West Hampshire CCG Board Papers 2013-2014

As with other CCGs, the West Hampshire CCG (one of three CCGs in Hampshire) was established on 31^st 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.