Quality and Safety in South Tyneside NHS CCG

1. Quality and Safety in South Tyneside NHS CCG Jeanette Scott-Thomas Head of Quality & Patient Safety

2. Aim of the presentation • To provide an update on the response to the Francis Inquiry Action Plan and what this means for South Tyneside NHS CCG community.

3. Findings from the first inquiry(published February 2010) • Lack of basic care across a number of wards and departments • Trust culture was not conducive to providing good care or a supportive environment for staff • Too high a priority on targets • Consultant body disassociated itself from management • Acceptance of poor standards • Management and Board thinking dominated by financial targets • Absence of effective governance • Lack or urgency to Board response to problems • Statistics and reports preferred to patient experience • Focus on systems and not outcomes • Lack of internal and external transparency

4. Learning from 1st Inquiry resulted in publication of: • Review of Early Warning Systems in the NHS • Assuring the Quality of Senior NHS Managers • The Healthy NHS Board • NQB – Managing Safety and Quality during in the transition

5. Findings from 2nd Inquiry • A lack of openness to criticism • A lack of consideration for patients • Defensiveness • Looking inwards and not outwards • Secrecy • Misplaced assumptions about the judgements and actions of others • An acceptance of poor standards • A failure to put the patient first in everything that is done

6. Key Recommendations • Governance and trust boards • Monitor and authorisation of Foundation Trusts • New fundamental and enhanced standards of quality • Duty of candour, complaints and clinical risk • Enhancements to provision of information, inspection and monitoring • Workforce issues • Commissioning for quality • Role for regulators

7. Expectations from Francis 2 • How lessons learned might be applied to other parts of the health economy • All healthcare organisations should consider the findings and recommendations and decide how to apply them to their own areas of work. • Each organisation should announce its progress against planned actions ( no less than once a year). • DoH should publish collective progress • House of Commons select committee on Health should consider incorporating update on actions from those organisations responsible to parliament. The whole enquiry has been focussed relentlessly on the need to protect patients from unacceptable and unsafe care.

8. “The extent of the failure of the system shown in this report suggests that a fundamental culture change is needed. This does not require a root and branch reorganisation – the system has had many of those – but it requires changes which can largely be implemented within the system that has now been created by the new reforms. I hope that the recommendations in this report can contribute to that end and put patients where they are entitled to be – the first and foremost consideration of the system and everyone who works in it.” • Sir Robert Francis QC (February 2013)

9. Initial Government Response to Mid Staffs Inquiry Statement of Common Purpose: • Renew and reaffirm NHS Constitution • Putting patients first- listening carefully and responding quickly to patients, especially the most vulnerable. • Collaborating on behalf of patients – rooting out poor care and promoting excellent care. • Outward facing – do the business of the patient, not the system or organisation.

10. Continued • Reduced bureaucracy- freeing up time to care and to lead. Rewarding staff for their care as well as for skills. • Single set of measures of success – focussing on what matters to patients. • Duty of candour- challenge ourselves and each other on behalf of patients. Culture of humility, openness and honesty. • Commitment to change – set out plans to make this a reality

11. Five Point Plan – Putting Patients First A. Preventing problems B. Detecting problems quickly C. Taking action promptly D. Ensuring robust accountability E. Ensuring staff are trained and motivated

12. Learning from Mid Staffs Inquiry • Francis is an opportunity to reassess what we (commissioners) are doing and why! • Quality and the Patient First • Getting the basics right • An open culture • Contracts that work for patients and clinicians

13. Headline considerations for South Tyneside CCG Issues to consider: • Performance and standards • Information • Professional regulation • Values and accountability • Openness and candour • Leadership • Care and compassion • Organisational culture and staff engagement • Learning from Keogh Review

14. Next Steps • Key organisations across health and social care will continue to take the action needed to make the document a reality for patients. • Government will report on progress annually. • Development NHS ST CCG draft action plan (September 2013, aligned with findings from Keogh Reviews) shared with partners and stakeholders for comment • Build on assurance from Providers

15. 123 Responsibility for monitoring delivery of standards and quality • Recommendation • GPs are ideally placed to undertake a monitoring role on behalf of their patients who receive acute hospital and other specialist services. They offer an independent, professionally qualified check on the quality of service, in particular in relation to an assessment of outcomes. They require robust internal systems enabling the identification of patterns of concern, so that cases are not considered in isolation.

16. CCG Initial position May 2013 • Datix is rolled out to all practices but use is variable. • There is not a standard for communication to patients and other clinicians re issues. • Often a GPs duty does end when a patient is admitted. This is variable. • Choice is not always informed. • No standard process from CCG perspective to cascade info down to practices.

17. CCG Actions • Explore strengthening use of Datix to capture concerns and other soft intelligence to feed into QRGs. • Use information from Datix, identifying themes and feedback information through QRG and back to practices. • Use information from Datix, identifying themes and feedback information through QRG and back to practices. • Need to make information easily available to GPs on South Tyneside Portal using GP data and other intelligence. Refresh STCCG Informatics Strategy. • Practices to implement systems of communication. • Create a consistent reporting and monitoring approach to quality for the major providers for South Tyneside.

18. Questions/Comments?