- Horsham and Mid Sussex CCG

Minutes
Meeting
Date and Time
Quality and Clinical Governance Committee
Wednesday 15th January 2014, 12.30-15.00
Present:
Sue Braysher (SB), Mark Lythgoe (ML), Paul Vinson (PV), Vicky Daley (VD), Adrian
Brown (AB), Peter Nicolson (PN), Mike Baxter (MB), Carol Pearson (CP)
Alison Ramsay (AR), Simon Chandler (SC), E J Gibbons (EJG), Simon Neale (SN)
Sally Thomson (ST), Naomi Cornford (NC), Betty Njuguna (BN) ), Alison
Hempstead (AH), Alan Kennedy (AK),
In attendance:
Apologies:
Those present at the meeting should be aware that their name will be listed in the Minutes which will be released to members of
the public on request.
Action
1.
Introductions and Apologies
Apologies were received from those listed above.
2.
Minutes of Last Meeting
The minutes of the meeting on 11th December should be amended under point 3.1
Stroke to read “stroke nurses have been trained to request scans”. The minutes were
otherwise agreed as an accurate record. Please find updated action tracker attached.
3.
Quality Reports
The Committee considered detailed quality reports for each of its main providers.
Report to include a flag system indicating if there has been an improvement or not and
whether items are newly added. Providers to be asked to submit the same data. This
could be included as a contractual requirement going forward to ensure consistency as
well as requesting that mortality data is provided more frequently. The aim is to include
everything on the dashboard from April onwards. There was a discussion regarding the
red/amber/green (RAG) ratings. There could be a summary for the Governing Body
showing whether the committee is assured that it is going in the right direction.
3.1
Fractured Neck of Femur (NOF)
Information to be requested from Brighton and Sussex University Hospital Trust (BSUH)
regarding admissions within 4 hours.
3.2
BN
Workforce
There is a significant issue at BSUH with appraisals and they will not achieve their
target by the end of March 2014. There are different trigger points for Trusts. There are
concerns regarding the locum and turnover rates at Surrey and Sussex Healthcare
Trust (SaSH). There was a discussion regarding cardiothoracic surgery at BSUH. The
Trust commissioned an independent review of cardio surgery at the end of 2013 which
highlighted a number of issues which have been raised with the NHS England Area
Team. As part of the actions, VD will be going on a site visit. There are cultural issues
at BSUH and the Committee were not assured.
Actions:
 SB to raise concerns regarding BSUH with Amanda Fadero.
 VD to provide feedback to Area Team following site visit.
SB
VD
Crawley Clinical Commissioning Group
Horsham and Mid Sussex Clinical Commissioning Group
V:\USF\West\NWSCA\General\NWSCA\Meetings\Quality\2014\01 Jan 15th\Minutes\QCGC Minutes 15th Jan 2014 Final.docx
3.3
Serious Incidents (Sis) and Never Events
VD is visiting Langley Green on 22nd January as there have been a number of SIs and
increasing concerns regarding safeguarding awareness, the culture and significant
delays in the reporting of SIs. There is an improvement action plan and VD will have a
formal discussion with Emma Wadey. NHS England published new guidance in
December regarding never events and has also published an analysis of never events
in the region. Never events has been added to the CCG risk register.
PV and Dr Luke have met previously with the Consultant and Chief Pharmacist to
discuss quality of performance however this has now been raised formally.
Action:
VD to analyse the never event report from the Area Team and report back.
3.4
Healthcare Acquired Infections
There have been 6 cases of MRSA at BSUH and 3 at SaSH. SaSH are within trajectory
for C Difficile. BSUH and Sussex Community Trust have both gone over their targets.
4.
Workforce Report
The report was collated by CSU South. The percentage rates are different for each
provider. CSU have been asked to look into the estates and ancillary staff rate at
BSUH. There is a relatively high turnover for Healthcare Assistants at SaSH.
Discussions should take place at workforce meetings with the Trusts and the QCGC
should get output from those meetings. VD attends the meetings on a monthly basis.
The workforce report informs and reinforces other information which the CCG receives.
Workforce report to be on the QCGC agenda every 6 months.
VD
Actions:
Horsham and Mid Sussex and Crawley CCGs to be included in future workforce reports. EJG
5.
Internal Audit Work Programme
There were no issues to be put forward to the internal auditors.
6.
Stroke
The committee needs to receive consistent data from Trusts. RAG ratings, trigger
points and benchmarking need to be consistent and could be included in contracts.
National guidelines state that transient ischaemic attacks (TIAs) should receive a scan
within 1 hour but there are no national targets. There was a suggestion to invite
Programme Leads to the QCGC. Stroke targets should be discussed at the Sussexwide stroke workshop at the end of January.
6.1
BSUH
Mischa Butler joined the meeting by phone to give an update. There has been an
improvement since they introduced training in A&E regarding stroke calls. Mischa
explained that some of the issues with direct admission to the stroke unit are related to
volumes and the small numbers at Princess Royal Hospital impacts on the unit and
overall for the Trust. In October the Trust started to offer patients appointments at the
Brighton site which has made a difference to the overall performance. The Trust are
focusing on direct access to the stroke unit and moving outliers out so that they can
admit stroke patients. This is work in progress. Mischa attends daily site bed meetings
and they are focusing on ensuring they have a minimum of one stroke bed available at
all times with an aim to have 2 available. This is on the agenda at the bed meeting
which has raised the profile. One bed is ring fenced but there are times when patients
are not discharged in time to get the next one in. There need to be more stroke beds
on the county site to accommodate direct admissions for stroke. They are also looking
at the way they escalate discharges of non-stroke patients from the stroke unit.
Page 2 of 4
The committee requested absolute numbers of stroke admissions, mortality rates, mean
time to scan data and also information on who sets the targets regarding access to
scans within 1 hour. The summary sheet goes to Jane Whitcher who has regular
meetings with Mischa to discuss the stroke action plan. BSUH are working with the
imaging team. The stroke co-ordinator attends all stroke calls (Monday-Friday). The
target for having a CT scan within 1 hour is 50% however the CCGs would like to see a
higher percentage than this and work towards a 24 hour/7 day service. Mischa has
regular input with the Chief Executive Officer at BSUH regarding availability of
resources to deliver the stroke services. It is a high priority on the clinical strategy work.
The mortality data contributes to the way the Trust makes decisions going forward.
There has been an improvement in the times taken to receive a CT scan.
BSUH will be attending the Sussex-wide stroke workshop at the end of January where
there will be a discussion regarding changing stroke services.
Action:
VD to Liaise with Mischa Butler and Jane Whitcher to get the following stroke data:
 Stroke admissions
 Mortality
 Mean time to scan
 Who sets the targets regarding access to scans within 1 hour
 Percentage of patients admitted with diagnosis of CT scan who receive thrombolysis
 Quarterly report with a narrative interpretation of the SNAPP data.
6.2
VD
SaSH
Ben Mearns, Stroke Lead at SaSH, updated the committee. The committee has ongoing concerns regarding the metrics which are being supplied from SaSH and issues
have been raised by the public at Governing Body meetings and in the press regarding
stroke services at SaSH.
SaSH had some issues when the stroke unit was full and they were unable to admit
stroke patients onto the unit. The committee raised concerns regarding SaSH having a
red rating, putting an action plan in place to make improvements, and then losing
capacity and having a red rating again. December and January are busy months.
SaSH do not admit minor strokes and TIAs which could affect the mortality data. A
query was raised over how the Trust knows it is a minor TIA if the patient has not had a
scan. Patients are now kept on the acute medical unit with a stroke nurse until a bed is
available on the stroke unit. The CCG wants to see improvements so that more than
50% receive a scan within 1 hour. SaSH has ring fenced beds which has made a
difference and they have 24 hour Band 6 stroke nurses who manage that. The stroke
nurses can order scans. SaSH would like to be able to admit every stroke patient and
want to improve the access within 4 hours. The mean time for a scan within 1 hour is
62 minutes and 66.7% who need thrombolysis receive it within 1 hour. The committee
would like to see an improvement in admission rates.
The Trusts are judged on Sentinel Stroke National Audit Programme (SNAPP) data
which has 400 metrics. When the mortality figures are cross referenced to the number
of patients, it is higher than expected. The committee need to receive the narrative
behind the data and would like more useful metrics e.g. median time to thrombolysis as
well as receiving absolute numbers. The mortality figures for March showed that there
were 9 stroke deaths, 8 of these had a TIA and had not been given anticoagulants in
the community. The notes have been reviewed by their quality committee and all
deaths in acute and the elderly are reviewed at the mortality meetings. They have
appointed more consultants and are working towards a 7 day service. SaSH would like
the CCGs to let them know what their priorities are so that they can focus on them. The
SNAPP data goes to Jane Whitcher.
Page 3 of 4
Actions:
VD to Liaise with Ben Mearns and Jane Whitcher to get the following stroke data:
 Quarterly report with a narrative interpretation of the SNAPP data
 More useful metrices
 Mortality data
 Absolute numbers
7.
Issues and Risks to be Escalated to the Governing Body
 Stroke – QCGC to gain assurance from SaSH and BSUH.
 Express concerns regarding BSUH and the workforce issues.
8.
Any Other Business
There was no other business.
VD
Date of Next Meeting:
Wednesday 12th February, 12-3pm, Room 1, lower ground floor, Crawley hospital
Distribution:
Sue Braysher, Alison Hempstead, Mark Lythgoe, Sally Thomson, Mike Baxter,
Paul Vinson, Adrian Brown, Carol Pearson, Peter Nicolson, Tom Insley, Vicky
Daley, Naomi Cornford, Betty Njuguna, Simon Chandler, Simon Neale, E-J
Gibbons, Alan Kennedy, Sailesh Chauhan, Sarah Smith, Joe Allan
Minutes taken by:
Contact:
Alison Ramsay
01293 600 300 extn 3212
Page 4 of 4
Minutes
Meeting
Date and Time
Quality and Clinical Governance Committee
Wednesday 12th February 2014, 12.00-15.00
Present:
Sally Thomson (ST), Sue Braysher (SB), Mark Lythgoe (ML), Paul Vinson (PV),
Vicky Daley (VD), Adrian Brown (AB), Carol Pearson (CP), E J Gibbons (EJG),
Betty Njuguna (BN)
Alison Ramsay (AR)
Naomi Cornford (NC), Alison Hempstead (AH), Simon Chandler (SC), Simon Neale
(SN), Peter Nicolson (PN), Sarah Smith (SS), Joe Allan (JA) Mike Baxter (MB), Alan
Kennedy (AK)
In attendance:
Apologies:
Those present at the meeting should be aware that their name will be listed in the Minutes which will be released to members of
the public on request.
Action
1.
Introductions and Apologies
Apologies were received from those listed above.
2.
Minutes of Last Meeting
The minutes of the meeting on 15th January were agreed as an accurate record. Please
find updated action tracker attached.
3.
Quality Reports
The Committee considered detailed quality reports for each of its main providers. The
team have incorporated a flag system as discussed at the last meeting. EJ was
congratulated for her work on the report. It is more useful to see the RAG rating per
individual indicator. There was a discussion regarding the way that other CCGs include
data within their quality reports and the indicator sets used. It is important to look at the
big picture. The team were congratulated on the report and it was agreed that it
absolutely meets the requirements currently.
3.1
Fractured Neck of Femur (NOF)
The CCG is still waiting for data from Brighton and Sussex Universities Hospital Trust
(BSUH) regarding admission to the ward within 4 hours. There was a NOF clinical
cabinet meeting during week commencing 5th February where there was a presentation
showing that there has been significant progress and that the pathway seems to be the
right one. There needs to be a discussion regarding the whole pathway. The outcomes
of the meeting were fed back to the local transformation board.
3.2
Workforce
There are issues at BSUH with only a slight improvement and they will not achieve their
target at the end of March. There is on-going work with BSUH. The CCGs would like
information on indicators on how this feeds into the process and how they quality
assure. There was a query regarding the appraisal rate for Sussex Partnership
Foundation Trust (SPFT).
Action
 Look at indicators for BSUH.
 Check appraisal rates for SPFT.
EJG
EJG
Crawley Clinical Commissioning Group
Horsham and Mid Sussex Clinical Commissioning Group
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3.3
Serious Incidents (Sis) and Never Events
The worst backlogs are at SaSH and SPFT. There are monthly meetings with SaSH
and there are a lot of Sis coming to the SI panel. It is work in progress. South East
Coast Ambulance Trust (SECAmb) to be included in the report. There are regular
meetings with SPFT and it is work in progress. There was a never event at BSUH in
January regarding methotrexate and this is currently being investigated. VD is waiting
for the 72 hour report and will chase this to get reassurance.
Action:
 Include SECAmb data in the report.
 Ask for 72 hour report from BSUH regarding the never event.
3.4
EJG
VD
Healthcare Acquired Infections
There have been 6 cases of MRSA at BSUH which means they are off trajectory and
there have been 41 cases of CDiff. There were 2 cases of CDiff at SaSH. There is an
Infection Prevention Action Group (IPAG) meeting regarding infection and governance.
Joe Allan (HCAI Lead) is in contact with BSUH and is trying to attend the IPAG
meetings.
VD has visited Langley Green and was invited by the Trust to a patient safety peer
review. There has been a significant change in the leadership roles. VD visited the
ward and had discussions with the leadership team, staff and patients. Their patients
said they felt safe and staff felt that there were improvements with the new leadership.
There is a problem with staffing levels which means they are unable to give proper
support. Recruitment can be a problem in Sussex due to competition with London
wages which means they have a number of bank and agency staff however they do
provide induction and mandatory training for them. Staff are keen to provide proper
care. It is a challenging environment. There was a serious incident 18 months ago.
They have an improvement plan. They had a poor staff survey which needs to be
looked at. The CCG will be invited to the peer group session. They have a
psychologist in place.
BSUH have centralised their referrals into a hub and there was a significant backlog in
the hub which had not gone through the appointment process. The CCGs have been
assured that the backlog has cleared and the hub is beginning to work effectively. A
communication was sent to GPs confirming what the problem was and how it has been
resolved. There is also an on-going issue with estates especially on the county site and
the impact prior to the Teaching, Trauma and Tertiary Care (3Ts) hospital
redevelopment. SB will be visiting the worst parts of the site before the building works
begin to see what the issues are.
There has been a lot of work on revalidation for primary care. There was a discussion
regarding the CCGs’ role in primary care and whether this could be discussed at an
LMC liaison meeting. There needs to be a clear understanding of who is responsible for
primary care. The CCGs are currently advertising for a primary care workforce tutor
who will have an insight through scoping of workforce issues and will be line managed
by VD.
3.5
Stroke
The Sussex collaborative discussions on stroke were useful and Surrey and Sussex
Healthcare Trust (SaSH) also attended the meeting. There was an agreement to do a
piece of work across Sussex which all organisations will contribute to. This will give a
clear understanding of what it will mean as far as configuration of services. The CCG
has not yet received the December data from SaSH on the percentage of patients
admitted to the stroke unit within 4 hours however there are no concerns regarding this
as they have stroke nurses who stay with the patient from the time they come into the
hospital. The stroke nurses assess the potential severity of the stroke and prioritise for
Page 2 of 4
scans (which can be requested by stroke nurses). Stroke is on the Quality Review
Meeting agenda for BSUH. There was a suggestion that VD should do a site visit at
Princess Royal Hospital. There are designated stroke beds at both sites for BSUH with
a 7 day service available.
Action:
Obtain metrics for stroke units for BSUH.
4.
4.1
EJG
Safeguarding Reports
Adult Safeguarding
There is currently a big focus on nursing homes. The Gables was flooded and the
residents were moved to the sister home. This will need to be monitored to ensure
there are no issues with the increased number of residents. There was a notification to
restrict the nursing element at Francis Court and the CCGs are waiting to find out if it is
going to be enforced. If it is there will be a significant impact on an already stretched
capacity. VD has had discussions and there is a need for the Care Quality Commission
(CQC) to have a broader picture and not look at homes in isolation.
There are issues at Russettings care home with manual handing and infection control.
Sussex Community Trust are working closely with them to formalise an action plan. BN
will monitor this.
The serious case review for Orchid View is due to be published in June. VD has
meetings to ensure the contents of the report are an accurate reflection of the events.
There could be issues if the enforcement of the CQC recommendations co-incide with
the publication of the report. VD has been asked to be available for the media panel
however the committee agreed that this would not be appropriate and SB will discuss
this with Amanda Fadero if necessary. A query was raised over whether the criminal
proceedings were in connection with Orchid view. Pound Hill completed a report and
there have been discussions with the Practice Manager. It is hoped that the report will
be shared with the CCG prior to publication to ensure it is a correct reflection.
There was a discussion regarding the funding for safeguarding and that 30% of their
time should be spent on Horsham and Mid Sussex and Crawley CCGs. Clarification
needed regarding the CCG’s contribution. Concerns were raised regarding the fact that
Naomi had not attended the meeting for a while. Sarah Smith, lead for safeguarding
children is now in post. BN will be setting up monthly meetings with Safeguarding
leads.
Actions:
 Check if the criminal proceedings are in connection with Orchid View.
 Clarify the CCGs contribution re safeguarding funding.
4.2
VD
VD
Child Safeguarding
SaSH have improved. There is no information for Queen Victoria Hospital (QVH) and
ML will raise this at the next Single Performance Conversation meeting. There used to
be a health visitor who liaised regarding A&E attendances however this post became
vacant. This was raised at the Clinical Quality Review meeting and it was thought that
the post has been advertised. Page 5 of the report stated that Juliet Williams leaving.
Clarification required regarding which post this refers to. The committee noted the child
safeguarding report.
Actions:
 Raise issue regarding information for QVH at SPC.
 Clarify which post will be left vacant following Juliet Williams’ departure.
ML
BN
Page 3 of 4
5.
Never Events
The report was circulated at the meeting and was assimilated based on information
from the CQC via NHS England around national data for never events and outliers for
Trusts. An updated never event list was attached to the report. When looking at the list
in detail, there are some concerns for example mal administration of insulin. Nationally
the never events are generally surgical procedures. There are concerns regarding the
never events at QVH which has been discussed with them. The committee asked for a
copy of the never events broken down by type. Private companies would report never
events on the STEIS system. The Quality Surveillance Group has an overall picture of
never events. The committee noted the report.
6.
Internal Audit Work Programme
There were no issues to be put forward to the internal auditors. Issues regarding the
auditors have been escalated to the Audit Committee.
7.
Issues and Risks to be Escalated to the Governing Body
Raise concerns regarding QVH being a national outlier regarding never events.
8.
VD
Any Other Business
 There was a discussion regarding the capacity of the quality team as they are
currently under a lot of pressure. There is recognition of the good work which the
team are doing and the committee agreed that they do not want to change the level
of detail which is currently provided. Programme Leads should be taking
responsibility for quality and there needs to be some education. An additional
resource will also be brought in to the quality team to relieve the pressure.
 Commissioning for Quality and Innovation (CQINS) – there was a general
discussion regarding CQINS for caesarean sections, and in relation to mental
health. Work has taken place in East Sussex regarding early prevention of suicides.
Any changes to CQUINs need to be agreed before the contracts are signed. If there
is a nurse from SPFT at the police station, they can put people into different referral
pathways. There is a huge success rate if people are referred at the beginning of
the crisis point. Tina Wilmer and Sarah Weston to be included in discussions
regarding CQUINs for SECAmb.
 Stroke network – there was a discussion regarding an emotional crisis network.
There is currently primary care, community services and mental health around
proactive care. This could be rolled forward to include other partners.
 Mental Health – Emma Wadey to discuss services in this area with Tom Insley.
 Care.data – this has been discussed at the commissioning patient reference group.
EJG
 BSUH caesarean sections - to be included in the quality report.
Date of Next Meeting:
Wednesday 12th March, 1-3pm, Room 1, lower ground floor, Crawley hospital
Distribution:
Sue Braysher, Alison Hempstead, Mark Lythgoe, Sally Thomson, Mike Baxter,
Paul Vinson, Adrian Brown, Carol Pearson, Peter Nicolson, Tom Insley, Vicky
Daley, Naomi Cornford, Betty Njuguna, Simon Chandler, Simon Neale, E-J
Gibbons, Alan Kennedy, Sailesh Chauhan, Sarah Smith, Joe Allan
Minutes taken by:
Contact:
Alison Ramsay
01293 600 300 extn 3212
Page 4 of 4
Minutes
Meeting
Date and Time
Quality and Clinical Governance Committee
Wednesday 12th March 2014, 13.00-15.00
Present:
Sally Thomson (ST), Sue Braysher (SB), Mark Lythgoe (ML), Vicky Daley (VD),
Adrian Brown (AB), Carol Pearson (CP), E J Gibbons (EJG), Alison Hempstead
(AH), Simon Chandler (SC), Simon Neale (SN), Peter Nicolson (PN)
Alison Ramsay (AR), Lucy Watson (LW), Keiran Diamond (KD)
Paul Vinson (PV), Betty Njuguna (BN), Sarah Smith (SS), Naomi Cornford (NC),
Joe Allan (JA) Mike Baxter (MB), Alan Kennedy (AK)
In attendance:
Apologies:
Those present at the meeting should be aware that their name will be listed in the Minutes which will be released to members of
the public on request.
Action
1.
Introductions and Apologies
Apologies were received from those listed above.
2.
Minutes of Last Meeting
The minutes of the meeting on 12th February were agreed as an accurate record.
Please find updated action tracker attached.
3.
Quality Reports
The Committee considered detailed quality reports for each of its main providers.
3.1
Fractured Neck of Femur (NOF)
The data has now been received from Brighton and Sussex University Hospitals Trust
(BSUH) and will be circulated. Surrey and Sussex Healthcare Trust (SaSH) are at 79%
for admissions within 4 hours against a target of 85%.
3.2
Workforce
The workforce assurance report was provided for information and will be discussed on a
6 monthly basis. There are still issues with the BSUH appraisal rates and the CCGs will
continue to monitor this.
3.3
Serious Incidents (Sis) and Never Events
The providers which have the most overdue SIs are Sash and SPFT. VD has a monthly
meeting with the Risk Manager at SaSH which is helping to reduce the number of Sis.
There was a query over the number of SIs for Queen Victoria Hospital (QVH).
Action:
Clarify the number of SIs at QVH.
3.4
EJG
Healthcare Acquired Infections
BSUH are an outlier for MRSA and C Diff. The CCGs have now received the trajectories
from NHS England (NHSE). A query was raised on whether there was an issue with a
particular ward at BSUH.
Action: Ask BSUH to provide information regarding wards with MRSA/C Diff.
VD
Crawley Clinical Commissioning Group
Horsham and Mid Sussex Clinical Commissioning Group
V:\USF\West\NWSCA\General\NWSCA\Meetings\Quality\2014\03 March 12th\Minutes\QCGC Minutes 12th March 2014
Final.docx
3.5
Stroke
There is an issue with receipt of information from SaSH. They have a good pathway
and there are no specific concerns regarding patient safety however the CCGs do need
the information to gain assurance. Patients admitted within 4 hours to the acute stroke
ward is on the agenda for the quality review meeting (QRM) with BSUH on 13th March.
They do not have as many ring fenced beds as SaSH. The committee needs
assurance from BSUH that patients are getting appropriate care. BSUH do not have
stroke nurses who stay with the patient from the time they get to the hospital. VD has
received BSUH information from Jane Whitcher. Need to ensure there is appropriate
information flow from Programme Leads. There was a suggestion that the quality team
would follow the pathway at BSUH as they have done at SASH. The issue regarding
scans at SaSH has been raised with them and they are prioritising patients who need a
scan.
Action:
Ask BSUH for information regarding admission to stroke unit to gain assurance that
patients are receiving appropriate care.
3.6
VD
Quality Issues
The following quality issues were discussed:
 The CCGs have received a local stakeholder letter regarding Care Quality
Commission (CQC) inspections taking place on 20th May at BSUH and SaSH. The
CCGs have been asked to provide evidence by 9th April. VD will look at the
information which needs to be provided and in what format. This will be discussed
at the Senior Management Team meeting on 17th March. The CCGs will need to
have a view as to its bearing on Foundation Trust trajectory.

Never Events – there was a never event at BSUH in January regarding a medication
error however the CCG are yet to receive the 72hr report from the Trust. Concerns
were raised regarding SIs being reported in a timely manner and VD will raise this at
the QRM on 13th March. VD has received notification from the NHSE Area Team
about an incident at SaSH regarding an alleged assault. SaSH had not notified the
CCGs. This should have been reported as an SI and will be raised at the SI
committee meeting. The issue will also be raised direct with Michael Wilson and at
the single performance conversation. VD will clarify if this has been reported to the
CQC. In addition there appears to be disparity between the information provided by
SaSH in the report and the dashboard and there are concerns regarding the
accuracy of information provided to the Trust Board. This should be raised at the
single performance conversation meeting, directly with Michael Wilson and via Alan
Kennedy and Alan McCarthy to gain complete assurance. SaSH has made
significant progress with the staff survey. The CCGs require assurance on behalf of
the population. CQC reporting data profiling raises concerns.
Actions:
o Clarify if the alleged assault at SaSH has been reported to the CQC.
o Issues regarding disparity between the information provided by SaSH in the
report and the dashboard to be raised at SPC, directly with Michael Wilson and
via Alan Kennedy and Alan McCarthy to gain complete assurance

Sussex Partnership Foundation Trust (SPFT) – they have published their staff
survey which raised some concerns regarding the workforce. The Chief Officers
from SPFT and the CCGs are meeting to discuss the staff survey. SPFT have just
appointed a new Chief Executive and are also appointing a specialised HR person
to do a deep dive.

Langley Green hospital had a CQC inspection. VD is having a teleconference
meeting with Emma Wadey on 13th March to look at the outcomes.
VD
VD
Page 2 of 3

BSUH referral issues – this was discussed at the Governing Body meeting and
Locality Group. The CCGs have discussed this with BSUH who have confirmed that
they are committed to sorting out the issues and are aware that improvements need
to be made. A template has been produced to be filled in with any referral
concerns. This goes to a dedicated email address at BSUH for a response within
24 hours. The CCG has received a weekly summary of the issues which have been
sent to BSUH. GPs have been advised to let Sue Pumphrey have details if they do
not get a satisfactory response.

Orchid View – the final report will be published on 9th June and will attract media
attention. VD will circulate the draft report to ML and PV for comment.

Complaints and comments – the commissioning support unit (CSU) manage this on
behalf of the CCGs. There is a working group looking at this area.

South East Coast Ambulance Trust (SECAmb) – there was an SI reported involving
an 18 month old child which will be investigated.

The CCG has been complimented regarding their handling of the incident at Pound
Hill in December 2013. A Security Adviser has been into the practice to give them
advice and assurance.
4.
Internal Audit Work Programme
The quality audit report contained no recommendations. This has been discussed with
the auditors and will be raised at the Audit Committee as well as at a meeting of the
local Audit Chairs. AH and Barry Young will be looking at the internal audit programme
for 2014/15. VD has received an email regarding undertaking a review of patient safety
and care.
5.
Issues and Risks to be Escalated to the Governing Body
There were no further issues to be escalated to the Governing Body.
6.
Any Other Business
 Best practice – there was a discussion regarding how this is recorded. The key
performance indicators should reflect the CCGs’ judgement of what the population
needs.
 SC volunteered to be involved in site visits if required.
 The quality reports for Governing Bodies need to be changed so that there is a 2
page assurance report from QCGC. There needs to be a better link in CSU
between quality and performance reports. Also need to produce population data.
VD/EJG
Date of Next Meeting:
Wednesday 9th April, 1-3pm, Room 1, lower ground floor, Crawley hospital
Distribution:
Sue Braysher, Alison Hempstead, Mark Lythgoe, Sally Thomson, Mike Baxter,
Paul Vinson, Adrian Brown, Carol Pearson, Peter Nicolson, Tom Insley, Vicky
Daley, Naomi Cornford, Betty Njuguna, Simon Chandler, Simon Neale, E-J
Gibbons, Alan Kennedy, Sailesh Chauhan, Sarah Smith, Joe Allan
Minutes taken by:
Contact:
Alison Ramsay
01293 600 300 extn 3212
Page 3 of 3
Minutes
Meeting
Date and Time
Quality and Clinical Governance Committee
Wednesday 9th April 2014, 13.00-15.00
Present:
Sally Thomson (ST), Sue Braysher (SB), Mark Lythgoe (ML), Vicky Daley (VD),
Adrian Brown (AB), Carol Pearson (CP), E J Gibbons (EJG), Alison Hempstead
(AH), Peter Nicolson (PN), Paul Vinson (PV), Sarah Smith (SS), Simon Chandler
(SC), Jayne Marklew (JM)
Alison Ramsay (AR), Lucy Watson (LW)
Betty Njuguna (BN), Naomi Cornford (NC), Mike Baxter (MB) Simon Neale (SN)
In attendance:
Apologies:
Those present at the meeting should be aware that their name will be listed in the Minutes which will be released to
members of the public on request.
Action
1.
Introductions and Apologies
Apologies were received from those listed above.
2.
Minutes of Last Meeting
The minutes of the meeting on 12th March should be amended on page 2, paragraph 1
to read “there are no specific concerns regarding patient safety” and “the committee
needs assurance from BSUH that patients are getting appropriate care” and “the quality
team would follow the pathway at BSUH”. The minutes were otherwise agreed as an
accurate record. Please find updated action tracker attached.
3.
Quality Reports
There was a discussion regarding the new combined quality and performance report.
The team are developing a data reporting hub which holds information on delivery,
quality and performance. It contains a large amount of data which can be filtered for
specific meetings or themes. They are developing a tool which will make the document
interactive, accessible and up to date. The main reporting supporting the document is
portfolio summaries which will be reported on a monthly basis and signed off by Clinical
Directors and Programme Directors. Each lead will provide a narrative. There is a
trend graph indicating the direction of travel. There will be a separate report for the
Governing Body which will consist of the top 3 areas of concern to the CCG which they
need to be aware of to gain assurance.
The following comments were made regarding the report:
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There is not a joint audit committee
Report to include complaints and comments
It should be clear what cut or view the information is taken from
VD to look at report ahead of the QCGC meeting and liaise with quality leads to
produce a front sheet summarising how it triangulates with data and highlight key
concerns. This can then be tailored for the Governing Body.
The report will be written by exception by VD, JM and David King
The colour ratings are correct however some of the data is missing
Actions should be highlighted if they are being actioned by the Trust
Crawley Clinical Commissioning Group
Horsham and Mid Sussex Clinical Commissioning Group
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Scorecards could be cut down to report exceptions
The areas of action summary table is useful
The report should include a key with explanation of arrows
The titles could be changed so that it is less negative
If providers are not in the report, could there be a line to say why?
Please send any further feedback to VD
The separate CSU Powerpoint should no longer be required
Action:
Report to be changed to take account of comments above.
3.1
Stroke
There is a comparison of Brighton and Sussex University Hospital Trust (BSUH) and
Surrey and Sussex Healthcare Trust (SaSH). The Programme Leads are working on
stroke and the intention is for them to provide a narrative. SaSH is realigning stroke
metrics to SSNAP and on the whole the data seems reasonable for SaSH. The quality
team have been assured that the CCGs will receive a quality report from SSNAP.
There are issues with the transient ischaemic attack (TIA) service at Princess Royal
Hospital (PRH). To protect patient safety, low risk TIAs will be seen at the county
hospital on a temporary basis.
3.2
Quality Issues
 There are a number of quality issues at BSUH:
 The Care Quality Commission (CQC) listening event report has been published
which highlights issues with the treatment of black and minority ethnic groups,
support for the workforce, appraisals and the culture of the organisation. They
will be visited by the Chief Inspector of Hospitals in June. SB/AB visited
Brighton hospital. If the 3Ts redevelopment programme is approved there will
be major improvements to the hospital estates and facilities. The report had a
lot of positives which includes the dementia unit. There was a suggestion that
the CCGs should focus on PRH and that a site visit takes place.
 There has been a wrong site surgery never event and an alleged assault at
PRH by a consultant
 The national CQUIN for pressure damage will be built into the contract. Grades
3 and 4 pressure damage is reported as a serious incident. Need to ensure
that learning continues and is disseminated across the organisation. The
transformation board will be discussing the possibility of a mattress which
adjusts its pressure. A check list has been devised as part of the investigation
process and is being trialled in East Sussex prior to roll out across the county.

JM/EJG
Sussex Partnership Foundation Trust (SPFT) – there have been a number of
significant issues at Langley Green over the last 2 years and there is a serious case
review coming up soon. There are a number of challenges and they have had a
CQC visit. There were concerns at the last review but they are not looking to take
enforcement action currently as they have new management to take things forward.
There is a clear action plan which is being monitored and there is level 4
safeguarding in place currently. There has also been an issue with prescribing
where a consultant has not been following prescribing guidance from NICE and
SPFT. It has been passed to the medicines management clinical lead and will be
raised as an issue with the Medical Director as well as being raised as a serious
Crawley Clinical Commissioning Group
Horsham and Mid Sussex Clinical Commissioning Group
incident. PV/SB to discuss. The committee needs assurance that safe practice is in
place. The staff survey has also been discussed with SPFT and the CCGs will work
with them to monitor the action plan through the single performance conversations.
4.
4.1
Safeguarding Reports
Adults
The report covers West Sussex. There was a business case to put the adult
safeguarding provision into the CCGs which will provide more parity across West
Sussex. There have been a number of significant issues with nursing homes. There is
a serious case review for Orchid View. Julia Dutchman-Bailey, Director of Quality/Chief
Nurse NHSE, will attend the media panel along with VD. There are also safeguarding
investigations taking place at other nursing homes.
4.2
Children
A serious case review was submitted to DfE on 4th April and will be published on 16th
April. This will affect some children from Horsham and Mid Sussex. There are some
implications for health and there will be some actions for Child and Adolescent Mental
Health. There is a presentation on the Local Safeguarding Children Board's website by
the designated doctor which is available to the public and NHS organisations. The
Children Board has identified 7 areas. There will be an action plan. All health
organisations will be asked to make a more in depth plan which will be monitored.
They are trying to produce a pan Sussex bi monthly reporting form which organisations
will be asked to complete and will feed into the quality assurance framework. SS has
spoken to Sussex Community Trust (SCT) regarding reporting and what is required.
There are concerns regarding the SCT named nurse vacancy. They have specialist
nurses in post and there is appropriate supervision. They have not got feedback on
training. They prioritise the support of practitioners with safeguarding work.
There are concerns regarding SaSH compliance with levels of training and the team
have not got the full data yet. The team are working with them and the in house training
is up and running. There is a serious case review in Brighton and Hove.
A serious incident was raised for South East Coast Ambulance Trust (SECAmb)
regarding a baby with complex medical needs. The police are not taking any further
action and the Local Authority Designated Officer is not going down the allegations
management route. There are concerns regarding the suitability of the practitioners.
The team are looking at sexual assault, domestic violence and abuse pan Sussex and
are working together to ensure they are represented on all relevant Boards. The new
Sexual Health Referral Centre provider from July is Mountain Healthcare. Work
continues to improve services for paediatric victims of sexual assault.
VD will be meeting the new Director of Nursing who started at SCT on 7th April. They
also have a new deputy Chief Nurse in post.
The Safeguarding Leads were thanked for their input into the Quality and Clinical
Governance Committee.
Crawley Clinical Commissioning Group
Horsham and Mid Sussex Clinical Commissioning Group
5.
Safeguarding Children and Adults Policies and Strategies
The West Sussex policies were circulated with the agenda and papers. Please let VD
know if there are any concerns regarding the governance process.
6.
Internal Audit Work Programme
The Audit Committee reviewed the first draft of the work plan for 2014-15. QCGC
members to make AH aware of any concerns as soon as possible.
7.
Issues and Risks to be Escalated to the Governing Body
There were no further issues to be escalated to the Governing Body.
8.
Any Other Business
 There was a suggestion for the QCGC to use a self-assessment tool to look at
performance.
Date of Next Meeting:
Wednesday 14th May, 1-3pm, Room 1, lower ground floor, Crawley hospital
Distribution:
Sue Braysher, Alison Hempstead, Mark Lythgoe, Sally Thomson, Mike Baxter,
Paul Vinson, Adrian Brown, Carol Pearson, Peter Nicolson, Tom Insley, Vicky
Daley, Naomi Cornford, Betty Njuguna, Simon Chandler, Simon Neale, E-J
Gibbons, Alan Kennedy, Sailesh Chauhan, Sarah Smith, Trisha Sharma, David
King, Jayne Marklew
Minutes taken by:
Contact:
Alison Ramsay
01293 600 300 extn 3212
Crawley Clinical Commissioning Group
Horsham and Mid Sussex Clinical Commissioning Group