Greater Huddersfield CCG – Shadow Accountable Officer’s Report Report Author – Carol McKenna 3 July 2012 Subject Quality & Safety
Summary Quality is a key governance priority for Greater Huddersfield CCG, recognising the role of CCGs in creating a culture which supports continuous improvement. As a subcommittee of the Cluster Board the CCE has the responsibility for scrutinising and gaining assurance in relation to the three domains of quality; safety, effectiveness and experience and the role of the Quality Group is to provide this assurance to the CCE. The group receives regular reports which collate information about quality, safety and experience from various sources.
The CCE Quality Group met on the 6th June 2012 where information on the following key quality metrics were reported:EMSA
CHFT reported one clinically unjustified breach in April 2012. This occurred on the Calderdale Royal site on the Acute Stroke Unit (ASU) and was due to capacity issues, this breach will be attributed to NHS Kirklees.
Follow up with CHFT clarification on the breach number as it is understood that there were three patients involved and therefore three breaches are required to be reported. We understand that one breach involved a Kirklees patient but are unsure where the other two patients reside.
VTE Risk Assessment VTE risk assessment at CHFT continues to be in line with the national average National Patient Safety alerts Information published by the NPSA in April indicates there are no NPSA safety alerts open for local NHS providers Health care associated infections HCAI data is considered at the Quality and Safety group and CCE, the current position as end May 2012 is: MRSA – 1 post 48 hr at LTHT involving a GHCCG resident , CHFT , 0 case of MRSA bacteraemia in May, cumulative total 1, against a trajectory of no more than 4 cases CDI – 6 cases attributed to GHCCG – 3 at CHFT, CHFT- C.difficile infections investigations have been
carried out on two wards at HRI, as both areas had two patients affected by C. difficile , typing showed that the cases are not related by strain. A programme of Bioquell has been used to decontaminate the affected areas. 6 post cases 72 hour C.difficile infections, in May, cumulative total 10, against a target of no more than 33 cases CQC Compliance In March 2012 the Secretary of State asked CQC, as the regulatory agency, to conduct an inspection of Termination of Pregnancy Services as a priority. Verbal feedback, given on the day of inspection, to CHFT indicated that they were complaint with the standards they were inspected against. We are still awaiting the publication of the report. SWYPFT report and action plan on rehabiltation services were discussed at the Clinical Quality Board with SWYPFT on 14th May. 2011 Survey of Adult Inpatients The indicator included in the dashboard shows the composite score for ‘responsiveness to inpatients’ personal needs’ comprising five key questions utilised for the national CQUIN indicator. It shows that both Trusts score below the SHA average. The table below shows the response rate plus the number of questions RAG rating for CHFT. Provider
Response rate (national 53%)
Green (highest 20% of Trusts)
5 – feeling threatened; posters on hand washing; availability of hand gels; nurses talking in front of them; nurses washing hands between patients
Amber (middle 60% of Trusts)
Red (lowest 20% of Trusts)
Inpatient Survey Improvement plan to be discussed with CHFT at Clinical Quality Board
CQUINs The overview of the development of local CQUIN schemes including implementation, trajectories setting, improvement plans and recommending these to the relevant Contract Management Boards continues to be managed through the Clinical Quality Board arrangements. All providers submitted Quarter 4 returns by the specified deadline (30 April 12). For Quarter 4, our main providers achieved the following performance: Provider
Calderdale and Huddersfield Foundation Trust (CHFT) acute
Did not achieve maternity indicators (Csection/bookings by 11 weeks), Partially achieved pressure ulcers, UTI & falls.
Data 65% submitted
Partially achieved End of Life, Common Assessment Framework and discharge planning. Did not achieve Pressure Ulcers indicator.
Not Local Community Partnership reported Community Interest Company
South West Yorkshire Partnership Foundation Trust (SWYPFT)
Spire Elland Hospital
Yorkshire Ambulance Service (YAS)
(Q1 & 2)
Schemes 79% did not start until Q2
Did not achieve access (acute, non-acute, and psychological therapies) and nutritional screening.
Provider challenging achievement level with lead commissioner
The CCG is currently reviewing its performance reports to CCE and its F&P sub group with the aim of ensuring that CCE discussion is focussed on any areas of under performance, with greater detail being reviewed in F&P. It is anticipated that the CCE in future will receive a high level performance report, similar in approach to that being received by the Cluster Board. The current Finance & Performance Committee which is shared with North Kirklees CCG
will separate into two CCG specific sub-groups from September. The current F&P Committee met on 20 June and has highlighted the following performance issues for consideration at the CCE meeting on 27 June: Cancer 31 days – figures for April indicate 3 breaches of this target, although we have yet to establish which CCG in Kirklees these patients belong to. CDiff – details reported in section on quality above Mixed sex accommodation – details reported in section on quality above Choice – latest published figures for Kirklees show performance at 51%, with the latest provisional data indicating 57% for the end of May.
Finance & QIPP
Cancer – PCT cancer lead to investigate breach causes further with LTHT and raise through Yorkshire Cancer Network. CDiff – high level focus on this via CCG/Trust Quality Board and infection control forums. Choice – GHCCG is very sighted on the issues relating to utilisation of Choose and Book and as of May, two of the three practices who were not utilising the system have started to do so. A range of other actions are in place and the position is being closely monitored.
Summary Financial Position: Budgets agreed for 12/13, including QIPP. May Financial Position balanced, and forecasting achievement of financial targets at year end, but early in year so only limited information on trading position. QIPP: QIPP plans in place for 12/13, monitoring being done using Performance + system. Forecasting achievement of overall total at year end. Risks:
QIPP plan in place with key responsibilities and timescales identified. Monitored on a monthly basis and reported to Finance and
Failure to deliver the required level of QIPP over the next 3 years.
Performance Group. Performance Plus system used to support monitoring and reporting
Items escalated from F&P Group: No specific financial items, although performance concerns summarised above. Governance and Risk
The CCE receive regular reports regarding the risk register and work ongoing with regard to revising the register to ensure it meets CCG specific requirements. To date, one CCG specific report has been received by the CCE, and areas for improvement have been highlighted and are being actioned. One issue identified was that GHCCG specific strategic risks were not adequately reflected, for example: The process of separating Kirklees wide budgets into two CCGs over the next few months â€“ this could present us with local pressures that are masked at a Kirklees wide level Staffing capacity and resilience issues â€“ in addition to specific issues such as governance, there is a need to target capacity at the C&H transformation programme and delays with this could impact on the success of the programme. Financial challenges facing the wider health and social care economy. These specific GHCCG risks are being added to the register. Other high level risks identified for Kirklees as a whole relate to: Challenge to delivery of QIPP over the next 3 years Management capacity and resilience during transition Emergency planning and resilience and the potential impact of NHS changes on our ability to respond Ability to realise quality improvements associated with reduction in pressure ulcers The CCGâ€™s Audit & Governance sub-group will receive a draft risk management framework for the CCG in July, with this then being taken to the CCE for approval in advance of our authorisation application. The CCG is currently in the process of identifying additional interim support on the governance agendas, in partnership with NKCCG.
CCG risk register continuing to develop in line with process described to Cluster Governance Committee on 20 June 2012.
Transition Actions being taken to support our workforce during transition include: The establishment of a GHCCG SMT that now meets on a weekly basis and includes the CCG Chair. Continued monthly meetings for all Kirklees staff, from July onwards these will be jointly led by the GHCCG and NKCCG shadow accountable officers. Provision of a report to the June CCE summarising actions being taken in response to the last staff survey. Incorporation of work on being a good employer into our OD programme. The shadow accountable officer and chief finance officer meet with colleagues from the Clusterâ€™s CCGs and HR representatives on a fortnightly basis to take forward work on the establishment of CCG structures. Transition GHCCG accepted as wave 2 for authorisation. Our application will be submitted by 3 September 2012, with the stakeholder survey being issued in July. Our organisational development programme continues, and we are currently utilising the team coaching support obtained via the Institute for Improvement and Innovation. Our forward plan for OD reflects the need to undertake team development alongside specific sessions to build knowledge and expertise, for example around quality, safeguarding and equality and diversity. In addition, the CCG welcomed the recent Board to Board meeting and is ensuring that any areas of development arising from that are reflected in our OD plan. An update on specific actions in these areas has already been provided to Cluster Governance Committee. Other areas of current priority to support transition include: Appointment processes now either underway or being put in place for the roles of accountable officer, chief financial officer, lay members, secondary care doctor and nurse. Ongoing work with the CSS to confirm the order book for the CCG, and to assess affordability of CCG structures and CSS support. Consider of the MoU with Public Health to ensure this is confirmed in advance of authorisation. Development of the CCG Constitution and Memorandum of Understanding in partnership with practices and the LMC as their representative body.
A separate report is provided on this agenda which summarises the work to date of the Calderdale and Huddersfield Health and Social Care Strategic Review. The GHCCG is well represented on the Programme Board and the Steering Group is chaired by Dr Paul Wilding, one of our CCE members.