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.
