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. 

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