A presentation/update will be given at the meeting.
Minutes:
Sharon Martin, Deputy Chief Officer and Director of Commissioning at Bury CCG attended the meeting to update Members on the work that was being undertaken and policies that had been implemented by the CCG and partners following the Winterbourne, Francis and Keogh reviews.
It was explained that the CCG's Executive Nurse had wanted to attend the meeting but had been unable to due to work commitments. It was anticipated that she would attend a future meeting to present the CCG Quality Strategy.
Sharon explained that the Winterbourne View Review had been carried out following issues raised relating to standards of care of patients with a mental health need or learning disability.
Bury CCG had reviewed all patients which fell into that category and mapped them on a register.
The CCG's review had ensured that all patients had:
· A personalised care plan which was produced and reviewed with input from the patients' families
· Discussions about whether there was a need to move them to a more appropriate local setting by a specific date.
· A named care co-ordinator
· An identifies lead to support them in the CCG
Sharon explained that there were currently nine patients from Bury placed in in-patient settings. Three funded by the CCG and the remaining six by Specialised Commissioning.
The patients funded by the CCG had a named worker that visits every four months to carry out a care plan review.
One of the patients was on active discharge, another had a discharge plan in progress and the remaining patient was in a clinically appropriate setting.
The CCG also provides quarterly updates to NHS England on the status of the patients within these settings.
Following the review a concordat: A Programme of Actions, had been produced by the Department of Health which required a Local Action Plan for Learning Disabilities and Challenging Behaviour to be produced.
A joint action plan had been developed with the Local Authority outlining how the two organisations and key partners will respond to the immediate requirements of the Winterbourne View Concordat.
The plan was separated into:
· Operational actions which focus on ensuring care services are appropriate, that people are safe from harm, and that effective monitoring processes are in place.
· Strategic actions to be considered as part of the refresh of the Learning Disability Strategy which is scheduled for 2014-2015. It was explained that the refresh will ensure that the Strategy is an all age strategy covering health, education and social care needs of all people with low, moderate and complex learning disabilities in Bury.
It was explained that the CCG would be working with the Local Authority to develop the Learning Disability Strategy.
Sharon went on to explain the implications following the Keogh review into hospital mortality rates and the Francis Review which had been carried out following serious concerns of standards of care at Mid Staffordshire Hospital. The Francis report had been published in 2013 and contained 290 recommendations which were split into the following categories:-
· Prevention
· Detection
· Taking prompt action
· ensuring robust accountability
· Ensuring staff are trained and motivated.
Sharon explained that of those 290 there were 40 that were relevant to the CCG as commissioners.
It was explained that the CCG has a strong governance structure which includes the CCG constitution, quality reporting within the Governing Body, a Quality and Risk Committee, Executive Management Team, a Primary Care Quality Improvement Group, regular Clinical Quality North East Sector Meetings with key providers, Safeguarding Team and a Communications and Engagement Strategy.
There was regular engagement with both member practices and patients and public which included Patient Cabinet members presence at provider walkarounds.
The CCG also has increasing access to high level data about quality, safety and serious incidents through NHS England's Area Team and the CCG were also members of the following Greater Manchester Committees:
· Quality Surveillance Group
· Quality Collaborative
· Direct Commissioning Collaborative
· Infection Control and Prevention Collaborative
· CCG Nurses Collaborative
· Practice Nurse Collaborative
Sharon reported that of the 40 standards, 28 were currently rated green and 12 amber.
Sharon explained that the Keogh Action Plan had highlighted 8 standards, 6 were currently green and 2 were amber. The two that needed strengthening were:-
Standard 3 'Patients, carers and members of the public will increasingly feel like they are being treated as vital and equal partners in the design and assessment of their local NHS. They should also be confident that their feedback is being listened to and see how this is impacting on their own care and the care of others'.
Standard 6 'Nurse staffing levels and skill mix will appropriately reflect the caseload and the severity of illness of the patients they are caring for and be transparently reported to trust boards'.
It was explained that standard 3 was progressing and was a key part of Bury CCG quality strategy moving forward and that standard 6 was being monitored nationally for acute providers from April 2014. This included the requirement to report staffing in detail as part of the contract; staff friends and family test: and the requirement to report any concerns regarding staffing to commissioners promptly. This standard also includes training and development, workforce analysis and planning for both nursing and medical staff.
Members of the Committee were given the opportunity to ask questions and make comments and the following points were raised:-
· Councillor Mallon referred to the requirement to keep people in settings as local as possible and asked how local was local.
Sharon explained that this would depend on the availability of appropriate services but they would be as local as possible to enable family support and input.
· Councillor Mallon referred to Quality Management and the requirement to have staff which was trained and motivated and asked if the necessary training requirements were built in.
Sharon explained that the CCG worked closely with the providers and the delivery of training was built into contracts as well as the requirement to report incidents and near misses and ensure that a robust whistleblowing policy was in place. There was also the possibility of providing training with the use of additional payments to offer support to providers where this was a requirement.
· Councillor Walker referred to the walkarounds that were carried out and asked if patients' family members were asked questions during these visits.
Sharon explained that if they were there at the time they would be included as part of the visit.
· Councillor Grimshaw explained that when a person is first admitted to a clinical setting if they have their medication in a dose box the staff will refuse to administer it. This can cause problems as the patients' relatives will have to get a prescription which is not always possible at weekends or evenings.
Sharon explained that this was normal practice as there could be a clinical risk issue. Bardoc was always available to issue prescriptions during out of hours.
· Councillor Fitzwalter explained that not all patients or their families would raise concerns or complain and asked how this was factored in.
Sharon explained that there was the friends and family test within the quality management policies and GPs and nurses were also asked if they had any concerns to raise. Monitor also highlighted issues and looked at trends as did the Care Quality Commission.
· Councillor Pickstone referred to the issue at Mid Staffordshire being around too much emphasis on money and statistics and not enough on care and asked how the CCG could ensure a culture change during a time when there were major pressures on finance and targets.
Sharon explained that the CCG works with providers to look at why the issues are there and help to implement systems and working partnerships to ensure that the changes in culture are implemented and work. There was a lot of work being carried out in this area to ensure that the emphasis was on care and care standards and that this was embedded within the providers policies and ways of working. Sharon explained that the clinicians had been given the lead in these areas.
It was agreed
1. That the contents of the presentation be noted.
2. That Sharon be thanked for her presentation.
3. That the CCG Executive Nurse be invited to attend the 8 October meeting of this Committee to present the Quality Strategy.