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Responding to the Francis Report

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1 Responding to the Francis Report
Putting Patients First Hello everyone my name is You might ask yourself what is Clinical Governance Clinical governance is an umbrella term for making sure the quality of the services provided continuously improves, standards are met and the environment is safe, the best care is delivered and patients experience is positive. And also making sure we don’t have a Mid Staff type healthcare in Wandsworth I’ve been asked to give you an overview from the Francis report and to tell you briefly as to how the CCG is responding to the report Evonne Harding Head of Clinical Governance/Lead Nurse 11th September 2013

2 Background & Timeline Mid Staffordshire NHS Foundation Trust: manages two hospitals: Stafford Hospital & Cannock Chase Hospital  provides healthcare for people in Stafford, Cannock, Rugeley and the surrounding areas, serving a local population of over 276,500 people. Appalling long term failure and suffering of many patients (2005 – 2009): HCC investigation brought scandal to light, high mortality rates among patients  Whistleblowing not acted on: Royal College Surgeons say dysfunctional surgical department Financial recovery = staff cuts FT: financial focus rather than quality New Government announced new public inquiry, chaired by Robert Francis QC 2004 2005/2006 2007 2008 2009 2010 2013 CHI 3 stars to zero stars Final Report published Full scale investigation I thought before I tell you about how the CCG is responding to the Francis report, you might find it helpful for me to start with some background information on Mid Staff hospitals Is in the West Midlands Patients suffered appallingly between the period of and Right through there were multiple warning signs which were not spotted or acted on Commission for Health Improvement which ceased from 2004 Peer Reviews raised concerns about cancer & children’s services HCC raised concerns re children’s services Auditors reports identified deficiencies in risk management systems, Staff & Patient surveys – worst 20% in country Andrew Burham announced further independent inquiry

3 What went wrong? Organisational
Staffing Issues Voice of People Lack of Care Data issues Systems issues Board issues Staffing: Poor standards of care Consultants not at forefront of change finance over availability of skilled nursing, Poor leadership and lack of training and support Voice of people: No culture of listening to patients: Inadequate complaints management (resources did not match need) No effective voice for people PPI Forums, LiNks , LA scrutiny committee were ineffective Lack of Care Compassion and humanity did not exist Inadequate care of the elderly and vulnerable Data Quality: Information not shared and inadequate action taken Lack of action on mortality figures Figures preferred to people Systems issues The system was poor and failed to protect patients There were no checks and balances Focus on systems not outcomes Board Issues: Accepted poor standards and didn’t want to hear bad news Failures to tackle insidious negative culture that tolerated poor standards (disengagement from managerial and leadership responsibilities Negative culture (“Kiss up, Kick down”), Report was not overly critical collective responsibility for failures Focus on national targets, being and FT and achieving financial balance and forgot what they were in the business of doing which is to care for patients

4 What went wrong 2? Other Agencies
Many Agencies failed to protect patients PCT/SHA/Monitor issues HCC/CQC Local MPs & GPs Professional Regulation (RCN, NMC, GMC) Others: Department of Health, Deanery/universities, HPA Plethora of agencies who should have detected something wrong and did not If they did detect something, they were ineffective in their action, especially when it was known the Trust was failing False reassurance from external assessments PCTs/SHAs/Monitor: Have a responsibility to monitor & improve quality, had tools to agree safety and quality standards, monitor & pursue remedies How become FT with all these concerns; did not share information with CHC too many re-organisations lack of clarity on responsibilities around quality & safety Failure to communicate , or share knowledge of concerns between each other Assumed monitoring, performance management or intervention was the responsibility of someone else Healthcare Commission/Care Quality Commission: Reliance on self assessment but no evidence Not open transparent but appears unhappy and top down closed approach Local MPs & GPs: Failed to speak up only expressed concern after HCC announced it was to investigate. Professional Regulation (RCN, NMC, GMC): Weak professional voice Ineffective as professional representative and as a trade union Not doing enough to support its members who were trying to raise concerns Department of Health: should have acted sooner did not involve it’s very experience clinical leaders Accepted disconnect between policy and practice Deanery/universities: insufficient importance placed on clinical training in a safe environment threats to remove trainees largely theoretical, superficial examination of standards use trainees as eyes and ears in a hospital setting HPA : did not escalate concerns about HCAIs

5 Overarching Recommendations Themes
Fundamental culture & standards of behaviour change: Responsibility for, & effectiveness Patient, Public Involvement & Engagement and Local Scrutiny Nursing & Medical (training and education) Openness, Transparency and Candour Effective complaints and incidents handling Commissioning for Quality Joint Working & Leadership Information 5 Immediate Pledges Immediate review by NHS Medical Director into 5 hospitals with high mortality rates*(Sir Bruce Keogh’s Overview Report) New role created of Chief Inspector of Hospitals Don Berwick brought in to make zero harm a reality in the NHS (Berwick Review into Patient Safety) Take advice on how hospitals should manage complaints Trust boards could be suspended for quality failures as well as losing control of the money We must all remain vigilant to ensure that patients are never again subjected to such poor quality of care. Fundamental culture & standards of behaviour change: Putting people at the centre; first and foremost Common culture & values made real throughout the system Everyone Counts: commitments in planning guidance Responsibility for, & effectiveness: Regulating healthcare systems governance : Monitor, Governors’ role enhance, CQC, simplify regulation, focus on quality Board of Directors accountability Patient, Public Involvement & Engagement and Local Scrutiny Healthwatch & CCG joint working Nursing & Medical (training and education): Compassion and Care: in practice; hands on training Caring for the elderly: registered older person nurse established Professional regulation of fitness to practice: NMC revalidation Nurse on each Executive Board Openness, Transparency and Candour: Enable concerns to be raised freely without fear Share true info about performance & outcomes with staff, patients, the public and regulators. If any patient harmed, they are informed and an appropriate remedy offered, regardless if complaints made or not Effective complaints and incidents handling: The learning Coroners and inquests Commissioning for Quality Focus on Quality: shaped by first Francis Report Fundamental standards set, monitored and enforced Quality accounts – common form and published, signed by all directors as true, Independent audit Joint Working & Leadership: NQB, DH, NHS, LA Leadership Academy in shaping new culture Enhancement of the role of supportive agencies No more re-organization without full risk assessment and public debate Information: Mortality* Collection and Analysis : triangulate, feeds into QSGs

6 Wandsworth CCG’s Mission Statement
Better Care and a Healthier Future for Wandsworth Patient Focused Involving & Engaging patients Supporting and Empowering them Outcomes Driven Improvements in quality & range of services provided Commission based on patient safety, clinical effectiveness, patient experience local & national strategic priorities Principled Uphold NHS Consitution Honesty & Integrity Thoughtful & Transparent Responsible Collaborative Co-operation with members Collaboration with partner organisations Co-ordinated and patient centred care Progressive & Professional Responsible to our employees Respect & value diversity Encourage innovation and experiment with new ways Celebrate successes I thought in telling you how we plan on responding to the Francis report, the key message is the WCCG’ mission statement We are not starting from scratch and have a reasonably high degree of assurance about services currently commissioned and Iain in his presentation will The CCG stands for and is driven and commitment to quality

7 CCG’s Framework for Action Approach
Clinicians at the heart of commissioning: system addressing what matters most for patients Quality Strategy: definition of quality, values based commissioning, quality alert systems: Quality Assurance Framework: 4 stage methodology Reflect & Gap Analysis against Francis recommendations Partnership working with NTDA, LA, Healthwatch, NHSE, CQC National Quality Reports discussed at IGC: Keogh, Berwick Duty of candour proposal being discussed at IGC Engage in South London Quality Surveillance Group meetings Stage 1: Quality Programmes Patients’ having access to information they want to make choices Healthwatch strengthening their collective voice: close working with the CCG, patient feedback Real-time to improve quality and timeliness of insight into patient experience (FFT, Enter & View, Commissioner walkabouts, etc) Publish our Francis Framework for Action to demonstrate our acceptance of the recommendations & our intentions Stage 2: Patient & Public Engagement

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