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
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.
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.
