Preventing problems through excellent leadership, clear accountability and transparency, consequences for failure and rewards for the very best, time to care through reduction in regulation and information requirements and a robust safety culture and zero tolerance of avoidable harm
Generated on: 22 August 2013 12:37 /
Francis Update August 2013 v1.0 1
Theme / Recommendation / Relevant to CCG? / RAG / Status / Progress / Assurances / Treatment/Actions / Updates / Notes / Last updatedResponsibility for, and effectiveness of, healthcare standards / Rec 41 - Use of information about compliance by regulator from Patient Safety Alerts
The Care Quality Commission should have a clear responsibility to review decisions not to comply with patient safety alerts and to oversee the effectiveness of any action required to implement them. Information-sharing with the Care Quality Commission regarding patient safety alerts should continue following the transfer of the National Patient Safety Agency’s functions in June 2012 to the NHS Commissioning Board. / Partly relevant
For monitoring / / Green / / Compliance with patient safety alerts included within contract, provider reports monitored through contract / quality meetings for GSTFT and SLaM.
Validated from national CAS system.
Used to inform serious incident discussions. / Continue with current monitoring.
Consider validating implementation / CAS alert function for primary care dissemination transferred to NHSE from 1/4 2013. Information sharing with CQC via Quality Surveillance Groups. / 12 Aug 2013
Responsibility for, and effectiveness of, regulating healthcare systems governance – Monitor’s healthcare systems regulatory functions / Rec 69 - FT Authorisation and standards
The assessment criteria for [FT] authorisation should include a requirement that applicants demonstrate their ability to consistently meet fundamental patient safety and quality standards at the same time as complying with the financial and corporate governance requirements of a foundation trust. / Yes / / Green / / All NHS providers must comply with CQC Essential Standards for registration and to operate. GSTFT, KCH and SLaM are compliant and met requirements at CQC inspection visits.
Monitoring provider reports (complaints / pals / litigation / incidents) and external reports (e.g. national patient survey reports) through contract / quality meetings.
PCT joint inspection visits for hygiene/infection and mixed accommodation. / Review inspection regime requirements and processes with NHS England and other local commissioners and amend as necessary in consultation.
Review complaint report content with providers / 'Monitor' Governance and Finance ongoing requirements and assessments regularly reviewed and inform provider discussions / 14 Aug 2013
Effective complaints handling / Rec 116 - Support for complaints
Where meetings are held between complainants and trust representatives or investigators as part of the complaints process, advocates and advice should be readily available to all complainants who want those forms of support. / Assurance required from providers and NHS England regarding processes followed etc. / / Amber / / GSTT have clear processes for providing complainant support confirmed July 2013 / Assurances outstanding in respect of NHSE provision of advocacy and advice for complainants. SLCSU liaising with NHSE for information. / SLCSU complaints and PALs team have drafted a patient leaflet and information sheet to provide details of the complaints process and available support. These will be in use from the end of August 2013. Individual CCG websites are being reviewed to ensure that appropriate complaints information is available.
SLCSU building relationships with the NHSE complaints team and in discussion about primary care complaint reports which will be available to CCGs. Current lack of assurance about support for complainants by NHSE.
CQRM GSTT meeting July 2013 reviewed complaints in detail including processes. Assurance given that the Trust has a process for supporting complainants. / 14 Aug 2013
Commissioning for standards / Rec 126 - Preserving corporate memory
The NHS Commissioning Board (NHS England) and local commissioners should develop and oversee a code of practice for managing organisational transitions, to ensure the information conveyed is both candid and comprehensive. This code should cover both transitions between commissioners, for example as new clinical commissioning groups are formed, and guidance for commissioners on what they should expect to see in any organisational transitions amongst their providers. / Yes / / Amber / / There were clear procedures established and followed for the organisational transitions leading up to April 2013 involving NHSE, local commissioners and local authorities. Handover certificates for functions ensured some corporate memory was shared.
Within Lambeth CCG staff changes were kept to the minimum with close working with SLCSU teams and NHSE patient safety action team (PSAT) to ensure continuity. / NHSE and local commissioners to develop and oversee a code of practice for managing organisational transitions. / Lambeth CCG sharing established working practices for serious incident and complaint management with SLCSU teams and serious incident management processes with NHSE PSAT. / 14 Aug 2013
Commissioning for standards / Rec 127 - Resources for scrutiny
The NHS Commissioning Board and local commissioners must be provided with the infrastructure and the support necessary to enable a proper scrutiny of its providers’ services, based on sound commissioning contracts, while ensuring providers remain responsible and accountable for the services they provide / Yes / / Amber / / Scrutiny via contract / quality meetings and ad hoc meetings including risk summits.
South London Quality Surveillance Group established June 2013.
Provider site visits by various organisations / Joint GSTFT quality monitoring involving NHSE and Lambeth CCG established
Discussions with NHSE concerning joint working and provider scrutiny including visits (GSTFT / SLaM)
NHSE commissioning structures and monitoring processes to be shared.
National Quality Dashboard, Quality Observatory and CareConnect websites established. Processes for monitoring and sharing between organisations to be further developed. / NHSE participate in GSTFT quality and serious incident monitoring meetings. South London Quality Surveillance Group established. Relationships developing between CCG/CSU commissioning teams and NHSE commissioning teams.
Resources for scrutiny being developed in the form of National Quality Dashboard, Quality Observatory and CareConnect. Processes for monitoring and sharing between organisations to be further developed. / 14 Aug 2013
Commissioning for standards / Rec 128 - Expert support
Commissioners must have access to the wide range of experience and resources necessary to undertake a highly complex and technical task, including specialist clinical advice and procurement expertise. When groups are too small to acquire such support, they should collaborate with others to do so. / Yes / / Green / / Commissioners with expertise in relevant commissioning fields
Analytical expertise
Governing Body Clinical Leads and Clinical Network Leads for clinical advice.
Procurement expertise via local authority and SLCSU.
Commissioners work across CCGs via a clinical strategy group and Lambeth and Southwark partnership.
The CCG also works at scale at the Commissioning Support Unit.
CCG smaller in number and capacity than PCT. / Review access to experience and resources, consider gaps and how these could be met.
Identify and implement software solution to integrating complex data and reporting / Solution to integrate complex data and reporting outstanding / 14 Aug 2013
Commissioning for standards / Rec 129 - Ensuring assessment and enforcement of fundamental standards through contracts
In selecting indicators and means of measuring compliance, the principal focus of commissioners should be on what is reasonably necessary to safeguard patients and to ensure that at least fundamental safety and quality standards are maintained. This requires close engagement with patients, past, present and potential, to ensure that their expectations and concerns are addressed. / / Amber / / Patient feedback sought by commissioners in developing and evaluating services, both new and established. Information used to inform contract development and monitoring. SLaM undertake detailed PEDIC (patient) surveys, GSTFT ward level patient surveys. Involvement with SLaM Living Well Collaborative for feedback, ad hoc patient surveys, GP PPGs. / Review patient and Healthwatch input into the development and review of contract KPIs and CQUINs – i.e into measures used and means of measurement. / Big Lambeth Health Debate to inform Lambeth CCG 5-year plan underway over the summer 2013 - wide engagement through numerous means of communication e.g meetings, web based feedback, events. / 14 Aug 2013
Commissioning for standards / Rec 130 - Relative position of commissioner and provider
Commissioners – not providers – should decide what they want to be provided. They need to take into account what can be provided, and for that purpose will have to consult clinicians both from potential providers and elsewhere, and to be willing to receive proposals, but in the end it is the commissioner whose decision must prevail. / Yes / / Amber / / Commissioning decisions rest with the PCT/CCG involving input and sometimes challenges from providers. PCT/CCG decisions not always fully implemented by providers.
Reports received from GSTT, KCH and SLaM about implementation of Francis recommendations / Consider how to develop relationships further with providers. Cultural elements both commissioners and providers - review for CCG and discuss implementation of Francis recommendations with providers.
Quality Summit around implementation of Francis recommendations proposed October 2013 / Lambeth Quality Summit to explore implementation of Francis recommendations proposed for October 2013. To be co hosted with HealthWatch and involve KHP providers, SLCSU, Locality leads and NHSE.
GSTT have confirmed in their Francis response that they will respond proactively to commissioning intentions. / 16 Aug 2013
Commissioning for standards / Rec 131 - Development of alternative sources of provision
Commissioners need, wherever possible, to identify and make available alternative sources of provision. This may mean that commissioning has to be undertaken on behalf of consortia of commissioning groups to provide the negotiating weight necessary to achieve a negotiating balance of power with providers. / Yes / / Red / / Lambeth actively involved in commissioning with other boroughs e.g. Lambeth /Southwark for GSTFT; 4 borough commissioning for SLaM / CCG to develop new relationships with local authorities and NHS England so that there is strong and consistent commissioning voice.
Commissioning for standards / Rec 134 - Role of commissioners in provision of support for complainants
Consideration should be given to whether commissioners should be given responsibility for commissioning patients’ advocates and support services for complaints against providers. / Yes / / Red / / Advocacy has been provided to support complaints involving primary care. Complaints management for primary care has moved to NHS England from April 2013. / NHSE currently reviewing their complaints management processes and role of commissioners in providing support for complainants / SLCSU complaints team developing relationships with NHSE complaints / 14 Aug 2013
Openness, transparency and candour / Rec 175 - Patients' questions about treatment
Full and truthful answers must be given to any question reasonably asked about his or her past or intended treatment by a patient (or, if deceased, to any lawfully entitled personal representative). / Yes / / Amber / / Requirement for candour included within contracts 2013/14. There is a definition of duty of candour in commissioning guidance for 2013/14 but this will need to be tested in practice.
Provider trusts have ‘Being Open’, Incidents and complaints policies which confirm this.
Serious incident reports include ‘being open ‘ section but information may be limited. Delays in notification of serious incidents to commissioners does not meet transparency requirements / Consider detailed provider contract requirements to evidence this recommendation
Discuss and agree serious incident report requirements in respect of ‘being open’ with providers in light of Francis
Discuss recommendation in detail with individual providers and consider provider response to meet letter and spirit of recommendation.
There is a definition of duty of candour in commissioning guidance for 2013/14 but this will need to be tested in practise. / Serious incident reports include information on patient / carer involvement. This is evaluated and discussed with GSTT as necessary. Contract discussions with providers to agree how to implement the duty of candour requirement. GSTT accept this recommendation and will support staff to ensure they can execute their duties fully. / 16 Aug 2013
Serious incident investigation reports include information on patient / carer involvement - this should reflect fully compliance with 'duty of candour'. Reports evaluated and discussed with GSTT. Contract discussions with GSTT to agree implementation of 'duty of candour' contract requirement. / 16 Aug 2013
Nursing / Rec 204 - Strengthening the nursing professional voice
All healthcare providers and commissioning organisations should be required to have at least one executive director who is a registered nurse, and should be encouraged to consider recruiting nurses as non-executive directors. / Yes / / Green / / CCG and main providers (GSTFT / KCH/SLaM) have Governing Body leads / Executive Directors who are registered nurses. / Consider provider response to NED recruitment. / GSTT have confirmed they are compliant with this recommendation for Executive Nurse Director with full voting rights on the board. Currently no nurse as a NED but a medically qualified individual. When NED post comes vacant this will be considered again. / 16 Aug 2013
Nursing / Rec 208 - Strengthening identification of healthcare support workers and nurses
Commissioning arrangements should require provider organisations to ensure by means of identity labels and uniforms that a healthcare support worker is easily distinguishable from that of a registered nurse. / Yes / / Amber / / This level of detail is not currently included in commissioning arrangements. / CCG to consider how to include within commissioning arrangements
Consider provider response to this recommendation / This level of detail is not included in commissioning arrangements. / 16 Aug 2013
Information / Rec 244 - Common information practices, shared data and electronic records
There is a need for all to accept common information practices, and to feed performance information into shared databases for monitoring purposes. The following principles should be applied in considering the introduction of electronic patient information systems:
· Patients need to be granted user friendly, real time and retrospective access to read their records, and a facility to enter comments. They should be enabled to have a copy of records in a form useable by them, if they wish to have one. If possible, the summary care record should be made accessible in this way.
· Systems should be designed to include prompts and defaults where these will contribute to safe and effective care, and to accurate recording of information on first entry.
· Systems should include a facility to alert supervisors where actions which might be expected have not occurred, or where likely inaccuracies have been entered.
· Systems should, where practicable and proportionate, be capable of collecting performance management and audit information automatically, appropriately anonymised direct from entries, to avoid unnecessary duplication of input.
· Systems must be designed by healthcare professionals in partnership with patient groups to secure maximum professional and patient engagement in ensuring accuracy, utility and relevance, both to the needs of the individual patients and collective professional, managerial and regulatory requirements.
· Systems must be capable of reflecting changing needs and local requirements over and above nationally required minimum standards / Yes / / Amber / / CCG information flow map, information asset register and register of PID users reporting tools / Review current shared information systems against requirements as part of Information Governance Workplan. / Review of current information systems against requirements is required within CCG / SLCSU.
GSTT accept the principles of this recommendation and will be considering this as they roll out E-noting and E-prescribing and developing their Qlikview system. / 16 Aug 2013
Francis Update August 2013 v1.0 1
Detecting problems quicklyDetecting problems quickly involving new Chief Inspectors of Hospitals and Social Care, local Quality Surveillance Groups, expert inspectors, development of a single rating which includes the Friends and Family Test for patients and staff, requirement for transparency on surgical outcomes, a statutory duty of candour and complaints review
Generated on: 22 August 2013 12:37 /
Francis Update August 2013 v1.0 1
Theme / Recommendation / Relevant to CCG? / RAG / Status / Progress / Assurances / Treatment/Actions / Updates / Notes / Last updatedAccountability for implementation of the recommendations / Rec 02 - Patient is priority culture
The NHS and all who work for it must adopt and demonstrate a shared culture in which the patient is the priority in everything done. This requires:
· A common set of core values and standards shared throughout the system;
· Leadership at all levels from ward to the top of the Department of Health, committed to and capable of involving all staff with those values and standards;
· A system which recognises and applies the values of transparency, honesty and candour;
· Freely available, useful, reliable and full information on attainment of the values and standards;
· A tool or methodology such as a cultural barometer to measure the cultural health of all parts of the system. / Yes / / Amber / / Lambeth mission statement, vision and values