Agenda item

Sally Allum (Director of Nursing and Quality (Kent and Medway), NHS England) and Dr John Allingham (Medical Secretary, Kent Local Medical Committee) were in attendance for this item.

(a)       The Chairman welcomed Sally Allum to the meeting and introduced the item, explaining that the Committee had received a presentation on quality issues in July and had asked for a further update on this specific area. The full Government response to the Francis Report had been published the previous week and this was a subject which would be returned to in due course, so the focus of this meeting would be on the Quality Surveillance Group (QSG).

(b)       Sally Allum explained that she had attended the Committee in July with Dr Steve Beaumont and she was glad to hear that the visit to Maidstone Hospital had been a success. It was hoped this would be the beginning of a rolling programme. She then proceeded to talk to a presentation, a copy of which was included in the Agenda before Members. Following this, Members proceeded to ask questions and discuss areas of particular interest or concern.

(c)        There are QSGs across England, one for each of NHS England’s Local Area Teams, with four regional ones matching NHS England’s regional offices. It was explained that one of the lessons of the Francis Report was the need to bring disparate information together. The QSGs were set up in April to do just this and work proactively to obtain soft and hard information on the quality of care. Through an early warning system by looking at a whole range of indicators, it would then be possible to react to issues early. While the QSG had no executive powers, it can make recommendations to commissioners and regulators. It did not duplicate the work of safeguarding boards, to which it could also make recommendations.

(d)       It was explained that the membership of the Kent and Medway QSG included commissioners, regulators, Kent County Council and Medway Council, Health Watch and Health Education England. The regional tier also included professional regulators, clinical networks and senates, and the Ombudsman. In response to a question it was confirmed that the Director of Public health and the Director of Families and Social Care were the representatives from Kent County Council. As regards Clinical Commissioning Groups (CCGs), the NHS England Area Director insisted on senior accountable officers attending, and this made the QSG in Kent and Medway slightly different to others. It was explained that there had been full attendance at all meetings and that while good work had been done, the QSG was reviewing how it worked to see how it can improve further. Sally Allum reported that while Health Watch Medway was fully engaged and had added value to the work on Medway NHS Foundation Trust, the QSG did not have the right representation from Health Watch Kent. Mr Nick Chard offered to follow this up after the meeting.

(e)       The QSG was supported by Sally Allum’s team, which consisted of eight members of staff. No additional staff were required just for the QSG. Sub-groups were established where a particular issue required more time to discuss, such as ones on Medway NHS Foundation Trust and Child and Adolescent Mental Health Services (CAMHS).

(f)         Bringing all these groups together enabled whole systems scrutiny. All areas of care were looked at, with work on primary care balancing out that one the acute sector. As the lead commissioner for health and justice provision across the south east, this area was something the Local Area Team for NHS England also looked to include in the work. The inclusion of Health Education England meant the perspective of students could be drawn upon and this was one which had been lacking in the past. Early benefits had been seen in the care home sector where pulling information together had brought providers onto the radar when they might not have been before. Here as in other areas, there was good challenge between the partners on the QSG as when the Care Quality Commission (CQC) reported positively on a care home, but where other partners had concerns. The involvement of both local authorities had been positive; both with regards care homes and children’s issues.

(g)       CAMHS made a good example of the kind of work the QSG did across the whole pathway. As a result of the piece of work carried out by the QSG, it began to be appreciated just how diverse the CAMHS provision was and it was not just a case of one main provider. It became clear that changing providers would make little difference unless the whole pathway was reviewed. It was explained that in the past there had been too much a focus on the provider of services, so in this example it would be part of the review to ask whether the commissioning of CAMHS was adequate, as well as the provision.

(h)        The QSG was looking at how to apply the model of the recent Keogh reviews into fourteen acute hospitals more widely as this was seen as effective. Heat maps were produced taking into account the number of quality issues, level of risk and level of confidence in the provider. There was then a determination as to whether issues identified could be dealt with during routine business or whether further action was required. This further action could involve an inspection, and this could possibly involve the regulators, commissioners or HOSC. The ultimate step was to hold a risk summit with the provider concerned and all the relevant partners there to ensure action was taken.

(i)         Comments were made by Members to the effect that over the years different organisations had been to HOSC and painted a particular picture, with a different picture emerging later. With the increased fragmentation of the health sector, Members questioned how things would be different in the future. Recent events at Medway NHS Foundation Trust were given as an example. It was explained that a number of issues had been known about at the Trust for ten years or more. What was new was a lack of tolerance of bad provision combined with a new regulatory system which could learn from the lessons of the Francis Report and look at a wide set of indicators. It was further explained that similar issues had been uncovered at Mid-Staffordshire as had been found at Maidstone and Tunbridge Wells and that for each of the fourteen Trusts reviewed by Keogh, there were likely to be as many facing similar problems. However, the work of QSGs around the county meant many of these were known to regulators and commissioners with action being taken. While it was still early days, this work would continue.

(j)         The issue of quality of access was raised by Members and the response was given that while it was not explicitly included in the presentation, it was a key area which was being looked at and got to the heart of considering the whole care pathway. A particular issue around problems accessing mental health services in West Kent was raised and Sally Allum undertook to feed this back to NHS West Kent CCG. Similarly, the issue of patients transferring from one organisation to another had long been recognised as an issue and that this was partly a cultural challenge with the need to avoid one organisation looking to blame another for any problems.

(k)        In response to a specific question, it was explained that the NHS did keep regular records on individual staff members’ performance and quality of care. The challenge now when there was a wider variety of providers was to ensure this was being done equitably.

(l)         The relationship of HOSC and the QSG was also discussed, and the view was expressed that there had been a certain randomness to the reporting of quality issues to the Committee. The QSG had been asked to produce quarterly report to the HOSC and the Health and Wellbeing Board to assist decision making.

(m)      The Chairman proposed the following recommendation:

§         That the Committee thanks its guest for the information provided, recognises the importance of this issue and looks forward to receiving quarterly reports.

(n)        AGREED that the Committee thanks its guest for the information provided, recognises the importance of this issue and looks forward to receiving quarterly reports.