The Committee received an update on
performance across the three CCGs at its September meeting. It was
agreed that a further meeting be held and a more detailed report on
performance provided, at which appropriate executives of the CCGs
would attend to present and take questions from the Committee.
Performance monitoring reports were submitted by South Warwickshire
CCG and a joint report on behalf of Coventry & Rugby and
Warwickshire North CCGs.
The report from South Warwickshire was
presented by Alison Cartwright, who provided an introduction on the
duties of the CCG, how it managed performance and held service
providers to account. Performance was reported on a monthly basis
through a governance process, which was outlined in the report. The
current performance was appended highlighting areas of concern. It
was noted that where applicable, the CCG served contract
performance notices and monitored remedial action plans.
A corresponding report had been provided on
behalf of Coventry & Rugby and Warwickshire North CCGs. This
report provided information on the performance monitoring and
consisted of three sections:
·
Overview of governance, key performance summary, priorities for
action across the three CCGs and how as joint working further
develops ensuring the role of ‘Place’ maintains local
visibility of performance;
·
Copies of the performance report taken to the CCGs most recent
public governing body meeting;
·
A glossary containing descriptions of the key performance targets
that were monitored routinely, how they were calculated and what
targets CCGs was expected to deliver.
The following
questions and comments were submitted with responses provided as
indicated:
- A number of stakeholders had raised
concerns about public involvement in CCGs in the future and it was
asked that these concerns be noted.
- An unannounced Care Quality
Commission (CQC) inspection had taken place at the George Eliot
Hospital in December. There were a number of concerns raised,
especially in regard to the A&E department. It was asked when
the Committee would see the CQC report and associated action plan.
This was noted and a response would be provided on when the report
would be available.
- There were concerns about the data
for Warwickshire North CCG relating to the George Eliot Hospital
A&E department. This could be applicable to a number of other
departments, but was highlighted by the indicator on twelve-hour
trolley waits before patients were transferred to a ward. This was
an indicator of insufficient bed numbers. It was acknowledged that
some people occupying acute hospital beds could be treated more
appropriately elsewhere, but there was a risk for patients due to
this lack of capacity. There were many contributors to the demands
faced by the A&E department and waiting times, not least an 8%
increase in patients presenting. Members were referred to the
glossary which provided key targets in regard to trolley
waits.
- A comment was made that service
performance for many key indicators reflected the national
position. Service performance for
mental health services was a cause for particular concern.
Similarly for dementia, there was a need for a single page guidance
leaflet and for consistent diagnosis. This was an area where the
local authority should be able to assist. These concerns regarding
dementia diagnosis were recognised by CCGs. Additional schemes had
been put in place to assist with dementia diagnosis, through GPs,
work with the Partnership Trust and other CCGs, but without
significant progress to date. It was questioned if HWW could assist
through its ‘enter and view’ visits to care homes. GPs
were visiting care homes as there was a need for a dementia
diagnosis and training for nurses at care homes.
- The Chair shared this concern and
the issue could be considered further when the Committee reviewed
its work programme.
- It would be helpful to have a
focussed report on the key areas of concern in Warwickshire, as the
information provided was very detailed.
- A comment was made about the
timeliness of the information in the performance report. The report
for WN and C&R CCGs, which had been submitted in error, was
particularly dated, being from 2018. The position could have varied
significantly since that report, with either improvements or
further decline. CCGs did report performance publicly on a
bi-monthly basis at their governing body meetings, but this data
was not available to the Committee. It was suggested that a more
proactive approach was taken. Reference was made to the finance and
performance appendix which was the latest information and up to
date information was available via the CCG website. The Chair
stated it should have been made available to the Committee.
- There was a need for the Committee
to be sighted on issues in Coventry which would impact on
Warwickshire. An example was planned significant housing
development in Coventry which would impact on UHCW services and the
Trust had objected to that planning application.
- Reference was made to the discussion
about quality assurance at the September Committee and the
comparative data for the three CCGs provided at that time. It was
questioned what actions would be taken to improve SWCCG performance
levels to that of other local CCGs. CCG representatives clarified
that the report provided previously had been compiled from their
previous year’s annual report, so it was out of date. The
data provided at this meeting was for the current year and it did
include actions to seek performance improvement.
- The data for cancellation of
operations at short notice was too high for some areas. This had
been raised as a concern in September. The indicator was influenced
by a number of factors and an offer was made to discuss this
further with the councillor immediately after the
meeting.
- Chris Bain of HWW commented that
this additional meeting had been called as there was a lack of
assurance previously and from member feedback this assurance had
still not been provided. He asked what the next steps would
be.
- Gillian Entwistle of SWCCG thought
that the report had addressed the Committee’s enquiries from
the September meeting, but apologised if this wasn’t the
case.
The Chair asked for a focussed report which
responded to the Committee’s questions and the key areas,
rather than providing such detailed reports. He referred members to
the report recommendations and questioned whether the Committee had
received the requested information. With the Committee’s
approval, he proposed that the questions raised at the September
Committee, together with those raised today, be referred again to
the CCGs. Additionally, a report should be provided on the recent
CQC inspection of the George Eliot Hospital. He suggested that this
item be brought back to the next Committee meeting. Personally, he
was concerned that a number of the indicators had been below target
levels for some time and it was time that improvements were seen in
those areas.
Resolved
- That the Committee requests a
further, focussed report to its meeting on 19 February 2020
answering the specific questions raised at both the September 2019
meeting and at this meeting.
That a report on the outcome of the Care
Quality Commission Inspection of the George Eliot Hospital and its
associated action plan for improvement is provided to the Committee
when available.