1. Quality & Safety Update
Item 11 Appendix 1
Quality & Safety Update
Item 12 Appendix 1
Purpose: This paper provides an update to the Governing Body.
It is intended to highlight key areas of note rather than be inclusive of all areas of work taking place, and is complimented by the minutes of the Quality and Safety Committee (QSC).
Highlights, risks or principal concerns across the broader quality domains of patient safety, experience and effectiveness are identified in order to inform the group of the controls and mitigation the CCG and Provider have taken.
Key Points: Current focus centres on meeting national targets with respect to infection prevention and control and identifying opportunities for improving quality of care in care homes.
Patient Safety
Key Point /Highlight/ Issue of Concern
Existing Controls /Mitigation
Quality in care homes
The CCG is aware of a number of homes in the area who have been highlighted as having some quality concerns and/or particularly contributed to the non-elective position.
NYCC continue to operate within their quality care processes to manage and escalate concerns, involving appropriate CCG representation
Plan developed for targeted review and support of top 6 care homes showing highest admission rates and/or quality concerns.
Key vanguard initiatives are being considered as part of this work in order to support care home staff to provide quality care across specific work streams
Wider linkages made with neighbouring CCG’s both in the North East and Yorkshire & Humber to share learning
Contact established with the independent care sector lead at NHSE
Deputy Chief Nurse attends the North East care home collaborative
Responsible Commissioning Managers looking to address care home issues in focused discussions around frailty with GP practices.
Plan:
Visits (combined with NYCC)
data review (reasons for highest admissions; pneumonia, falls with # and sepsis/HCAI/Cath related),
Discussion, engagement events and
training analysis and procurement (i.e. as in falls training secured from NEAS)
- Underlying challenge is undervalued, transient workforce in care homes who do not have sufficient (and/or suitably qualified) staffing to provide care against national pressures in workforce picture
Partners in improving local health

2. Key Point/Highlight / Issue of Concern Existing Controls /Mitigation
Item 11 Appendix 1
Patient Experience
Key Point/Highlight / Issue of Concern
Existing Controls /Mitigation
Patient Advice and Liaison service (PALs)
6 PALs enquiries were received in November 2017; 5 concerns, 1 complaint
No specific themes or trends have been identified
Complaints and concerns are increasingly more complex however involving variety of service issues which need addressing through different providers. These can often take several weeks and engagement with the complainant to resolve satisfactorily
Complaints regarding CHC processes and decisions are now being handled by the CHC team (hosted by S&R CCG).
The communications and engagement dashboard is presented and discussed at each QSC meeting and submitted to the Audit and Integrated Governance Committee on a quarterly basis
There is an established screening system and process in place to respond to concerns/complaints within nationally recommended timeframes and ensure that enquiries are dealt with in the most appropriate place.
N.B November 2017 patient communication and engagement dashboard is provided as an appendage to this paper.
Organisational/Clinical Effectiveness
Key Point/Highlight/Issue of Concern
Existing Controls/Mitigation
Commissioner assurance visits to provider organisations
A process for conducting for Commissioner –Led Quality Assurance and Informed Commissioner Site Visits has been recently formalised across the region
It is suggested that each CCG GB member commits to undertake one site visit per annum with a member of the quality team.
A programme of visits is being considered by the quality and safety committee to reflect and prioritise current concerns against potential outcomes sought, in collaboration with NYCC and other lead CCG’s as required.
CQC update: GP practices
Prior to the three most recent inspections, there were six out of the 22 practices rated as requires improvement (5) or inadequate (1)
Recent inspections show 3 of those 6 improved and are now rated as “good”
Only practices rated as requires improvement or inadequate will be inspected more frequently under the new CHC inspection regime.
Nature of CCG complaints is that the CCG acts as a third party (i.e. conduit) to resolve issues. This makes it unnecessarily lengthy and bureaucratic. PALS team are always looking for ways to improve signposting to the public to ensure right people are able to respond in a timely manner.
Partners in improving local health