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