Minutes of the - DOC 3 by S1av5moR


									                               Draft Minutes of the
                                  18 April 2012

Present:           Susan Mead (Chair), Chris Day, Sue Doheny, Brian Hanford, Steve Jarman,
                   Karen Hunter, Linda Izquierdo, Andrew Mason, Trevor Neatherway, Mick
                   O’Donnell, Rob Parker, Nigel Sellar, Bryan Smith, Carol Thompson, Dr Rod
Present for        Thompson, Nicky Willett
part of the
meeting:           Helen Herrity, Jo Newton

In                 Lynda Williams (minutes)
Apologies:         Sarah Aitken, Jo Galloway, Simon Hairsnape, Louise Lomax, Lucy Noon, Dr
                   Catherine Woodward

Minute                                                               Action by Due    Status
No                                                                             by
018/12     Minutes of Previous Meeting

           The minutes of the meeting on 14 March 2012
           were agreed as a correct record.

019/12     Matters Arising

           Minute 011/12 Forward Plan 2012/13
           CD confirmed that the updates agreed at the last
           meeting had been incorporated into the Forward CD                  April
           Plan and he would circulate the revised version
           after the meeting.

           SD and CD had met with the CCG leads for
           Hereford and Worcestershire, but were still to meet
           with the leads for Shropshire and Telford & Wrekin.
           SD said it would be difficult to achieve a reporting
           format that was the same for everyone.           She
           asked if the Committee required a combined report
           for Worcestershire or one from each CCG. The
           quality information at the moment was at a County
           level so it would not be appropriate at this stage for
           each CCG to report on it, but a decision had to be
           made about who was going to be accountable for
Quality, Performance and Resources Committee Minutes 18 April 2012
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          reporting on these issues at a local level.
                                                           CD        April
          RP suggested identifying those areas that would
          continue to be quality assured on a County basis
          and those that would be quality assured by the SD          April
          CCGs and clarify who would be accountable for
          what. SM felt the Forward Plan went some way
          towards this and it should be circulated to the
          CCGs. It was important to engage the CCG leads CD          April
          and Chief Operating Officers in the process and
          share ownership of this agenda. SD agreed to
          invite the CCG leads to come to the June meeting
          to discuss patient experience and the quality
          assurance framework in detail.

          Minute 012/12 CCG authorisation
          It was not clear whether LN had circulated the
          report as agreed at the last meeting and this
          needed to be checked.

          Minute 015/12 Quality & Performance Issues –
          Never Events
          SD said some assurance had been received from
          the Acute Trusts that they were now auditing all
          areas for compliance with the WHO checklist.
          Each organisation was building an escalation
          policy to include more frequent audits where
          necessary. In response to RP, SD felt that training
          was adequate, all the standard operating
          procedures were in place and individuals were
          performance managed where appropriate.

          HH joined the meeting.
020/12    West Mercia Quality & Performance Dashboard
          SD asked for comments from members on the
          future format of the report, how it could be made
          more meaningful and provide appropriate
          assurance to the Board. In particular, whether the
          reporting on this dashboard should be year end
          forecast or year to date; how it should be
          represented in cases where no data was being
          provided and where the data was not monthly,
          whether it should still be reported on a monthly
          basis. Although the complete report had until now
          been submitted to the Cluster the aim was to
          provide an exception report for the Board instead.

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          SM said members needed to know clearly from the
          Performance Report if quality was getting worse
          within the major Acute Trust providers and also
          that there was an improvement plan in place
          agreed by commissioners and at Cluster level.
          The Committee could then take a view on whether
          it was achievable and whether timescales and
          milestones were explicit so they could be tracked.
          CD suggested the possible weighting of metrics,
          either on a clinical or assurance basis.

          SD said it was important the CCGs were
          represented here so the Committee could
          challenge them about what was being done when
          performance was getting worse or remaining static.

          BS preferred the use of arrows to show where
          performance was going up or down and the
          dashboard should show only actual reported
          performance, not speculation. He also believed
          that failure to provide the data was a serious
          matter so that should continue to be shown as red.
          AM added that the Committee also needed to
          know what remedial action was being taken and SJ           May
          the projected timescales.

          RP said it was important to try to understand what
          had to be achieved over the rest of the year in
          terms of quality assurance. SD said this level of
          information was not currently being received from
          commissioners. SJ said action plans and recovery
          plans were available but it was not possible to
          include all of the information in the report.

          MO’D said it would be very difficult to capture the
          strategic changes in this report. SD suggested KH          April
          issuing a framework for CCGs to complete with
          information on projections on a monthly basis. SJ
          agreed to bring this back to the next meeting.      LI     April

          BH said consideration should also be given to how
          QIPP is being addressed throughout the year and
          that would probably require a separate report.

          RP asked for an update on the A & E situation at
          Worcester. SJ advised that a recovery plan was in
          place which had been shared with the SHA and
Quality, Performance and Resources Committee Minutes 18 April 2012
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          was being reviewed every two weeks by the
          Worcestershire local health economy. KH gave an
          update on the TIA position at Worcester which she
          believed had improved over the last quarter. CT
          asked if the data was provided by site or
          aggregated and KH agreed to check.

          With regard to TIA at SaTH, SD advised that the
          data was site specific and not trust specific. LI had
          asked for the information to be sent to CD and she
          agreed to follow this up.

          It was agreed that, in addition to the dashboard
          report, the Cluster Board should receive a covering
          report highlighting the issues discussed by the

021/12    West Mercia Cluster Finance Report
          BH summarised the current position with regard to
          producing the draft Final Accounts for 2011/12.
          The report identified that all four PCTs were on
          track to deliver against their financial duties.

          BH said the Herefordshire PCT commissioning
          position and Shropshire County PCT had been put
          on the risk register and a series of Board to Board
          meetings were being held with the providers. He
          said Wye Valley was a particular concern and
          financial support would be required.
                                                                     CD   May
          With regard to managing the 2% transitional fund
          and QIPP, BH said there should be a standing
          agenda item on the measurement of delivery
          against QIPP and a template provided in time for
          the next meeting.

          RP asked about the proposal to broker the budget
          between the three Worcestershire CCGs which
          had been discussed by the Cluster Board. BH said
          this was progressing and was close to being

022/12    Serious Incident Management Devolvement
          SD stated that the cluster would be responsible for
          serious incident reporting and the governance

Quality, Performance and Resources Committee Minutes 18 April 2012
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          aspect until the NCB took over.       The Board
          needed to be assured that the correct governance
          was in place. Although the process could be within
          the CSO, the ultimate sign off would be at CCG
          level because that was where the accountability
          lay. SD said she was working with the CCG leads
          to develop a framework. SM said it was important
          the CCG boards were alert to this as well as the
          CCG quality leads.

023/12    Quality Reports
          SD said the reports were locality based rather than
          CCG based.        Some of the CCGs had quality
          committees therefore were able to respond to the
          Committee on an assurance level, others were not
          yet at that stage, therefore at this point in time the
          accountability remained with this Committee.

          RP referred to an assurance document outlining
          when the CCGs were going to be ready for SD                April
          authorisation which might be useful in terms of
          looking at when each CCG could pick this up. SD
          agreed to speak to LN about this. SM said it would
          be helpful to have an overview of how these quality
          issues were being addressed in the CCGs.

          Herefordshire -
          NW reported that draft terms of reference for the
          CCG’s quality committee were going to their Board
          in May and she expected the first committee
          meeting to take place in May or early June. The
          CCG had met with the local authority providers of
          the engagement, involvement and complaints
          service to see how the SLA could be developed.
          There had also been discussions with LINK and
          Healthwatch about representation on the Board
          and the CCG Board meeting in July would be held
          in public.

          RP felt the performance on patient experience was
          disappointing.    NW said a patient experience
          assurance visit to Wye Valley was planned for 20
          April and they would be questioned about those
          areas where they scored particularly low.

          Shropshire and Telford & Wrekin -
          LI explained that a quality and performance
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          committee had been established for the Shropshire
          CCG       which received quality performance
          exception reports.     There were no plans to
          establish a similar committee in Telford & Wrekin
          and currently the responsibility for quality
          assurance was with the CCG Board.

          LI said a robust patient experience programme
          was still in place within the PCT reporting directly
          into the Board and there would also be a public
          representative on the Board. HH added that work
          was in progress to develop a more structured and
          proactive visit process and LI reported that a KH          June
          minimum number of announced visits had been
          included in contracts.       SM asked if the Chief
          Operating Officers would be able to present their
          strategy to this Committee. LI said that would be
          possible for Shropshire but the COO for Telford &
          Wrekin was not yet in post.
                                                               KH    May
          Worcestershire -
          KH spoke to the Worcestershire report which
          would also be presented to the CCG Boards. She
          said the CCGs had not yet established their quality
          committees but terms of reference were being
          drawn up and they had each nominated a GP
          clinical quality lead who would be working closely
          with the quality teams. Each CCG had formally
          adopted the quality strategy and work on the
          framework was in progress. She expected to be
          able to bring this to the June meeting.

          In response to a question from CT on out-of-hours
          performance, TN confirmed the figures for
          performance over Easter had not yet been
          received, however he felt that insufficient
          management resource was being put into the
          contract. RP considered this should be added to
          the risk register. The lead responsibility needed to
          be clarified and also how the other CCGs would
          monitor performance.

024/12    Maternity Services
          SD gave a presentation on the programme of
          assurance visits to the maternity services
          commissioned. She summarised the findings and
          the areas for development.
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          With regard to breast feeding RT said the Directors
          of Public Health were concerned that what should
          be a core activity for midwives was not necessarily
          being picked up in the hospital or the community.
          RT also asked what was being done within primary
          care and maternity units to encourage pregnant
          women to have the seasonal flu vaccination. SD
          felt the CCGs could play an important role in this.

025/12    Benchmarking information
          SJ reported he was developing an information
          pack for members which would give the level of
          benchmarking for all the identified areas and show
          how each of they compared regionally and
          nationally. NS said this should go to the CCGs for SJ      May
          them to identify where they were outliers and
          explain how they were addressing that. MO’D
          suggested holding a workshop for the CCGs on

026/12    Update: Management of Hepatitis C issue in
          Shropshire, Telford & Wrekin
          RT reported on an audit of data going back over 15
          years which highlighted that patients tested for
          Hepatitis C may not have been followed up at that
          time because the guidance around treatment was
          significantly different then to what it was now. The
          purpose of the audit was to determine what
          potential follow up would be needed for a cohort of
          patients going back to 1993. The team had been
          working closely with the HPA who had identified
          that it was a national issue. It would therefore
          have     implications      for   Herefordshire   and
          Worcestershire also. and legal and ethical advice
          had been received.

          The process had identified patients that should be
          followed up. Stage one would be to contact the
          referring clinician or GP and check whether there
          was any information to confirm that the patient was
          tested and had been treated, so that they could be
          eliminated. If there was insufficient information it
          might be necessary to follow them up. Currently
          there was no requirement for additional resource
          but that might be necessary if patients

Quality, Performance and Resources Committee Minutes 18 April 2012
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          subsequently needed to be contacted. SD said the
          Committee could not agree to bringing in external
          support without receiving further detail. RT said
          that BH and finance colleagues were aware of the
          potential cost implications and had discussed what
          might need to be set aside.

          The Committee supported RT’s recommendation
          to proceed with the stage one assessment. SM
          said the Committee was not in a position to commit
          resource to this activity but would welcome a report
          back following stage one at which point there might
          be more progress in terms of a national campaign
          to take it forward.

027/12    Update: Under 18 conception rate in Telford &
          Wrekin                                                     LW   May
          It was agreed to defer this item until the next

028/12    Any other business
          NS asked if there were indicators to link financial
          risks with potential quality risks, for example in
          relation to staff numbers, absences, or the use of
          agency staff. SJ said this was becoming more
          systematic, for example through looking at board
          papers and workforce plans. SD said the quality SD              May
          assurance frameworks from the CCGs should be
          looking at this. NS said it would be helpful to have
          this on the agenda for the next meeting to SD                   May
          understand where the data was coming from and
          who was looking at it.

          With regard to overnight discharges, SD said this
          was being looked at and a full report would be
          available for the next meeting.

029/12    Date and Time of Next Meeting

          16 May 2012, 2.00pm, Shropshire Education &
          Conference Centre, Shrewsbury.

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