​​Chat from the Chair - June 2016​​

We had a shorter agenda for the public part of the June Board meeting but as the saying goes, it’s quality not quantity that counts. Indeed our focus this month was on how we monitor, seek assurance and influence the quality of the services we commission so it was very appropriate to be able to give this, a core function of the CCG, some quality time.

Sean Morgan our Director of Performance, Corporate Affairs and Quality and Eileen Bryant, Deputy Director of Quality and Lead Nurse presented a comprehensive report that covered how we monitor quality, highlighting areas of good practice as well as areas for concern.

We have robust systems in place to provide information to assure the Board. These include committees and groups that feed into the Board; Quality Group, Safeguarding Sub-Committee, Clinical Quality Review Groups and the Integrated Governance Committee. These groups and committees receive a range of data that tells them about the quality of services including the Make a Difference reports from Wandsworth GPs.

We heard about the excellent work of the Clinical Quality Review Groups (CQRGs). These are formal dedicated monthly meetings held with large providers of commissioned services to monitor and discuss all aspects of quality of care provided and the quality element of the contract. We are the lead commissioner for St George’s University Hospitals NHS Foundation Trust and associate commissioner or the other trusts.

The CQRGs look at data about patient experience, clinical effectiveness, patient experience, workforce and other information like the Trust Quality Board reports and CQC inspection reports.

Over the past year, St George’s has made good progress in a number of areas; senior clinicians have engaged with the task of working with commissioners to improve quality, the number of pressure ulcers acquired by patients in the hospital has reduced, the trust has received two national awards for innovative ways of encouraging patients to feedback through the Friends and Family Tests, quality visits by GP clinical leads highlighted the high quality of inpatient care. And there was more.

But we all know that there are big challenges at St George’s and at other trusts that our patients rely on. We want our patients to get good quality care and have positive experiences of healthcare. The areas of main concern are listed in the report that you can read on our website. While they make for worrying reading Sean was able to clarify that for example, many “never events” are dealt with immediately and haven’t actually put the patient in danger. Nevertheless, they are recorded and reported to try to ensure that they don’t happen again. It’s really important that we know what isn’t working well and where there are risks so that we can work with the trusts to make improvements.

Our discussion was very much about how we can make all the data we have more meaningful; where we can benchmark against other trusts, CCGs or previous years to have a clearer understanding of progress. Quality is at the heart of what we want to do. This report was a good start in helping the Board to focus on more on quality, although it probably underplayed the excellent work that we’ve done over the past three years. I look forward to seeing how this develops in future.

The next item was about agreeing the provider for the Planning All Care Together (PACT) enhanced care pathway. This is a programme that will target care for vulnerable older adults in Wandsworth and provide co-ordinated care to give them better support and experience and reduce avoidable hospital appointments and admissions.

The Board was assured that this had been a robust process, acknowledging that in the end there was a single bidder. We approved the award of the contract for this programme to Battersea Healthcare Community Interest Company. The contract is from 1 July 2016 to 31 March 2019. We look forward to hearing how the service goes with a view to making the service available to larger numbers of patients in the future.

We received the year end performance and finance reports. These reflect what has gone well and what the challenges have been. On performance, we did well on access rates for talking therapies, C. Difficile infection rates, 6 weeks waiting times for diagnostics and dementia diagnosis. We weren’t able to meet A&E waiting times, and 18 week referral to treatment waiting times, cancer 2-week and 62 day waiting times and 8 minute ambulance response times have been below target throughout the year. These will continue to be challenging this year, in the context of increasing demand, and will be areas of focus alongside our work on quality.

We had reviewed last year’s finances in detail at the extraordinary Board meeting on 25 May when the Board approved the 2015/16 annual report and accounts. We achieved a balanced financial position and returned a surplus of £4.2m (1%). This financial year will be much more difficult. We have less to spend so will be scrutinising everything we do to ensure that we are getting absolutely best value for money. You can read the full 2015/16 annual report and accounts on our publications page.

I hope you can join our next meeting on 20 July or watch online via our live stream.