Enc N 165 11 Quality report

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					 ENCLOSURE: N
 Formal Clinical
 Commissioning Cabinet
 Meeting: 15 December 2011
 Agenda Item: 165.11




Meeting                              Bexley Clinical Commissioning Cabinet
Agenda Heading                       Paper for information & discussion
Enclosure                            N Item 165.11
Date of Meeting                      15 December 2011
Title of report                      Quality Report
                                     Quarter 2 (July - September 2011)
Recommendation                       The committee is asked to:-

                                      receive the report

                                      and note that the reports contained have been received
                                       by the BCCC Clinical Quality Assurance Group who
                                       have agreed that quality concerns identified by the
                                       report are, or have been actively addressed though the
                                       appropriate groups.

Executive summary
Quality Monitoring Process:
This report examines the key quality domains (Patient Safety; Clinical Effectiveness; and Patient
Experience) relating to services commissioned by Bexley Business Support Unit, NHS South
East London (BBSU) and identifies the quality assurance process that has been developed for
monitoring these services. This report is an outcome of this assurance process and is based on
reports that have been approved at various external and internal committees. The report is
designed as a quarterly review and is not designed to represent a real time snapshot of the
quality of provider services. Where necessary, when there are urgent concerns around the safety
or quality of provider services, these will be raised directly with the Bexley Clinical Quality Lead or
the Medical Director and escalated as necessary.

To enable the provision of robust assurances of quality, commissioned services are monitored at
the following Quality Groups:

      BBSU/Oxleas Community Health Services Quality Group;

      BBG/Oxleas Mental Health Services Quality Group - established with BBSU, Bromley &
       Greenwich BSUs;

      NHS South East London & SLHT Clinical Quality Review Meetings.

Quality & Safety reports are prepared by the relevant providers for the above meetings. These
reports are reviewed in detail by the commissioning representatives at these meetings. Further
assurance is requested when commissioners are not satisfied with the controls or outcomes or
further information is needed.




       1
The Quality reports from the above Quality Groups are fed into the Bexley BSU Clinical Quality
Assurance Group whose role is to review and ratify the reports and report to the Bexley Clinical
Commissioning Cabinet and the NHS South East London Cluster Board sub-committee meeting
on Quality & Safety.

The Quality & Safety reports from the above providers’ Quality Meetings have been used to
inform this Bexley BSU Quality Report. The report covers Quarter 2, 2011/12.

The last meeting of the BBSU Clinical Quality Assurance Group was held on 01.12.11.

Oxleas Community Health Services

There are currently two red indicators on the Q2 dashboard.

      Safeguarding Children Training level 3, Q2= 47% (Target 80%). Oxleas are undertaking a
       mapping exercise to ensure correct staff assigned to each training level. Non compliant
       staff to undertake training as a matter of urgency. This will be reported back at the next
       Clinical Quality meeting. Safeguarding Children level 2 training is also 4% below target
       and is Amber rated.

      Agency & Bank use for staff was 10% or more below target for two months out of three for
       Q2. This indicator is being monitored by the Bexley Community Health Service Clinical
       Quality Meeting. The other Workforce related indicator (sickness) is on target.

Oxleas Mental Health

There is currently one red rated indicator on the Q2 MH Dashboard.

Quality CE3.1 – Clinical Effectiveness: Providing better information for our users and
carers.
Ensure patients detailed under the Mental Health Act are provided with information as stated and
action to be recorded on RiO. - Quarter 2 position under target by 10.8% (6 patients).

Oxleas Commissioning Group stated in the Quality Meeting on 9 November that action would be
undertaken Trust wide to brief all Assertive Outreach Team members to ensure correct
procedures were understood and followed. This will be reviewed when the October 2011 figures
are received for the Monthly Contract Monitoring and will be reviewed by Commissioners at the
Q3 Quality Meeting.

South London Healthcare NHS Trust (SLHT)

The Joint Quality Group continue to monitor and seek assurance. Highlights form the Quality
monitoring Summary (October 2011) include:

    Serious Incidents (SI’s) – slight improvement on completion of investigation timeframes
     and reduction of numbers of serious incidents from Q1 to Q2.
    The mortality rate is below the national average: HSMR 84.7 mortality rate (national
     average 100).
    Safeguarding Children targets for supervision of staff have been 100% achieved.
    Infection control rates for C.diff & MRSA have not quite met the targets action plan being
     developed.




       2
BBSU Complaints/PALS -

Total Complaints investigated by Bexley BSU in Q2
    25 investigated (Q1 – 22)

Complaints about directly provided services
   2 complaints -1 premises, 1 IFR Commissioning
   Independent contractor complaints =15 complaints -10 GP practices: 5 Dental

The number of GP complaints has slightly increased from the previous quarter. The number of
Dental complaints has also increased slightly from 3 in Q1 to 5 in Q2.

Of the 10 GP complaints raised key themes are:
          o Refused appointment
          o Attitude of Nurse
          o All aspects of care and treatment
          o Delayed diagnosis

Dental themes include treatment, charges, standards of care and treatment and refused
appointment.

Commissioned services (e.g. Bexley Community Provider Unit & Acute services)
   9 complaints (Q1 = 6)
    (1 UCC, 8 Acute)

Key themes from commissioned services include:
    Attitude of staff
    Cancelled operation
    All aspects care and treatment/misdiagnosis

PALS
The number of PALS contacts for Q.2 is 732 this is an increase from Q.1 624.

Key themes
    Concerns/Advocacy -: Manner and attitude, refusal to refer, incorrect prescriptions issued,
      changes to prescriptions without prior notification or refusing to prescribe without
      explanation, ongoing difficulties in obtaining an appointment.
    Delays in Individual Funding Requests (IFR) requests –
    Savoy Transport
    SLHT - Rise in number of concerns raised regarding SLHT, particularly QMH in respect of
      Orthopaedic and Gynae services.
    IVF

CQC reviews
The following reviews have been undertaken or are underway
    Stroke Care
    Care Homes.
    Support for families with disabled children
    CQC/HMI Probation: Youth Offending inspection

Further details included



       3
Infection control
Infection control at independent contractors is currently monitored by the Bexley BSU Lead Nurse
Infection Prevention & Control. For the period January 2011-September 2011 there have been 7
audits covering the 14 out 28 different Bexley GP practices. Scores out of 100 were assigned for
each audit. From this an Overall Compliance score for each surgery was assigned. The top line
results of the Overall Compliance score in these audits is as follows:
 95% and above      9 practices
 85-94%             3 practices

 75-84%             1 practice
 Below 75%          1 practice
Cairngall Medical Practice is the only practice below the target of 75% compliance (70%)
Care Home Quality Report Q2
No concerns raised via the Oaks monitoring report
       All pre-placement assessments completed within 48 hours
       All CHC patients care plans were reviewed monthly
       There were 22 falls (15 in Q1) which after considering each case no issues were
         identified
       One CHC patient had a grade 1 pressure ulcer (redness of skin)
No concerns identified from monthly monitoring reports from 5 other Nursing Homes
       All pre-placement assessments completed within 48 hours
       All CHC patients care plans were reviewed monthly
       There was 1 fall and no issue was identified after reviewing the information
       Two CHC patients had grade 2 pressure ulcers on admission to the home
No significant concerns raised via Adult Safeguarding, Bexley Council or Complaints
NICE Implementation status report
At the September meeting of CQAG the Bexley BSU NICE Guidance process was approved. The
NICE Implementation Status report is an output of this process and highlights where the BSU has
not yet completed undertaking its responsibilities as commissioners. For the following NICE
Guidance at least one recommendation from the guidance (relevant to the BSU) has not been
met but an action plan is in place and on target:
     Alcohol Dependence Quality Standard
     Chronic Obstructive Pulmonary Disease Quality Standard
     Chronic Heart Failure Quality Standard
Other pieces of NICE guidance are still under review by commissioners. This includes Public
Health Guidance on Preventing Type 2 Diabetes.


Organisational implications
Financial              Quality of services is contractually linked via CQUINs
Equalityand            No Equality and Diversity issues identified.
Diversity
Risk    (governance    This report provides assurance that there are processes and procedures
and /or clinical)      in place for ensuring the quality and safety of commissioned services.
Patient impact         This paper sets out quality & patient safety indicators for Bexley patients
                       and patients of provider services.



      4
NHS constitution       This paper supports the pledges as set out in the NHS constitution


Which objective does this paper support?                                         Insert Tick ()
Improve choice and access to integrated health services for Bexley patients      
Reduce the level of health inequalities across Bexley                            
Improve care for patients with long term conditions & increase the range of      
services offered within the community
Improving the health & wellbeing for people in Bexley                            
Maximizing the opportunities of joint working (APoH, JSNA, Wellness agenda       
etc)
Using our resources in the most efficient & effective manner (organisational &   
financial)


Report Authors                  Andrea Davis, Clinical Governance Facilitator
                                Michael Fairbairn, Clinical Governance & Corporate Risk
                                Manager
                                David Parkins, Clinical Quality Lead
Date                            02.12.11
Contact Details                 0208 298 6279
Executive sponsor               Dr Jo Medhurst




      5
                              Bexley Business Support Unit
                                     Quality Report

                                           Index

1.   Introduction                                                  Page 7

2.   Oxleas Community Health Services

     2.1 Introduction                                              Page 8

     2.2 CQUINS                                                    Page 7

     2.3 Quality Dashboard                                        Page 10

3.   Oxleas Mental Health Services

     3.1 Quality and Safety Improvement Plan                      Page 13

     3.2 CQUINS                                                   Page 13


4.   South London Healthcare NHS Trust (SLHT)

     4.1 Highlight report                                        Pages 15-17


5.   PALS/Complaints                                              Page 18

6.   CQC Reviews

     6.1 CQC Review of Stroke care                                Page 20

     6.2 Review of healthcare in care homes                       Page 20

     6.3 Review of support for families with disabled children    Page 20

     6.4 CQC Youth Offending Inspection                           Page 20


7.   NICE Guidance

     7.1 NICE Status Report                                       Page 21

8.   Infection Control                                            Page 25

9.   Care Home Quality Report                                     Page 25




                                                                               6
                                  Bexley Business Support Unit
                                         Quality Report

1.      Introduction

This report examines the key quality domains (Patient Safety; Clinical Effectiveness; and Patient
Experience) relating to services commissioned by Bexley Business Support Unit (BBSU) and
identifies the quality assurance process that has been developed for monitoring these services.
This report is an outcome of this assurance process and is based on reports that have been
approved at various external and internal committees. The report is designed as a quarterly review
and is not designed to represent a real time snapshot of the quality of provider services. Where
necessary, when there are urgent concerns around the safety or quality of provider services, these
will be raised directly with the Bexley Clinical Quality Lead or the Medical Director and escalated
where urgency is indicated.

The report examines the above quality themes for the following providers of care:

    Oxleas Community Health Services
    Oxleas Mental Health Services
    South London Healthcare NHS Trust (SLHT)

This report aims to inform the BBSU Clinical Commissioning Cabinet about the quality and safety of
services commissioned by the BBSU and in doing so provide assurance that the BBSU is upholding
its responsibility and commitment to commission safe, high quality and value for money health
services for the population of Bexley.

To enable the provision of robust assurances of quality and to enable monitoring of commissioned
services the following Quality Groups have been established:

    BCT(Bexley BSU)/Oxleas Community Health Services Quality Group
    BBG/Oxleas Mental Health Services Quality Group- established with BCT(Bexley BSU), Bromley
     & Greenwich PCTs
    NHS South East London Cluster & SLHT Clinical Quality Review Meetings

Quality & Safety reports have been provided by the relevant providers for the above meetings.
These reports are reviewed in detail by the commissioning representatives at these meetings.
Further assurance is requested when commissioners are not satisfied with the controls or outcomes
or further information is needed. These reports have been used to inform this BBSU Quality Report.




                                                                                                 7
2. Oxleas Community Health Services

2.1 Introduction

Oxleas Community Health Services were previously part of Bexley Care Trust until the
provider/commissioner split on 1st July 2010 when services were transferred to Oxleas NHS
Foundation Trust. Oxleas Community Health Services provide a range of primary and community
health services to people of all ages across Bexley.

Oxleas CPU Quality Dashboard measures performance, quality and efficiency in patient safety,
patient experience, clinical effectiveness and workforce showing how care is being delivered and
revealing areas of care that need to be improved. This dashboard is monitored by the Oxleas CPU
Quality Group. Chair David Parkins.

There are currently two red indicators on the Q2 dashboard.

      Safeguarding Children Training level 3, Q2= 47% (Target 80%). Oxleas are undertaking a
       mapping exercise to ensure correct staff assigned to each training level. Non compliant staff
       to undertake training as a matter of urgency. This will be reported back at the next Clinical
       Quality meeting. Safeguarding Children level 2 training is also 4% below target and is Amber
       rated.

      Agency & Bank use for staff was 10% or more below target for two months out of three for
       Q2. This indicator is being monitored by the Bexley Community Health Service Clinical
       Quality Meeting. The other Workforce related indicator (sickness) is on target.

For several of the indicators the thresholds are determined over the first 6 months (July - September)
and as such no RAG rating has yet been assigned. The indicator relating to Agency & Bank usage
has been rising during Q1. This is being monitored at the BBSU/Oxleas Community Health Services
Quality Group.

There have been 6 Serious incidents in total for Q2. Four of these related to grade 3 pressure ulcers
at the Step Up Step Down Unit. One related to a fall (with fracture) on the unit and one related to a
Child Safeguarding incident reported by Health Visitors. The Child safeguarding incident occurred in
August 2011 and is currently under investigation and an investigation panel has been established.

All beds in SUSD are being fitted with movement sensors to alert nurses to patients trying to get out
of bed. All staff have been trained in the use of the new equipment.

Oxleas will provide Roots Cause Analysis reports on the pressure ulcer incidents to the Clinical
Quality Meeting.

2.2 CQUINS have been agreed in the following areas:-
   1) To encourage effective communication between community and primary care.
   2) Improving access to Care Plans for Long Term Conditions Services by recording Care Plans
      on RiO.
   3) Improve the numbers of patients who are actively case found and provide a proactive and
      preventative care plan to case manage their condition.
   4) Pressure ulcers.
   5) Smoking cessation.


At the 25.10.11 Oxleas CPU Quality Group it was reported that CQUINs 1a), 1b), 2 & 5 were met for
Q2.


                                                                                                    8
CQUIN 1c) was reported as being more than 10% below target for Q2. This related to patients being
discharged from the community team with a full discharge summary to practices within 2 days of
discharge. Oxleas considered that clinicians were not uploading onto RiO using the correct
terminology and are undertaking an investigation into the cause of this under performance. Oxleas
will report back at the next Oxleas CPU Quality Group meeting.

CQUIN 4, reduction of pressure ulcers, was also reported as being more than 10% below target for
Q2. However, certain elements of the pressure ulcer targets had been met. It was agreed by Bexley
BSU that Oxleas would receive payment for those parts of the targets that it had met.




                                                                                               9
BEXLEY COMMUNITY HEALTH SERVICES DASHBOARD OVERVIEW - 2011/12
                 Ref   Quality                  METHOD OF              Report      2010/11     Target   APR    MAY     JUN      JUL    AUG    SEP             COMMENTS
                       Indicator                MEASUREMENT            Freq          Qtr 1
                                                                                   Baseline
                 PS    MRSA                     Incidence (SUSD        Quarterl       No       Nume      0       0       0       0      0       0          There have been no
                 1     Incidence (VS            only)                  y          reportable    ric                                                          incidents YTD
                       - Nat - VSA01)                                             incidence
                                                                                    for Q1
                                                                                   2010/11
                 PS    C Diff                   Incidence (SUSD        Quarterl       No       Nume      0       0       0       0      0       0          There have been no
                 2     Incidence (VS            only)                  y          incidence     ric                                                          incidents YTD
                       - Nat - VSA03)                                               for Q1
                                                                                   2010/11
                 PS    Number of                Number of SI’s         Monthly                 Nume      5       3       1       1      1       4      4 Grade 3 Pressure Ulcers,
                 3     Serious                  reported in a                                   ric                                                       1 Fall, 1 Safeguarding
                       Incidents                contract month.                                                                                             Children SIs for Q2
                                                                                                                                                        No RAG rating for numeric
                                                                                                                                                                  indicator
                                                                                                                                                       SIs continue to be monitored
                                                                                                                                                                   closely
                 PS    Falls -SUSD              The number of          Quarterl   Baseline     Nume      0       0       31      0      0       14
                 4                              patients falling in    y            to be       ric                     falls                  falls    No RAG rating for numeric
                                                community                         provided                             in Q1                  in Qtr            indicator
PATIENT SAFETY




                               PATIENT SAFETY




                                                hospital by severity                                                   either                    2      Reduction in Qtr 1 figures
                                                of harm (as per                                                          no                   either
                                                NPSA definition).                                                      harm                   low or
                                                                                                                       or low                   no
                                                                                                                       harm                    harm
                 PS    % Staff trained          Number of eligible     Quarterl    80.54%      95%      0.00   0.00%   75.00    0.00   0.00    81%
                 6     for Infection            staff trained in       y                                 %               %       %      %
                       Control                  Infection Control
                                                within the past
                                                twelve months as
                                                at the last day of
                                                the contract year
                 PS    Safeguarding             Safeguarding           Quarterl    64.29%      80%      0.00   0.00%   80.43    0.00   0.00   85%
                 7     Children                 Children Level 1       y                                 %              %        %      %
                       Governance               Measure training
                                                rate for relevant
                                                staff.
                 PS    Safeguarding             Safeguarding           Quarterl    80.25%      80%      0.00   0.00%   91.10    0.00   0.00   76%        Non compliant staff to
                 8     Children                 Children Level 2       y                                 %              %        %      %                undertake training as a
                       Governance               Measure training                                                                                           matter of urgency
                                                rate for relevant
                                                staff.




                                                                                                                                                                                      10
                         Ref   Quality           METHOD OF               Report     2010/11      Target   APR     MAY      JUN     JUL     AUG     SEP
                               Indicator         MEASUREMENT             Freq        Qtr 1
                                                                                    Baseline
                         PS    Safeguarding      Safeguarding            Quarterl   59.68%       80%      0.00    0.00%    84.62   0.00    0.00    47%       Oxleas are undertaking a
                         9     Children          Children Level 3 -      y                                 %                %       %       %              mapping exercise to ensure
                               Governance        Measure training                                                                                            correct staff assigned to
                                                 rate for relevant                                                                                          each level. Non compliant
                                                 staff.                                                                                                    staff to undertake training as
                                                                                                                                                           a matter of urgency. This will
                                                                                                                                                           be reported back at the next
                                                                                                                                                              Clinical Quality meeting
                         PS    Safeguarding      No case                 Monthly    Approx       Nume      44      67       75      80      34      39      Over 150 attended during
                         10    Children          conferences                        150 per       ric                                                                the quarter
                               Governance        attended by BCHS                   quarter


                         PS    PSA13             No. Of High Risk        Quarterl    Baseline      %      0.00    0.00%    80.92   0.00    0.00    89%     This indicator was added to
                         11    Improved Child    Children <5 years       y            to be                %                %       %       %               the dashboard in October
                               Safety            old followed up                    investigat                                                               2011. A RAG rating and
                                                                                        ed
                                                 compared to                                                                                                   baseline is still to be
                                                 number of Red                                                                                                      identified.
                                                 and Amber A&E
                                                 slips received.
                         PE    Number of         Number of               Monthly     15 per      Nume      2        0       5       1       6       2       No RAG rating for numeric
EXPERIE
PATIENT




                         1     Complaints        Complaints                          quarter      ric                                                      indicator. Complaints levels
  NCE




                                                 received in                                                                                                   monitored at BCHS
                                                 contract month.                                                                                            Clinical Quality Meeting
                         CE    Health Visitors   % of new birth          Monthly    85.00%         %      90.09   81.45    86.55   86.83   89.00   96.00
                         1     – Health          visits carried out to                                     %       %        %       %       %       %
                               Promotion         Bexley Babies
                               (including New    within 17 days
                               Born hearing,
CLINICAL EFFECTIVENESS




                               screening and
                               breast feeding
                               input).
                         CE                      % of patients to        Monthly      No         Nume     73.68   100.00   100.0   86.96   78.57   83.33     Baseline currently under
                         2     SUSD –            have an estimated                  baseline      ric      %        %       0%      %       %       %               discussion
                               Estimated         date of discharge
                               Date of           planned &
                               Discharge         documented on
                                                 admission
                         CE    SUSD –            % of patients who       Quarterl     No           %      0.00    0.00%    65.22   0.00    0.00    92.31     Baseline currently under
                         3     Structured        have a care plan        y          baseline               %                %       %       %       %                discussion
                               Rehabilitation    for their stay on                                                                                           Significant improvement
                               Plan              SUSD within RiO                                                                                                     from Qtr 1



                                                                                                                                                                                            11
            Ref   Quality          METHOD OF             Report    2010/11      Target   APR    MAY     JUN     JUL     AUG    SEP            COMMENTS
                  Indicator        MEASUREMENT           Freq       Qtr 1
                                                                   Baseline
            W1    Agency &         Agency & bank         Monthly   3 months     8.5%     9.10   9.77%   12.52   11.39   7.53   12.23   This indicator is being
                  Bank hours as    staff hrs in the                    to                 %              %       %       %      %
                                                                   establish
                                                                                                                                       monitored by the BCHS
                  a % of overall   contract month /                                                                                    Clinical Quality Meeting
                                                                   threshold
                  staff hours      Total staff hrs (%)                                                                                             0
                                                                       &
WORKFORCE




                                                                    baseline
            W2    Sickness         Total days lost due   Monthly      No        5.0%     5.05   4.32%   3.69    5.46    4.28   4.89
                  Rates            to sickness per                  baseline              %              %       %       %      %
                                   month in the
                                   contract month /
                                   Total days
                                   available per
                                   month in the
                                   contract month.



            Key
                                                          1-9% below           10% or more
                              Target achieved             target               below target




                                                                                                                                                                  12
3.0 Oxleas Mental Health, Oxleas NHS Foundation Trust
Oxleas Mental Health Services, Oxleas NHS Foundation Trust offer a wide range of health and social
care services in south east London, specialising in caring for people with mental health problems or
learning disabilities. Oxleas is the main provider of specialist mental health care in Bexley, Bromley and
Greenwich.

3.1 Oxleas Quality and Safety Improvement Plan 2011 -2012
Oxleas Quality and Safety Improvement Plan 2011-12 measures performance, quality and efficiency in
patient safety, patient experience and clinical effectiveness showing how care is being delivered and
revealing areas of care that need to be improved. These reports feed into the quarterly Quality Report
which forms the basis of the annual Quality Accounts reported externally.

Progress against the QSIP and CQUIN indicators is presented as a dashboard overview which
detailed below. Highlights from the reports are as follows

      10 out of 17 indicators have been achieved at target or higher;
      1 indicator at red - this indicator relates to patients’ rights under Section 132 of the Mental
       Health Act following formal detention in hospital. In four cases breaches arouse as a
       consequence of Assertive Outreach Team patients being made subject to Community
       Treatment Orders without their rights being communicated to them. A further four patients
       were highlighted as failing to have received their rights whilst being made subject to short
       term detentions and being referred between wards requiring acute in-patient care under
       provisions of the Act.
      6 indicators are recorded at Amber

Further actions:

      Focused work is taking place in the Assertive Outreach Team to ensure staff are aware and
       understand provisions under Section 132 of the Mental Health Act;
      The Trust has reported 1 incident of CDIFF – this has arisen as a consequence of a patient
       being admitted to an Oxleas ward and prior to admission was prescribed antibiotics for a pre-
       existing condition. The patient subsequently experienced side effects which could not have
       been predicted

CQUIN progress update

The Trust CQUIN dashboard provides an overview of progress against agreed indicators. Highlights
from the report include the following

      CQUIN 1 has not been fully achieved in Quarter 2. The Trust has failed under 1.4 to send
       discharge notifications for inpatient and community teams to GP’s within 3 days of discharge.
       Commissioners agreed that this could be split from Quarter 3 – 1.4a Discharge notification to
       GP from Wards and 1.4b discharge notification from the Community Teams.
      CQUIN 2 – Owing to the late date information was sent to GP practices it has not been
       possible to validate whether GP’s have received patient related data.
      CQUIN 3 – relates to the increase in BME patients being referred for acute inpatient care.
       This Target is currently on target.

Further Actions:

      CQUIN 3 - Commissioners have agreed to audit ten practices to ascertain if data has been
       received before confirmation of CQUIN can be made.
      CQUIN 4 relating to joint work between substance misuse and mental health services
       continues to report low numbers for assessment. Commissioners have agreed to consider
       how the baseline data can be translated into a CQUIN for 12/13 to improve in assessment
       and screening around substance misuse and mental health.


                                                                                                   13
MENTAL HEALTH: QUALITY AND SAFETY IMPROVEMENT PLAN DASHBOARD OVERVIEW -                                                                                                                                  2011/12
Key
                      Target achieved
                      1-9% below target
                      10% or more below target




                                                                                                                                                              Movement

                                                                                                                                                              previous
                                                                                                                                        Aug-11
                                                                                                 May-11




                                                                                                                                                     Sep-11
                                                                                                              Jun-11
                                                                                    Apr-11




                                                                                                                                                               month
                                                                                                                           Jul-11




                                                                                                                                                                from
                      Indicator                                      2010/11                                                                                              2011/12                                                         Comments added by Commissioners after Q2
Quality Domain                  Full description                                                                                                                                     Comments
                      Code                                           Baseline                                                                                             Target                                                          Quality Meeting with Oxleas



                               Ensure percentage carer details                                                                                                                       RAG rating based on year end target.
                                                                                                                                                                                                                                          Oxleas stated that work is on-going and continues
                      PE1.1    are recorded on RiO for clients on     93.7%     89.1%        86.7%        89.9%        88.6%        91.0%        91.7%                     95%       Percentage includes 'no of carers' present
Patient                        new CPA                                                                                                                                               and 'valid no carer present' recorded on RiO
                                                                                                                                                                                                                                          steadily towards the target
Experience:
Increasing support
for families and               To ensure that 60% of registered                                                                                                                      Number of carers registered as at March
carers                         carers of clients on CPA have                                                              244                                                        Baseline = 1313. RAG rating is based on
                      PE1.2                                            631         51*          89*          151                       376          413                     788
                               been offered a carers assessment                                                         (93%)                                                        percentage rather than number. Sept target
                               from March 2011 baseline                                                                                                                              394 YTD Actual 2% above target

                               Ensure percentage of clients on
                      PE2.1    new CPA have care plans                98.7%     99.1%        98.9%        98.5%        98.4%        98.5%        99.0%                     95%
                               recorded on RiO
Patient
                               Ensure percentage of clients on                                                                                                                                                                            Oxleas stated that 40 CAMHS and LD patients had
Experience:
                      PE2.2    new CPA have a crisis plan on          93.1%     94.1%        93.6%        92.2%        92.5%        94.1%        94.8%                     95%                                                            been identified and these will be targeted to be
Enhancing Care
                               RiO                                                                                                                                                                                                        completed next month.
Planning

                               Ensure percentage of clients on
                                                                                                                                                                                                                                          Oxleas stated that lists will be sent out with reminders
                      PE2.3    new CPA have received a review         91.0%     91.7%        94.5%        92.3%        89.7%        90.0%        89.6%                     95%
                                                                                                                                                                                                                                          to review patients in Q3.
                               within the last 6 months
Patient
Experience:                                                                                                                                                               Surveys
                               Undertake patient experience                                                                                                                        Survey reports to be reported to the
Improving the way                                                                                                                                                        completed
                      PE3.1    surveys across inpatient and                                                                                                                        commissioners via the quarterly quality
we relate to both                                                                                                                                                           and
                               community services                                                                                                                                  meetings.
service users and                                                                                                                                                         reported
carers

                                                                                                                                                                                                                                          Oxleas stated that QE had not followed up on one
                               All clients discharged on new CPA
Patient Safety:                                                                                                                                                                                                                           patient in out-patients. Whilst the process is clear it did
                      PS1.1    receive a follow-up within 7 days      98.7%     97.3%        95.9%        94.0%        98.5%        96.2%        98.8%                     100%      One breach in OA Services Bromley
Ensuring patient                                                                                                                                                                                                                          not happen on this occasion and all staff involved have
                               (Nationally Mandated)
                                                                                                                                                                                                                                          been reminded of the procedure.
safety and risk
reduction
following                                                                                                                                                                            Proposed new way of capturing this data is
                               Percentage of clients who have
discharge from                                                                                                                                                                       being discussed - use of Pre-Discharge
                               been discharged with a history of
inpatients            PS1.2                                           100%      100.0%       100.0%       100.0%       100.0%       100.0%       100.0%                    100%      Planning Form in RIO where HCP is able to
                               self harm to receive a follow-up
                                                                                                                                                                                     flag one of the following '7 day follow-up', '48
                               contact within 48 hours
                                                                                                                                                                                     hour follow-up', 'None'.
                                                                                                                                                                         maintain
Patient Safety:                Number of MRSA reportable
                      PS2.1                                             0              0            0            0            0            0            0                current
Manage HCAI risk               infections
                                                                                                                                                                          level
                                                                                                                                                                                                                                          Oxleas stated that one patient arrived on antibiotic
                                                                                                                                                                         maintain    Maximum level within tolerance = 6 (one new
Patient Safety:                                                                                                                                                                                                                           medication This is a side-effect of the medication but
                      PS2.2    Number of CDIFF                          0              0            0            1            0            0            1                current     episode relates to client admitted at the end
Manage HCAI risk                                                                                                                                                                                                                          there was no option to cease as patient had physical
                                                                                                                                                                          level      of Sept and identified early Oct)
                                                                                                                                                                                                                                          health need.
                               All identified 17 year olds
                               transferring to adult mental health
Patient Safety:                                                                                                                                                                      This is reported on a quarterly basis.
                               services to have a transfer CPA 3
Transition            PS3.1                                            83%                   100.0%       100.0%          n/a          n/a       100.0%                    95%       Reported performance excludes Bromley
                               months prior with clear joint
Planning                                                                                                                                                                             Services as data was not available.
                               working to 18th birthday/move to
                               service
Clinical
Effectiveness:
                                                                                                                                                                                                                                          Oxleas stated that they wereusing the clustering tool
Standardising
                               Percentage of W AA & OA clients                                                                                                                                                                            but HONOS has not been validated - training and
assessments and       CE1.1                                           90.5%     92.1%        91.6%        93.0%        92.9%        93.8%        94.4%                     95%       RAG rating based on year end target
                               on CPA allocated to a care cluster                                                                                                                                                                         background influences clustering decisions, therefore
allocation of care
                                                                                                                                                                                                                                          consistency of clustering is questionable.
pathways in line
with SLR

                               Primary diagnosis of patients
                                                                                                                                                                                     Reduced due to Medic rotation, in line with
                               discharged from Inpatients to
                      CE2.1                                           100%      99.5%        99.5%        100.0%       100.0%       100.0%       96.5%                     80%       previous trends. Bexley 96%, Greenwich
                               have diagnosis codes recorded on
Clinical                                                                                                                                                                             93%, Bromley 100%
                               RiO
Effectiveness:
Ensuring multi
axial diagnosis
                               Percentage of ICD10 coding and
coding
                               reporting for clients on LD and                                                                                                           Diagnosis
                      CE2.2    autistic spectrum both primary and     1.8%       1.7%         1.3%         1.3%         1.3%         1.4%         1.4%                     to be     Only Trustwide data available
                               secondary diagnosis (Nationally                                                                                                           recorded
                               Mandated)


                                                                                                                                                                                     There were s132 breaches for 2 long term patients
                                                                                                                                                                                     in September. A section 48/49 patient on Heath
                                                                                                                                                                                     Clinic. A section 3 patient who spent time on both
                               Ensure patients detained under                                                                                                                        the Tarn and Maryon. The short term detention
                               the Mental Health Act are                                                                                                                             breaches were in Bromley (s136) and Lesney
                      CE3.1    provided with information as           83.0%     93.1%        95.0%        95.9%        99.0%        95.7%        89.2%                     100%      (s17E). There were 4 patients made subject to
Clinical                       stated and action to be recorded                                                                                                                      CTO where evidence of an explanation of rights
Effectiveness:                 on RiO (S132)                                                                                                                                         could not be found, 2 patients under the care of
Providing better                                                                                                                                                                     Greenwich AOT, 1 patient under the care of
information for our                                                                                                                                                                  Bromley AOT and a patient with a referral to
users and carers                                                                                                                                                                     Bexley SIT.


                               Ensure consent to treatment is
                               obtained from clients assessed
                      CE3.2                                           93.0%     90.9%        94.0%        100.0%       100.0%       100.0%       100.0%                    100%
                               and detained under the Mental
                               Health Act. (S58)

Clinical
                               To ensure percentage of delayed
Effectiveness:
                      CE4.1    discharges as a percentage of all      3.18%      0.0%         1.1%         0.6%         0.6%         0.6%         1.4%                    <7.5%
Delayed
                               occupied bed days
Discharges

* Revised figure



                                                                                                                                                                                                                                                                                                        14
4.0 South London Healthcare NHS Trust (SLHT)
SLHT Quarter 2 - Quality Monitoring Summary
Commissioning of acute services, including SLHT, is now undertaken by the SE London Cluster
commissioning team. Quality assurance is through the Joint SLHT Quality monitoring group which
reports to the Joint Quality and Safety committee. Main Bexley representatives are Dr Neil
Santamaria and David Parkins. Highlights are presented here for the BCCC

                                                                         Getting better compared to previous month
                                                                         No difference
                                                                         Getting worse compared to previous month




R 1. Serious Incidents (SIs) (PS&PE Report October 2011)
  The number of SI reports being submitted to NHS London within the 45 day timeframe
  has improved in July (8), August (8) and September (6) from Trust’s position in June(12).

  The Trust has reported 17 SIs between the month of July and August compared to 22 in the
  period between May and June. Never events zero. SLHT to improve root cause analysis
  training.

A 2. Infection Prevention (MRSA) (PS&PE Report    September 2011, Level 2 Score card September 2011)


  The Trust had two MRSA cases in Quarter 1 and one MRSA case in Quarter 2. The one
  new case of trust-acquired MRSA bacteraemia has been reported In September. Year to date
  (September 2011) the Trust has reported 3 cases of MRSA against an annual target of 5.

A Infection Prevention (C.Difficile) (PS&PE Report   September 2011, Level 2 Score card September 2011)


  The Trust has exceeded the national trajectory for C.difficile in May, June and July. However,
  the number of C.difficile cases in August has fallen to five and has gone up again by 1 in
  September to 6 cases. Year to date (September 2011), 43 cases have been reported against
  an annual target of 71. A monthly performance needs to be below 6 per month to enable this
  target to be achieved.

  The Trust has implemented a focused action plan to address this. It is believed that the actions
  in the plan appear to have had significant impact, which resulted in a much lower number of new
  cases in August 2011. The Trust will continue to monitor implementation of the Action Plan in the
  coming months; with the aim to return to the target trajectory position by October/November
  2011.

G 3. HSMR (PS&PE Report October 2011)
  The Trust’s HSMR is below national average. Year to date 86.6 cases have been reported
  which is below the national average of 100. The performance continues to be good.

R 4. Safeguarding Children (PS&PE Report October 2011)
  The Trusts performance on the Supervision for Safeguarding Staff had improved
  significantly over the period between July and September to 100% achievements against
  the monthly target of 80%. This was a remarkable achievement for the Trust in terms of
  improvement from its position in June with a 63% against the target of 80%.

A The performance in level 2 training was better both in June (85%) and July (80%) than in August
  (79%) against a target of 80%. September was back to 80%. The progress at the level 1 and 3
  training has been very slow.

  Progress in training remains a priority area for the Trust. The trust reported that a Training
  Tracker programme, has been developed to assist the Trust in meeting Level 1 training
  requirements. It has also undertaken work to identify and contact members of staff who still
  require level 3 training which should reflect higher numbers trained in the coming months.
G 5. Safeguarding Adults (PS&PE Report Oct       2011)


  The Trusts performance on the Supervision for Safeguarding Adults – SLHT Training –
  had improved in September (70%) from its previous position in July (65%) against a target
  of 80%.

  The Trust reported that the Progress continues to be made on the number of staff receiving
  Safeguarding, Deprivation of Liberty and Mental Capacity Act training

R 6. Hospital Acquired Pressure Ulcers           (Level 2 Score card September 2011)


  The number of Hospital Acquired Pressure Ulcers Grade 2 for August (28) and September
  ( 31) was higher than July (22). There were nil Grade 4 Pressure Ulcers in July, August and
  September however 5 cases of Grade 3 Hospital Acquired Pressure Ulcers have been reported
  in August compared to none reported in July and September.

  In August the Trust reported 33 cases of Hospital Acquired Pressure Ulcers All Grade (this
  include mostly Grade 2 cases) and 31 cases in September compared to 22 cases that were
  reported in July.

  The Trust reported that an Executive led focused action plan is being put in place, with
  appropriate actions being taken for ulcers that have developed as a consequence of
  substandard inpatient care in the hospital. The key areas of focus are now on pressure ulcer
  prevention, validation/grading and documentation. The community and SLHT are now working
  closely under the revised requirements for pressure ulcer reporting and investigation. Training on
  validation and grading is taking place across all sites and a new e-learning module has been
  introduced. A good network of pressure ulcer link nurses has been in place across all wards.

R 7. Falls   (PS&PE Report September 2011)


  The number of falls reported in July was (212) and August (197) and September (181), so
  there has been a reduction in falls from Q1 to Q2.


R 8. VTE (Venous Thromboembolism) (PS&PE Report September 2011, Level 2 Score card September 2011)
  The national aim is to carry out VTE risk assessment on 90% of patients admitted to the Trust.
  The SLHT’s figure for July was 29.2 for August it was 28.4%. Thus the trend is that no
  improvement has been seen since September 2010.

  The Trust reported that the checks on completion of the VTE risk assessments had been
  incorporated in matron and consultant ward rounds. During the National Patient Safety week, in
  September all staff had been reminded about the importance of risk assessment.

  However, SLHT confirmed that it still had IT problems with data collection but that even their own
  interim audit in February had only found a disappointing 48% completion rate. SLHT agreed to
  share its action plan and timescales to improve VTE performance. This is also linked to 2011/12
  CQUIN.

R 9. Complaints     (Level 2 Score card September 2011)


  The Trust’s internal target for responses within 25 days is 75%, a positive trend with month-
  on-month improvement had been noticed since April up until the end of July (34.8%), the
  figure for August (23.7%) seems to have reversed this positive trend.
  The current performance of the Emergency Care and Specialist Medicine Divisions has
  deteriorated significantly from July (34.4%) to August with a (16%) against the target of 75%.
  The Trust reports that a performance trajectory has been set with the Emergency Care and
  Specialist Medicine Divisions to ensure more timely responses to complainants. The Trust is
  participating in a national research study led by CQC around patient expectations and it believes
  that this should help reduce the volume of complaints in future.

  The Trusts Deputy Chief Nurse also confirmed that the delay in responding to complaints related
  to the Emergency Care & Specialist Medicine Division. She had met the Division and the
  Complaint Teams to devise an action plan to reduce the overall number of complaints as well as
  the delay to complete complaints. She agreed to share this action plan with the CQRG.

R 10. Maternity (Level 2 Score card September 2011)
      The Elective Caesarian section rates for July (7.9%) and August (8.1%) have
        improved compared to the Q1 2011 (10.3%), the target is 8%. However the figure for
        September was up by 2% compared to August. The Q2 figure now stands at 8.7% making
        it impossible to be on the target of 8%.

      Early access for women to maternity services target is 90%. The figures for September
       (83.2%) is higher than that of August (81%), indicating an improvement in
       September.


      Concerns were raised at the CQRG on the 5th of October 2011, on the maternity access
       indicator. The overall performance across the sites in SLHT was reported to be 81% and
       where QE was 71% and PRUH was 83%.

         The Deputy Chief Nurse agreed to provide a presentation and a briefing paper
         incorporating the issues raised at the October’s themed discussion



      The Home births - percentage of deliveries: The Septembers figure (2.28%) for the
       Home births has improved which was higher than August (1.89%).

      Maternity Hospital Episode Statistics data quality indicator: The Trust is yet to meet the
       target of 15%. However the Trust’s position on this remains virtually unchanged since the
       beginning of April. The figures for Q1 (31.7%) and Q2 (32.6%) shows a negative trend.

  13. Other Targets/Quality Items     (Level 2 Score card September 2011)


R CE3 – Stroke care
  On the percentage of higher risk TIA patients who are scanned and treated within 24 hours, for
  Q2 SLHT achieved 44.8% against the target of 60%. This has improved from 32.1% in Q1.

G CE14 - Fractured neck of femur
  For the percentage of patients having surgery within 48 hours the target is 91%. The figure for
  July (92.3%) has improved from the average of Q1 (53.6%). The data for August and
  September have not been provided on the Dashboard report.
5. PALS/Complaints Report

COMPLAINTS & PALS SUMMARY REPORT

QUARTER 2 - 1st July 2011 – 30th September 2011



This report summarises complaints and PALS activity for Quarter:2 of the Trust’s directly provided
services and Independent contractors. Key data is summarised below.
Total Complaints investigated by Bexley Care Trust in Q:2
    26 received (increase on Q.1 -22)
    1 withdrawn
    25 investigated
Complaints about PCT directly provided services
    2 complaints
       (1 premises,1 IFR Commissioning)
Key theme include:
    Commissioning/funding decisions (1)
Independent contractor complaints
    15 complaints
      10 GP practices: 5 Dental
The number of GP complaints has slightly increased from the previous quarter. The number of Dental
complaints has also increased slightly from 3 in Q.1 to 5 in Q.2
Of the 10 GP complaints raised key themes are:
           o Refused appointment
           o Attitude of Nurse
           o All aspects of care and treatment
           o Delayed diagnosis

Dental themes include treatment, charges, standards of care and treatment and refused appointment

Commissioned services (e.g. Bexley Community Provider Unit & Acute services)
   9 complaints ( 6 Q:1)
     (1 UCC, 8 Acute )

Key themes from commissioned services include:
    Attitude of staff
    Cancelled operation
    All aspects care and treatment / misdiagnosis

PALS themes for Q2

The number of PALS contacts for Q.2 is 732 this is an increase from Q.1 624.

Key themes from PALS contacts
    Concerns/Advocacy - Increase in contacts raising concerns along with a 40% rise in
       information required about the NHS services. Complaints cover a multitude of areas some of
       which are: Manner and attitude, refusal to refer, incorrect prescriptions issued, changes to
       prescriptions without prior notification or refusing to prescribe without explanation, ongoing
       difficulties in obtaining an appointment.


                                                                                                   18
   Action - PALS met with Head of Practice Support for Commissioning and will now have
    regular meetings to update on concerns/issues being raised and receive information regarding
    initiatives in Bexley and how that could impact on patients.

   Delays in Individual Funding Requests (IFR) requests – Since service centralised at cluster
    we have continued to experience delays in obtaining information regarding IFR requests. This
    can impact on the service provided by PALS as we are unable to adhere to timescales which
    leads to further unnecessary complaints.

   SAS (Special Allocation Scheme) – Clinical incident raised after GP consulted with a SAS
    patient in own surgery, this could put staff and patients at risk. Investigations also highlighted
    that SAS telephone line (provided by OOH service) was not working and patients were
    contacting allocated GP directly. PALS advised OOH service of the fault which they had been
    aware of for 3 weeks without action. This service is now being reviewed by the Primary Care
    Team at NHS South East London and we are working together with SLHT and their Health and
    Safety Manager to establish a suitable alternative venue to see Bexley SAS patients.

   Savoy Transport – Concerns continually being raised by patients and practice staff (some
    progressed through formal route). Head of Patient Experience is now involved in regular
    contract monitoring meetings with Commissioners, SLHT and Savoy in order to raise trends
    and ensure improvements are implemented.

   SLHT - Rise in number of concerns raised regarding SLHT, particularly QMH in respect of
    Orthopaedic and Gynae services. Unfortunately due the nature and severity of some concerns
    the formal route was followed. Specific issues related to removal of ICT which resulted in
    delayed operations, 9 month wait for pulmonary rehabilitation, removal of security on QMS site
    (unable to see SAS patients), Patient receive appointment letter 2 weeks after appointment
    then had to wait 10 weeks for another appointment. We continue to highlight concerns via
    PALS at SLHT and BSU Governance lead.

   IVF – continued concerns raised by patients (and via MP’s) from patients who are still waiting
    for appointments following transfer of service. PALS and HOPE liaising with Commissioners
    and team at cluster to resolve issues as they arise and to try and offer reassurance to patients.
    However, some patients are raising formal complaints.




                                                                                                  19
6. CQC Current Reviews

6.1 Review of Stroke care
Early in 2010 the CQC undertook a review into NHS healthcare provision for stroke care within the
borough of Bexley. Bexley Care Trust scored ‘about average’ or above average for 3/15 of the 15
categories identified by the review. An action plan to address the categories where Bexley
performed below average was developed and presented to the Risk Management Committee.
Actions have been developed in partnership with the Clinical Stroke Round Table. These include:
recruitment of Speech and language therapy staff; discharge summaries to be explored across
secondary care; and continued working with carers support in regards to peer support. In addition, a
Business Case for a stroke rehab pilot has been developed which will shortly go before the Bexley
Clinical Commissioning Cabinet. This action plan continues to be implemented and monitored by
the Clinical Stroke Round Table. Further action implementation reports will be brought to the Clinical
Quality Assurance group

6.2 Review of healthcare in care homes
In March 2010 the CQC began a national review of healthcare in care homes. The results of this
review will be published later in winter 2011.

On 10th May the CQC visited Bexley BSU to interview various staff about aspects of their healthcare
in care homes review. A summary of their findings will be sent to the trust shortly. CQAG will be
kept informed about any CQC findings and actions developed in response.

Actions are underway to improve access to healthcare services and further develop the monitoring of
quality in Care Homes in the Bexley area. A Quarterly Care Home Quality Report has been
developed that is reported to CQAG. A schedule of services, pathways and contacts has been
produced and distributed to all Care Homes and GPs and a draft LES/Best Practice document and
including a Care Home Service Agreement has been passed to Cluster for approval.

6.3 Review of support for families with disabled children
The CQC have started a review of support for families with disabled children. This review looks at
support for families with disabled children. Bexley have submitted a self assessment questionnaire.
This was completed by Alison Rogers, the Joint Commissioner for Children & Young People
Services, London Borough of Bexley/NHS SE London Bexley Business Support Unit. No major
concerns were identified by the assessment. Actions been developed to address the minor
concerns and these have been presented to CQAG who will continue to monitor them.

6.4 CQC/HMI Probation: Youth Offending inspection in July/Aug 2011
The CQC in partnership with HMI Probation have undertaken a Youth Offending Team inspection in
July/Aug 2011. This involved interviews with the health workers within the YOT, operational /clinical
managers for those workers and the health representative on the YOT management board.

The findings from this inspection will be included in the CQC assessment systems for 2010-2011
and an individual findings letter will be provided by CQC. The local authority will be the lead
organisation responding to this review and inspection. The BSU lead for this is Alison Rogers, Joint
Commissioner Children & Young People Services.

Feedback from the CQC has been that they were very pleased with the health report. Ofsted had
also inspected Fostering Services which had been a very positive inspection and had complimented
Bexley’s partnership working. CQAG will be kept updated regarding further developments.




                                                                                                   20
7    NICE Guidance

Bexley Clinical Commissioning Cabinet (CCC) BSU aims to follow all relevant NICE guidance and
Quality Standards and commission services that aim towards these. A NICE Guidance Process has
therefore been devised which sets out how this is to be established and monitored.

The process has been designed to highlight where the BSU is not undertaking its responsibilities as
commissioners. The outputs of this process will be:

 Monitoring & reporting of NICE guidance relevant to Bexley CCC / BSU in its role as a
  commissioning organisation;

 Reviews of key pieces of NICE guidance highlighting actions necessary for Bexley CCC / BSU
  as commissioners;

 A quarterly report that highlights where the commissioning responsibilities towards NICE
  guidance are not being met. The status report for October 2011 is below.

There is one standard which is red rated, which is Preventing Type 2 Diabetes – population and
community interventions.

There are two Quality standards which are amber rated Chronic Obstructive Pulmonary Disease
(COPD) and Chronic Heart Failure.

All other NICE guidance produced since April 2011 is either not relevant to the BSU or still under
consideration by the relevant commissioners

Bexley BSU NICE Guidance Status Report (April –Oct 2011)

October 2011
 Ref                          Title                           Position            RAG
                                                          To be taken to Shreeya Patel
TA236 Acute coronary syndromes - ticagrelor
                                                          December MMC
                                                          Not applicable to
DTG1 EOS 2D/3D imaging system
                                                          BSU
                                                          Not applicable to Confirmed by
CG130 Hyperglycaemia in acute coronary syndromes
                                                          BSU               John Grummit
                                                          To be taken to Shreeya Patel
TA235 Osteosarcoma - mifamurtide
                                                          December MMC

September 2011
 Ref                           Title                          Position             RAG
         Arthroscopic femoro-acetabular surgery for hip   Not applicable to
IPG408
         impingement syndrome                             BSU
                                                      Majority of             Alison Rogers
                                                      Guideline met.          Autism Care
                                                      Review of QMC           Pathway
                                                      Child                   Group.
      Autism spectrum disorders in children and young
CG128                                                 Development
      people
                                                      Centre to take
                                                      unmet parts of
                                                      guideline into
                                                      account
         Minimally invasive oesophagectomy for cancer or Not applicable to
IPG407
         high-grade dysplasia of the oesophagus          BSU
                                                          Not applicable to
CG129 Multiple pregnancy
                                                          BSU
QS       NICE Quality Standard –Breast cancer             Cancer guidance Winnie Khan


                                                                                                     21
  Ref                           Title                        Position               RAG
                                                          is reviewed by       (Sab Jenner)
                                                          SE London            SELCN confirm
                                                          Cancer Network       that Standard is
                                                          who then advise      reflected in
                                                          commissioners        model of care
                                                          and providers on     for London
                                                          implementation       Cancer Review

August 2011
 Ref                            Title                         Position               RAG
                                                          To be taken to       Shreeya Patel
                                                          SLHT Interface
TA233 Ankylosing spondylitis - golimumab
                                                          Meeting in
                                                          November
                                                          Distributed to
CG127 Hypertension
                                                          GPs & Practices
         Inditherm patient warming mattress for the       Not applicable to
MTG7
         prevention of inadvertent hypothermia            BSU
                                                          Not applicable to
IPG405 Laparoscopic cryotherapy for renal cancer
                                                          BSU
         Microwave ablation for the treatment of liver    Not applicable to
IPG406
         metastases                                       BSU
                                                          To be taken to       Shreeya Patel
                                                          SLHT Interface
TA234 Rheumatoid arthritis - abatacept (2nd line)
                                                          Meeting in
                                                          November
                                                          2 elements of    Edwin Mensah
                                                          standard not
         Alcohol dependence and harmful alcohol use
                                                          met. Bid for ALW
QS       quality standard
                                                          post to meet
                                                          these submitted
                                                          and under review

July 2011
  Ref                           Title                          Position               RAG
         Ambulight photodynamic therapy for the treatment Not applicable to
MTG6
         of non-melanoma skin cancer                      BSU
                                                           To be taken to       Shreeya Patel
                                                           SLHT Interface
TA231 Depression - agomelatine (terminated appraisal)
                                                           Meeting in
                                                           November
         Endoluminal gastroplication for gastro-           Not applicable to
IPG404
         oesophageal reflux disease                        BSU
                                                           To be taken to       Shreeya Patel
                                                           SLHT Interface
TA232 Epilepsy (partial) - retigabine (adjuvant)
                                                           Meeting in
                                                           November
                                                           To be taken to       Shreeya Patel
      Macular oedema (retinal vein occlusion) -            SLHT Interface
TA229
      dexamethasone                                        Meeting in
                                                           November
         MIST Therapy system for the promotion of wound Not applicable to
MTG5
         healing in chronic and acute wounds            BSU
         Multiple myeloma (first line) - bortezomib and    Use in
TA228
         thalidomide                                       secondary care
         Myocardial infarction (persistent ST-segment      Use in
TA230
         elevation) - bivalirudin                          secondary care


                                                                                                  22
  Ref                            Title                             Position             RAG
                                                               only
         Open femoro-acetabular surgery for hip                Not applicable to
IPG403
         impingement syndrome                                  BSU
                                                               Not applicable to
IPG402 Percutaneous cryotherapy for renal tumours
                                                               BSU
                                                               Not applicable to
CG125 Peritoneal dialysis
                                                               BSU
         Selective internal radiation therapy for non-         Not applicable to
IPG401
         resectable colorectal metastases in the liver         BSU
                                                               Distributed to
CG126 Stable angina
                                                               GPs & Practices
                                                               Dharini             Business case
                                                               Shanmugabavan       being prepared
         Chronic obstructive pulmonary disease (COPD)
                                                               Kate Dawes          for amber/red
QS       quality standard
                                                               Eileen Doyle        elements of
                                                               CQAG Sept           standard
                                                               2011

June 2011
  Ref                           Title                              Position             RAG
         BRAHMS copeptin assay to rule out myocardial          Not applicable to
MTG4
         infarction in patients with acute chest pain          BSU
                                                               Not applicable to
IPG398 Endoscopic radical inguinal lymphadenectomy
                                                               BSU
                                                               Distributed to
CG124 Hip fracture
                                                               GPs & Practices
      Lung cancer (non-small-cell, advanced or
TA227 metastatic maintenance treatment) - erlotinib
      (monotherapy)
                                                               Use in
TA226 Lymphoma (follicular non-Hodgkin's) - rituximab          secondary care
                                                               only
         Percutaneous endoscopic catheter laser balloon        Not applicable to
IPG399
         pulmonary vein isolation for atrial fibrillation      BSU
                                                               Use in
         Rheumatoid arthritis (after the failure of previous
TA225                                                          secondary care
         anti-rheumatic drugs) - golimumab
                                                               only
                                                               Use in
         Rheumatoid arthritis (methotrexate-naïve) -
TA224                                                          secondary care
         golimumab (terminated appraisal)
                                                               only
       Thoracoscopic exclusion of the left atrial
       appendage in atrial fibrillation (with or without       Not applicable to
IPG400
       other cardiac surgery) for the prevention of            BSU
       thromboembolism
                                                                                   South London
                                                                                   Cardiac &
                                                               Sab Jenner. To
                                                                                   Stroke Network
         Chronic heart failure quality standard                be reported at
QS                                                                                 is reviewing a
                                                               Dec CQAG
                                                                                   proposal to
                                                                                   extend cardiac
                                                                                   rehab service.

May 2011
 Ref                            Title                              Position             RAG
                                                               Under review by Martin Murphy
CG123 Common mental health disorders                           commissioners.
                                                               Distributed to GP


                                                                                                    23
  Ref                           Title                           Position             RAG
                                                            practices
         Endoscopic radiofrequency therapy of the anal      Not applicable to
IPG393
         sphincter for faecal incontinence                  BSU
                                                            Not applicable to
IPG394 External aortic root support in Marfan syndrome
                                                            BSU
         Percutaneous tibial nerve stimulation (PTNS) for   Not applicable to
IPG395
         faecal incontinence                                BSU
                                                            To be taken to      Shreeya Patel
      Peripheral arterial disease - cilostazol,
                                                            SLHT Interface
TA223 naftidrofyryl oxalate, pentoxifylline and inositol
                                                            Meeting in
      nicotinate
                                                            November
                                                                            Khushbu
         Preventing type 2 diabetes - population and        Under review by Lalwani
PH35
         community interventions                            commissioners Presented to
                                                                            July CQAG
         Trabecular stent bypass micro-surgery for open     Not applicable to
IPG396
         angle glaucoma                                     BSU
         Trabeculotomy ab interno for open angle            Not applicable to
IPG397
         glaucoma                                           BSU

April 2011
 Ref                            Title                           Position
       Carotid artery stent placement for asymptomatic      Not applicable to
IPG388
       extracranial carotid stenosis                        BSU
         Carotid artery stent placement for symptomatic     Not applicable to
IPG389
         extracranial carotid stenosis                      BSU
         Endovascular stent-grafting of popliteal           Not applicable to
IPG390
         aneurysms                                          BSU
                                                            Not
         Everolimus for the second-line treatment of
TA219                                                       recommended
         advanced renal cell carcinoma
                                                            by NICE
         Extracorporeal membrane oxygenation for severe Not applicable to
IPG391
         acute respiratory failure in adults            BSU
                                                            Not applicable to
CG121 Lung cancer
                                                            BSU
                                                            Not applicable to
CG122 Ovarian cancer                                        BSU. Distributed
                                                            to GP practices
                                                            Use in
TA222 Ovarian cancer (relapsed) - trabectedin               secondary care
                                                            only
                                                            Use in
TA220 Psoriatic arthritis - golimumab                       secondary care
                                                            only
                                                            Not applicable to
IPG392 Stent insertion for bleeding oesophageal varices
                                                            BSU
                                                            Use in
TA221 Thrombocytopenic purpura - romiplostim                secondary care
                                                            only

Green= No recommendations requiring BSU action or all recommendations (relevant to the BSU) completed
Amber = At least one recommendation (relevant to the BSU) requiring BSU action -action plan in place and on
target
Red = At least one recommendation (relevant to the BSU) requiring BSU action with no action plan in place or
action plan not on target.



                                                                                                         24
8. Independent Contractors
Infection Control
Infection control at independent contractors is currently monitored by the Bexley BSU Lead Nurse
Infection Prevention & Control. For the period January 2011-September 2011 there have been 7
audits covering the 14 out 28 different Bexley GP practices. The following topics were audited: Hand
Hygiene; Waste Disposal; Sharps; Environment; Equipment; Clinical Practices; and Vaccination
(Transport and Storage). Scores out of 100 were assigned for each audit. From this an Overall
Compliance score for each surgery was assigned. The top line results of the Overall Compliance
score in these audits is as follows:

Overall Audit compliance

95% and above         9 practices
85-94%                3 practices

75-84%                1 practice
Below 75%             1 practice

Bexley practices where overall audit compliance did not meet target of 75%

                                         Overall Audit compliance
Practice                                       (Target 75%)
Cairngall Medical Practice                         70%

As a result of these audits the following actions have been put in place.

Actions
   1. Following the Infection Prevention and Control audits an action plan with time scale have
      been put together and sent to each practice followed by a post visit.

   2. Infection Prevention Mandatory training is in place for all clinical staff from Independent
      contractors and runs on a monthly basis since 2008 up to date.

   3. A copy of the New National Specifications for Cleanliness in Primary Care 2010 have been
      forwarded to all Independent contractors

   4. A copy of all revised Infection Prevention and Control Policies have been sent to all
      Independent Contractors

   5. A copy of all Patient Infection Control Information leaflets have been sent to all Independent
      Contractors

The GP surgeries in question will continue to be monitored by the Bexley Lead Nurse Infection
Prevention and Control and results reported to CQAG.

9. Care Home Quality Report
As part of the Bexley Action Plan developed in the light of the CQC national review of healthcare in
care homes it was identified that to ensure placements were made in high quality care homes that a
Care Home Quality Report would be developed and reported to CQAG.

The number of placements relating to Continuing Healthcare patients during quarter 2 was
approximately 60 for Older people who are physically frail, palliative care patients and younger
physically disabled people. There were 38 placements relating to mental health patients over 65.

The Quarterly Care Home Quality Report is compiled by the Continuing Healthcare team and
includes the quality information from following:

      a Quality monitoring template for the BSU block contract for care homes (The Oaks- approx
       33% of the BSU beds).

                                                                                                    25
      Monitoring of reports from 4 other care homes monitored jointly by the CHC team with the
       London Procurement Project (LPP)
      Informal monitoring
      Liaison with Bexley Council
      Adult Safeguarding meetings
      Complaints

Key concerns identified by report
No concerns raised via the Oaks monitoring report
       All pre-placement assessments completed within 48 hours
       All CHC patients care plans were reviewed monthly
       There were 22 falls (15 in Q1) which after considering each case no issues were
          identified
       One CHC patient had a grade 1 pressure ulcer (redness of skin)

No concerns identified from monthly monitoring reports from 5 other Nursing Homes
       All pre-placement assessments completed within 48 hours
       All CHC patients care plans were reviewed monthly
       There was 1 fall and no issue was identified after reviewing the information
       Two CHC patients had grade 2 pressure ulcers on admission to the home

No significant concerns raised via Adult Safeguarding, Bexley Council or Complaints

Care Home Quality Monitoring developments
Visits are made by the Continuing Healthcare team to Care homes where continuing healthcare
patients are placed. An issues log has been instigated that will record quality issues raised by the
Continuing Healthcare team with the care homes and a summary report of this log will be included in
future quarterly Care Home Quality reports




                                                                                                 26

				
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