Sunday 30 March 2014

West Hampshire CCG Board Papers 2013-2014

West Hampshire CCG Board Papers 2013-2014


As with other CCGs, the West Hampshire CCG (one of three CCGs in Hampshire) was established on 31st March 2013. The reason for having a look at the Board papers for West Hampshire CCG is that the headquarters of Southern Health NHS Foundation Trust is in Hampshire. Furthermore, the NHS Oxfordshire PCT document “Maintaining and improving quality during transition” (designed to inform newly created CCGs and other new NHS agencies) specifically stated with respect to Ridgeway (now Southern Health):
5.3.3. NHS Oxfordshire and all of the direct receiver organisations will not be the lead commissioner for Southern Health and a relationship needs to be developed with CCGs in Hampshire to make sure that clinical quality is reviewed to a high level.

Because of this statement, I thought it was worth looking at the Hampshire CCGs’ Board papers to see if I could find any Hampshire CCGs either identifying themselves as the lead commissioner for Southern Health learning disability services or identifying any other agencies as the lead commissioner. For example, on at least two occasions the Governing Body papers for South East Hampshire CCG identify West Hampshire CCG as the lead commissioner for Southern Health’s learning disability services.

West Hampshire CCG Board (Governing Body) papers are available here http://www.westhampshireccg.nhs.uk/about-us/board-meetings-and-papers

Papers for March 2014 Board meeting

Quality Scorecard.
                Board Quality Dashboard Exception Report Section 3: Southern Health
Six key areas of concern were highlighted to the Clinical Governance Committee (CGC), which provide a common theme across all of the services. These were:
        Risk Assessments
        Care Planning
        Crisis Plans
        Care Programme Approach (CPA)
        Implementation of service redesign
        CQC – non-compliance with standards

Risk assessments, care plans, CPAs and crisis plans. The concern in relation to assessment and care planning is that they are often not completed in a timely manner or regularly reviewed. This can have an impact on the immediate and future care and support of the individual. Concerns with these issues have been highlighted by SIRI panels, CQRMs, CQC inspection visits and Commissioners visits.
Implementation of service redesign . There are some aspects of the implementation of the service redesign that have been a cause for concern, for example the full implementation of the Hospital at Home service was not realised in the North. There has also been an increased use of non-commissioned health beds for people requiring assessment and treatment; it is worth noting that there may not be a direct correlation with the service redesign.

The list below provides a summary of the assurance methods and processes being utilised by the commissioner and provider:

Area of concern 3. Quality review. Assurance method/process:
        Monthly CQRMs have been reviewed and will now be specifically focused on MH/Learning Disability (LD) services
        New quality indicators developed for 2014/15 which are outcome focused
        CQRM to include on a twice yearly basis “live patient stories”
        Commissioners to take part in SHFT’s mock CQC inspections with immediate effect
        All CQC reports which fail to meet standards are monitored at CQRM.
        Commissioners have undertaken a series of clinical visits to all of the MH/OPMH/ LD in patient units and an unannounced visit was undertaken as a result of the recent Antelope House inspection visit by CQC
        Analysis of: unexpected deaths, use of restraint, use of Section 136 suites undertaken by commissioners
        Robust SIRI panels include clinical leads and commissioners from CCGs and Wessex Area Team.

Area of concern 5. Governance. Assurance method/process:
In December 2013 Monitor requested SHFT to request Deloitte to provide assurance and support in the form of a governance review. This is currently underway and the final report is due in March to be sent to Monitor.

Area of concern 6. Contract. Assurance method/process:
Contract. Commissioners hold monthly contract and performance meetings with SHFT – this year it has been necessary to raise a number of formal contract queries – which either have or continue to be worked through. Concerns remain regarding the use of non-commissioned beds – commissioners have been invited to an internal SHFT workshop on 6.3.14 to consider this.

Section 3.3: SHFT Risk Summit
As previously reported to WHCCG Board, in January 2014, SHFT received notification from Monitor on 3 December 2013 that they were commencing an investigation due to governance concerns arising as a result of CQC judgements on the quality of care provided by the non-Hampshire Learning Disability services of the Trust. The CQC also raised their concerns with the Oxford Safeguarding Board.

These included:
        The warning notices issued by CQC against six of CQC’s essential standards of quality and safety after their inspection of Slade House and the Short Term Assessment and Treatment (STATT) Unit (part of Slade House) in September 2013
        The death of a service user at the STATT Unit.

Monitor held a meeting with SHFT Trust Board on 10 December 2013.

 On 19th December 2013 the Wessex and Thames Valley Area Teams decided that a risk summit should be called to discuss the long standing and continuous concerns about the welfare and safety of patients in the non-Hampshire Learning Disability (LD) services in the STATT Unit.

 The risk summit was held on 8th January 2014 involving both Area Teams, WHCCG, Oxfordshire, Buckinghamshire and Wiltshire CCGs and local councils. The main focus of the risk summit was on the LD services provided in Oxfordshire, Berkshire and Wiltshire.

As a result of the summit, a meeting was arranged by the Thames Valley Area Team to review the models for LD provision in the Thames Valley area as the ethos of LD services within Hampshire is considered to be a more appropriate model which took place in March 2014.

WHCCG Learning disability lead attended the meeting and is producing a summary report which will be shared at the April CQRM

Trust action(s): Progress reports will be presented to the CQRMs

CCG action(s): A follow up meeting to the Risk Summit will take place on 20th March 2014 which the Director of Quality is attending

Finance and Performance Report
Summary of Southern Heath’s performance does not mention services for people with learning disabilities.


Papers for January 2014 Board meeting

Quality Scorecard.
                Board Quality Dashboard Exception Report Section 3: Southern Health

3.1 CQC Enforcement actions. Enforcement actions were identified by CQC due to major non-compliance with standards during their visits to Slade House and Antelope House.
Trust Action(s): Immediate action plans were put in place to address any immediate concerns. Further action plans were developed for CQC and shared with the CCG.
CCG Action(s): Slade House is commissioned by NHS England via the Wessex Area Team who are monitoring the action plans against compliance together with Oxford CCG [Bold my emphasis].
The action plans for Antelope House will be reported to the monthly CQRMs until the actions are closed.
Recommendations: A visit to Antelope House by WHCCG and SCCCG will be undertaken.

3.2 Monitor Risk Rating. SHFT received a notification from Monitor in December informing them that they will be commencing an investigation due to governance concerns arising as a result of CQC judgements on the quality of care provided by the Mental Health and Learning Disability services of the Trust.
Monitor will determine whether the Trust is in breach of its licence and what, if any, regulatory action is appropriate in relation to its concerns.
 Trust Action(s): SHFT met with Monitor on 10th December 2013 in response to this investigation.
CCG Action(s): WHCCG will respond to the report from Monitor when produced. Subsequent actions and recommendations will be monitored via the CQRM.

3.3 CQC Required improvement actions. Improvement actions were identified by CQC due to moderate non-compliance with standards [Bold my emphasis] during their visits to Slade House, Melbury Lodge, Antelope House and The Potteries.
Trust Action(s): Action plans are in place to address these issues.
CCG Action(s): The action plans are reported to the monthly CQRMs until the actions are closed. The issues regarding Slade House are being managed by Oxford CCG and the Local Area Team (NHS England) [Bold my emphasis].
A quality and safeguarding visit was undertaken to Melbury Lodge and assurance was gained that all actions had been undertaken and there were no care concerns.
Recommendations: A visit to Antelope House by WHCCG and SCCCG is planned.

Papers for November 2013 Board meeting

Quality Scorecard.
                Board Quality Dashboard Exception Report Section 3: Southern Health
3 Southern Health Foundation Trust (SHFT) (MH/LD and Integrated Community Services)
3.1 Number of SIRIs breaching closure date: The number of SIRIs breaching their closure date across both the MH/LD and Community services has steadily decreased and SHFT are on track to clear these by the end of November.
 3.2 Commissioners and the provider are reviewing quality indicators to assess if there are any additional indicators that need to be added to the dashboard in order to provide a broader view of the Trust.

Papers for September 2013 Board meeting
Quality Scorecard.
                Board Quality Dashboard Exception Report Section 3: Southern Health
3 Southern Health NHS Foundation Trust (SHFT) (Mental Health/Learning Disabilities and Integrated Community Services)
3.1 Number of SIRIs breaching closure date: There continue to be a number of Serious Incidents Requiring Investigation (SIRIs) breaching their closure date across both the Mental Health/Learning Disabilities and Community services. SHFT have been asked to clear the numbers breaching by mid-October. This will be closely monitored by CQRM.

Papers for 25 July 2013 Board meeting
Board Meeting: Summary of discussions and decisions. No mention of Connor or Southern Health’s learning disability services.

Quality Scorecard.
                Board Quality Dashboard Exception Report Section 3: Southern Health
3.1 Monitor Governance Rating: The governance rating for this foundation trust was amended from AMBER-RED to AMBER-GREEN in December 2012 following the Trust’s actions to address previous corporate governance concerns.
 3.2 Number of SIRIs breaching closure date: This has been raised at the Contract Review meeting with SHFT and will continue to be monitored at this meeting and at the CQRM when SHFT will be asked for actions as to how they will bring this under control.

Papers for May 2013 Board meeting
Board Meeting: Summary of discussions and decisions. No mention of Southern Health’s learning disability services.

Quality Scorecard.
                Key issues to note:
On reviewing the data for Serious Incidents Requiring Investigation (SIRIs) reported per organisation, the CCG’s main Community & Mental Health/Learning Disabilities services provider, Southern Health NHS Foundation Trust (SHFT), has significantly higher numbers compared to other providers. This is relative to the size of the organisation and services provided, however the CCG has been and continues to follow up the high numbers of pressure ulcers reported. The number of unexpected deaths for SHFT also appears higher than other providers, and the Board needs to be aware that this includes all suicides for those in receipt of care or who have been in receipt of care in the previous six months.

Papers for March 2013 Board meeting

Quality Handover Plan

Southern Health NHS Foundation Trust
Southern Health NHS Foundation Trust joined with Hampshire Partnership Foundation Trust in 2011 and has recently acquired the Ridgeway Partnership Oxford Learning Disability NHS Trust. This means that the Trust is now an extremely large and diverse organisation providing mental health including medium secure services, learning disability and community services across a large geographical area. 
In 2011/12, the Trust received a series of unannounced CQC visits which resulted in issues being identified at Antelope House, Elmleigh and Ravenswood units. The trust took swift action to remedy the issues and worked with the PCT Cluster to progress a programme of unannounced visits.
 The Trust has also inherited an action plan following a CQC visit to the Ridgeway Partnership Oxford Learning Disability NHS Trust when non compliance was found in the standard for personal records.
 The PCT Cluster has been undertaking detailed work with Southern Health NHS Foundation Trust to understand and ensure there is timely closure of SIRIs. At the time of writing, there remain 171 open SIRIs at the trust with the highest trend in SIRIs relating to pressure ulcers.

Quality Scorecard.

No mention of Southern Health.

South East Hampshire CCG Board Papers 2013-2014

South East Hampshire CCG Board Papers 2013-2014


As with other CCGs, the South East Hampshire CCG (one of three CCGs in Hampshire) was established on 31st March 2013. The reason for having a look at the Board papers for South East Hampshire CCG is that the headquarters of Southern Health NHS Foundation Trust is in Hampshire. Furthermore, the NHS Oxfordshire PCT document “Maintaining and improving quality during transition” (designed to inform newly created CCGs and other new NHS agencies) specifically stated with respect to Ridgeway (now Southern Health):

5.3.3. NHS Oxfordshire and all of the direct receiver organisations will not be the lead commissioner for Southern Health and a relationship needs to be developed with CCGs in Hampshire to make sure that clinical quality is reviewed to a high level.

Because of this statement, I thought it was worth looking at the Hampshire CCGs’ Board papers to see if I could find any Hampshire CCGs either identifying themselves as the lead commissioner for Southern Health learning disability services or identifying any other agencies as the lead commissioner.
South East Hampshire CCG Board (Governing Body) papers are available here http://www.southeasternhampshireccg.nhs.uk/about-us/gbmeetings.htm

Papers for March 2014 Governing Body meeting

 Performance Report. No mention of Southern Health’s learning disability services in reporting on the performance of Southern Health.

Joint CCG Governing Body Report (think this is joint between Fareham & Gosport and South East Hampshire CCGs) contains the following:

Southern Health Foundation Trust Mental Health and Learning Disability Services Exception Report.

Care Quality Commission (CQC) visits. Out of Hampshire areas visited by CQC include Learning Disabilities (LD): Slade House and John Sharich House. The Trust has received enforcement notices in relation to these services and NHS England has subsequently held a risk summit which identified key work streams to progress, with a follow up meeting planned for March 2014. The LD service pathway in Oxford is under review and there are plans to implement the Hampshire model. Monitoring continues via the Lead Commissioner (West Hampshire CCG) [Bold is my emphasis] with local CCG quality and vulnerable adults team input.

Papers for January 2014 Governing Body meeting

Performance Report. No mention of Southern Health’s learning disability services in reporting on the performance of Southern Health.

Joint CCG Governing Body Report (think this is joint between Fareham & Gosport and South East Hampshire CCGs): No exception reporting for learning disability services within Southern Health.

Papers for November 2013 Governing Body meeting

 Performance Report. No mention of Southern Health’s learning disability services in reporting on the performance of Southern Health.

Joint Quality and Safety Report contains the following:

Southern Health Foundation Trust Mental Health and Learning Disability Services Exception Report.

Non-Hampshire Learning Disability quality concern - A CQC inspection outlined concerns re care for patients in a residential setting in oxford. In addition a SIRI was reported in association with LD services, raising concerns around governance. The NHS Wessex Area Team have met with SHFT to discuss in response to concerns voiced by commissioners and have agreed a way forward.

Papers for September 2013 Governing Body meeting
No papers beyond the agenda seem to be available online.

Papers for July 2013 Governing Body meeting

 Performance Report. No mention of Southern Health’s learning disability services in reporting on the performance of Southern Health.

Quality Report contains the following:

CCQ Joint Quality and Safety Committee proceedings:
An update on the review of placements following the “Winterbourne View “ report, which demonstrated that all in & out of area placement review s for Fareham and Gosport and South Eastern Hampshire patients has now been completed.

Southern Health NHS Foundation Trust [Provider Quality Report]:
Safety/HCAI/SIRIs. There were 5 unexpected deaths in April 2013, all of which occurred within Psychiatric Mental Health.
Patient outcomes & risks to quality. Postern House: This LD unit was transferred over to SHFT from Ridgeway Partnership earlier this year and has one resident from Hampshire who was transferred from Winterbourne View. Other issues were raised regarding staffing. A review has been undertaken by SHFT staff and found there to be no safeguarding concerns. It is planned to undertake an in-depth review in July/August to determine the future of Postern House.
2012/13 Quality Account.  SHFT have provided the CCGs with an opportunity to review their Quality Account for 2012/13. The Trust is congratulated on the improvement against a number of local key quality indicators namely a reduction in incidents involving patient violence, increase usage of the structured handover tool, increased percentage of patients with a physical health assessment, and increased usage of patient reported outcome measures.
SHFT also achieved a reduction in violent incidents in Adult Mental Health, Older People’s Mental Health and Specialised services and a small increase in Learning Disabilities and Integrated Community services by the end of 2012/13.
Summary of Achievements, Best Practice and Areas Under Review. SHFT Areas Under Review include: Ridgeway transfer; Restraint policies.

Papers for May 2013 Governing Body meeting

Performance Report. Very little mention of Southern Health services at all – no mention of their learning disability services.

Contracting Update for 2013/14. Includes the following:
SOUTHERN HEALTH FOUNDATION TRUST MENTAL HEALTH (WEST HAMPSHIRE COORDINATING COMMISSIONER) [Bold my emphasis]: The Contract document is largely complete. However, there have been some recent QIPP changes and utilisation of CQUIN money raised by CCGs which need to be reflected in the documentation. The expectation is that the contract will be signed by 7 May 2013.
[Are Southern Health’s learning disability services assumed to be part of their mental health service in terms of the contracting arrangements?]

Joint Quality Report

Southern Health NHS Foundation Trust Provider Quality Report:
Safety/HCAI/SIRIs. The national reporting and learning system (NRLS) March report shows some improvement for the period 04/12 to 09/12 but SHFT appears to be in the lowest 25% of all MH and LD trusts for reporting incidents. The trust are reviewing the data and attribute the fall in reporting to the implementation of a new data system. Further assurances will be sought.
Patient outcomes & risks to quality. Ridgeway: a clinical quality review of all former Ridgeway services was undertaken prior to merger and an action plan is in place to improve quality. Concerns remain around the quality of services.
2012/13 Quality Account.  SHFT have provided the CCGs with an opportunity to review their Quality Account for 2012/13. The Trust is congratulated on the improvement against a number of local key quality indicators namely a reduction in incidents involving patient violence, increase usage of the structured handover tool, increased percentage of patients with a physical health assessment, and increased usage of patient reported outcome measures.
SHFT also achieved a reduction in violent incidents in Adult Mental Health, Older People’s Mental Health and Specialised services and a small increase in Learning Disabilities and Integrated Community services by the end of 2012/13.

Summary of Achievements, Best Practice and Areas Under Review. SHFT Areas Under Review include: Ridgeway transfer; Restraint policies.

NHS Oxfordshire PCT (sub?) cluster

NHS Oxfordshire PCT (sub?) cluster


NHS Oxfordshire “Maintaining and Improving Quality During Transition” document, March 2013, available here http://www.oxfordshireccg.nhs.uk/wp-content/uploads/2013/03/Paper-13-Oxfordshire-Quality-Handover-Document-FINALv2.pdf

Documentation concerning the Oxfordshire PCT before this date seems to be no longer available online – the website address oxfordshire.pct.nhs.uk goes to a page stating ‘This website is no longer live’.

As far as I can tell, NHS Oxfordshire was a merged collection of PCTs covering Oxfordshire within the larger Buckinghamshire and Oxfordshire PCT Cluster. Excerpt from Section 5 below:

NHS Oxfordshire (NHSO) [a part of NHS Buckinghamshire and Oxfordshire Cluster] is responsible for the planning and securing of health services and improving the health for the people of Oxfordshire. NHSO was formed on 1 October 2006 as part of a national reconfiguration of Primary Care Trusts to reduce their number from 303 to 152. In Oxfordshire, five Primary Care Trusts were merged to form a single PCT with a single Board and management team. The principal place of business for NHSO is Jubilee House, Oxford Business Park South, Cowley, Oxford.

This document is a close match to the quality handover document excerpted and reported in the newly forming Oxfordshire CCG March 2013 Board Meeting. However, this document does seem to contain more detail in some respects.

Executive summary: One of the 10 “biggest challenges that future commissioners in Oxfordshire need to focus on” is:
·         Improved learning from serious incidents with the LD Trust

Section 1.1: Key issues during transition
The key issues for maintaining quality during transition are as follows:
        To ensure that during transition the needs of the patient remain the key focus for the health and social care economy
        To maintain clear lines of accountability at all times to ensure early warning of any concerns about the quality of care
        To maintain clear communication channels with staff and patients and to make time to listen to what they are saying
        To set up systems whereby hard and soft intelligence on quality is shared with the receiving organisations

Section 2: Transition Lead
Sula Wiltshire (Cluster Director of Nursing and Quality at Oxfordshire PCT – destination Oxfordshire CCG) was one of two people “responsible for signing off document”.

Section 5.2: Receiver Organisations

Section 5.2.2.: Oxfordshire CCG
Key Responsibilities and Functions
Commission majority of NHS funded healthcare services – CCGs will be responsible for commissioning the majority of NHS funded services including:
·         Planned hospital care; (acute and community hospitals)
·         Rehabilitative care;
·         Urgent and emergency care;
·         Most community health services;
·         Maternity, mental health and learning disabilities services.
Working together with other commissioners - CCGs will need to work with each other and with other local partners. For example, where a number of CCGs each commission a significant volume of care from the same provider, they may wish to agree collaborative arrangements that enable them to collectively specify services and monitor the quality of services. They will also need to actively engage the local communities, patients and service users whom they serve.

Section 5.2.4.: Oxfordshire County Council
Key responsibilities and functions
Commission learning disability services on behalf of Oxfordshire CCG – There is a pooled budget between OCCG and OCC. Both organisations are responsible for ensuring that the people of Oxfordshire have access to high quality learning disability services. This is done via a Section 75 arrangement of the contract. The lead commissioning role is with Oxfordshire County Council.

Section 5.3: Provider Organisations

Section 5.3.3 Ridgeway Partnership (now a part of Southern Health NHS Foundation Trust)
Ridgeway Partnership was one of the leading providers in the UK of specialist health and social care services for people with learning disabilities and other long term complex care needs. The Trust specialises in providing services for adults with moderate to severe learning disabilities and also provides services to people with milder disabilities and was the Trust that provided healthcare for Oxfordshire patients. The Trust integrated with Southern Health NHS Foundation Trust in November 2012. Southern Health provides community health services, specialist mental health and learning disability services for people across Hampshire and its surrounding area. NHS Oxfordshire and all of the direct receiver organisations will not be the lead commissioner for Southern Health and a relationship needs to be developed with CCGs in Hampshire to make sure that clinical quality is reviewed to a high level.

The Trust offers a range of supported living, community teams, inpatient, step down and assertive outreach services across Oxfordshire, Buckinghamshire, Swindon, Wiltshire, Dorset, Bath and North East Somerset. The lead commissioner for the contract with Ridgeway Partnership is Oxfordshire County Council.

Challenges
·         To assess dignity in care in each area and roll out training to all staff in the light of Winterbourne
·         To develop best practice guidelines for dysphagia awareness
·         To ensure all staff, including senior managers, have had appropriate safeguarding training
·         To ensure that effective learning takes place following a serious incident as per duty of candour guidelines

Section 6: Quality Profile

Section 6.1: Areas of clinical quality challenges (10 areas listed)
Improved learning from serious incidents within the LD Trust: Staff at NHS Oxfordshire have worked together with Ridgeway to ensure that best practice is implemented to learn from any serious incidents so as to avoid the possibility of a situation like Winterbourne View happening in Oxfordshire. Going forward, this relationship should continue with the lead commissioner for Southern Health.

Section 6.2: CQUIN

Section 6.2.1 CQUIN scheme for 2012/13
No CQUINs listed for Southern Health or related to people with learning disabilities

Section 6.2.2 CQUIN scheme for 2013/14 (‘being negotiated’)
No CQUINs listed for Southern Health. ‘Learning Disabilities’ listed for Oxford University Hospitals.

Section 6.3: Quality Account

Section 6.3.3 Ridgeway Partnership
Quality improvement priorities for 2012/13
• To continue to deliver high quality services that safeguard essential standards for service users
Rationale:
        To ensure that services are built on the development of therapeutic relationships between staff and service users
        To ensure that practice is based on the best available evidence. To ensure that staff are provided with the appropriate knowledge to support service users with this complex health need
        To promote the importance of policies, procedures and training in relation to Safeguarding across the Trust, following the Internal Review of Quality and Safety in response to the Winterbourne View revelations
• To improve the effectiveness of assessment and care planning processes across services
Rationale:
        To maintain the continuity of effective assessment, care planning and review processes in the transition from paper to electronic records.
        The need to streamline processes and reduce duplication of paperwork in order to ensure that all service users receive care based on identified needs and that all service users are offered the same pathway through services.
        Within the Forensic Service, there is a need to ensure that service users are accessing the right facilities with the right level of security to support reduced length of stay (QIPP Target)
• To increase recorded evidence of service user’s experience and involvement in their own care
Rationale:
        To ensure that the broad range of approaches used on a daily basis to involve service users in their care are captured in a meaningful way and documented within their care records.

Section 6.4: National quality metrics

This section does not seem to contain any information regarding Ridgeway/Southern Health learning disability services, even in areas (e.g. inpatient surveys, staff surveys, friends and family test) where such measures would be relevant.

Section 6.4.6a - Care Quality Commission (CQC) Inspections, compliance issues and registration status
Oxfordshire Learning Disability NHS Trust 2012/13
Registration details: Accommodation for persons who require nursing or personal care, Personal care, Treatment of disease, disorder or injury, Assessment or medical treatment for persons detained under the Mental Health Act 1983
Warning notices: None
Current status: Registered

Section 6.4.6d - Winterbourne View transition arrangements
 In May 2011, a BBC Panorama programme showed disturbing scenes of people with learning disabilities being abused within a hospital. Oxfordshire had made 3 placements at Winterbourne View (WBV) and 2 Oxfordshire people were placed there at the time of the broadcast. Oxfordshire County Council (OCC) has responsibility for commissioning specialist hospital placements for people with a learning disability on behalf of the NHS, through the pooled budget and lead commissioning arrangements. Like other hospitals, WBV was regulated and monitored by the Care Quality Commission.

Following the identification of the abuse OCC and NHS Oxfordshire carried out reviews into the commissioning, placement and monitoring arrangements of these 3 patients. The NHS Oxfordshire review was reported to Oxfordshire Safeguarding Adults Board and fed into a series of commissioning assurance frameworks submitted to the SHA jointly by NHS Oxfordshire and OCC.

A joint action plan was completed which set out the actions Oxfordshire Commissioners would take to strengthen the commissioning of specialist inpatient placements for adults with learning disabilities. A number of strengths in the current commissioning system were identified including the very low number of out of county placements.

The implementation of the action plan was monitored through a steering group comprising of the Commissioning Manager for OCC, Ridgeway Partnership Trust Senior Management and consultant psychiatrists, service users and carers and Oxfordshire PCT Safeguarding lead manager. The main findings from the Department of Health ‘NHS Review of Commissioning of Care and Treatment at Winterbourne View’ have been identified and addressed in the NHS Oxfordshire / OCC action plan.
Post Winterbourne view concordat actions involved ensuring there was an accurate register of LD patients in NHS funded care and that quality standards had been met for these patients. Oxfordshire is fully complaint with the concordat requirements.

The appointment of the Director of Quality and Innovation to the OCCG, who has responsibility for the NHS contribution to this work, and Safeguarding Manager, will ensure the safe transfer and continued application of the WBV, Department of Health review and Serious Case Review findings.

Appendix 2: BOx Board Assurance Framework – Oxfordshire

Risk 3: Accountable Officer Oxon CCG, and Cluster Director of Quality
Under Monitoring of CQUIN, identifies the following risk:
Limited information where PCT is not lead commissioner, e.g. learning disabilities (social care), and specialised commissioning

NHS South of England/NHS South Central Annual Report and Accounts 2012/13

Strategic Health Authorities (established 1st July 2006; abolished with creation of CCGs on 31st March 2013)


NHS South of England/NHS South Central Annual Report and Accounts 2012/13



July 2006 to September 2011, Oxfordshire was covered by South Central SHA.
From October 2011, South Central SHA merged with South East Coast SHA and South West SHA to become one SHA covering the South of England (although annual reporting was still produced for each individual SHA).

SHA responsibilities listed in the section ‘About South Central’
·         Providing strategic leadership to the local NHS, ensuring national policy is implemented at a local level
·         Leading on organisational and workforce development, ensuring the NHS organisations in the region are fit for purpose and have a workforce to meet the future healthcare needs of the population
·         Developing plans for improving health services in their region
·         Making sure local health services are of a high quality and are performing well.

The NHS South Central SHA region consisted of:
·         8 Primary Care Trusts (PCTs) which merged to form three PCT clusters
·         8 NHS Foundation Trusts
·         4 NHS Trusts yet to achieve NHS Foundation Trust status
·         18 Clinical Commissioning Groups

This report is almost all accounts, I could not see any mention of services for people with learning disabilities in the report. The Chairman and Chief Executive’s foreword states:

Each report should be read in conjunction with the SHA handover documents:
·         Maintaining and improving quality during transition: handover document
·         Operational Handover and Closedown Report

Unfortunately these documents (or any earlier online information, e.g. papers for Board meetings) do not seem to be available online.

Annual Accounts for NHS South Central 2012/13
·         2012/13 Expenditure: £329.3 million, against available funding of £368.9 million (‘surplus’ of £39.6 million “will be available to invest across the South Central health economy in future years”)
·         2011/12 Expenditure: £331.8 million, against available funding of £386.6 million (‘surplus’ of £54.8 million)


In the ‘related party’ transactions section of the annual accounts (section 20), £8.6 million is recorded as an expenditure from NHS South Central to Southern Health NHS Foundation Trust.

Wednesday 26 March 2014

Info Oxfordshire CCG Board Meetings

This is a set of excerpts from publically available documents concerning the Oxfordshire Clinical Commissioning Group, mainly drawn from documents relating to Board meetings from the CCQ being set up in March 2013 to the upcoming Board meeting in March 2014. They specifically concern information relating to LB and learning disability services commissioning by the CCG (formerly Ridgeway, then Southern Health). There may be much that I've missed.

Oxfordshire Clinical Commissioning Group


Website address for Oxfordshire CCG is here ( http://www.oxfordshireccg.nhs.uk/ ) – all information below is taken from the website.

The names and a bit of background on Board members are available here http://www.oxfordshireccg.nhs.uk/about-us/whos-who/

Board meetings and papers are available here (http://www.oxfordshireccg.nhs.uk/get-involved/board-meetings/ ), although the page it takes you to refers to them as Governing Body meetings.

Next meeting Thursday 27th March, 9.30-12.30, Jubilee House, Oxford Business Park South, OX4 2LH
Website states “ oxon.gpc@nhs.net click here”. The website says that answers are provided on its website up to 21 days after the meeting.

 

Papers for March 2014 Governing Body meeting


Minutes of January meeting
Section 12: Quality and Performance Report
She [Director for Quality and Innovation] noted concerns around the Learning Disability services run by Southern Health NHS FT and informed the Governing Body that a risk summit had been held with agreed actions which included a review of how Learning Disability services are commissioned to review if these can be more community focussed.
Section 13: Clinical Assurance Framework
The Interim Chief Operating Officer was asked about the working of the CQUIN payments. She noted that CQUINs must incentivise a demonstrable improvement of quality and these will be a critical part of the approach to commissioning and contracting.

Chief Executive’s Report [Chief Exec is an interim Chief Exec, Ian Wilson]
            9. Southern Health NHS Foundation Trust
 The investigation report into the death of Connor Sparrowhawk at Slade House, Headington has
been published and the Chief Executive of Southern Health NHS FT which runs the unit has
apologised and confirmed that work is underway to address the findings and recommendations of
the report .

Along with Oxfordshire County Council, Oxfordshire Clinical Commissioning Group will work to
ensure the Trust undertakes the recommendations from the review as part of an overall
improvement plan.

Finance Report

2.4 Financial Performance – Mental Health & Learning Disability
Learning Disability Pool
The month 11 position is based upon the latest pre JMG agreed figures which are for month
10. The forecast position for the pool in total has remained the same as the previous four
months at an overspend of £1.9m for year-end of which the CCG share is 15.13% or
£287k.The overall forecast overspend is after adjusting the expenditure downwards by
£1.2m which reflects the assumption that there are underspends within Personal Budgets
and other budget areas that can be managed to keep the overspend down. There continues
to be a level of anxiety around whether these assumptions will hold true.

The underlying overspend has arisen due to panel allocations in the last two months of
2012/13 and the first part of this year which will impact on the remainder of the year. There is
a degree of uncertainty in the forecast due to possible changes in the timing of implementing
these packages although this is being closely monitored. The Pool Manager continues to
report that all packages discussed at panel have been through scrutiny at locality teams
before coming to panel and that the majority of high cost requests were for statutory and /or
critical needs.


Quality and Performance Report

Executive summary
Section 3 c iii. Learning disability: Concerns about Southern Health increased following a
CQC investigation. Two inpatient facilities are currently closed to admissions. There has been a coordinated response to the issues at Southern Health by Wessex and Thames Valley Area Teams alongside CCGs. This work is on-going.

Full report
Section 3 c iii Learning disability
 Learning disabilities services are commissioned through a section 75 agreement with OCC. Concerns remain over the safety culture of the inpatient learning disability services run by Southern Health. Despite established concerns about the quality of care in inpatient services for people with learning disabilities, the required improvements did not come about following the transfer of Ridgeway NHS Trust to Southern Health NHS Foundation Trust. Furthermore there is some evidence that the change in leadership led to a decline in morale and a worsening of the situation.

In September 2013, an unannounced visit from the CQC found serious failings in the
STATT unit in Oxford. The unit was immediately closed to admissions and all patients have
subsequently been moved out.

A risk summit has been held as a result of concerns raised and follow up actions are in
place and a further meeting planned.
The SIRI closure meeting for the incident in which a young man died in the STATT unit in
July 2013 was help on 26 Feb. Following requests from OCCG SHFT commissioned an
independent company, Verita, to carry out the investigation. The report found that the
young man’s death was preventable and detailed a range of failings in the unit. The trust
has accepted the findings of the report.

Commissioners in Oxfordshire and Buckinghamshire have continued their suspension of
placements in the Ridgeway Assessment and Treatment Centre in High Wycombe until a
programme of improvements has been completed.

Thames Valley Area Team of NHS England is coordinating a commissioner wide review of
future service needs. All Oxfordshire patients who are currently in Southern Health inpatient
learning disability facilities are being closely case managed.

Papers for January 2014 meeting

 Chief Executive’s Report [Interim Chief Exec Ian Wilson]
No mention of Connor or services for people with learning disabilities

Quality and Performance Report

                 Executive summary
Section 3 c ii Learning Disability: Concerns about Southern Health have increased following a CQC investigation. Two inpatient facilities are currently closed 14/07 January 2014 4 of 45 to admissions. There has been a coordinated response to the issues at Southern Health by Wessex and Thames Valley area teams alongside CCGs. This work is on-going.

Full report
Section 3 c iii Learning disability
On 27 November the CQC published its inspection report on Slade House, which comprises 2 inpatient units for people with learning disability and mental health issues and/or challenging behaviour. In total there were 6 enforcement notices, and the remaining core standards were failed with ‘moderate’ concerns. Both STATT (Short Term Assessment and Treatment Team) and John Sharich House remain closed to admissions. The greater number of concerns relate to the STATT unit. All the patients have now been moved out of STATT. Southern Health has put in place a turnaround team to work intensively with the Slade House units in order to bring them up to the required standards.

This closure to admissions has meant that commissioners have had to place patients in the Ridgeway Centre in High Wycombe, which is an inpatient assessment and treatment unit run by Southern Health. Despite a positive CQC report, commissioners have had on-going safeguarding concerns about the Ridgeway Centre and the decision has been made not to place in the unit.

Learning disability services are commissioned by Oxfordshire County Council through a section 75 pooled budget. OCCG is working closely with Oxfordshire County Council, to design an alternative model of service for this patient group. There has been a coordinated response to the issues at Southern Health by Wessex and Thames Valley area teams alongside CCGs. This work is on-going. A risk summit was held on 8 January 2014.

Papers for November 2013 meeting

 Chief Executive’s Report [Chief Exec Stephen Richards]
No mention of Connor or services for people with learning disabilities

Quality and Performance Report

                Executive summary
Section 3 c ii. Learning Disability: Concerns about Southern Health have increased following a CQC investigation: OCCG attended a meeting with Southern Health Executive Team on 16 October. The meeting was organised by NHS England Wessex area team. The Chief Executive set out assurance of the actions being taken to address the concerns.
Full report
Section 3 c iv. Learning disability. Concerns remain over the safety culture of the inpatient learning disability services run by Southern Health. Southern Health has commented on the enforcement notices which the CQC proposes to issue on the STATT inpatient service in Oxford and their comments are currently being considered by the CQC prior to publication.

OCCG attended a meeting with Southern Health Executive Team on 16 October along with the other commissioners of the non-Hampshire LD services. The meeting was organised by NHS England Wessex area team. The Chief Executive set out assurance of the actions the trust are taking to address the quality concerns which have been identified by both commissioners and by the CQC. Commissioners are providing a coordinated response to this and are setting out the outcomes which they will expect from these services.
  

Papers for September 2013 meeting

 Chief Executive’s Report [Chief Exec Stephen Richards]
No mention of Connor or services for people with learning disabilities

Quality and Performance Report

Executive summary
Section 2 d ii. Learning Disability – Southern Health: OCCG continues to work with the
provider to address concerns over their safety culture.
Full report
Section 3 c ii. Learning disability.
OCCG continues to work with Southern Health to address concerns over their safety culture. The Wessex team is coordinating a commissioner-wide approach to issues with learning disability assessment and treatment services. The performance notice raised by OCC about the use of physical restraint is currently being addressed by Southern Health.

Papers for 25 July 2013 meeting

Chief Executive’s Report [Chief Exec Stephen Richards] [reporting first 100 days of Oxon CCG]
No mention of Connor or services for people with learning disabilities

Quality and Performance Report [the first integrated quality and performance report for Oxon CCG]
[No executive summary]

Full report
Section 3 d i. Southern Health.

LD services are commissioned through section 75 agreement with the CCG and Oxfordshire County Council (OCC).

There are concerns about the safety culture and quality of patient care in specialist inpatient ‘Assessment and Treatment’ services for people with a learning disability and mental health issues.

Since 2011 there have been concerns about the way in which serious incidents requiring investigation (SIRIs) have been investigated by the Ridgeway Partnership. The concerns were around the organisational response to incidents and specifically that they appeared to suggest the lack of a robust safety culture within the organisation.

It was hoped that when The Ridgeway Partnership NHS Trust was acquired by Southern Health NHS Foundation Trust that concerns would be addressed. However OCCG and OCC have not been ufficiently assured that the required change has taken place. Currently Oxfordshire are not placing patients in one Southern Health Assessment and Treatment Service and there are conditions in place around placing patients in a second service of this type.

Many of the SIRIs involve the use of physical restraint. This is a high risk area which requires a clear organisational approach, strong leadership and close supervision. At OCCG’s request, OCC has issued a performance notice to Southern Health around the management of physical restraint. The notice requires that the trust develops and implements a code of practice for restriction and restraint.

OCCG and OCC have been working with Southern Health and continue to do so. OCCG continues to monitor Southern health SIRIs in services used by Oxfordshire patients closely.

Papers for May 2013 meeting

Chief Executive’s Report [Chief Exec Stephen Richards]
No mention of services for people with learning disabilities

Quality Report
Section 2 5. Southern Health
 5.1 Safety culture in learning disability services

Since the abuse uncovered at Winterbourne View by the BBC’s Panorama, there has been an increased focus on learning disability services, and in particular inpatient assessment and treatment services for people with learning disability and mental health issues. Learning disability services in Oxfordshire are commissioned under a section 75 agreement by Oxfordshire County Council. In 2011 NHS Oxfordshire (NHSO) raised concerns about the safety culture within what was then the Ridgeway Partnership NHS Trust. In particular there was a concern about the way in which the
trust responded to, and investigated, SIRIs. In November 2012 the Ridgeway Partnership became a part of Southern Health NHS Foundation Trust (SHFT). NHSO, and latterly OCCG, had hoped that Southern Health would quickly address our concerns about the safety culture within the learning disability services. However, progress towards this aim has been slow. OCCG continue to work closely with SHFT to ensure a robust safety culture is established.

Papers for March 2013 meeting

Chief Executive’s Report (Chief Exec Stephen Richards]
No mention of services for people with learning disabilities

Quality Handover Document

Executive summary
One of the 10 biggest challenges identified for future commissioners is “Improved learning from serious incidents within the LD Trust”.

     Full  report

Section 5.3.3. [Provider Organisations]  Ridgeway Partnership (now a part of Southern Health NHS Foundation Trust)
Ridgeway Partnership was one of the leading providers in the UK of specialist health and social care services for people with learning disabilities and other long term complex care needs. The Trust specialises in providing services for adults with moderate to severe learning disabilities and also provides services to people with milder disabilities and was the Trust that provided healthcare for Oxfordshire patients. The Trust integrated with Southern Health NHS Foundation Trust in November 2012. Southern Health provides community health services, specialist mental health and learning disability services for people across Hampshire and its surrounding area. NHS Oxfordshire and all of the direct receiver organisations will not be the lead commissioner for Southern Health and a relationship needs to be developed with CCGs in Hampshire to make sure that clinical quality is reviewed to a high level.

The Trust offers a range of supported living, community teams, inpatient, step down and assertive outreach services across Oxfordshire, Buckinghamshire, Swindon, Wiltshire, Dorset, Bath and North East Somerset. The lead commissioner for the contract with Ridgeway Partnership is Oxfordshire County Council.

Challenges
• To assess dignity in care in each area and roll out training to all staff in the light of Winterbourne
• To develop best practice guidelines for dysphagia awareness
• To ensure all staff, including senior managers, have had appropriate safeguarding training
• To ensure that effective learning takes place following a serious incident as per duty of candour guidelines


Section 6.3.3. [Quality Account] Ridgeway Partnership
Quality improvement priorities for 2012/13

• To continue to deliver high quality services that safeguard essential standards for service users
Rationale:
o To ensure that services are built on the development of therapeutic relationships between staff and service users
o To ensure that practice is based on the best available evidence. To ensure that staff are provided with the appropriate knowledge to support service users with this complex health need
o To promote the importance of policies, procedures and training in relation to Safeguarding across the Trust, following the Internal Review of Quality and Safety in response to the Winterbourne View revelations

• To improve the effectiveness of assessment and care planning processes across services
Rationale:
o To maintain the continuity of effective assessment, care planning and review processes in the transition from paper to electronic records.
o The need to streamline processes and reduce duplication of paperwork in order to ensure that all service users receive care based on identified needs and that all service users are offered the same pathway through services.
o Within the Forensic Service, there is a need to ensure that service users are accessing the right facilities with the right level of security to support reduced length of stay (QIPP Target)

• To increase recorded evidence of service user’s experience and involvement in their own care
Rationale:
o To ensure that the broad range of approaches used on a daily basis to involve service users in their care are captured in a meaningful way and documented within their care records.


Excerpts from Southern Health Foundation NHS Trust Annual Report 2012/13 (available here file:///C:/Users/hattonc/Downloads/HANTSPART%20Annual%20%20Report%20and%20Accounts%202012-13%20(1).pdf )

Quality Report pages 40-41

Commissioning for Quality and Innovation framework (CQUIN)

A proportion of Southern Health income in 2012/13 was conditional upon achieving quality improvement and innovation goals agreed between Southern Health and any person or body they entered into a contract, agreement or arrangement with for the provision of relevant health services, through the Commissioning for Quality and Innovation payment framework. Further details of the agreed goals for 2012/13 and for the following 12 month period are available online at:
www.gov.uk/government/news/commission-for-quality-and-innovation-scheme-data-available

In 2012/13 income totalling £5,446,826 million was conditional upon the Trust achieving quality
improvement and innovation goals. In 2011/12 income totalling £0.886 million was conditional upon the Trust achieving quality improvement and innovation goals, of which payment of £0.772 million were received.
There is a table of CQUINs on page 41 of the Quality Report – cannot copy the table but it includes (as well as CQUINs for three other commissioners that specifically mention learning disability services):
Commissioner: Oxfordshire
Service Area:      Learning Disabilities
Scheme:               Improving access to general healthcare for adults with learning disabilities
                                Service user involvement
                                Prison liaison
                                Dysphasia
Available £:         £153,974

Quality Report pages 54-55

Joint Feedback Statement from Oxfordshire County Council and Oxfordshire Clinical
Commissioning Group

Oxfordshire Clinical Commissioning Group (OCCG) has reviewed the Southern Health NHS Foundation Trust Quality Account for 2012-13. There is evidence that the Trust has relied on both internal and external assurance mechanisms to produce this report. OCCG is satisfied that the Account meets the nationally mandated criteria for a Quality Account and that the document does not contain any inaccuracies to the best knowledge of the CCG.

Oxfordshire CCG’s comments are confined to Southern Health NHS FT services which were previously provided by the Ridgeway Partnership NHS Trust. The contract with Southern Health NHS FT for learning disability services is managed by Oxfordshire County Council under the section 75 agreement.

Oxfordshire CCG is pleased to see the Southern Health NHS FT’s approach to quality and look forward to Oxfordshire learning disability services realising the benefits of the integration. We hope that the integration with Southern Health will address the concerns expressed last year by NHS Oxfordshire about the lack of emphasis on continuous improvement of LD services and the lack of information to demonstrate quality. 

Oxfordshire CCG will work together with Oxfordshire County Council and Southern Health NHS FT to ensure that the learning disability services in Oxfordshire are not isolated from the rest of the Southern Health NHS FT and are therefore able to develop a culture of continuous improvement. OCCG will continue to seek assurance that a robust safety culture is developed and evidenced.