Agenda Heading / Paper for information & discussion
Enclosure / N Item 165.11
Date of Meeting / 15 December 2011
Title of report / Quality Report
Quarter 2 (July - September 2011)
Recommendation / The committee is asked to:-
- receive the report
- and note that the reports contained have been received by the BCCC Clinical Quality Assurance Group who have agreed that quality concerns identified by the report are, or have been actively addressed though the appropriate groups.
Executive summary
Quality Monitoring Process:
This report examines the key quality domains (Patient Safety; Clinical Effectiveness; and Patient Experience)relating to services commissioned by Bexley Business Support Unit, NHS South East London (BBSU) and identifies the quality assurance process that has been developed for monitoring these services. This report is an outcome of this assurance process and is based on reports that have been approved at various external and internal committees. The report is designed as a quarterly review and is not designed to represent a real time snapshot of the quality of provider services. Where necessary, when there are urgent concerns around the safety or quality of provider services, these will be raised directly with the Bexley Clinical Quality Lead or the Medical Director and escalated as necessary.
To enable the provision of robust assurances of quality, commissioned services are monitored at the following Quality Groups:
- BBSU/Oxleas Community Health Services Quality Group;
- BBG/Oxleas Mental Health Services Quality Group - established with BBSU, Bromley & Greenwich BSUs;
- NHS South East London& SLHT Clinical Quality Review Meetings.
The Quality reports from the above Quality Groups are fed into the Bexley BSU Clinical Quality Assurance Group whose role is to review and ratify the reports and report to the Bexley Clinical Commissioning Cabinet and the NHS South East London Cluster Board sub-committee meeting on Quality & Safety.
The Quality & Safety reports from the above providers’ Quality Meetings have been used to inform this Bexley BSU Quality Report. The report covers Quarter 2, 2011/12.
The last meeting of the BBSU Clinical Quality Assurance Group was held on 01.12.11.
Oxleas Community Health Services
There are currently two red indicators on the Q2 dashboard.
- Safeguarding Children Training level 3, Q2= 47% (Target 80%). Oxleas are undertaking a mapping exercise to ensure correct staff assigned to each training level. Non compliant staff to undertake training as a matter of urgency. This will be reported back at the next Clinical Quality meeting. Safeguarding Children level 2 training is also 4% below target and is Amber rated.
- Agency & Bank use for staff was 10% or more below target for two months out of three for Q2. This indicator is being monitored by the Bexley Community Health Service Clinical Quality Meeting. The other Workforce related indicator (sickness) is on target.
There is currently one red rated indicator on the Q2 MH Dashboard.
Quality CE3.1 – Clinical Effectiveness: Providing better information for our users and carers.
Ensure patients detailed under the Mental Health Act are provided with information as stated and action to be recorded on RiO. - Quarter 2 position under target by 10.8% (6 patients).
Oxleas Commissioning Group stated in the Quality Meeting on 9 November that action would be undertaken Trust wide to brief all Assertive Outreach Team members to ensure correct procedures were understood and followed. This will be reviewed when the October 2011 figures are received for the Monthly Contract Monitoring and will be reviewed by Commissioners at the Q3 Quality Meeting.
South London Healthcare NHS Trust (SLHT)
The Joint Quality Group continue to monitor and seek assurance. Highlights form the Quality monitoring Summary (October 2011) include:
Serious Incidents (SI’s) –slight improvement on completion of investigation timeframes and reduction of numbers of serious incidents from Q1 to Q2.
The mortality rate is below the national average: HSMR 84.7 mortality rate (national average 100).
Safeguarding Children targets for supervision of staff have been 100% achieved.
Infection control rates for C.diff & MRSA have not quite met the targets action plan being developed.
BBSUComplaints/PALS -
Total Complaints investigated by Bexley BSU in Q2
- 25 investigated (Q1 – 22)
- 2 complaints -1 premises, 1 IFR Commissioning
- Independent contractor complaints =15 complaints -10 GP practices: 5 Dental
Of the 10 GP complaints raised key themes are:
- Refused appointment
- Attitude of Nurse
- All aspects of care and treatment
- Delayed diagnosis
Commissioned services (e.g. Bexley Community Provider Unit & Acute services)
- 9 complaints (Q1 = 6)
Key themes from commissioned services include:
- Attitude of staff
- Cancelled operation
- All aspects care and treatment/misdiagnosis
The number of PALS contacts for Q.2 is 732 this is an increase from Q.1 624.
Key themes
- Concerns/Advocacy -: Manner and attitude, refusal to refer, incorrect prescriptions issued, changes to prescriptions without prior notification or refusing to prescribe without explanation, ongoing difficulties in obtaining an appointment.
- Delays in Individual Funding Requests (IFR) requests –
- Savoy Transport
- SLHT - Rise in number of concerns raised regarding SLHT, particularly QMH in respect of Orthopaedic and Gynae services.
- IVF
The following reviews have been undertaken or are underway
- Stroke Care
- Care Homes.
- Support for families with disabled children
- CQC/HMI Probation: Youth Offending inspection
Infection control
Infection control at independent contractors is currently monitored by the Bexley BSU Lead Nurse Infection Prevention & Control. For the period January 2011-September 2011 there have been 7 audits covering the 14 out 28 different Bexley GP practices. Scores out of 100 were assigned for each audit. From this an Overall Compliance score for each surgery was assigned. The top line results of the Overall Compliance score in these audits is as follows:
95% and above / 9 practices
85-94% / 3 practices
75-84% / 1 practice
Below 75% / 1 practice
Cairngall Medical Practice is the only practice below the target of 75% compliance (70%)
Care Home Quality Report Q2
No concerns raised via the Oaks monitoring report
- All pre-placement assessments completed within 48 hours
- All CHC patients care plans were reviewed monthly
- There were 22 falls (15 in Q1) which after considering each case no issues were identified
- One CHC patient had a grade 1 pressure ulcer (redness of skin)
- All pre-placement assessments completed within 48 hours
- All CHC patients care plans were reviewed monthly
- There was 1 fall and no issue was identified after reviewing the information
- Two CHC patients had grade 2 pressure ulcers on admission to the home
NICE Implementation status report
At the September meeting of CQAG the Bexley BSU NICE Guidance process was approved. The NICE Implementation Status report is an output of this process and highlights where the BSU has not yet completed undertaking its responsibilities as commissioners. For the following NICE Guidance at least one recommendation from the guidance (relevant to the BSU) has not been met but an action plan is in place and on target:
- Alcohol Dependence Quality Standard
- Chronic Obstructive Pulmonary Disease Quality Standard
- Chronic Heart Failure Quality Standard
Organisational implications
Financial / Quality of services is contractually linked via CQUINs
Equalityand Diversity / No Equality and Diversity issues identified.
Risk (governance and /or clinical) / This report provides assurance that there are processes and procedures in place for ensuring the quality and safety of commissioned services.
Patient impact / This paper sets out quality & patient safety indicators for Bexley patients and patients of provider services.
NHS constitution / This paper supports the pledges as set out in the NHS constitution
Which objective does this paper support? / Insert Tick ()
Improve choice and access to integrated health services for Bexley patients /
Reduce the level of health inequalities across Bexley /
Improve care for patients with long term conditions & increase the range of services offered within the community /
Improving the health & wellbeing for people in Bexley /
Maximizing the opportunities of joint working (APoH, JSNA, Wellness agenda etc) /
Using our resources in the most efficient & effective manner (organisational & financial) /
Report Authors / Andrea Davis, Clinical Governance Facilitator
Michael Fairbairn, Clinical Governance & Corporate Risk Manager
David Parkins, Clinical Quality Lead
Date / 02.12.11
Contact Details / 0208 298 6279
Executive sponsor / Dr Jo Medhurst
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Bexley Business Support Unit
Quality Report
IndexIntroduction / Page 7
Oxleas Community Health Services
2.1 Introduction
2.2 CQUINS
2.3 Quality Dashboard / Page 8
Page 7
Page 10
Oxleas Mental Health Services
3.1 Quality and Safety Improvement Plan
3.2 CQUINS / Page 13
Page 13
South London Healthcare NHS Trust (SLHT)
4.1 Highlight report / Pages 15-17
PALS/Complaints / Page 18
6. / CQC Reviews
6.1 CQC Review of Stroke care
6.2 Review of healthcare in care homes
6.3 Review of support for families with disabled children
6.4 CQC Youth Offending Inspection / Page 20
Page 20
Page 20
Page 20
7. / NICE Guidance
7.1 NICE Status Report / Page 21
8. / Infection Control / Page 25
9. / Care Home Quality Report / Page 25
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Bexley Business Support Unit
Quality Report
- Introduction
This report examines the key quality domains (Patient Safety; Clinical Effectiveness; and Patient Experience)relating to services commissioned by Bexley Business Support Unit (BBSU) and identifies the quality assurance process that has been developed for monitoring these services. This report is an outcome of this assurance process and is based on reports that have been approved at various external and internal committees. The report is designed as a quarterly review and is not designed to represent a real time snapshot of the quality of provider services. Where necessary, when there are urgent concerns around the safety or quality of provider services, these will be raised directly with the Bexley Clinical Quality Lead or the Medical Director and escalated where urgency is indicated.
The report examines the above quality themes for the following providers of care:
- Oxleas Community Health Services
- Oxleas Mental Health Services
- South London Healthcare NHS Trust (SLHT)
This report aims to inform the BBSU Clinical Commissioning Cabinet about the quality and safety of services commissioned by the BBSU and in doing so provide assurance that the BBSU is upholding its responsibility and commitment to commission safe, high quality and value for money health services for the population of Bexley.
To enable the provision of robust assurances of quality and to enable monitoring of commissioned services the following Quality Groups have been established:
- BCT(Bexley BSU)/Oxleas Community Health Services Quality Group
- BBG/Oxleas Mental Health Services Quality Group- established with BCT(Bexley BSU), Bromley & Greenwich PCTs
- NHS South East London Cluster & SLHT Clinical Quality Review Meetings
Quality & Safety reports have been provided by the relevant providers for the above meetings. These reports are reviewed in detail by the commissioning representatives at these meetings. Further assurance is requested when commissioners are not satisfied with the controls or outcomes or further information is needed. These reports have been used to inform this BBSU Quality Report.
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2. Oxleas Community Health Services
2.1 Introduction
Oxleas Community Health Services were previously part of Bexley Care Trust until the provider/commissioner split on 1st July 2010 when services were transferred to Oxleas NHS Foundation Trust. Oxleas Community Health Services provide a range of primary and community health services to people of all ages across Bexley.
Oxleas CPU Quality Dashboard measures performance, quality and efficiency in patient safety, patient experience, clinical effectiveness and workforce showing how care is being delivered and revealing areas of care that need to be improved. This dashboard is monitored by the Oxleas CPU Quality Group. Chair David Parkins.
There are currently two red indicators on the Q2 dashboard.
- Safeguarding Children Training level 3, Q2= 47% (Target 80%). Oxleas are undertaking a mapping exercise to ensure correct staff assigned to each training level. Non compliant staff to undertake training as a matter of urgency. This will be reported back at the next Clinical Quality meeting. Safeguarding Children level 2 training is also 4% below target and is Amber rated.
- Agency & Bank use for staff was 10% or more below target for two months out of three for Q2. This indicator is being monitored by the Bexley Community Health Service Clinical Quality Meeting. The other Workforce related indicator (sickness) is on target.
For several of the indicators the thresholds are determined over the first 6 months (July - September) and as such no RAG rating has yet been assigned. The indicator relating to Agency & Bank usage has been rising during Q1. This is being monitored at the BBSU/Oxleas Community Health Services Quality Group.
There have been 6 Serious incidents in total for Q2. Four of these related to grade 3 pressure ulcers at the Step Up Step Down Unit. One related to a fall (with fracture) on the unit and one related to a Child Safeguarding incident reported by Health Visitors. The Child safeguarding incident occurred in August 2011 and is currently under investigation and an investigation panel has been established.
All beds in SUSD are being fitted with movement sensors to alert nurses to patients trying to get out of bed. All staff have been trained in the use of the new equipment.
Oxleas will provide Roots Cause Analysis reports on the pressure ulcer incidents to the Clinical Quality Meeting.
2.2 CQUINS have been agreed in the following areas:-
1)To encourage effective communication between community and primary care.
2)Improving access to Care Plans for Long Term Conditions Services by recording Care Plans on RiO.
3)Improve the numbers of patients who are actively case found and provide a proactive and preventative care plan to case manage their condition.
4)Pressure ulcers.
5)Smoking cessation.
At the 25.10.11 Oxleas CPU Quality Group it was reported that CQUINs 1a), 1b), 2 & 5 were met for Q2.
CQUIN 1c) was reported as being more than 10% below target for Q2. This related to patients being discharged from the community team with a full discharge summary to practices within 2 days of discharge. Oxleas considered that clinicians were not uploading onto RiO using the correct terminology and are undertaking an investigation into the cause of this under performance. Oxleas will report back at the next Oxleas CPU Quality Group meeting.
CQUIN 4, reduction of pressure ulcers, was also reported as being more than 10% below target for Q2. However, certain elements of the pressure ulcer targets had been met. It was agreed by Bexley BSU that Oxleas would receive payment for those parts of the targets that it had met.
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BEXLEY COMMUNITY HEALTH SERVICES DASHBOARD OVERVIEW - 2011/12
Ref / Quality Indicator / METHOD OF MEASUREMENT / Report Freq / 2010/11 Qtr 1 Baseline / Target / APR / MAY / JUN / JUL / AUG / SEP / COMMENTSPATIENT SAFETY
PATIENT SAFETY / PS1 / MRSA Incidence (VS - Nat - VSA01) / Incidence (SUSD only) / Quarterly / No reportable incidence for Q1 2010/11 / Numeric / 0 / 0 / 0 / 0 / 0 / 0 / There have been no incidents YTD
PS2 / C Diff Incidence (VS - Nat - VSA03) / Incidence (SUSD only) / Quarterly / No incidence for Q1 2010/11 / Numeric / 0 / 0 / 0 / 0 / 0 / 0 / There have been no incidents YTD
PS3 / Number of Serious Incidents / Number of SI’s reported in a contract month. / Monthly / Numeric / 5 / 3 / 1 / 1 / 1 / 4 / 4 Grade 3 Pressure Ulcers, 1 Fall, 1 Safeguarding Children SIs for Q2
No RAG rating for numeric indicator
SIs continue to be monitored closely
PS4 / Falls -SUSD / The number of patients falling in community hospital by severity of harm (as per NPSA definition). / Quarterly / Baseline to be provided / Numeric / 0 / 0 / 31 falls in Q1 either no harm or low harm / 0 / 0 / 14 falls in Qtr 2 either low or no harm / No RAG rating for numeric indicator
Reduction in Qtr 1 figures
PS6 / % Staff trained for Infection Control / Number of eligible staff trained in Infection Control within the past twelve months as at the last day of the contract year / Quarterly / 80.54% / 95% / 0.00% / 0.00% / 75.00% / 0.00% / 0.00% / 81%
PS7 / Safeguarding Children Governance / Safeguarding Children Level 1
Measure training rate for relevant staff. / Quarterly / 64.29% / 80% / 0.00% / 0.00% / 80.43% / 0.00% / 0.00% / 85%
PS8 / Safeguarding Children Governance / Safeguarding Children Level 2
Measure training rate for relevant staff. / Quarterly / 80.25% / 80% / 0.00% / 0.00% / 91.10% / 0.00% / 0.00% / 76% / Non compliant staff to undertake training as a matter of urgency
Ref / Quality Indicator / METHOD OF MEASUREMENT / Report Freq / 2010/11 Qtr 1 Baseline / Target / APR / MAY / JUN / JUL / AUG / SEP
PS9 / Safeguarding Children Governance / Safeguarding Children Level 3 - Measure training rate for relevant staff. / Quarterly / 59.68% / 80% / 0.00% / 0.00% / 84.62% / 0.00% / 0.00% / 47% / Oxleas are undertaking a mapping exercise to ensure correct staff assigned to each level. Non compliant staff to undertake training as a matter of urgency. This will be reported back at the next Clinical Quality meeting
PS10 / Safeguarding Children Governance / No case conferences attended by BCHS / Monthly / Approx 150 per quarter / Numeric / 44 / 67 / 75 / 80 / 34 / 39 / Over 150 attended during the quarter
PS11 / PSA13 Improved Child Safety / No. Of High Risk Children <5 years old followed up compared to number of Red and Amber A&E slips received. / Quarterly / Baseline to be investigated / % / 0.00% / 0.00% / 80.92% / 0.00% / 0.00% / 89% / This indicator was added to the dashboard in October 2011. A RAG rating and baseline is still to be identified.
PATIENT
EXPERIENCE / PE1 / Number of Complaints / Number of Complaints received in contract month. / Monthly / 15 per quarter / Numeric / 2 / 0 / 5 / 1 / 6 / 2 / No RAG rating for numeric indicator. Complaints levels monitoredatBCHS Clinical Quality Meeting
CLINICAL EFFECTIVENESS / CE1 / Health Visitors – Health Promotion (including New Born hearing, screening and breast feeding input). / % of new birth visits carried out to Bexley Babies within 17 days / Monthly / 85.00% / % / 90.09% / 81.45% / 86.55% / 86.83% / 89.00% / 96.00%
CE2 / SUSD – Estimated Date of Discharge / % of patients to have an estimated date of discharge planned documented on admission / Monthly / No baseline / Numeric / 73.68% / 100.00% / 100.00% / 86.96% / 78.57% / 83.33% / Baseline currently under discussion
CE3 / SUSD – Structured Rehabilitation Plan / % of patients who have a care plan for their stay on SUSD within RiO / Quarterly / No baseline / % / 0.00% / 0.00% / 65.22% / 0.00% / 0.00% / 92.31% / Baseline currently under discussion
Significant improvement from Qtr 1
Ref / Quality Indicator / METHOD OF MEASUREMENT / Report Freq / 2010/11 Qtr 1 Baseline / Target / APR / MAY / JUN / JUL / AUG / SEP / COMMENTS
WORKFORCE / W1 / Agency & Bank hours as a % of overall staff hours / Agency & bank staff hrs in the contract month / Total staff hrs (%) / Monthly / 3 months to establish threshold & baseline / 8.5% / 9.10% / 9.77% / 12.52% / 11.39% / 7.53% / 12.23% / This indicator is being monitored by the BCHS Clinical Quality Meeting
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W2 / Sickness Rates / Total days lost due to sickness per month in the contract month / Total days available per month in the contract month. / Monthly / No baseline / 5.0% / 5.05% / 4.32% / 3.69% / 5.46% / 4.28% / 4.89%
Key
Target achieved / 1-9% below target / 10% or more below target
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