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					                                                                  Cluster Board meeting
                                                                   Agenda item number

                      7th March 2012

Report Title:    Quality Report                                        Item No:

1.   Background and context

     1.1   Background
           NHS Derbyshire County and NHS Derby City as statutory bodies are working
           with the emergent Clinical Commissioning Groups to develop systems and
           processes to monitor quality of care, outcomes of care and high level risks.
           The new CCGs have a strong basis to develop new reporting arrangements to
           provide assurance in ‘transition’ and organisational change.

           The experience and learning from the Mid Staffs Enquiry reinforce the need to
           establish good systems, strong leadership and clinical networks and
           intelligence to assure the best possible care that is safe and responsive to
           Derbyshire patients is delivered and sustained.

           Staff with the necessary skills and expertise have been aligned to the CCGs
           to shape and develop the quality improvement and patient safety culture.
           Reporting of quality outcomes and patient safety will over the next 3 months
           become evident through the CCGs.

     1.2   Quality Assurance of Commissioned Services
           Currently the following providers are monitored by CCGs on behalf of the PCT
           Cluster: Chesterfield Royal Hospital NHS Foundation Trust, Derbyshire
           Healthcare NHS Foundation Trust, Derbyshire Community Health Services
           NHS Trust, Derby Hospitals NHS Foundation Trust, Barlborough NHS
           Treatment Centre, East Midlands Ambulance Service NHS Trust, Derbyshire
           Health United (not on standard contract).

           Based on an annual cycle this includes the following:
               Development of Quality Schedules, including drafting, negotiating and
                 finalising Schedule 3 (general quality) and Schedule 18 (CQUINs)
               Monitoring of contracts through Contract Management Boards and
                 Quality Assurance Groups
               Analysing data, identifying themes for targetted performance
                 management such as Infection Control and Delivering Single Sex
                 Accommodation and to pull issues through into the commissioning
                 cycle e.g. mental health, findings of Children and Adult serious case
                 review and major incidents
               Undertake a minimum of quality visits four per year for each main
               Monitor providers serious incidents and undertake thematic reviews
               Lead work on DH outcomes and advise on quality indicators for service
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                                                              Agenda item number

            Analyse and report Quality Accounts through to the Clinical
             Commissioning Groups
            Maintain electronic solutions to all provider quality reports on
            CCGs to report to PCT Cluster Governance Committee on processes,
             monitoring and outcomes on a quarterly basis on dashboards or by
            Annual Report as summary of assurance within commissioning

1.3   Patient Safety – remains a high priority
          Key element of all Quality Assurance Groups sub groups with providers
          Infection Prevention & Control
                - negotiating targets for bMRSA and CDI
                - management of actions and critique of providers from Root
                   Cause Analysis reports
                - mandatory requirements are surveillance, alert organisms and
                   working with Health Protection Agency
                - major incident/pandemic planning
                - input into MRSA/CDI outbreaks
                - performance management of providers IP&C targets
                - monitoring of mortality rates/SHIMI
          Management of STEIS – serious incident system. Focus on Never
             Events as key indicator
          Monitoring incident reporting – NRLS
          Ensuring CAS alerts are actioned
          Monitoring patient safety indicators in contracts
          Developing an early warning system in consultation with CCGs + NHS
             Providers + NHS FT
          Lead on Serious Incident investigations
      Detailed reports are provided to Cluster Governance Committee. Cluster
      Performance report details HCAI targets and progress.

1.4   Complaints
      Complaints remain an important indicator of patient experience and quality of
      care.   Quarterly reports across the Cluster will continue.        Contract
      Management of each provider will monitor cases, response and themes. The
      recent Ombudsman report is being considered by CCGs.

1.5   Safeguarding Children and Looked After Children
      Statutory Requirement under legislation: ‘Working Together to Safeguard
      Children’ (2010) and The Children Act 1989 and 2004 for safeguarding
      children and their families. There is Statutory Guidance on promoting the
      health and well-being of Looked After Children (DH 2009).

      There is a well defined regulated system to support the safeguarding of
      children and ensure compliance with the statutory framework.

      The designated professionals are currently working with CCGs to develop a
      network approach which incorporates leadership and governance.
                                                               Cluster Board meeting
                                                                Agenda item number

1.6   Safeguarding Adults
      This is guided by the review policy titled ‘No Secrets’ (2000). In 2008 a review
      of ‘No Secrets’ was launched and the outcome of this review is awaited. The
      recent CQC reports and recent Mencap report will inform new models.

1.7   Care Homes
      The care homes across Derby City and County are supported by the quality
      team to develop and improve the quality of care for residents, monitor
      standards and alert LA and CQC when standards cause concern.

      The key areas are:
          Supporting the development of high quality End of Life Care
          Infection Prevention & Control
          Monitoring of standards of care supported by audit

      Using different models the care homes are visited and quality of care
      assessed and monitored. Improvement plans are agreed and the homes
      supported to implement them. Close working with local authorities and Care
      Quality Commission is pivotal to maintaining patient safety and care

1.8   Early Warning Process
      In consultation with stakeholders across Derby City and Derbyshire County
      and the SHA an Early Warning Process has been developed as a pilot. Using
      the guidance from the National Quality Board the process will be key in the
      transition year to CCGs being authorised as statutory organisations.

1.9   Intentional Rounding
      The Prime Minister announced the following priorities in January 2012:
          Patients not paperwork: we will get rid of a swathe of bureaucracy that
             stops nurses from doing what they do best
          Regular nursing rounds: to systematically and routinely check that
             patients are comfortable, are properly fed and hydrated and are treated
             with dignity and respect, with the Royal College of Nurses (RCN)
             working with us to make it happen
          Leadership on the wards: people want to see a figure of authority on
             the ward – call them a Matron, a ward sister, or a team leader.
          New patient-led inspections of hospital wards: local people will go in as
             part of teams assessing cleanliness, dignity and nutrition and their
             findings will be published
          New ‘friends and family test’: this will simply ask whether patients,
             carers and staff would recommend their hospital to their families and
             friends in their hour of need.

      Progress on Provider Trusts

      Royal Derby Hospitals Foundation Trust
      Currently has Intentional Rounding on all of Medical and Orthopaedic wards.
      Matrons implementing across ward areas.

      Derbyshire Community Health Services
      Introduction of Intentional Rounding as part of Safety Express and Safety
                                                                       Cluster Board meeting
                                                                        Agenda item number

           Thermometer work plan.

           Derbyshire Healthcare Foundation Trust
           Commissioned review to consider Intentional Rounding in line with what is
           currently ‘in place’ in mental health impatient services i.e. observation and
           engagement policy, protected mealtimes. Review to report findings by end of

           Chesterfield Royal Hospital Foundation Trust
           Currently piloting approaches in 2 wards and intend to role out March 2012.

2.   Matters for consideration
     High level risks in transition will be monitored through risk register

3.   Actions and recommendations
         Note the current position and acknowledge work to transfer responsibilities to
           Clinical Commissioning Groups
         Governance Committee to receive CCG reports to provide assurance to PCT
           statutory bodies
         Audit Committee to receive a report describing CCG processes after April

Name:       Maggie Boyd, Director of Clinical Quality & Nursing
Sponsor:    David Sharp, Chief Executive Officer
Date:       23rd February 2012

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