Quality and Safety in South
Tyneside NHS CCG
Ann Fox
Director of Nursing, Quality & Safety
Aim of the presentation
• To provide an overview of the response to the
Francis Inquiry and what this means for South
Tyneside NHS CCG community.
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
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
Scope of the Francis 2
inquiry
To build on the evidence of the first inquiry and
examine the operation of:
•
Commissioning
•
Supervisory and regulatory organisations :
DoH, SHA, PCT’s, Monitor, CQC, HSE
•
Other agencies
Local scrutiny and public engagement bodies, Coroner
To identify lessons to be learned for the future NHS and make
recommendations to the Secretary of State for Health
Findings from
Inquiry
•
•
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•
nd
2
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
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
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.
“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)
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.
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
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
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
Headline considerations for
South Tyneside CCG
Issues to consider:
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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
Next Steps
• Key organisations across health and social care
will take the action needed to make the
document a reality for patients.
• Government will report on progress annually.
• Developing NHS ST CCG action plan by
September 2013 ( aligned with findings from
Keogh Reviews)
• Build on assurance from Providers
Themes from draft action
plan……
REC NO THEME
Commissioning for standards
123
Responsibility for monitoring delivery of standards and quality
124
Duty to require and monitor delivery of fundamental standards
125
Responsibility for requiring and monitoring delivery of Enhanced standards
126
127
128
Preserving corporate memory
Resources for scrutiny
Expert support
129
Ensuring assessment and enforcement of fundamental standards Through contracts
130
131
132
133
134
Relative position of commissioner and provider
Development of alternative sources of provision
Monitoring tools
Role of Commissioners in complaints
Role of commissioners in provision of support for complainants
135 &
136
137
Public accountability Of commissioners and public engagement
Interventions and sanctions for substandard or unsafe services
Local Scrutiny
138
Local Scrutiny
Performance management and strategic oversight
139
The need to put patients first at all times
140
Performance Managers working constructively with regulators
141
142
Taking responsibility for quality
Clear lines of responsibility supported by good information flows
143
144
Clear metrics on quality
Need of ownership of quality metrics at a strategic level
Questions/Comments?