Agenda item

Further to the report, Matthew Cole (Director, Public Health) delivered a thought provoking presentation to the Board which brought to life some of the harrowing testimony from the Francis Report and the comments and reactions of key individuals, including; Sir Francis QC, Sir David Nicholson, and local Staffordshire campaigner Julie Bailey. The Board, in its debate on what its role is and contribution is to recommending the recommendations made by Francis. In particular its licence around the whole-system view. The following points were noted in the discussion:

·  The Board should give collective thought to how we arrive at an index of suspicion and when it is appropriate to call-time on a poor performing provider. How might the Health and Wellbeing Board take a leading role in ascertaining the index of suspicion through the triangulation of evidence?

·  Complaints must be listened to and taken seriously. Trends in complaints should be analysed and problems resolved with due diligence, with meaningful service change where necessary.

·  Professionals from across the health and social care economy and wider partnership need to be alert to standards of care and have the strength and resolve to report bad care that is witnessed.

·  Commissioners must change performance reporting so that it relates to the patient experience and gives a true account of quality. Furthermore, all contracts must contain quality levers and be vigorously monitored. Commissioners must cut bureaucracy and reporting issues to understand how patients view services and treatment.

·  All Health & Wellbeing Board member organisations confirmed that they did not have gagging clauses preventing whistleblowing.

·  Electronic surveying of patients upon discharge could be an effective means of collecting intelligence that can be evaluated and acted upon instantly.

·  Following publication of the Francis Report the North East London NHS Foundation Trust (NELFT) board begin every meeting with a patient story. The H&WBB was asked to think of other ways in which governance structures can bring through the patient voice.

·  The friends and family test is now being used as another way to test quality in the NHS.

·  The Board needs to take a leadership role and ensure that the post-Francis culture (paragraph 6.2 of the report) is enacted.

·  At Mid-Staffordshire a major problem was the lack of connection between clinicians and managers. Relationships between clinicians and managers are much closer in the outer North East London sector but there is still a need to guard against management issues getting in the way of good quality healthcare and clinical decision-making.

·  The Board considered what could be learned from previous failures of care in mental health.  The outcome has been at NELFT has been the introduction of a very organised patient engagement and representation of any local NHS or Foundation Trust.

·  The Board considered the role of the Council’s Health and Adult Services Select Committee and how its role can be strengthened and how it can perform better to avoid the mistakes and passivity of Staffordshire Borough and County Councils scrutiny committees. The Board noted that a separate report will be presented to the Health and Adult Services Select Committee on the Francis recommendations focussing on the specific implications for scrutiny.

·  The Board recognised that post-April 2013 the commissioning system is more complex with several commissioners and even more providers of services. In light of this, how can there be whole system accountability in new NHS landscape?

·  Further to the above point, how can Barking and Dagenham GPs be held to account as a local provider. What is the role of NHS England in monitoring GP quality?

·  Poor performance by providers cannot be excused by pressure on resources. Commissioners must set high standards and review the provider’s performance. Where standards are not being me there must be mechanisms to engender changes to service delivery.

·  Dr Mike Gill (Medical Director, BHURT) was clear that the public should not have low expectations with regard to health and social care services and that the expectations of services user should not be impacted by resource issues (perceived or real). Patients should expect high standards and have their expectations met.

·  The Board recognised that the themes running through Francis are not isolated to the acute hospital setting. The lessons from Francis equally apply across all health and social care settings and the home environment in which people can be especially vulnerable.

There was consensus that the NHS Barking and Dagenham Clinical Commissioning Group (CCG) is the best placed organisation within the health economy to lead on working through next steps to implement the Francis recommendations and provide assurance to the H&WBB that local NHS action plans around Francis have been implemented. Although led by the CCG, the task and finish group will be inclusive and accountable to local Health and Wellbeing Boards. It was felt that a CCG-led approach would result in less duplication and less competition for similar actions among the local authorities involved.

The Board agreed to write to local safeguarding boards requesting participation and input into the task and finish group.

The Board agreed the following actions:

·  That the group established by the CCG develops a local response to the Francis Report involving all partners on behalf of the Health & Wellbeing Board.

·  That the CCG-led task and finish group take into consideration the following issues:

o  the role of GPs in reviewing care standards

o  formalised early warning systems and the part they might play

o  how patient /user involvement can be strengthened and the mechanisms

o  needed for the patient/user voice to be heard by decision makers

o  whether the single agency action plans are adequate and what changes are needed to ensure a whole systems approach

o  how the Health and Wellbeing Board can gain assurance on behalf of local residents about the quality of our local health and care system

o  consider how to communicate more widely to those using services what they have a right to expect from these services

o  review progress made by the Clinical Commissioning Group, local NHS Trusts and Foundation Trusts in the implementation of their action plans

o  consider the views of the Safeguarding Adults Board and Local Safeguarding Children Board.

·  The Director of Public Health meets with his colleagues from neighbouring boroughs to agree an approach to both the identification of problems and solutions required from the analysis of hospital mortality rates.

·  To receive a progress report to its September meeting.