- Horsham and Mid Sussex CCG

Minutes
Meeting
Date and Time
Quality and Clinical Governance Committee
Wednesday 13th August 2014, 13.00-15.00
Present:
Sally Thomson (ST), Vicky Daley (VD), Sue Braysher (SB), Adrian Brown (AB),
Carol Pearson (CP), Sharon Ward (SW), Alison Hempstead (AH), Paul Vinson (PV),
Simon Chandler (SC), Jayne Marklew (JM), Betty Njuguna (BN), Sarah Smith (SS),
Naomi Ellis (NE)
Alison Ramsay (AR), Nicky Blanco (NB)
Mark Lythgoe (ML), Mike Baxter (MB), Peter Nicolson (PN), Trisha Sharma (TS)
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. VD was congratulated for the staff
awards which she received at the AGM.
2.
Declaration of Interests
ST has a new declaration of interest and will fill out a new form accordingly. No other
new items of interest were declared.
3.
Minutes of Last Meeting
The minutes should be amended to reflect that the committee expressed significant
concerns regarding performance at Brighton and Sussex University Hospital Trust. A
query was raised regarding the preparedness for a potential outbreak of Ebola. This is
the responsibility of Public Health England. The CCGs are category 2 responders. The
minutes of the meeting held on 9th July were otherwise agreed as an accurate record.
Please find updated action tracker attached.
4.
4.1
Performance and Quality
Integrated Performance and Quality Report (IPQR)
The IPQR contains a lot of information which gives the committee assurance. The
report is produced with input from quality, performance and the commissioning support
unit and it continues to evolve.
4.2
Performance and Quality Exception Report
 Referral to treatment (RTT) times – locally the providers have slightly higher
average waits than the national profile. A joint guidance document has been
published to support planning for operational resilience during 2014/15. Both CCGs
have been informed of a nominal financial value to disseminate across providers to
start to clear the backlog. Plans have been agreed with providers in terms of
volumes which will be monitored. There is a demand capacity tool. JM was
thanked for the exceptional work which she has done on the IPQR/exception report.
A query was raised over when the clock starts for 18 weeks. The CCGs are not
assured that the Brighton hub is working effectively and are working with them
regarding the issues. Queen Victoria Hospital has problems with data due to the
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Crawley Clinical Commissioning Group
Horsham and Mid Sussex Clinical Commissioning Group
high volume of visiting consultants. Brighton and Sussex University Hospital Trust
(BSUH) have not currently got a lead for 18 week RTT. The CCGs are doing a
piece of work looking at referral data and then checking back with practices to see if
it ties in with their data.
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Care Quality Commission (CQC) Quality Summits – both Surrey and Sussex
Healthcare Trust (SaSH) and BSUH had extensive inspections in May and as a
result there was a quality summit. BSUH was an example of a medium risk Trust
and the CQC wanted to follow up on issues that had been raised by staff at BSUH
as part of the listening event held in December 2013. The intelligent monitoring
system looks at a wide range of data, including patient and staff surveys, hospital
performance information and the view of the public and local partner agencies. Both
Trusts are aspirant Foundation Trusts. SaSH had a very good inspection with a
positive report and was the most improved Trust in the South of England. The
reports will be looked at in detail to see where improvements can be made and
there will be an action plan with stakeholders.
There are a number of significant issues at BSUH including patient flow, culture,
booking hub, staff, environment, cleaning and food. The Quality and Clinical
Governance Committee had previously expressed concerns regarding maternity.
The flow of patients into A&E, through the Trust and out again is a significant
problem. There needs to be a process for the flow of patients. The Trust is dealing
with challenging environments which will have an impact on patients’ experience
and healthcare associated infections. All issues have been raised by Matthew
Kershaw (Chief Executive at BSUH) and his team in an up front and honest way.
The Senior Team at BSUH is changing and they are beginning to address the
issues. There are different issues at the Sussex County Hospital and Princess
Royal Hospital.
Resilience funding is under national review. Winter plans have not been signed off
yet as there are on-going discussions regarding extra bed capacity. The ambulance
service flow has changed. The CCG will need to work closely with Brighton and
Hove CCG regarding the issues at BSUH. SC is a member of the Local
Transformation Board where the issues are discussed. Recruitment is a problem
and the CCGs will need to work with the Deanery to ensure there is a stable
workforce. CCGs are linked into each other through a number of joint working
groups where plans have to be signed off. There are system-wide processes in
place. The CCGs need to ensure that GPs are given information regarding the
Trust to ensure appropriate referrals. Matthew Kershaw is attending the Locality
Group meeting in September to discuss GP referral patterns. VD is invited to
internal quality meetings with providers.
Actions:
 CQC reports to be circulated.
 Letter to be sent to SaSH on behalf of QCGC re CQC inspection
 BSUH newsletter to be circulated.
 SC/CP to work with VD regarding complaints to take to the Commissioning
Patient Reference Group.
VD
VD
VD
SC/CP
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Crawley Clinical Commissioning Group
Horsham and Mid Sussex Clinical Commissioning Group
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Nursing homes and domiciliary care:
 Goffs Park - The CCGs, the Safeguarding Team and the Local Authority have
met to discuss Goffs Park. The Integrated response team was at Goffs Park but
have now finished that piece of work. A new Manager is in place at Goffs Park.
 Aniska Lodge – The home have in recent months accepted 20 residents from
their sister home, The Gables, when this closed due to flooding at the beginning
of the year. The local authority have been undertaking regular monitoring visits
over the past few weeks to gain assurance on the standards of care at the home
and monitor actions being put in to place to mitigate against the potential risks.
In addition, the CCG Quality Manager remains in close contact with the County
Council contracting lead. There are not currently any safeguarding alerts raised
in relation to the home.
 The CCGs will need to work with the County Council regarding domiciliary and
residential care. CCG’s to work with the County Council regarding a different
strategy
Action:
Governing Body to ask if the Health and Wellbeing board are sighted on issues
with nursing homes.
5.
5.1
Safeguarding Reports
Adults
New posts have been created and advertised. They have recruited a Quality Assurance
Officer and the other posts will be re-advertised. The Serious Case Review regarding
Orchid View has now been published and a working party has been set up to prepare
and deliver an action plan. The Safeguarding Team have met with NHS England to
look at the actions. Reports are being collected from GPs regarding the domestic
homicide review in Horsham and Mid Sussex.
The Mental Capacity Act lead professional post has been recruited to and should be
starting on 1st September. Their role is to act as advice and support for mental health
capacity across West Sussex. They will deliver training in Acute Trusts and primary
care. Sussex Community Trust (SCT) still has no adult safeguarding provision however
they have now recruited to the Head of Safeguarding post and are actively trying to
recruit the rest of the team. The CCG safeguarding team are filling the gap where there
are issues. The CCGs have raised concerns regarding SCT providing data and this will
be addressed at the Quality Review Meeting. SCT have asked for an independent
review of safeguarding.
All other providers except for Sussex Partnership Foundation Trust (SPFT) have sent
back the template with data. This is reassuring particularly with regard to SaSH who
has an extra 19 hours of an Adult Safeguarding Lead. The Dean (a medium secure
mental health unit private hospital in Hassocks) has had a major turnaround and is no
longer under close enhanced procedures and has had a large reduction in safeguarding
alerts. A Clinical Lead for Safeguarding Adults has been agreed as a joint post across
the 3 CCGs in West Sussex.
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Crawley Clinical Commissioning Group
Horsham and Mid Sussex Clinical Commissioning Group
VD
5.2
Children
There are concerns as they are losing the designated doctor and named GP. They
have been unsuccessful so far in recruiting to the named GP role. The named GP
carries a lot of responsibility and needs to be appropriately remunerated. It can be
challenging getting information from GPs. The designated doctor is a statutory role and
recruitment to this post is a national problem. The Local Safeguarding Children’s Board
Chairs have acknowledged the concerns and are taking this forward. There is a
designated doctor for looked after children who will be the link in the meantime and the
role for designated doctor on the Board will be carried out via Michelle Bond.
Information will also be put on the website giving contact details of the named doctor in
each area. SS will work closely with the named doctors. Each Trust also has a named
doctor. There was a discussion regarding remuneration and whether the named doctor
can be built in as rotational and how the post can be protected so that people contact
the Trust named doctor initially. SCT are employing a locum consultant in the
meantime.
The named nurse for Safeguarding at SPFT has been on long term sick leave but is
returning in September. The level 1 and 2 training at SCT has fallen as they have
changed the training. An audit of training is taking place as part of the serious case
review to ensure procedures are discussed and there is information sharing.
Safeguarding training at BSUH has been highlighted as a recall area. There are issues
with receiving the data from BSUH.
There have been 3 serious incidents raised by SPFT in relation to Child and Adolescent
Mental Health Services (CAMHS) and young people taking significant attempts on their
life. There have been 2 recent suicides of young people. Information is being gathered
and the Police are actively following up on allegations of social media bullying. It is
important to work with schools and liaise with Emma Wadey. Discussions on how to
help young people and how to engage with them will take place at the child death
overview panel. SS to discuss with Emma Wilson (Health Advocate). The Programme
Board is considering on-line counselling. Discussions are taking place regarding having
a lead school in each town and developing them as health champions. There need to
be communication links into school networks. Issues are discussed at the community
safety partnership.
There have been recent reports from Broadmoor hospital. The Trust Development
Authority has sent letters to the Chief Executive of the Trust to read the reports and
reflect on safeguarding. Actions to be brought back to the CCGs.
Actions:
 SS to draft letter of thanks to designated doctor and named GP for SB to sign.
 Raise concerns at Governing Body meetings regarding the child safeguarding
designated doctor and named GP vacancies.
 SS to forward issues re BSUH training data to SB to forward to Matthew Kershaw.
6.
Child Safeguarding Serious Case Review
SS gave an update on the following findings:
 Finding 1 - practitioners and managers involved in the case did not have knowledge
and understanding of the particular procedure relating to children who abuse other
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Crawley Clinical Commissioning Group
Horsham and Mid Sussex Clinical Commissioning Group
SS
VD
SS
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children. Internal procedures did not relate to the pan Sussex procedures. There
will be briefings to address these issues. Procedures need to be embedded in
safeguarding training. Procedures should be regularly updated and go to
safeguarding practitioners. This is also done through a professional forum.
Finding 2 - joint working between police and children’s social care. It was less
focused when CID were involved. A number of allegations made where the young
people interviewed had no involvement with child protection. There needs to be a
multi-agency safeguarding hub and this is being considered. Part of the action plan
is around training for police and the child protection team.
Finding 3 - investigation and assessment in West Sussex often involves police and
Children’s Social Care without the sufficient involvement of other agencies. There
needs to be health input into the safeguarding hub.
Finding 4 – less clarity in West Sussex about professional child protection roles
when the threat is external to the family. There are very few intervention strategies.
There is no multi-agency protection for children.
Finding 5 – complex database arrangements. Police had to go to 8 different
sources to gather information. They are reviewing procedures.
Findings 6 and 7 – regarding CAMHS and SPFT. Lack of assessment of children
who are abusers who deny allegations. The assessment treatment service is
responding to the action plan. The action plan is being monitored by the Local
Safeguarding Children Board. SS feeds back to them.
Finding 7 – CAMHS choice and partnership approach. There needs to be a reliable
system to liaise with Children’s Social Care. They are reviewing the active
engagement policy. Administration leads in CAMHS will have access to the
Framework so that they can see if they are known to Social Care. There can also
be issues with the transition from child to adult services.
There is a sub group looking at the action plan.
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
 Individual Funding Request (IFR) Panel – AB gave an update. There were17
applications in Horsham and Mid Sussex with 5 being approved by the triage panel.
3 went to the IFR panel, 2 of which were approved. There is one outstanding
complaint. There were 17 applications in Crawley and 4 of those went to the IFR
panel, 2 of which were approved. They are in the process of finalising a review of
the terms of reference.
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Responders are requesting funding to buy equipment. They buy from the
ambulance services. Some responders are reporting that ambulances which were
on their way are being diverted. This should not happen and should be fed back as
serious incidents.
Action:
SC to ask Kieran to send information to David Whale to raise with SECAmb.
SC
A query was raised regarding Ebola. This is the responsibility of Public Health
England. There are designated beds at the Royal Free hospital. A briefing has
been sent to all Trusts.
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Crawley Clinical Commissioning Group
Horsham and Mid Sussex Clinical Commissioning Group
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Healthwatch representative – there was a discussion regarding their attendance at
meetings. There are no other external stakeholders on this committee. VD can
receive reports from them and meet with the Healthwatch representative. An
observer role could be considered. CPRG can invite public to attend their meetings
for specific items. VD to liaise with Healthwatch re attendance.
Date of Next Meeting:
Wednesday 10th September, 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 Ellis, Betty Njuguna, Simon Chandler, Sharon Ward, Alan
Kennedy, Sailesh Chauhan, Sarah Smith, Trisha Sharma, David King, Jayne
Marklew
Minutes taken by:
Contact:
Alison Ramsay
01293 600 300 extn 3212
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Crawley Clinical Commissioning Group
Horsham and Mid Sussex Clinical Commissioning Group
Minutes
Meeting
Date and Time
Quality and Clinical Governance Committee
Wednesday 10th September 2014, 13.00-15.00
Present:
Vicky Daley (VD), Sue Braysher (SB), Mark Lythgoe (ML), Adrian Brown (AB), Carol
Pearson (CP), Alison Hempstead (AH), Peter Nicolson (PN), Simon Chandler (SC),
Jayne Marklew (JM), Betty Njuguna (BN)
Alison Ramsay (AR)
Sally Thomson (ST), Paul Vinson (PV), Sarah Smith (SS), Naomi Ellis (NE), Mike
Baxter (MB), Sharon Ward (SW), Trisha Sharma (TS)
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. Mark Lythgoe chaired the meeting.
2.
Declaration of Interests
No new items of interest were declared.
3.
Minutes of Last Meeting
The minutes of the meeting held on 13th August were agreed as an accurate record
subject to the sentence on page 4 regarding safeguarding children being changed to
read “the designated doctor is a statutory role and recruitment to this post is a national
problem.” NHS England (NHSE) has confirmed that some surveys have taken place
regarding Ebola.
Please find updated action tracker attached.
4.
4.1
Performance and Quality
Integrated Performance and Quality Report
There was a discussion regarding Sussex Community Trust (SCT), their workforce and
vacancy rate as well as issues over capacity and capability. Surrey and Sussex
Healthcare Trust (SaSH) have been able to recruit. The 4 Chief Executives of the
CCGs who use SaSH will be having regular meetings with the Chief Executive of SaSH.
There are workforce issues in Brighton and there will be discussions regarding Brighton
and Sussex Universities Hospital Trust (BSUH) and their foundation trust status. There
is a new Chief Executive at Sussex Partnership Foundation Trust (SPFT). SaSH have
been undertaking work on mandatory training. The CCGs are discussing workforce
issues with West Sussex County Council.
Discussions have taken place regarding the re-procurement of 111 and linking this with
the out of hours service, South East Coast Ambulance service and urgent care. There
is a pre-qualification questionnaire which describes an integrated service with a single
point of access.
The never events at Queen Victoria Hospital (QVH) have been discussed with the Trust
at the Programme Board. VD to undertake a site visit to theatres on 24th September.
Crawley Clinical Commissioning Group
Horsham and Mid Sussex Clinical Commissioning Group
Data can be broken down for delayed transfers of care in terms of NHS and social
delays to help with understanding how these affect our metrics. Poor performance can
sometimes be related to how busy the hospital is and this is not necessarily in the
winter. Discussions have taken place with BSUH regarding the top 6 indicators to focus
on. One of these is delayed transfer of care. There were some 12 hour breaches in
Brighton during week commencing 1st September.
The performance and quality team intend to have detailed portfolio summaries as a
follow up and to act as a route to flag up items in the exception report. Crawley
Governing Body has asked for a report on cancer. Committee members asked for a
report on frail elderly/developing community services at a future meeting.
Actions:
 Provide report on community services for QCGC.
 Investigate the 12 hour breaches in Brighton.
4.2
Performance and Quality Exception Report
 Langley Green hospital – this was raised previously as an exception in May 2014. A
Care Quality Commission (CQC) inspection took place in February which identified
a number of issues. Since then the Trust has done patient safety peer reviews. A
mock CQC inspection was undertaken in August and the report is due shortly. The
Trust has been proactive. Emma Wadey, Director of Nursing and Safety at SPFT,
visits Langley Green on a regular basis. The patient homicide independent
investigation report is now complete. VD is meeting with the Thames Valley team
during week commencing 15th September to look at the outcomes and see how the
CCGs can hold the Trust to account. There have been a number of peer reviews
and VD/BN have been involved in some of these. They have had discussions with
staff and patients and looked at the environment as well as summary meetings to
look at outcomes. There is a joint action plan to incorporate issues raised by the
CCGs and the CQC inspection.
SPFT has taken the decision to reduce the bed capacity from 19 to 16 on Opal
ward. They are being monitored on a weekly basis. Concerns have been raised
regarding an appropriate level of support for Emma Wadey and this has been
escalated within SPFT. There are some cultural issues and they have had new
senior management teams which will take time to bed in. Quality issues are being
taken forward within the contracting and performance meeting which is led by
Coastal West Sussex CCG. Recently it was identified that progress was not being
made as quickly as it should be on the action plan and the CCGs are expecting a
report by 12th September. Site visits will continue and issues are raised at the single
performance conversation meetings. There was a poor staff satisfaction survey and
there are action plans against this which are being monitored. A lot of work is going
on to make improvements.
There have been 21 serious incidents for SPFT and it would be useful to have a
comparison with other mental health trusts however it was felt that this was not
significantly different to other trusts. It was felt that a lot of the serious incidents are
related to suicides and unexpected deaths and were not demonstrating lapses of
care. They have demonstrated that they are an open organisation by announcing
Crawley Clinical Commissioning Group
Horsham and Mid Sussex Clinical Commissioning Group
JM
JM
serious incidents. Issues to be discussed at a Board to Board meeting with SPFT.
VD will provide an update at the next meeting.
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Workforce – there are a number of issues and this is a priority. There are significant
problems with recruitment which has a huge effect on care. Two work streams have
been set up for Surrey and Sussex and organisations are being asked to work
together and to provide workforce plans for the next 5 years. Kent, Surrey and
Sussex have aggregated the workforce plan however there are financial issues.
There needs to be a Sussex-wide conversation as well as a local health economy
conversation with our providers to tie up the finance with the workforce plans.
Discussions are taking place with schools regarding work experience and school
health champions which will give the CCGs access to school bags for health
messages. Some careers fairs have taken place.
5.
Issues and Risks to be Escalated to the Governing Body
Langley Green hospital will be raised at the Crawley Governing Body meeting in
September and was raised at the Horsham and Mid Sussex Governing Body on 2nd
September. The CCG will be monitoring workforce issues for SPFT and SCT over the
next 3 months.
6.
Any Other Business
 Commissioning Support Unit (CSU) for quality – discussions are taking place
 SaSH radiotherapy unit – the CCGs will monitor this for their patients. The GP
referral patterns will change and they will need reminding that if patients go to the
unit at SaSH then the multi-disciplinary teams will be based in Surrey.
Date of Next Meeting:
Wednesday 8th October, 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 Ellis, Betty Njuguna, Simon Chandler, Sharon Ward, 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
Minutes
Meeting
Date and Time
Quality and Clinical Governance Committee
Wednesday 8th October 2014, 13.00-15.00
Present:
Mike Baxter (MB), Sue Braysher (SB), Adrian Brown (AB), Carol Pearson (CP),
Alison Hempstead (AH), Paul Vinson (PV), Simon Chandler (SC), Jayne Marklew
(JM), Betty Njuguna (BN), Sarah Smith (SS), Naomi Ellis (NE) Mark Lythgoe (ML),
Peter Nicolson (PN), Mona Walker (MW), Kudzi Mukandi (KM)
Alison Ramsay (AR), Nichola Blanco (NB),
Sally Thomson (ST), Vicky Daley (VD), Trisha Sharma (TS)
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.
Declaration of Interests
PV declared a new item of interest but confirmed that this did not cause a conflict with
any of the agenda items. No other new items of interest were declared.
3.
Minutes of Last Meeting
The minutes of the meeting held on 10th September were agreed as an accurate record.
Please find updated action tracker attached.
4.
4.1
Performance and Quality
Integrated Performance and Quality Report (IPQR)
The IPQR was discussed and the following points were highlighted:
 It appears that some information is either missing or intermittently missing e.g.
mortality rates from providers. It was thought that a clause had been put into
provider contracts regarding the supply of mortality data. The Committee cannot
discharge its function without that information. JM confirmed that the IPQR is
exception based so it does not mean that the data is not available.
 The report should include an executive summary to give the committee assurance
as to whether the providers are a safe organisation and a perspective of how Trusts
are performing. The information needs to be triangulated and should include
discussions from senior team meetings. The report goes to the respective
programme leads to comment on exceptional areas.
 Each team deals with quality issues within their own programmes and has their own
portfolio summary where they address issues. Issues are escalated to the Quality
and Clinical Governance Committee (QCGC) if there is a problem.
 It was good to see that 5 nursing homes had positive reports from the Care Quality
Commission (CQC). VD to write to congratulate them.
 There are on-going conversations regarding system-wide plans. Brighton and
Sussex Universities Hospital Trust (BSUH) were called to a summit meeting by the
Trust Development Authority and NHS England (NHSE) regarding them missing the
national standards for A&E. More support is being provided to help change working
practices.
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Queen Victoria Hospital (QVH) specialist services - they are working with the
practices in East Grinstead to become a community hub.
NHSE sent out a revised never events list for consultation and review of the
categories. The never events at QVH are monitored at quality review meetings.
Following similarity of the two recent never events, QVH has contracted an external
review of the never events and the Quality team are waiting to receive the report
identifying any actions that have been generated as a result.
Surrey and Sussex Healthcare Trust (SaSH) – there is a lot of pressure regarding
their Foundation Trust status. The CCGs have fed back concerns regarding their
financial footing, the Trust not recognising the impact on the wider system and the
workforce issues.
Workforce/recruitment – Sussex Community Trust (SCT) have been recruiting from
abroad. SaSH have also done this but in isolation and it would be better if there
was a joined up approach. BSUH have a very high temporary staff rate compared
to other Trusts. There needs to be a whole system approach.
Matthew Kershaw (Chief Executive BSUH) attended the Horsham and Mid Sussex
Locality Group meeting as he wants to work in partnership.
It would be useful to do some deep dives at the QCGC.
Discussions have previously taken place regarding reporting on the effectiveness of
the QCGC. The Audit Committee used a self-assessment template which could
possibly be adapted for the QCGC.
Action:
 Discussion to take place before next meeting on how to present the IPQR in a
slightly different format to ensure the committee is assured.
 Write to congratulate the nursing homes who had positive reports from the CQC.
4.2
BN/JM
Performance and Quality Exception Report
Langley Green Hospital - a number of quality concerns have been identified since the
beginning of the year. Following the CQC unannounced visit in February 2014, the
report published in March indicated that Langley Green hospital did not meet all of the 7
standards of quality assessed. A follow up of SPFT’s own mock CQC inspection in
August identified very little progress in regards to the CQC actions from February.
There also have been recent reports of serious incidents and when triangulated with
soft intelligence, highlighted the urgent need for escalation of these concerns. The
CCGs Quality teams have raised their serious concerns via several different routes
including SPFT. There has also been an exchange of letters formally with the CQC
notifying them of our concerns and asking them to do a further Visit. SPFT have also
requested for CQC’s inspection. This has been arranged for January 2015. However
the CCGs have further written to the CQC asking them to bring the dates forward. A
recent conversation between the Chief Nurse at the CCG and the CQC raised concerns
that internal communications at the CQC have not resulted in appropriate escalation
and that the mental health team at the CQC were unaware of the issues at Langley
Green hospital. The CCGs remain very concerned regarding the safety of patients in
Langley Green hospital and will be writing to NHSE requesting a Quality Risk Summit.
The CCGs have a duty of care regarding the organisation and how it functions as well
as to our patients. SPFT have changed the management and oversight of Langley
Green hospital and they are trying to strengthen the resource of the management. SB
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Crawley Clinical Commissioning Group
Horsham and Mid Sussex Clinical Commissioning Group
VD
and Amit Bhargava are meeting Colm Donaghy, Chief Executive SPFT.
The CCGs have raised the lack of commitment from the CQC with Monitor and NHSE.
The next step would be a patient safety risk summit to decide collectively if Langley
Green should remain open. This would be called by NHSE and would be attended by
the CQC, Monitor, CCG Clinical Directors and members of the QCGC. The CCGs
should consider looking at alternative providers. There is currently level 4 safeguarding.
VD is meeting with the Head of SPFT on 9th October. There will be a small group to
monitor delivery against the action plan.
There is a Healthwatch report covering the period from July 2013 to June 2014. PN and
Amit Bhargava are meeting Healthwatch in October to look at what they are doing.
Action:
Write to NHSE to request a Quality Risk Summit.
5.
5.1
Safeguarding Reports
Adults
The following points were highlighted from the report:
 The West Sussex Adult Safeguarding Board Chair has been appointed with the
other roles going out for re-advert. They will put processes and systems in place.
 The working party is continuing to look at the serious case review for Orchid View
and they are looking at how to link the review under headings to give assurance of
better outcomes for patients.
 There is a domestic homicide review in Horsham and Mid Sussex. The draft report
has been produced. Awaiting the final version from the Chair.
 A new structure for the Pan Sussex Domestic and Sexual Violence groups has been
agreed. An Executive Board has been set up with working boards underneath.
There is concern that SPFT are sitting on the Executive Board but not the CCGs.
 The Mental Capacity Act lead professional post has now commenced and will be the
key contact for advice, scrutiny and support. Discussions have already taken place
regarding rolling out a training programme.
 The Adult Safeguarding team have quarterly meetings with the CQC. There is a
new Head of Safeguarding at SCT and the CCGs now receive bi-monthly data on
their alerts and training.
 SPFT – there is still level 4 safeguarding at Langley Green hospital and alerts
relating to opal ward. There is concern regarding the Section 75 agreement for
SPFT with the Local Authority regarding the lead for safeguarding as it is different
for under 65s and over 65s. This is causing problems now that there are ageless
wards with 2 safeguarding systems. There are concerns that SPFT have been
conducting their own safeguarding investigations. It is however stipulated under the
Section 75 agreement that these should be led by an external investigator in cases
of neglect or institutional abuse. The issues have been escalated.
 There are no real concerns at SaSH or BSUH.
 An advert has gone out for the Clinical GP Lead.
 Primary care – NHSE have introduced clinical advisor roles for safeguarding if a GP
is required to do an investigation. Further training will be taking place.
 The Care Governance Board is a multi-agency board mainly looking at independent
care supply and demand. They report to the Health and Wellbeing Board and are
looking at new contracts with care homes. They are looking at devising a better
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Crawley Clinical Commissioning Group
Horsham and Mid Sussex Clinical Commissioning Group
VD

5.2
contract for continuing healthcare which will hopefully include a service
specification. They are also looking at competencies for care staff. Some
safeguarding issues have been raised regarding the community equipment service
as SCT are no longer supplying profiling beds.
NUA have now handed patients back to West Sussex County Council and have deregistered.
Children
The following points were highlighted from the report:
 The named GP role is currently out to advert. SCT are now advertising for a
substantive post. The Surrey Designated Doctor retires in November. The Child
Safeguarding Board Chairs are aware of the issues with recruitment.
 Training – an audit has taken place and the action plan will hopefully be completed
by December. The audit has highlighted some issues and SS/NE are working with
Clare Webster regarding this.
 SCT – SS will discuss their figures with them.
 Female genital mutilation – Acute Trusts have to report to the Department of Health.
Western Sussex and SaSH have identified the need to look at training.
 A serious case review briefing is being held and NHS safeguarding are attending as
part of the action plan. The action plan will be monitored.
 Child deaths – there have been further deaths of a 17 and 18 year old. Both cases
have been discussed at the overview panel. There has been a national increase in
young person suicide. The suicide prevention group is now specifically looking at
this area. They link in with Community Safety Partnerships.
 CCGs were asked to feedback on action plans by 30th September. All actions are
now green however issues need to be addressed in relation to training.
 The Board raised concern that the Designated Nurse had completed the report for
all 3 CCGs. There is a suggestion in future to do one report for Horsham and Mid
Sussex and Crawley.
 Section 11 audit – the audit tools have been sent to agencies. There is an increase
in the number of children on child protection plans. Children’s Social Care are
looking at the cause. The independent enquiry into child sexual exploitation in
Rotherham has been published. The West Sussex Safeguarding Children Board
will look at the recommendations.
 Paediatric sexual assault referral centre (SARC) – NHSE plan to have the final
report to the SARC Board in November with plans to implement in April 2015. West
Sussex were not agreed on the whole plan. Concerns had been raised regarding
the Crawley SARC for adults and whether there should be one for children.
 SaSH – report not received this month. They have asked if they can send a 6
monthly report with exception reports in between. The Committee would still like to
receive bi-monthly reports for both child and adult.
 SPFT – no information received this month but SS is meeting with their named
nurse and is also meeting with named nurses across SPFT to look at their training.
 There was a discussion regarding child protection plans and court orders. SS to
provide data for looked after children.
Actions:
 Provide data for looked after children.
SS
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Crawley Clinical Commissioning Group
Horsham and Mid Sussex Clinical Commissioning Group
6.
Tailored Health Coaching
Tailored health coaching was included in the CCG plans which were signed off by the
Governing Bodies. The CCGs have been offered national pilot status in terms of
tailored health coaching. Horsham and Mid Sussex CCG are going ahead with tailored
health coaching. There was agreement at the Crawley Commissioning Patient
Reference Group (CPRG) but some members of the Clinical Reference Group (CRG)
were not aware that it was part of the 2014/15 commissioning plan and are unhappy
about pursuing tailored health coaching. CRG have raised concerns over whether there
is a benefit from investing in the programme. The general understanding in Crawley
was that the plan would be signed off by CRG and then agreed by the Governing Body.
CRG felt that it was put in the plan on the assumption that they would then receive a
business case. The issue will be discussed at the Executive Group meeting on 9th
October. The scheme of delegation for Crawley states that the CRG influence the
commissioning plan. There are 2 or 3 practices in Crawley who are willing to pilot the
scheme. The QCGC has oversight of where the commissioning plan is in terms of
delivery of an equitable service. If the commissioning plan needs to be changed then
that decision would need to take place at a Governing Body meeting. A review of the
constitution and scheme of delegation is taking place for both CCGs.
7.
Issues and Risks to be Escalated to the Governing Body
There were no issues to be escalated to the Governing Body.
8.
Any Other Business
 Ebola – the CCGs have received national guidance for clinicians regarding
questions to ask and action to take if required. The command and control is through
Public Health England. The CCGs are category two responders. The guidance will
be put on the intranet.
 The Committee thanked the team for their challenging work in putting the IPQR and
Exception reports together.
AH
Date of Next Meeting:
Wednesday 12th November, 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 Ellis, Betty
Njuguna, Simon Chandler, Alan Kennedy, Sailesh Chauhan, Sarah Smith, Trisha Sharma, David
King, Jayne Marklew, Kudzi Mukandi
Minutes taken by:
Contact:
Alison Ramsay
01293 600 300 extn 3212
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Crawley Clinical Commissioning Group
Horsham and Mid Sussex Clinical Commissioning Group