pgb-15-47 joint quality committee minutes 10.02€¦ · pgb-15-47 . joint quality committee minutes...

PGB-15-47 Joint Quality Committee Minutes

10.02.15

PGB-15-47 Governing Body Meeting in Public 21 April 2015

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Quality Committee Meeting Minutes Tuesday 10 February 2015 13:00 hrs to 15:50 hrs

The Board Room, Francis Crick House

Present: Christina Edwards (CE) : Non-Executive Director NHS Nene CCG (Chair) Peter Boylan (PB) : Director of Nursing & Quality, NHS Nene & NHS Corby CCGs Sebastian Hendricks (SH) : Secondary Care Consultant, NHS Corby CCG

In attendance: Richard Bailey (RB) : Deputy Head of Joint Commissioning, NHS Nene & NHS Corby

CCGs (item 13) Jane Bell (JB) : Head of Nursing, NHS Nene & NHS Corby CCGs Alison Berlie (AB) : Complaints Manager, Arden & GEM CSU (item 10) Karen Cornick (KC) : Public Health Consultant, Northamptonshire County Council

(items 1-3) Sue Freeman (SF) : Joint Commissioning Lead, Learning Disabilities, NHS Nene CCG

(item 5) Alison Jamson (AJ) : Deputy Director of Quality, NHS Nene & NHS Corby CCGs David Knight (DK) : Senior Quality Improvement Manager, NHS Nene & NHS Corby

CCGs (items 14-15) Kelly Morris (KMo) : Service Relationship and Health Protection Manager,

Northamptonshire County Council (items 1-3) Matthew Spilsbury (MS) : Head of Performance, NHS Nene CCG (items 7-8) Helen Sutton (HS) : Minute Taker NHS Nene CCG

1. Welcome and apologies for absence The Chair welcomed attendees and confirmed that due notice of the meeting had been given in line with the Terms of Reference and that the meeting was quorate. Apologies for absence were received from Matthew Davies (MD), Kathryn Moody (KM) and Joanne Watt (JW).

2. Declarations of Interest There were no declarations of interest made by those present.

3. Breast feeding initiation rates in Northamptonshire Karen Cornick (KC) and Kelly Morris (KMo) from Public Health, Northampton County Council (NCC), attended to discuss work being undertaken in relation to increasing breast feeding initiation rates in Northamptonshire. It was noted that KC and KMo, who were new in post, were keen to address challenges and issues in the county whilst working in partnership with health. KC had commenced working with Richard Bailey, Deputy Head of Joint Commissioning for NHS Nene and NHS Corby Clinical Commissioning Groups (CCGs). She had also established links with NHS England (NHSE) and Northamptonshire Healthcare NHS Foundation Trust (NHFT) regarding health visiting and family nurse partnerships with a view to reviewing and


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optimising discussions around breastfeeding during anti/post-natal checks. With 74% of Health Visitors trained on breastfeeding and relationship building, work was ongoing to train 100% of staff and provide a rolling training programme to ensure skills were kept up to date. They were also working with School Nursing Teams via PHSE lessons and supporting the ‘Baby Friendly’ accreditation initiative. KC was working with children’s centres around implementation of the Baby Friendly accreditation process and this included a proposal to have breast feeding champions in each centre. A review of GPs undertaking on-line training was ongoing as well as discussions with the National Childbirth Trust in order to use their expertise to promote breast feeding within local communities. NCC social media platforms were being used to give consistent messages about the benefits of breast feeding and public health would be supporting national breast feeding week. Committee members noted the work being undertaken and suggested prioritising the three highest impact scheme in order to focus on areas that could achieve highly successful outcomes and promote breast feeding initiation. In this regard KC advised she attended the Breast Feeding Strategy and Maternity Northants Group meetings with a view to ensuring work was co-ordinated and progress made against action plans already in place. Progressing the Baby Friendly accreditation process in children’s centres was also a priority. With national targets not being met, it was important to understand people’s intention to breast feed before they entered hospital, and in particular there was a focus on young people who may not have personal experience of a relative breast feeding. By reviewing data available they could proactively steer their focus towards pertinent groups using knowledge regarding the demographic groups of women. Data indicated that although 77% of women initiated breast feeding in hospital, a reduction of approximately 6% had occurred by the time of discharge. JB was concerned that working with midwives had not been mentioned and stated that with the current infrastructure unable to support breast feeding numbers being as good as they could, the role of midwives (anti/post-natal) was critical with initiation as a woman breast feeding at 14 days post birth was more likely to continue. The Maternity Services Liaison Committee (MSLC – see item 13) could monitor and support initiatives to drive breast feeding initiation rates and it was noted that local authority representation was yet to be confirmed, although KMo advised an invitation to attend had been received. It was acknowledged that care pathways in maternity services had changed significantly over the last 20 years placing a greater focus on hospital midwives. However, women often left hospital within a short period of giving birth which shifted the focus for breast feeding initiation to anti/post natal care. Following discussion it was concluded that although work had commenced there was still a long journey ahead. Quality Committee members commented that public health were a critical part of driving the improvement of initiation rates, while continuing to work in partnership with health. It was suggested that a progress update against the implementation plan be submitted to the June meeting. Action: KC/KMo to provide a public health update on the breast feeding initiation rate implementation plan to the Quality Committee in June 2015.


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KC and KM left the meeting. 4. Patient Story

AJ presented a patient story outlining the experience of an individual in a care home who had been moved to a new placement, with the assistance of a member of the quality team, following the closure of their home. The positive outcome of the move for the individual and their family was noted, as was the positive story about the work our teams were doing to make a difference and help people lead the best possible life from beginning to end. Action: AJ to arrange for the patient story to be shared with colleagues via the Care Homes Forum and CCG staff newsletter.

5. Minutes of the previous meetings held on 9 December 2014 QC-15-01 The minutes of the meeting held on 9 December 2014 were approved as an accurate record.

5.1 Matters arising There were no matters arising that were not already on the agenda.

5.2 Action Log QC-15-02 The Action Log was received and reviewed. The following was noted: • Performance Data 0-9 year olds attending A&E (12/8/2014) A date for an audit of attendances and admissions of 0-9 year olds to both acute trusts was still to be agreed. This audit had been requested in order to gain a better understanding around the reasons why high numbers of children were attending, and being admitted to, hospital by accident and emergency (A&E). Northamptonshire was a national outlier for deliberate self-harm and a separate audit would also be required to understand the reasons for that. A three stage audit process had been agreed and was ongoing. Stage one had been completed. This had looked at the last twelve months of data for A&E attendance and emergency admissions for 0-17 year olds. Patterns had been established and trend analysis carried out with key messages and peak and troughs being found. Stage two had been a more focussed review with data analysis during a specific month of activity being undertaken; including age ranges, times of day, day of week, etc. The final stage would be to identify ten children from each trust and complete a case file audit on their admission, the reasons for it and whether it was the most appropriate option in the circumstances. The findings would be presented to the Board of Directors when finalised. • Internal Audit Clinical Governance Report: Serious Incident Policy (8.4.2014 item 11) National guidance was still awaited from NHS England. Concern was expressed regarding the delay. • Adult Safeguarding Awareness Training (9.12.2014 item 18) PB reported that a Workforce Committee had been set up. An inaugural meeting had been held and a review of mandatory training fell within the scope of the Committee. Accordingly, this action could be closed. The remaining actions and updates were noted.


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Sue Freeman (SF) joined the meeting.

6. Transforming Care Programme update QC-15-03 SF presented a Transforming Care Programme for Learning Disability (LD) clients update. Committee members noted progress to date since the last presentation at the December 2014 meeting. The key points were: • The original five people remained in independent hospitals. The CCGs and

Northamptonshire Healthcare NHS Foundation Trust (NHFT) clinical case managers are working closely to finalise the plans for the new build and plan to discharge into supported living in July 2015.

• The Care and Treatment Reviews NHS England all Clinical Commissioning Groups were tasked to carry out have been completed on behalf of NHS Nene and NHS Corby CCGs. There were six in total, five of whom were the original patients.

• The three year strategy remains in its final draft and is under consultation. The report will need updating based on recent publication of the ‘Bubb Report’ (2015). The pathway for children still remains a priority. The three month project exploring services for children is progressing well and planned to be completed by the middle of March.

Quality Committee members sought clarity regarding processes in place to prevent people being admitted to hospital incorrectly going forwards. SF provided assurance that checks and systems were in place with proactive case management and intensive support from community teams in order to challenge and avoid inappropriate admissions to hospital; although where required local arrangements were in place for individuals who may require a short stay in hospital. Systems were also in place to proactively manage any occurrence or crisis should an individual be out of county. NHS England (NHSE) were gathering data on the cohort of patients post-Winterbourne View from all CCGs and Northamptonshire’s forward thinking approach had been noted. NHSE recognised the importance of commissioning Directors of Nursing having oversight and sign-off of all individuals that fall within the transforming care programme going forwards, and would continue to monitor this on a monthly basis. Matthew Spilsbury (MS) joined and SF left the meeting.

7. Review of the Quality Directorate Risk Register QC-15-04 AJ presented the updated Quality Directorate Risk Register (risk register) for information and discussion. There were twelve live risks, two of which were new. One risk had been closed. A discussion ensued regarding the use of the phrase ‘tolerated risk’. It was acknowledged that this approach had been used at the request of the NHS Nene CCG Audit and Risk Committee, and referred to risks that were ‘business as usual’. A rationale as to why the risk was ‘tolerated’, rather than ‘live’, would be added where appropriate on future risk registers Action: AJ to update the tolerated risks on the risk register to include a rationale. QT033: This risk related to services not included in the usual GP contractual arrangements, and accreditation in relation to the same. It was noted that item 18 on the agenda provided the General Practitioner’s with Specialist Interests (GPwSI) Accreditation Process.


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QT045: This risk remained live as the new domiciliary care providers were not yet fully established. Clarification should be added to the risk register in this regard. Action: AJ to provide clarity on the risk register.

8. Quality and Performance Report QC-15-05 Performance: MS provided a brief summary update for information. • Cancer performance: ‘62 day standard’ Northampton General Hospital NHS Trust (NGH) continued to work closely with the University Hospital of Leicester and implement their action plan with progress discussed at their monthly Cancer Board meetings. Good progress was being made, but there was still more work to be done. In December NGH had recorded 84.6% performance against the 85% standard; and Kettering General Hospital NHS Foundation Trust (KGH) 84.9%. • Urgent Care: ‘Patients waiting 4 hours or less in A&E’ Performance in January 2015 was at 87% (unvalidated) for KGH and NGH. Issues included huge demand at the front door, system waits, a large increase in the number of unplanned admissions, closed beds as a result of Noro virus and a shortfall in domiciliary/social care packages. Although additional winter monies had been made available nationally to help clear elective back-logs, it was anticipated that the local rise in non-elective admissions would result in challenges around the 18 week referral to treatment (RTT) standard as elective back-logs began to build. • Planned care: ‘Diagnostics within 6 weeks’ KGH had not met the standard of no more than 1% of patients waiting more than 6 weeks for a diagnostic test; with performance deteriorating to 6.87% (280 patients) in December 2014. KGH expected to recover their position by March, and be back on track by April 2015. It was noted that additional radiologists had been brought in to make inroads into the backlog. Quality: AJ provided a brief summary update for information. • Northampton General Hospital NHS Trust (NGH) Investigations had commenced into two cases of Methicillin-resistant Staphyloccus aureus (MRSA) bacteraemia that had been reported in January 2015. • Kettering General Hospital NHS Foundation Trust (KGH) The Trust had submitted their response to the Care Quality Commission (CQC) Chief Inspectors report in December 2014. An action plan had been received and progress would be monitored through Clinical Quality Review meetings.


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• Northamptonshire Healthcare NHS Foundation Trust (NHFT) The CQC Chief Inspectors visit to the trust had taken place week commencing 2 February 2015. Approximately 110 inspectors had taken part in the inspection and it was anticipated the report would be available in approximately 6 weeks. • Brackley Cottage Hospital NHS Nene and NHS Corby CCGs had been served notice by Brackley Cottage Hospital with the intention of closure on 31 March 2015 due to a shortage of registered nurses. The CCG was working with the Trustees of Brackley Hospital Trust, and other local stakeholders, to explore the options available to continue with these services.

• Woodland Hospital Woodland Hospital reported a wrong site surgery (Never Event) in September 2014. The completed investigation report is under review by the CCG. An assurance visit to the hospital is planned for March. • St Andrew’s Healthcare PB had attended the Quality Summit following their CQC inspection. As an independent provider St Andrew’s held several sites nationally which had been rated as ‘requires improvement’. However, it was noted that the CQC rating given for the Northampton site had been ‘good’. MS left the meeting.

Items for Approval / Ratification 9. Inclusion and Equality Strategy 2013-2016 QC-15-06

Quality Committee members received the Inclusion and Equality Strategy 2013-2016 (the strategy) for approval. PB confirmed that the strategy been reviewed by the Inclusion and Equality Leadership Group in January 2015 and approved as fit for purpose. It was noted that as there had been no change in legislation, the objectives set in 2013 remained relative and were being monitored by the sub-committee. Quality Committee members approved the Inclusion and Equality Strategy 2013-2016, with a recommendation it be submitted to the Governing Bodies of NHS Nene and NHS Corby Clinical Commissioning Groups (CCGs) for ratification. Action: HS. Alison Berlie (AB) joined the meeting.

10. Complaints Handling Service QC-15-07

AB presented the updated complaints policies for approval (items 10.1 and 10.2). It was noted that following an organisational review the Complaints Handling Service would return to be managed in-house with effect from 1 April 2015. The policies had been drafted with this in mind, and would be published and effective from that date.


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10.1 Complaints Handling Policy Quality Committee members commented that the Complaints Handling Policy was comprehensive but required a short summary on how to make a complaint, and the subsequent journey, and that this should be added to the website page where the policy is published. Action: AB to provide the complaint journey summary for publication. Subject to this, the Quality Committee approved the Complaints Handling Policy with a recommendation it be submitted to the Governing Bodies of NHS Nene and NHS Corby Clinical Commissioning Groups (CCGs) for ratification. Action: HS.

10.2 Management of Persistent and Vexatious Complainants Policy The Quality Committee approved the Management of Persistent and Vexatious Complainants Policy with a recommendation it be submitted to the Governing Bodies of NHS Nene and NHS Corby Clinical Commissioning Groups (CCGs) for ratification. Action: HS.

Once ratified, the policies would be effective and published from 1 April 2015. Action: HS to publish the ratified polies on the NHS Nene and NHS Corby CCG websites on 1 April 2015.

AB left the meeting.

11. Quality Strategy 2014-2019: Annual review QC-15-08

AJ reported that an annual review of the Quality Strategy 2014-2019 (the strategy) had been undertaken. Whilst the vision for quality remained unchanged, the strategy had been refreshed to include key national issues, the revised Quality Visit Process and the commissioning for quality and innovation (CQUIN) schemes for 2015-16. SH questioned whether, as commissioners, there were appropriate ethical processes in our governance procedures and how we made our decisions and, if so, whether that should be included within this strategy. Following discussion it was concluded that ethical processes and governance procedures should be included within organisational strategy as commissioning decisions did not fall within the remit of this Committee. The Quality Committee approved the Quality Strategy 2014-2019 with a recommendation it be submitted to the Governing Bodies of NHS Nene and NHS Corby Clinical Commissioning Groups (CCGs) for ratification. Action: HS.

AJ suggested that a ‘quality strategy on a page’ would be a useful tool on the websites and it was agreed this should be placed on the agenda for the next meeting. Actions: • AJ to provide a quality strategy on a page for use on the CCGs’ websites. • Agenda April 2015


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Themed items for discussion: Clinical Effectiveness 12. Review of the Quality Strategy 2014-2019 work plan QC-15-09

A review of the Quality Strategy 2014-2019 work plan (work plan) had been undertaken and an overview on progress and implementation of the three overarching strategic quality goals, outlined below, was provided for information: i. Compliance with National NHS Constitutional Expectations. ii. Delivery of local quality improvement objectives. iii. Delivery of the quality team Operational work plan. The Quality Committee noted the progress made to date and congratulated AJ and the quality team on progress against implementing the above goals. Richard Bailey (RB) joined the meeting.

13. Northamptonshire Maternity Services Liaison Committee QC-15-10 ‘Maternity Northants’

RB introduced the ‘Maternity Northants’ Maternity Services Liaison Committee (MSLC) paper for information, which included a brief précis of the work done in the county over the past six years. RB reminded members that health economies are required to have a Maternity Services Liaison Committee (MSLC) as defined by the National Guidelines issued by the Department of Health in 2006. The MSLC is made up of a commissioner, maternity healthcare professional, service user and voluntary group representatives. It is chaired, or co-chaired, by a lay representative. The role of the MSLC is to ensure that the body that commissions maternity services listens to, and takes account of, the views and experiences of both the users and providers of those services. It was noted that during the last six years, Maternity Northants had developed its own brand and website and supported many maternity initiatives. RB indicated that a formal governance route was required for health to receive reports from, and direct the work of, Maternity Northants. It was proposed that the minutes of the Maternity Northants Committee meetings be submitted to the Quality Committee, and that an annual report be produced and submitted for information and assurance purposes. RB reported that both co-chairs of Maternity Northants had indicated that they would be standing down from the role. Accordingly, a process for electing the chair(s) had been drafted and submitted to the Quality Committee for consideration and approval. In addition, drafts Terms of Reference (ToR) were also submitted for discussion and approval, having been reviewed and agreed as fit for purpose by NHS England.

Committee members were minded that governance arrangements for the MSLC should be linked with the Breast Feeding Strategy Group, discussed earlier with public health under item 3. Clarity was sought as to how the two groups would link and how reporting might look from a governance perspective. Following discussion it was concluded that it would be logical if the Breast Feeding Strategy Group report to the MSLC, and they subsequently


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reported to the Quality Committee. This proposal would enable the MSLC to support its function to inform planned commissioning intentions. Agreement to this direction of reporting would be required by the Breast Feeding Strategy Group and public health and Quality Committee members requested that RB seek agreement with Public Health regarding the above reporting structure. Action: RB to seek approval regarding the proposed governance reporting route for the Breast Feeding Strategy Group into MSLC and then the Quality Committee. Having considered the recommendations contained within the paper, the Quality Committee: • Endorsed the proposed line of reporting to the Quality Committee by way of an annual

report and receipt of minutes of meetings. • Approved the process for electing the chair(s) for Maternity Northants. • Requested the Terms of Reference (ToR) be amended to define the reporting

arrangements discussed above and include public health membership. The ToR should be returned to the Quality Committee for ratification in April. Action: RB / Agenda April 2015

David Knight (DK) joined and RB left the meeting.

14. Cancer Patient Experience Survey QC-15-11 DK introduced the overview of the National Cancer Patient Experience Programme Survey, highlighting that both of the acute trusts had performed better than national peers in several areas. Discussions had been held with both trusts regarding action plans for development post survey and it was noted that the following had been agreed: i. Both providers would be taking forward action plans to address areas of concern. ii. The quality team would work with providers through the relevant trust committees.

Any issues of sustained concern or lack of progress would be escalated through the Clinical Quality Review meetings and/or operational contracting meeting.

Quality Committee members remained concerned regarding performance against cancer targets, however, the results of the survey suggested patients were less critical. What was heartening was that feedback was positive around professional/patient relationships and behaviour which was important to the patient experience. Quality Committee members were reminded that cancer targets were only one metric with some breaches being caused by delays in patient choice. In order to obtain a full view of what was happening, triangulation of all data and information was required. The Quality Committee noted the content of the report.

General Items for Discussion 15. Never Event Overview Report QC-15-12

Committee members received and noted the contents of the Never Event Overview Report. Learning would be shared at the Countywide Patient Safety Forum.


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DK left the meeting.

16. NHS Nene and NHS Corby Clinical Commissioning Groups: QC-15-13 Inclusion and Equality Workforce Statements for publication PB reported that there was a statutory duty to publish workforce profile statements for NHS Nene and NHS Corby CCGs by 30 January every year on the CCGs’ websites. The Inclusion and Equality Leadership Group had reviewed and approved the statements for publication in 2015, and assurance was provided to the Quality Committee that they had been published in compliance with legislative requirements in line with the deadline.

Review of the current risks 17. Review of the current risks

There were no new risks to be added. Items for Information 18. General Practitioners with Special Interests (GPwSI) Accreditation Process QC-15-14

The paper was received and noted.

19. Clinical Quality Review Visits QC-15-15 The paper was received and noted.

20. Clinical Quality Review Meeting Notes QC-15-16

The notes were received and noted. 21. Inclusion and Equality Leadership Group Minutes dated 12 January 2015 (draft) QC-15-17 Received and noted. 22. Countywide Patient Safety Forum minutes dated 27 November 2014 (draft) QC-15-18

Received and noted. 23. Northamptonshire Health Strategic Safeguarding Forum minutes dated QC-15-19 3 December 2014 and 21 January 2015 (draft) QC-15-20

Received and noted. 24. Northants Prescribing Management Group minutes 13 January 2015 (draft) QC-15-21

Received and noted. 25. Northamptonshire Maternity Services Liaison Committee minutes dated QC-15-22 12 November 2014 (draft)

Received and noted. 26. Quality Surveillance Group minutes dated 28 November 2014 (draft) QC-15-23

Received and noted. Any Other Business 27. Any Other Business There was no other business.


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Date of the next meeting: 28. Date of the next meeting:

Tuesday 14 April 2015, 13:000 hrs to 16:30 hrs in the Board Room, Francis Crick House.

There being no further business the meeting closed at 15.50 hrs.


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pgb-15-47 joint quality committee minutes 10.02€¦ · pgb-15-47 . joint quality committee minutes...

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