year 3 2015-6


1. BROOM VALLEY

2. DINNINGTON

3. KIVETON 13.05.15

4. MAGNA

5. MARKET

6. ROSEHILL

7. SHAKESPEARE ROAD

8. ST ANNS

9. STAG

10. VILLAGE 22.04.15

11. YORK ROAD 08.07.15

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APPENDIX 2 - QUALITY ASSURANCE FRAMEWORK IN PRIMARY CARE

The three domains of quality: patient safety, clinical effectiveness and patient experience will be monitored through routine internal contractual processes and clinical governance structures and external sources such as CQC, peer reviews, national surveys etc. GP practices as providers are required to have their own quality monitoring processes in place and through the duty of candour and the contractual relationship with commissioners they have to provide information and assurance to commissioners and engage in system wide approaches to improving quality. There should be consideration of the contractual process throughout the quality assurance process

The following describes the process and escalation in relation to Quality Assurance:

Stage 1 Routine Quality Monitoring for Primary Care:

Routine Monitoring includes the following:

Routine Quality Metric Monitoring

Patient Safety Indicators include: monitoring of HCAI, safeguarding vulnerable children and adults, reporting of patient safety incidents, workforce numbers, skills and training, Uptake of vaccinations and Immunisations

Patient Experience Indicators include: complaints, Friends and Family test, Access to appointments/services

Effectiveness Indicators include: Emergency admissions data, referral rates, and partnership working arrangements.

Stage 1 Routine Quality Assurance Visits / Arrangements for Primary Care – Peer review visits

Where the concerns are not addressed RCCG is able to invoke Stage 2. In significant, exceptional circumstances, the breach may be so severe that it may escalate the practice to Stage 3 as described in the Quality Assurance Framework.

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QUALITY ASSURANCE FRAMEWORK

Local Assurance External Assurance

Patient Safety Incident reporting Safeguarding incidents SCR/IMR HCAI Vac & Imms uptake Medicines Management CAS alert compliance Workforce Section 11 audit QOF Patient Experience Complaints FFT Access to services Patient Surveys Effectiveness Emergency admissions A&E attendances Low Level Concerns Referral Rates Pathway compliance Clinical Governance arrangements NHS health check Partnership working

Routine Quality Monitoring

Bodies CQC Registration/Inspection/Compliance CQC Monitoring Public Health England Local Authority Monitoring Professional Bodies Healthwatch LMC Deanery re placements QSG LPN DATA Health and Social Care Information Centre NHS England Quality Dashboard National Reporting and Learning System (Safety Incidents) Central Alert system. Web Tool

Medicine Management arrangements Safeguarding visits/processes IP&C visits Proactive routine CCG quality visits Incident investigation support Maintaining high professional standards process Contract monitoring visits

Routine Quality Assurance Visits/Arrangements

Enhanced Quality Surveillance/Visits

Enhanced Quality Surveillance Visit

Increasing Risk and reducing assurance of quality

NHS England CCG and provider Risk Summit

Reducing Assurance

Increasing Risk to

patient safety

patient safety/quality assurance report nhs … body papers/may 2… · 2015 casey report published...

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