Agenda item 5

Ref: CM/09/03/23

BOARD MEETING – 23 JULY 2009

CHIEF EXECUTIVE’S REPORT

1. This second report from the Chief Executive to the Board since the launch
of the Care Quality Commission provides an update on some of the key
issues for us not otherwise covered on the Board’s agenda. The transition
programme finished at the end of June and, with a comprehensive
handover briefing from the Transition Director, all project work was either
concluded or integrated into business-as-usual. This includes work relating
to ICAP system and process, national processing centre, national contact
centre, estates migration and business continuity planning. The full
Executive Team is in place with the final member of the team – David
Johnstone – having commenced as Director of Operations on 1 July.

2. The rest of this report highlights some of the big issues for us as we move
into the next phase of CQC.

National Processing Centre and National Contact Centre

5. Having at last had the opportunity to visit these centres on 3 July to see
and hear for myself how things are working, I was struck by how much has
been achieved in such a short time. I believe it embraces so much about what
CQC is about for three key reasons:

• the significant practical achievement and progress over such a short

period of time;
• the response from people in the North East that has resulted in many
people from diverse backgrounds and experience working in the health
and social care world for the first time as the key interface for the public
with CQC;
• the amazing job our staff are doing to contribute to our new approach
and to help shape the organisation we will become – putting customer
service at the heart of our culture and having an impact on everything
we do to promote quality in care.

Patient Safety

6. The report from the House of Commons Health Select Committee was
published on 3 July 2009 following a six month inquiry into patient safety
within the NHS. The inquiry, involving eight oral evidence sessions and
receiving 108 written submissions from individuals and organisations,
addressed the following key questions:

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• What the risks to patient safety are and to what extent they are
avoidable
• The effectiveness of the local, regional and national bodies in ensuring
patient safety
• Systems for incident reporting, risk management and safety
improvement
• National policy
• What the NHS should do next regarding patient safety

7. The Chairmen of both the Healthcare Commission and Care Quality

Commission gave oral evidence to the committee, and both organisations
submitted written evidence to the inquiry. The final report makes many
recommendations for local and national organisations, a number of which
impact on the work and role of the Care Quality Commission. The
Government has already prepared its response to the report but, at the time of
writing, is unclear whether this will be published before recess. The
Department of Health provided CQC with an opportunity to comment on the
response with regard to the recommendations of relevance to us. A summary
of CQC comments is available for Board members should they wish.

8. The Care Quality Commission will have two months from the
publication of the report to submit its own response. The arrangements for
doing this have yet to be finalised, but I expect that the Safe Care Senior
Policy Lead will establish an internal task and finish group to plan and
formulate the response on behalf of the organisation. In doing so, a steer from
the Board would be welcome on the stance to take with regards to
recommendations 46 (respective roles of Monitor and CQC) and 47 (proposal
for CQC to take on the National Health Service Litigation Authority (NHSLA)
risk management programme); we would also welcome the Board’s views on
an additional recommendation, not consulted on by the Department of Health
as part of the Government’s response, to establish an independent body to
undertake root cause analyses of serious and sentinel events.

Mid Staffordshire Foundation NHS Trust: 3 months progress report.

9. The former Healthcare Commission investigated mortality rates in

emergency care at the trust. The results of their report were published in
March 2009. The Care Quality Commission has undertaken the first of its
three formal checks on progress which we set out in Part 1 of our Mid
Staffordshire Review of Progress report which will be published on our
website on 20 July. We will conduct a second, detailed review in a further
three months time which will include unannounced inspections where we
will expect to see substantial progress on key priority areas. In one year’s
time we will conduct a full review against the action plan and report on all
areas. Part 2 and Part 3 of our report will be available on our website in
October and May 2010.

10. CQC found that the Trust has made an acceptable start in putting in place
the systems, resources and people it needs in order to make the

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improvements recommended by the former Healthcare Commission. It

has developed a comprehensive transformation programme that should
enable it to deliver the improvements needed. It has determined its
priorities for action – including the evident need to restore local people's
confidence. Mortality rates show early signs of improvement, which is
encouraging and needs to be sustained. However it is early days. It will
take time for the effects of the Trust's action to be felt fully and consistently
by all of the people who use their services and people's experiences at this
stage remain variable. We will continue to monitor this closely. Monitor,
the independent regulator of NHS Foundation trusts has used its formal
powers to appoint Anthony Sumara as the Chief Executive and Sir
Stephen Moss as the Chair of Mid Staffordshire NHS Foundation Trust.
Critical areas that remain to be addressed urgently by the Trust include
purchase and use of equipment and a full complement of permanent
nursing staff. The Trust must also maintain focus on delivery of current
services at the same time as delivering the full transformational
programme. Our internal report on complaints / public confidence is
available should Board members like to see this.

HCAI Update

11. At the May Board I reported that follow-up work was underway for the 21
NHS Trusts that had conditions attached to their registration for
compliance in relation to Healthcare Associated Infections. As of 13 July,
we have removed conditions from 10 trusts (one of these, Coventry, still
has one condition and we have sent a notice of decision to a further 2).
One application for removal has been refused (Manchester PCT). Two
trusts have had an HCAI inspection visit as part of consideration of their
application with a third visit being scheduled (Royal Surrey County
Hospital NHS Trust and Barnet, Enfield and Haringey Mental Health NHS
Trust and Barking, Havering and Redbridge University Hospitals NHS
Trust). One trust has had an unannounced inspection visit to monitor
compliance with its condition (Plymouth Hospitals NHS Trust).

12. Isle of Wight NHS PCT has not yet applied for removal of one condition
which has an expiry date of 31 July 2009. Coventry and Warwickshire
Partnership Trust’s second condition has an expiry date of 30 September
2009. United Lincolnshire Hospitals NHS Trust has a non-time bound
element to its condition that is related to remedial actions following HCAI
inspection visit. The trust has indicated that it is addressing these but has
not yet fully completed the actions. I expect to be able to provide a further
update if required at the Board Meeting.

Mental Health Launch

13. We are due to publish two important mental health reports on Monday 20th
July and Tuesday 21st July. CQC is also holding a stakeholder debate on
21st July. Our publications in relation to Mental Health coming out this year

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touch on different aspects of care quality and areas of the sector. We are
bringing together a cohesive story on our aims for mental health using
CQC's 'dimensions of quality care'’. CQC’s strategy for mental health is
due for completion in August and will take account of the findings of these
two reports in shaping our future approach and priorities. The local
investigation into West London Mental Health Trust - triggered by
concerns about the trust's response to suicides and the national MHAC
biennial report both highlight areas where providers can do more to
ensure that people in vulnerable circumstances receive high quality, safe
care, have a good experience of services, and that their human rights are
protected.

Safeguarding children

14. A report on NHS compliance with statutory requirements for safeguarding

was published on 16th July. The review, requested by the Secretary of
State in December, sets out clearly what needs to be done by NHS bodies
to ensure systems are safe. Trust-level data will be released later in
August and we have asked Trusts to focus on the importance of the next
CQC survey. Media coverage was open and fair, probing areas of
concern such as GP provision and training, and indeed support anywhere
in NHS bodies. We will be following up with those Trusts that declared non
-compliance with the safeguarding standards, and will also use the
information they gave us to see if any apparently compliant Trusts are
causing concern and should be inspected.

15. During May, CQC published an intervention report on the four trusts
serving Haringey who had contact with Baby Peter. CQC was also
involved in the follow up Joint Area Review in Haringey and is monitoring
progress carefully against the action plan developed by the council and its
partners. Internally, two safeguarding lead staff have now been appointed
to our Operations team to provide vision and support to front line staff. The
programme of joint inspections with Ofsted has just commenced and we
are also undertaking joint inspections with the HMI Probation for Youth
Offending Teams.

Green Paper on the future of care and support and other policy
developments.

16. Entitled ‘Shaping the Future of Care Together’, the much-awaited adult
social care green paper was finally published on 14 July 2009, setting out
proposals for a ‘big debate’ about reforming care and support to achieve a
‘National Care Service’ that is fair, simple and affordable. Having attended
an early breakfast session with the Prime Minister, I went to the Secretary
of State’s afternoon launch with Barbara Young. Alongside the much
reported options for future funding of social care, many of the key issues
highlighted in the Green Paper and by Secretary of State in his speech –
such as improving quality, personalisation, integration and ensuring health
and social care can, as more equal partners, have a greater focus on
people using services - accord very much with CQC priorities. The

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Government will be holding a public consultation until 13 November and

Board members may wish to comment on how they would like CQC to
respond.

17. The Green Paper is one of a number of key strategic policy developments
with which CQC is actively engaged on contributing evidence to inform
and shape policy. They include the Department of Health’s (DH) national
review of age discrimination in health and social care, Government’s
strategy – Building a society for all ages (published last week), the DH
Commission on the future of Nursing and Midwifery, Chaired by Ann Keen,
the Ministerial Group on Integrated Services and through joint DH/CQC
sponsorship of a programme of engagement with the public and people
who use services on the purpose, content and development of quality
accounts. We expect to be keeping the Board up to date with
developments through the new weekly newsletter.

Cynthia Bower
Chief Executive
17 July 2009

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