Bracknell & Ascot

Clinical Commissioning Group

Name of Meeting

Paper Number

Governing Body Meeting

4.2

Title of Paper

Quality concerns at Heatherwood and Wexham Park

Date of Paper

Date of Meeting

31/07/2013

14^th August 2013

Purpose of Paper (For information, For discussion, For decision)

For discussion

Summary

The purpose of this paper is to update the governing body of quality concerns raised by the federated quality committee and formally advise the governing body of the results of a recent CQC inspection at Heatherwood and Wexham Park Foundation Trust (HWWP) and the on-going monitoring and actions to ensure the continuous improvement in commissioned services.

Recommendations

Who has been involved from WAM CCG?

Accountable officer

Clinical Chair

Director of Nursing

Financial implications

Poor quality impacts on costs of care

Has an Equality Impact Screening been undertaken? If so please attach

Please list any other committees or groups where this paper has been discussed

Federated quality committee

NHS Outcomes Framework 2013/14

Please indicate which Domain this paper sits within by highlighting or ticking below:

Please note there may be more than one Domain.

Domain 1 Preventing people from dying prematurely;

Domain 2 Enhancing quality of life for people with long-term conditions;

Domain 3 Helping people to recover from episodes of ill health or following injury;

Domain 4 Ensuring that people have a positive experience of care; and

Domain 5 Treating and caring for people in a safe environment; and protecting them from avoidable harm.

Paper Author

Sarah Bellars

1. Introduction

1.1 The purpose of this paper is to update the governing body of quality concerns raised by the federated quality committee and formally advise the governing body of the results of a recent CQC inspection at Heatherwood and Wexham Park Foundation Trust (HWWP) and the on-going monitoring and actions to ensure the continuous improvement in commissioned services.

2. Background

2.1 The Governing Body will be aware that the CCG monitors quality of service provision at HWWP hospital through the federated quality arrangements, these arrangements have been in place prior to the authorisation of the CCG in April 2013.

2.2 Concerns relating to the quality of care provided at HWWP had been raised at the monthly Clinical quality review meetings (CQRG) held with the Trust and reported to the federated quality committee where escalation plans were agreed and carried out (key concerns highlighted in more detail in the quality risk register).

2.3 The main areas of concern have related to the impact of extreme pressure on services over a prolonged period during the winter months with higher than planned demand, this was seen in the significant deterioration of a number of quality markers including, A+E handover times and waits, stroke performance and a decrease in patient experience and staff satisfaction.

2.4 As part of the CCG escalation plans they reported concerns to the Area Team Quality Surveillance Group (QSG), the CCGs were not the only organisations that reported concerned and the QSG raised HWWP to an escalated monitoring status at the April 2013 prior to the CQC inspection in May 2013.

2.5 From the information received by its member organisations the QSG took the decision to call a risk summit.

3. The CQC inspection

3.1 At the beginning of May 2013 the CQC carried out an unannounced inspection at HWWP.

The CQC report was published on the 17^th of July and the Trust must be compliant with the warning notice by the 12^th of August.

3.2 The inspectors undertook a full unannounced inspection, interviewed staff and patients, reviewed notes and charts, made observations of practice and followed patients through their pathway over a period of 4 days.

3.3They visited wards 2 wards at Heatherwood, and a larger number of wards and departments at Wexham Park.

3.4 The CQC inspected against a number of outcomes:

Outcome 1: Respecting and involving people who use services
Outcome 4: Care and welfare of people who use services
Outcome 8: Cleanliness and infection control
Outcome 9: Management of medicines
Outcome 13: suitability of Staffing
Outcome 16: Assessing and monitoring the quality of service provision
Outcome 21: Records

3.5 They identified a number of issues that caused them concern; poor care care-planning, poor communication, privacy and dignity issues, access of call bells and medication issues amongst others.

3.6 Many of the issues were actioned by the Trust immediately and the Trust have implemented a daily executive regime to scrutinise compliance with CQC standards.

3.7 The CQC judged the trust to be noncompliant with all of the standards inspected at the Wexham park site and 2 of the 5 standards inspected at the Heatherwood site.

The CQC issued a warning notice against outcome 16, which the Trust must be compliant with by the 12^th of August 2013.

3.8 The CQC also noted that there were many dedicated staff who were working very hard and were being as responsive as they could be and that patients were being treated clinically appropriately.

4. Risk Summit

4.1 A risk summit chaired by the regional NHS England team was held on the 30^th of July to discuss the risks identified by the CQC and other organisations in relation to HWWP.

4.2 The Risk summit heard the concerns from all the invited organisations; these included the Area Team, CCG’s, Public Health England, CQC, Monitor and a representative of the 3 local authorities in Berkshire East.

4.3 The QSG reviewed and interrogated the plans put forward by the Trust to achieve compliance with the CQC essential standards and the other concerns raised and actions going forwards for monitoring the plan.

Monitoring and follow up Actions

A number of monitoring actions were agreed at the Risk Summit these included:

CQRG to monitor action plan with the Trust at monthly meeting
Federated quality committee to review action plan monthly
Pace of the work of the Urgent Care Board to be maintained
Weekly review of maternity capacity between CCG and Trust
Second Risk summit to be held at the end of September to review actions

In addition to the actions agreed at the risk summit the CCGs will continue to monitor, triangulate and question the information it receives from a range of sources, such as patient experience, clinical concerns (a system of local intelligence informed by primary care) and other quality metrics, supported regular clinical ‘walk-abouts’ at the Trust by CCG directors.