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20190925 QRS Board Papers - September 2019 V1 for Web 1
Quality Review Service
Board Meeting
Date: Wednesday 25th September 2019
Time: 1.30 – 3.30 pm
Location: 5th Floor Large Meeting Room, Kingston House,
438-450 High Street, West Bromwich, B70 9LD
Option to join by telephone conference:
• Please dial 0800 917 1950
• When prompted, enter the Participant Passcode: 83298861 then #
Agenda
1. Apologies for absence
2. Notes of the meeting held on 26th June 2019 Appendix 1
3. Actions and matters arising from the last meeting Appendix 2
4. Quality Review Service Board Chair – Confirmation of appointment Verbal
5. Legal advice on governance Appendix 3
6. Board membership Appendix 4
7. Review Programmes – Progress Report Appendix 5
8 2020/21 income projections Appendix 6
10 Funding Model Appendix 7
11 Website www.qualityreviewservicewm.nhs.uk Verbal
12 Quality Review Service Trademark Appendix 8
13 UKAS Accreditation Appendix 9
14. QRS Finance report Appendix 10
15. Director’s update Appendix 11
Any other business
Date of next meetings (held at Kingston House. West Bromwich):
• Wednesday 11th December, 1.30 pm to 3.30 pm
Some parts of these board papers are redacted where financial or personal confidentiality requires.
20190925 QRS Board Papers - September 2019 V1 for Web 2
Board Membership
Representative Start date
Forename Surname Position Organisation Attendance 2019
March June Sept Dec
Patient Member Mar-12 Nick Flint Patient Member Apologies Attended
Patient Member Mar-12 David Orme Patient Member Apologies Attended Yes
Patient Member Mar-19 Gordon Prescott Patient Member Attended Attended
Patient Member Mar-19 David Trigger Patient Member Attended Attended
Patient Member Sep -19 Jane Williams Patient Member Yes
Commissioning / STP: Shropshire
Apr-17 Phil Evans Programme Director Shropshire and Telford &
Wrekin STP Apologies Apologies Now left
post
Commissioning / STP: Herefordshire & Worcestershire
Dec-18 Rachael Skinner Associate Director of Nursing and Quality
NHS Redditch and Bromsgrove, NHS South Worcestershire &NHS Wyre Forest CCG
Attended Attended Yes
Commissioning / STP: Birmingham & Solihull
Dec-18 Helen Jenkinson Chief Nursing Officer NHS Birmingham and Solihull CCG
Apologies Attended Yes
Commissioner: NHS England Specialised Commissioning
Sep-15 Simon Collings Assistant Director of Specialised Commissioning
NHS England – Midlands and East
NHS England Regional Team Sep-18 Aisling Crombie Deputy Director of Nursing
NHS England – West Midlands
Attended Attended Apologies
Commissioning / STP: Black Country
Vacant Simon Brake Chief Officer NHS Walsall CCG Attended Resigned
Commissioning / STP: Coventry & Warwickshire
Vacant
20190925 QRS Board Papers - September 2019 V1 for Web 3
Representative Start date
Forename Surname Position Organisation Attendance 2019
March June Sept Dec
Commissioning / STP: Staffordshire
Vacant
Trust: Medical Director Apr-17 Dr Matthew Banks Medical Director The Dudley Group NHS Foundation Trust
Apologies Apologies Resigned
Trust: Head of Governance Dec-18 Gill Harrad Company Secretary Worcestershire Health and Care NHS Trust
Attended Apologies By Phone
Trust: Executive Director Jun- 19 Bev Tabernacle Deputy Chief Executive
The Shrewsbury and Telford Hospital NHS Trust
N/A Attended
Trust: Chief Executive VICE CHAIR
Jul-13 Richard Kirby Chief Executive Birmingham Community Healthcare NHS Foundation Trust
Apologies Attended Yes
Trust: Nurse Director Feb-16 Helen Lancaster Director of Nursing South Warwickshire NHS Foundation Trust
Attended Apologies Yes
Trust: Medical Director Mar-17 Dr John Oxtoby Medical Director University Hospitals of North Midlands NHS Trust
Dr Nick Coleman
Dr Nick Coleman
Host organisation Sep-16 Simon Bourne Strategy Unit Midlands and Lancashire CSU
Apologies Apologies
West Midlands Strategic Clinical Networks & Senate
Jul-15 Charlotte Barry Network Senior Quality Improvement Manager
West Midlands Strategic Clinical Networks & Senate
Attended Attended
Quality Review Service Jan-18 Tim Cooper Director QRS Attended Attended Yes
The Board is quorate when at least five Board members or deputies are present, including at least two representatives from commissioners and at least two representatives from Trusts
Return to Agenda
20190925 QRS Board Papers - September 2019 V1 for Web 4
Aᴘᴘᴇɴᴅɪx 1 Notes of the Meeting Held on 26th June 2019
Present: Richard Kirby (RK), Charlotte Barry (CB), Nick Flint (NF), Helen Jenkinson (HJ), David Orme (DO),
Gordon Prescott (GP), Rachael Skinner (RS), Bev Tabernacle (BT), David Trigger (DT) and Tim Cooper (TC).
Joined by telephone conference: Dr Nick Coleman (NC), Aisling Crombie (AC)
In attendance: Sarah Broomhead, Charlotte Henderson
1. Formal apologies: for absence were received from Simon Bourne, Gill Harrad, Helen Lancaster, Lisa Levy
(RS Attending), Dr John Oxtoby (NC attending)
2. Notes of the meeting held on 20th April 2019: agreed as an accurate record.
3. Actions and matters arising from the last meeting
Actions were reviewed.
The possibility of QRS selling training to quality leads so they could review their own services was being
looked into by TC, awaiting the new branding.
4. Quality Review service Chair
It was with regret that Professor Simon Brake had had to step down from the QRS Board.
His resignation had left a vacancy on the Board for both QRS Chair and for a Commissioner representative
for the Black Country.
RK asked that the Board’s thanks be passed onto to Simon Brake for his contribution.
ACTION: Simon Brake to be thanked for his contribution to the QRS Board - TC
Historically the Chair had been a Commissioner representative, but the Board was asked whether this
was still relevant as QRS was moving away from the West Midlands programme model and what
strengths and qualities were important for the role.
The Board discussed the requirements needed and it was agreed that the new Chair should bring the
following qualities to the role:
1. The ability to open doors, the leverage to get engagement - including Nationally
2. A commitment to Peer review with a vision for the future. Integrating the whole health economy;
social care, mental health, dementia.
3. The understanding of governance that comes with role of Board Chair
TC shared his suggestions of people he felt had the strengths needed and who the Board might want to
consider.
• Professor Kiran Patel, Medical Director, UHCW
• Stan Silverman, Secondary Care Clinician, NHS Birmingham and Solihull CCG
• Paul Jennings, Chief Executive, NHS Birmingham and Solihull CCG
HJ suggested that Paul Jennings, although very committed to Peer Review and a champion for QRS
may already have significant commitments on his time.
It was agreed that the post should be advertised with NHS jobs. Those people who the Board had
identified as possible candidates for the role would be invited to apply.
20190925 QRS Board Papers - September 2019 V1 for Web 5
It was agreed that the Chair did not necessarily need to be West Midland based as long as they fitted the
requirements and could commit to attending the Board meetings face:face.
ACTION: Draft advert for QRS Board Chair to be agreed, then posted with NHS jobs – TC and RK
5. Branding and website
TC provided the Board with a short presentation on the Branding and Website.
• The QRS logo had been chosen after receiving the most votes from a shortlist circulated to the
Board, QAG and via Twitter.
• Re-branded document templates and corporate stationery had been designed.
• A new twitter and Linked-in identity had been created and migration of followers was in progress.
The Board were asked to follow QRS on twitter @review_quality
• The website design was complete and now in the user acceptance testing phase.
Jane Shaw and Charlotte Henderson would be attending training to manage and upload website
content. [email protected]
To show the Board representation on the website, TC asked that all members provide a very short
biography and photograph for the website.
ACTION: Board members to provide a short biography and Photo for Website – All
The Board highlighted the need to register the name and logo to protect the QRS Brand.
ACTION: To investigate copywrite of QRS name and logo - TC
6. Review Programme - Progress Report
TC had provided a report to update the Board on progress. He suggested the Board Governance meeting
be moved to May in future years to review the year in a timelier way.
The proposed Herefordshire and Worcestershire Cancer programme hadn’t received traction despite
planning work by TC and RS, as clinicians were not able to be released. The credits were now being used
for an End of Life Review on 18th September.
The Sandwell and West Birmingham Hospitals NHS Trust had pulled the Review of Children’s services at
late notice.
TC had met with Andy Williams, Accountable Officer SWB CCG several times but SWB were not
subscribing to QRS products or services this year.
The WM Critically Ill Children Review Programme had been completed in September 2018 and the HSJ
were interested in the review outcomes. TC had plans to meet with Dale Bywater, Midlands Regional
Director, NHSI & NHSE to suggest carrying out a similar Review Programme for the East Midlands.
The final reports for the completed Inherited and Acquired Bleeding Disorders (IABD) Reviews,
commissioned by the UKHCDO, and not yet been published because of the ongoing infected blood
inquiry. However, the Haemophilia Centre Leads had received copies of the reports and were able to
make improvements based on findings.
Compliance with QRS Standards
Non-compliance with QRS internal Standards included ‘Immediate Risk responses’ not being received
within agreed timescales from Trusts and ‘Comments on Draft Reports’ not being received within agreed
timescales from Trusts and Centres.
The Board were satisfied that QRS were committed to achieving compliance and where standards were
not met the reasons had been addressed.
20190925 QRS Board Papers - September 2019 V1 for Web 6
7. Annual Report 18/19
The annual report had been circulated to the Board. The report had been produced using data from the
last four years. The figures for 15/16 showed that this was an incredibly busy year for the organisation.
The data also illustrated that the number of Commissioned reviews was significantly higher than the
West Midlands programme reviews in 2018/19.
8. QRS 2018/19 Annual Review and 2019/20 Plan
Evaluation Report 2018/19
TC reported on the Evaluation report, circulated to the Board.
• All evaluations received were reviewed at monthly Team meetings and any issues and learning
addressed.
• The response rate from the Product evaluations was very low and approaches on how to increase
feedback were being looked into.
• Online reviewer training had been introduced for the IABD Review Programme and was also being
delivered for the Haemoglobin Disorders (HD) Review Programme. The training was evaluating well
and the Reviewers were as well prepared as those completing training face to face.
Feedback from Staff being Reviewed
The Board suggested that QRS looked into ways to engage with staff working operationally day to day to
ensure the review was a positive experience. E.g. were their views heard, did they feel included, were the
review team friendly, did they feel intimidated.
TC suggested that there might be an opportunity to do more to get staff feedback when the online
evaluations were introduced with the launch of the new website.
Report Recommendations
It was asked by the Board if QRS followed up organisations to see if suggested improvements had been
implemented. TC responded that QRS did not have the resources or the remit to do this. However, HJ
commented that Commissioners did use the reports and followed up recommendations to keep the
momentum on improvements.
Recognition of Good Practice
The Board also asked if Good Practice was shared. TC responded that the team had discussed developing
a good practice page on the website and QRS were planning a good practice sharing event in October.
DT gave the example of the Academy of Fabulous Stuff http://www.fabnhsstuff.net, a website where the
good ideas, innovations and concepts across the NHS were shared.
Audit Report 2018/19
There were three audits outstanding to be completed by July 2019.
The Audits would be reviewed at the July Team Meeting.
Some of the issues raised in the Audit report included document and filing procedures not always being
followed. There was still a challenge with Board attendance with not all members having attended a
meeting during the last 12 months. It was agreed that member non-attendance should be addressed and
those unable to attend or send a deputy asked to re-assess their commitment.
ACTION: Follow up Board membership non-attendance during 2018/19 – TC
20190925 QRS Board Papers - September 2019 V1 for Web 7
The outstanding Audits would be completed and any significant issues shared with the Board.
Post Board Note: Audits completed and no other significant issues identified.
Annual review plan outturn 2018/19
TC reported on the Annual review plan outturn 2018/19, circulated to the Board.
The plan of work to update the Quality Standards (QS) due for review had not been achieved.
There were a number of QSs which were out of date. The work to review Standards was very involved
and time consuming. Each set required available guidance to be reviewed and a Steering Group to be
assembled to provide certification and drafts to be circulated for consultation.
QRS would consider if any of the QS could be retired and an updated work programme had been included
in the work plan for 19/20.
Post Board Note: The current status of 37 standards is: 22 standards in date and valid; 4 standards in
progress of update; 6 standards not in date; 5 standards agreed to archive as not used.
Annual plan 2019/20
The Annual Plan 2019/20 circulated had not included items six to 14. (Please see amended Annual Plan
19/20 attached).
RK commentated that the Programme of Reviews was not included on the Annual Plan, also the work on
QS was missing.
The Board were happy to agree the Annual Plan 2019/20 once the above items had been added.
9. Hosting, Establishment, Principles and Approach
Hosting agreement
The Board agreed the Hosting agreement with no issues. RK was happy to sign on behalf of the Board.
Establishment agreement
The Board asked that the Establishment agreement be clearly marked as draft until agreed.
The Board asked that the following items be reviewed before the document was put for agreement:
3.5 The Board will appoint a Chair and Vice-Chair from among its members.
It was questioned whether, following the discussion around item 3, this item was still relevant.
5.5 In the event of Chief Executives (or Accountable Officers) of participating NHS organisations deciding
to cease support for QRS, all participating NHS organisations will cooperate in attempting to offer suitable
alternative employment to QRS staff. If suitable alternative employment cannot be found, redundancy
costs are covered by the QRS Hosting Agreement.
The Board agreed that this item was no longer relevant and advised QRS seek legal advice from the CSU.
7. Accountability
The QRS Board is accountable to the Chief Executives (or Accountable Officers) of participating NHS
organisations for all its activities and has no power to commit additional resources without their
agreement.
The Board agreed that this item was no longer relevant and advised QRS seek legal advice from the CSU
with regards to Accountability.
ACTION: QRS to seek legal advice on items 5.5 and 7 in the Establishment agreement from CSU – TC
The Board asked that items 5.5 and 7 be added to the Risk Register.
20190925 QRS Board Papers - September 2019 V1 for Web 8
ACTION: Add Establishment Agreement – items 5.5 and 7 to the Risk Register - QRS
Principles and Approach
The Board asked that the Principles and Approach be clearly marked as draft until agreed.
10. Risk Register
The Risk Register had been brought to the meeting as part of the Board’s request to have sight of the
report every six months.
The Risk Register was reviewed by the Board and risks noted.
11. UKAS accreditation
TC had provided a report to update the Board on the forthcoming UKAS accreditation visit.
UKAS would be conducting an office assessment on 12th July 2019 and would be attending the HD Review
visit to Homerton University Hospital NHS Foundation Trust on 20th November 2019.
At the last assessment, UKAS had given QRS actions to improve the recording of the staff induction
process which had now been implemented. They had also asked for impartiality to be added to the Risk
Register. This had been added as item QRS201808 ‘The risk that Peer Reviews will not be completed with
full impartiality’ with the current controls.
QRS were now accredited for Formative reviews.
UKAS were aware of the rebranding; and TC commented that the assessors would be sighted on the legal
issues the Board had raised within the Establishment agreement.
TC would report to the Board on the outcome of the assessments.
ACTION: Report to the Board on UKAS 2019 assessment – TC
The report was noted by the Board.
12. Immediate Risk escalation process
TC had provided a report to seek guidance from the Board on escalation of immediate risk (IR) responses.
A recent example had involved an IR being identified and an IR letter being sent to the Trust with the
deadline for response.
The Trust were contacted when the IR response was not received and QRS were assured that the Trust
were working on a response and resolving the issue.
However, the agreed IR process is that if a response is not received QRS should raise this with NHS
England.
The Board questioned what the equity was for not following the process.
TC responded that the process wasn’t followed because QRS understood the issue was being dealt with.
They were confident that the CCG had seen the IR and were involved. The delay had been with the Trust
trying to solve the IR, where QRS were only asking for a mitigation plan.
The Board confirmed the need to follow the agreed process without exception.
In the example, QRS could have let NHS England know that although a response had not been received
the Trust had been in communication.
13. Finance
A report on the current financial position and forecast for the year had been circulated to the Board.
The work on the new QRS branding and website had been funded using the carry forward from 2018/19.
20190925 QRS Board Papers - September 2019 V1 for Web 9
The ‘Cost to deliver’ row in Table 2 – Budget overview included the payment to the Clinicians leading the
IABD and HD review programmes and paying reviewer expenses (travel and accommodation).
QRS was still receiving income from CCG credits but more work was moving to individual contracts.
The budget overview for 19/20 forecast a c.£40,000 short fall.
TC asked the Board to be sighted on the shortfall and acknowledged there was work to do to mitigate this
however, there was potential from pipe-line work.
The Board noted that there may be an issue for 20/21 as there would not be any carry forward. (£40,000
made available for 19/20).
14. Director’s update
TC had provided a report circulated with agenda.
15. AOB
DT asked whether any further thought had been given to QRS exhibiting at the Manchester Health and
Care Innovation Expo in September.
TC responded that QRS did not have the budget to exhibit at the conference this year. From exhibiting in
London last year QRS had found that although the conference increased brand visibility it had not directly
brought in work.
The Board suggested that QRS could provide a presentation in conjunction with an organisation who had
made improvements following a QRS review.
RK agreed to suggest the presentation to Dale Bywater as part of the agenda for an upcoming Midlands
Trust meeting.
ACTION: Suggest a joint QRS/Trust presentation to Dale Bywater NHSI & NHSE - RK
Return to Agenda
20190925 QRS Board Papers - September 2019 V1 for Web 10
Aᴘᴘᴇɴᴅɪx 2 Actions and matters arising from the last meeting
Note Action/Matter Arising Who Progress
4 Simon Brake to be thanked for his contribution to the QRS
Board TC Completed
4 Draft advert for QRS Board Chair to be posted with NHS jobs TC and RK Completed
5 Board members to provide a short biography and Photo for
Website All In progress
5 Register QRS name and logo TC Agenda item
8 Follow up Board membership non-attendance during 2018/19 TC Agenda item
9 QRS to seek legal advice regarding items 5.5 and 7 in the
Establishment Agreement from CSU TC Agenda item
9 Add Establishment Agreement – items 5.5 and 7 to the Risk
Register QRS Completed
11 Report to the Board on UKAS 2019 assessment TC Agenda item
15 Suggest a joint QRS/Trust presentation to Dale Bywater NHSI &
NHSE RK Completed
Return to Agenda
20190925 QRS Board Papers - September 2019 V1 for Web 11
Aᴘᴘᴇɴᴅɪx 3 Legal advice on governance of QRS
Purpose of Report:
The Board identified at the Board meeting in June 2019, that the current Establishment Agreement no longer
reflected the arrangements in place as understood by the Board and commissioning and provider service leaders
within the West Midlands.
The Board requested QRS to seek legal advice on the current arrangements and Board accountability.
This report summarises the legal advice obtained from Hill Dickinson LLP solicitors, who are the solicitors for the
CSU.
Advice from Hill Dickinson LLP solicitors, who are the solicitors for the Midlands and Lancashire CSU has now been
received. Attachment 1: QRS Legal Advice on governance.
This advice contains both the brief given and the legal advice.
Return to Agenda
Financial, Human Resources & Legal Implications: The board will want to ensure it is appropriately established
and accountable.
Equality impact: QRS review programmes improve quality of health services
and reduce inequalities in access to and quality of care.
Recommendations: The Board is asked to consider the advice received and advise on actions to be taken
20190925 QRS Board Papers - September 2019 V1 for Web 12
Aᴘᴘᴇɴᴅɪx 4 Board Membership
Purpose of Report:
The Board are asked to consider updates to the Board membership.
Board membership
At previous meetings; the board have discussed membership.
Medical Director Representative
Dr Matt Banks has indicated that with a recent role change; he is now unable to continue his role on the Board. He
has been thanked for his contribution to the Quality Review Service.
In discussion with potential applicants for the role of Board Chair; Mr Matthew Revel, Executive Medical Director
and Consultant Orthopaedic Surgeon at the Royal Orthopaedic Hospital NHS Foundation Trust expressed an
interest in the work of Quality Review Service and indicated he would wish to be considered for membership of the
Board if a vacancy arose. Mr Revel has also been a QRS reviewer for a number of years, and most recently reviewed
the Sandwell and West Birmingham hip fracture pathway.
It is proposed that Matthew Revell be invited to join the Board in place of Dr Banks.
Specialised Commissioning Representative
Simon Collings at NHSE specialised commissioning has been contacted on a number of occasions but to date no
response has been received.
Herefordshire and Worcestershire STP Commissioner Representative
Lisa Levy’s role has now been extended to include Chief Nurse for Herefordshire CCG. Following conversation with
Lisa it is with regret that due to her workload she is unlikely to be able to attend meetings in future.
Proposal: That Rachael Skinner, who has deputised for Lisa, takes up the substantive post.
Black Country Commissioner STP Representative
With the resignation of Simon Brake there is a vacancy for a commissioner role on the board in the Black Country
and West Birmingham. Two options are suggested.
Paul Tulley. Paul is Director of Commissioning for Walsall CCG. QRS have written to Paul to see if he would be
keen to allow his name to go forward.
Phil Evans. Phil is currently the QRS Board member for Shropshire and Telford and Wrekin STP; but has
recently moved role to head the MCP programme in Dudley. Phil is keen to stay involved with the QRS Board.
Proposal.
• If he agrees, Paul Tulley should be invited to join the Board as the Black Country commissioning
representative.
• As Phil Evans is keen to stay engaged with QRS and has board level director, operational and programme
management experience, he should be invited to remain on the board.
Shropshire Commissioner STP Commissioner Representative
As Phil Evans can no longer represent Shropshire and Telford and Wrekin STP. An email has been sent to both
Accountable Officers at the Shropshire and Telford and Wrekin CCGs to seek a commissioning nomination from that
STP. A verbal update on nomination will be provided at the board.
20190925 QRS Board Papers - September 2019 V1 for Web 13
Return to Agenda
Financial, Human Resources & Legal Implications: Membership of the Board should be representative of
organisations using the services of the Quality Review Service.
Equality impact: QRS review programmes improve quality of health services
and reduce inequalities in access to and quality of care.
Recommendations:
It is proposed that
1. Matthew Revell be invited to join the Board in place of Dr Banks.
2. Rachael Skinner, who has deputised for Lisa, takes up the substantive board membership post.
3. Paul Tulley should be invited to join the Board as the commissioning representative for the Black Country
STP?.
4. Phil Evans should be invited to remain on the Board.
20190925 QRS Board Papers - September 2019 V1 for Web 14
Aᴘᴘᴇɴᴅɪx 5 Review Programmes – Progress Report
Purpose of Report:
This report updates the Board on progress with the QRS review programmes.
Appendix 5a shows the position of the 2019/20 West Midlands work programme as at 18th September 2019.
2018/19
1 An End of Life Care strategy workshop was planned for 18th September 2019 to utilise the remaining 2018/19
Herefordshire and Worcestershire credits. This was cancelled at very short notice and will be rearranged for
early November. This will be the last date available to avoid carrying this work forward to next year.
2019/20
Commissioned reviews:
2 National Inherited and Acquired Blood Disorders Programme (IABD) in partnership with the United Kingdom
Haemophilia Centre Doctors’ Organisation (UKHCDO): Rachael Blackburn is leading this programme. A
Clinical Lead (Dr Anne Yardumian) is also present on the review. This programme is almost two thirds
complete (23/35). There have been positive comments from both reviewers and those reviewed noted.
Reports have not yet been published as the national Infected Blood Inquiry is underway. Additionally, it is
now clear that the UKHCDO intend to use the outcome, in part, as a method of accreditation. As such it
would create an unfair advantage if some early reports were published and used by those being reviewed
later. A decision has been taken to publish all reports at the end of the programme along with the
programme overview report. Reports have been progressed as normal (e.g. through QAG) and the centre
directors have received a copy of the final report; allowing improvement and learning to continue without
delay.
3 A national Haemoglobinopathies (HD) peer review programme is underway. Sarah Broomhead is leading on
this programme. Risk stratification and review of all centres self-assessments is complete. The centres
selected for a review have been notified and review dates agreed. The programme is due to complete in
Spring 2020.
4 Herefordshire and Worcestershire have indicated that they wish to pursue a review of cancer services in
2019/20. A presentation to the STP Cancer board is planned for 26 September to finalise this.
5 QRS have been asked to review Orthodontics services at Birmingham Women's and Children's NHS
Foundation Trust on 2nd October 2019. This is largely (but not exclusively) the regional cleft palate service.
Standards for this review have been developed. There has been some indication that others in the
orthodontics community would see this as a beneficial programme beyond the Trust. Sarah Broomhead has
led the standards development; Tim Cooper is leading the review.
6 The Self-Improving Teams work described in previous board papers will begin on 16th October. Tim Cooper is
leading this work. This will be in pilot form to begin with; two teams in Worcestershire (Wyre Forest and
Tenbury) and one in Herefordshire (Ledbury) with a view to a wider roll-out.
7 The Black Country have indicated that they wish to focus on frailty in 2019/20. The Quality Review Service
Frailty standards are being updated to support this. Sarah Broomhead is leading on revising these Quality
Standards. Dr Simon Harlin is leading the Black Country Frailty Group.
8 The Black Country have also indicated that they wish to explore their services for school age children. This is
currently in the scoping phase. Tim Cooper is currently leading this.
20190925 QRS Board Papers - September 2019 V1 for Web 15
9 The work with Hestia (London based charity) on supporting their governance framework has now concluded.
Rachael Blackburn was leading this work.
10 Quality Review Service have been working with Canada to develop peer review standards and training to
support their HD programme. Sarah Broomhead is leading this. QRS have been asked to support the early
stage of their programme on site. This will require two visits as they wish to embed the learning from the
first visit before they undertake the second. This will be May/June 2020. Full cost recovery for this is
included.
11 A review in Solihull of their services for children with autism is planned for early 2020. Tim Cooper is
currently leading this.
12 A facilitated Self-Assessment for Mental Health Services is in the planning stages. In this type of review, one
of the QRS senior team will work with the eservice to review (and challenge) their self-assessment. This helps
ensure that these self-assessments are robust. This will be done across a number of sites. Using the output of
this, a risk assessment will identify areas that may benefit from a full Peer Review.
13 Maternity. The West Midlands Maternity Network have commissioned QRS to train its prenatal mortality
review team using the QRS reviewer training methodology. It is expected that this will be done in December.
14 The British Society of Rheumatology have commissioned QRS to train their review teams under the QRS
reviewer methodology.
Pipeline work:
15 Clatterbridge Cancer Centre have asked Quality Review Service to undertake a formative review of both their
Radiotherapy and Imaging Services. This will most likely be in December/January. Final confirmation is
expected soon.
16 QRS have been approached by clinicians at Shropshire Community Trust to look at their Childrens
Community pathway. It is not clear yet if this will be through support for their self-assessment or through
review.
QRS Standards
Appendix 5b gives the current position on the 2019/20 achievement of QRS standards.
Return to Agenda
Financial, Human Resources & Legal Implications: Progress with securing commissioned reviews has
implications for the QRS financial position in 2019/20.
Equality impact: QRS review programmes improve quality of health services
and reduce inequalities in access to and quality of care.
Recommendations: The Board is recommended to note the contents of this report.
20190925 QRS Board Papers - September 2019 V1 for Web 16
Appendix 5a West Midland Work Programme 2019/20
2019/20 WMQRS West Midlands Reviews - September 2019
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ign
Thea
tres
Worcestershire 5.5
Herefordshire 2
Wolverhampton 3
Walsall 3
Birmingham and Solihull 0 _
Totals 0 13.5
Standards
development
involvement
Topic
considered but
not being
pursued
Cancelled by
HE
7.5
6
Discussed but awaiting
confirmation (NB. Provider &
commissioner agreement
needed for topic to go ahead)
Agreed Completed
20190925 QRS Board Papers - September 2019 V1 for Web 17
Appendix 5a Compliance with QRS Standards 2019/20
Return to Agenda
2019/20 Work Programme
Vis
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ate
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tter
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Imperial IABD 7th Apri l 2019 N/A N/A N/A N/A N/A Y Y Y Y
Sheffield IABD - Adults 2nd May 2019 N/A N/A N/A N/A N/A Y Y N
Sheffield IABD - Paeds 3rd May 2019 N/A N/A N/A N/A N/A Y Y N
Cambridge IABD 9th May 2019 N/A N/A N/A N/A N/A Y Y Y
Glasgow IABD - Paeds 15th May 2019 N/A N/A N/A N/A N/A Y Y Y
Glasgow IABD - Adults 16th May 2019 Y Y Y Y Y Y Y Y
BCH IABD 10th June 2019 N/A N/A N/A N/A N/A Y Y Y
Canterbury IABD 13th June 2019 N/A N/A N/A N/A N/A Y Y Y
Cardiff IABD 17th June 2019 N/A N/A N/A N/A N/A Y Y Y
HD Alder Hey 21st June 2019 N/A N/A N/A N/A N/A Y Y Y
HD Southampton 28th June 2019 Y Y Y Y Y Y Y Y
Bham QE IABD 2nd July 2019 N/A N/A N/A N/A N/A Y Y Y
HD Whittington 4th July 2019 N/A N/A N/A N/A N/A Y Y Y
HD Leeds 9th July 2019 N/A N/A N/A N/A N/A Y Y Y
Truro IABD 16th July 2019 N/A N/A N/A N/A N/A Y Y Y
BSol Pulmonary Rehab 25th July 2019 N/A N/A N/A N/A N/A Y
Leeds IABD 2&3 Sep 2019 N/A N/A N/A N/A N/A Y
Southampton IABD 9th Sep 2019 N/A N/A N/A N/A N/A Y
Plymouth IABD 12th Sep 2019 Y
3 2 2 2 2 18 15 13 1
0 0 0 0 0 0 0 2 0
3 2 2 2 2 18 15 15 1
100 100 100 100 100 100 100 87 100
% standards met
Yes
No
Tota l Yes + No
% Yes
20190925 QRS Board Papers - September 2019 V1 for Web 18
Aᴘᴘᴇɴᴅɪx 6 2020/21 income projections
Purpose of Report:
This paper updates the board on the current known and expected income for 2020/21 and seeks Board approval for
inflationary uplifts.
Credits and Subscriptions uplift.
Historically, credits and subscriptions have been set on a capitation basis. Our host organisation have asked QRS to
look to increase costs by 9.6% (3.3% for the pay award and 6.3% for pension increase).
The Board are asked to approve an inflation uplift for QRS credits and subscriptions.
There has been no uplift in recent years.
A 3% uplift and a 6% uplift is modelled along with the 9.3% rate card uplift.
CCG 2019/20 contract
value
2020/21 proposed value 3%
uplift
2020/21 proposed value 6%
uplift
2020/21 proposed
value 9.3% uplift
Credit Model BSOL 20,000 20,600 21,200 21,860
Wolverhampton 14,388 14,820 15,251 15,726
Walsall 15,144 15,598 16,053 16,552
Herefordshire 10,131 10,435 10,739 11,073
Worcestershire 31,962 32,921 33,880 34,934
Sub-total 91,625 94,374 97,123 100,146
Subscription Model Cov and Rugby 5,000 5,150 5,300 5,465
Dudley 2,750 2,833 2,915 3,006
Shropshire 4,750 4,893 5,035 5,192
Telford 2,750 2,833 2,915 3,006
Sub-total 15,250 15,708 16,165 16,668
Total 106,875 110,081 113,288 116,814
Action – The Board is asked to confirm uplift amount.
2020/21 Income projections.
Note that a later paper on this Board agenda seeks to reconsider the model of credits and subscriptions.
The paper assumes a rollover of credits and subscriptions from 2020/21 for participating organisations. There has
been no indication to suggest otherwise.
Based on a 3% approved uplift the total income from Credits and subscriptions would increase to £110,081.
Based on the CSU recommended level (9.3%) the total income from Credits and subscriptions would increase to
£116,814.
20190925 QRS Board Papers - September 2019 V1 for Web 19
The Canadian Haematological Society have asked QRS to support the two pilot peer review visits, which are
planned to in May/ June 2020 in Canada. This has been modelled as £13,680 plus travel costs and the contract for
this work agreed.
2020/21 modelled income (9.3% uplift)
£
Credits 100,146
Subscriptions 16,668
Canada 13,680
Sub total 130,494
QRS has often been in a similar position with this level of unsecured income. However, in previous years we have
had more certainty of future work that would be secured for the following financial year (e.g. national review
programmes). The scale of the shortfall is of concern.
Potential Opportunities.
1. Pulmonary Rehabilitation (PR). A proposal is being prepared for a regional pulmonary rehabilitation review
programme based on recent BSol PR reviews in 2018/19. Although the West Midlands respiratory network
group are keen, it would need to work on the same basis as the national red cell programmes whereby
participating organisations are requested to fund the programme.
2. An approach has been made to the Regional Director of NHS England and Improvement (Dale Bywater) and
the regional team offering a Quality Review Service review opportunity. The offer cites the challenges exposed
as part of the West Midlands Critical Ill Children review as strong justification for a Midlands wide programme.
3. As we have recruited some external peer reviewers for the Orthodontic review, it is possible, (but not certain)
this may attract interest and others may see this as helpful. However the British Orthodontic Society have not
been keen to fully engaged with supporting the visit.
Return to Agenda
Financial, Human Resources & Legal Implications: This paper has clear implications for the QRS financial position
for 2020/21.
Equality impact: QRS review programmes improve quality of health services
and reduce inequalities in access to and quality of care.
Recommendations:
The Board is asked to
1. Approve the level of uplift to 2020/21 charges.
2. Note the current 2020/21 financial forecast and advise actions as appropriate.
20190925 QRS Board Papers - September 2019 V1 for Web 20
Aᴘᴘᴇɴᴅɪx 7 Funding Model
Purpose of Report:
The current financial and contracting operating model for the Quality Review Service has a strong historical
background; however the QRS leadership team believe the time is right to seek Board approval for changing that
model.
The Board is asked to consider changes to charging for standards and the credits/subscription model with the view
that making changes to QRS relationships with those who commission QRS services will make the organisation
more resilient.
Background
Historically, all West Midlands CCGs (or PCTs at the outset) were part of a collaborative agreement to fund the
WMQRS. In return WMQRS ran regional peer review programmes focused on agreed priorities through the Board,
which was made up of representatives from these areas.
As the CQC model developed in 2013 to a peer review approach to inspections a number of CCGs began to question
the double effort in peer review. Some CCGs decided to withdraw from the collaborative arrangement.
To off-set the loss of some funding partners, the QRS Board previously approved the move to a credit and
subscription model. Organisations entering into a credit agreement obtained access to QRS resources along with an
agreed number of pre-purchased reviews driven by a credit at a discounted rate. Organisations wishing access to
the QRS resources, but not wishing to pre-commit to reviews, could access this via a subscription. For both of these
models a capitation weighted figure was calculated and agreed.
Each month, QRS sends to the organisational QRS lead progress with their agreed programme and update on any
actions required.
An increasing number of West Midlands organisations are deciding not to commit to the QRS model year on year.
Although It should be noted that clinical engagement with Peer Review is strong and there are 600+ reviewers
trained on the QRS data base. Additionally, it is rare for the QRS to struggle to obtain a clinician to work with us on
reviews.
This fall in credit and subscription income is having an impact on the Quality Review Service financial viability.
Current Credit and Subscriptions
CCG
2019/20*
contract value
*Capitation based values
Credits*
*Capitation based values
Credit Model BSOL 20,000 4
Wolverhampton 14,388 3
Walsall 15,144 3
Herefordshire 10,131 2
Worcestershire 31,962 5.5
Subscription Model Cov’ and Rugby 5,000
Dudley 2,750
Shropshire 4,750
Telford 2,750
20190925 QRS Board Papers - September 2019 V1 for Web 21
Access to Standards
In early 2018, it became apparent that although some CCGs were paying either credits or subscriptions for access to
the QRS resources; standards and self-assessments were also available freely on the website. The QRS Board
agreed that in future Standards would be a chargeable item for those not funding QRS. Based on a calculation of
the equivalent value to one organisation using the subscription model; this was set at £800 per set of standards, or
£2,000 for one organisation access to all standards. The exception to this is where standards had been funded for a
national or regional programme, e.g. IABD, or HD programmes and Eye Quality Standards .
Whilst QRS has had a number of enquires for access to the standards, only one enquiry has progressed to a
purchase (Truro Hospital – self-assessment for Services for People with Progressive and Advanced Chronic Kidney
Disease). Many organisations decline to proceed to purchase. It is not known how many people then access
standards through their peer contacts. An example is the Paediatric Long Term Ventilation Standards, which are
referenced within the National Specialised Commissioning Specification. Several organisations have made contact,
none have resulted in purchase. QRS have written the NHS Specialised Commissioning as to whether they would be
prepared to purchase this set of QS for national use, but to date have not received a response.
Data from the WMQRS original website shows regular traffic downloading standards where access is free and
available. In 2017; over 500 downloads were recorded. Data for early 2018/19 supports this trend. Data for 2019
shows that activity is greatly reduced to less than 300 per year. It is therefore concluded that the cost rather than
the quality or the usefulness of the standards is the barrier.
Removing the charging for access would engage a wider community more easily with the Quality Review Service
and its offer. Opening access to QRS products would create a greater opportunity to offer QRS services. Clearly
many are outside our immediate geography, but travel and access (as proved with current national programmes) is
not a barrier and consistent with our new model. Clearly, QRS would need to create a model of capturing those
who download standards before they are accessed in order to manage the dialogue of “how can we help?”. Access
would be free but regulated.
The downside to this is that the model of subscription would need to be abandoned, as offering free access is
inconsistent with charging others for access.
Currently, the income derived from subscriptions is £15,250. Current subscribing organisations would be
encouraged to use this identified funding to contribute to a review, which may further increase QRS utilisation.
Though there is a risk that this would not materialise as the subscription model was introduces to try and keep
West Midlands organisations engaged with the work of QRS.
Action: The Board are asked to consider if removing charging for access to standards would increase utilisation
sufficiently to offset the loss of subscription income.
Credits based work
Currently there are a number of CCGs who have a credit based agreement with QRS. These credits are only held by
CCGs.
This agreement in its concept (i.e. a pre-agreed contract) is robust. However it is an arbitrary capitation based
number that rolls over each year. It is (notionally) a West Midlands agreement and is reported as such.
QRS are finding increasingly that organisations with credits either struggle to ‘spend’ them each year; or struggle
with fitting their ambitious programme into the number of credits.
The loss of the Sandwell and West Birmingham contract is believed to be, in part, due to the fact that the CCG
struggled year on year to spend the agreed credits.
20190925 QRS Board Papers - September 2019 V1 for Web 22
It is proposed that QRS move from a credits based contract seen as part of a single wide system, to individual
contracts with both provider organisations and CCG/commissioners. This would be set yearly based on need or
could be as a rolling contract. There would be a discount for quantity bookings.
For example:
• One Review £7,500
• Two Reviews £14,000 (£7,000/review)
• Three Reviews £20,000 (£6,600/review)
• Four reviews £25,000 (£6,250/review)
• Five reviews £30,000 (£6,000/review)
This model has five distinct differences from the current credits system.
1. It is negotiated and agreed annually.
2. It is not West Midlands centric.
3. It is not entirely commissioner focused.
4. There is a benefit of STP collaboration and can be used system wide.
5. Can be accessed by a collaborative venture, e.g. all mental health providers seeking a single view on quality.
Rather than reported as a single credits process; they would be reported to the Board as individual contracts.
The largest risk would be the lack of certainty of that income stream, however a contract based system would
enable greater flexibility, engagement and value for money.
Return to Agenda
Financial, Human Resources & Legal Implications: QRS income is currently at risk; this proposal seeks to address
this key issue.
Equality impact: QRS review programmes improve quality of health services
and reduce inequalities in access to and quality of care.
Recommendations:
The Board is asked to advise on making standards free to access, with the implication of losing the subscription
model.
The Board is asked to advise on changes to the credits model.
The Board may wish to recommend updating the risk register in parallel with these options.
20190925 QRS Board Papers - September 2019 V1 for Web 23
Aᴘᴘᴇɴᴅɪx 8 Quality Review Service Trademark
Purpose of Report:
The Board requested the Quality Review Service Director to take action to protect the identity of the QRS name and
logo.
This paper sets out the progress of that application and seeks advice from the Board on a future application.
Background
The Board asked that the QRS logo and name be protected.
An application was made under the Trade Marks Act 1994, to register the Quality Review Service trade mark.
The application was made to the Governments Intellectual Property Office.
Process
The Trade Marks Registry has 45 classes. Goods are listed in classes 1 to 34; Services are listed in classes 35 to 45.
More details can be found of this individual classes via this link
QRS applied for trade mark in
• class 35 (advertising; business management; business administration; office functions),
• class 41 (education; providing of training; entertainment; sporting and cultural activities)
• class 44 (medical services; veterinary services; hygienic and beauty care for human beings or animals;
agriculture, horticulture and forestry services).
Appendix 1 shows the full range of sub-classifications applied for.
The application was made to register 3 trade marks.
1. The Quality Review Service logo
2. ‘QRS' as an acronym
3. Quality Review Service as a description.
These were felt to be the main descriptors.
The application has to be made in the name of a legal entity that is able to hold the trade mark and other
intellectual property. The application was made in the name of Midlands and Lancashire CSU.
20190925 QRS Board Papers - September 2019 V1 for Web 24
Outcome
Each application is made for a series. i.e. a set of marks that link together and have a flow.
Application 3 was objected to by the Trade Mark Registry assessor. In essence it is three words that each have an
individual definition. When joined together it tells the reader what the organisation does; but is not in itself a trade
mark.
It was agreed to remove this from the application.
Application 2 raised some concerns. Firstly it is not part of a series. it could be considered as part of a separate
application; but not as a series in this application.
In addition; in the international search, two uses of QRS were found. One was discounted as it was substantially
different; the other was similar to the Quality Review Service application.
If the Board were to consider applying separately for a trade mark of ‘QRS' this would need to be a separate
application. The other use of ‘QRS’ that is trade marked is a non-UK organisation. As such; the UK Trade Mark
organisation does not notify them of the application. They can object if they see it on the register, but objections
are seen as rare and many similar marks co-exist.
It was agreed to remove this from this current application.
Application 1. This is for the Quality Review Service logo. This was felt to be the primary trade mark and was put
forward. The application for this trade mark has been accepted.
The letter confirms
The requirements for registration appear to be met so your application is accepted. The details of your
application will now be published in our online Trade Marks Journal for opposition purposes. As soon as
your trade mark is published, we will send you confirmation of the publication details.
After the mark has been published, there is a 2 month opposition period in which anybody may oppose its
registration. If someone gives notice that they are considering an opposition, this period will be extended to
3 months. If we receive any opposition, or the opposition period is extended, we will write to tell you.
If nobody opposes the mark, we will register it 2 weeks after the opposition period ends and send you the
registration certificate by post.
Quality Review Service has received confirmation that
The above application has been published on 13/09/2019 In the Trade Marks Journal, No
2019/037. The journal is published on our website, please visit ipo.gov.uk/tmjournal
The opposition period begins immediately after the date of the publication. The end of the
opposition period date is 13/11/2019. However, the opposition period may be extended to
3 months if a third party files an electronic form TM7a ‘Notice of threatened opposition’
before the end of opposition date.
This process should have concluded by the date of the next Board meeting.
20190925 QRS Board Papers - September 2019 V1 for Web 25
Appendix 1
Full list of application in each class applied for.
Return to Agenda
Financial, Human Resources & Legal Implications: Protection of the Quality Review Service trade mark has
significant legal and financial implications for the service.
Equality impact: QRS review programmes improve quality of health services
and reduce inequalities in access to and quality of care.
Recommendations:
The Board is asked to recognise the application made to protect the QRS logo by Trade Mark held MLCSU has been
made and accepted.
The Board is asked to advise if a separate application to register the QRS acronym (current application 2) should be
made.
20190925 QRS Board Papers - September 2019 V1 for Web 26
Aᴘᴘᴇɴᴅɪx 9 UKAS Accreditation
Purpose of Report:
This report updates the Board following the annual review by UKAS reported at the previous Board meeting.
Background
Quality Review Service quality systems is accredited by UKAS (8831) for both standards based peer reviews and
formative peer reviews.
The accreditation is important as it is seen as a mark of the quality of our work and processes.
Accreditation is renewed annually following an office inspection to test our internal quality systems, and a site
review visit to test our application of the quality system in practice.
Update from visit July 2019
UKAS visited the QRS office on 12th July 2019. No actions were required as reported to the board via email following
their feedback.
QRS has since received an email from UKAS setting out three mandatory actions that were subsequently identified
following the review visit.
These relate to the detail in the Quality Manual. They were:
• There is not a named person to deputise in the absence of the technical manager.
• Quality Review Service has not yet indicated within its documentation the management system Option it has
adopted (either option A or option B).
• There is no named person responsible for document approval prior to them being included to the
management system.
All changes have been made to the quality manual as a result of these and the appropriate response made with the
evidence to UKAS. The form for this is enclosed.
UKAS have responded and confirmed that this evidence and the changes have been accepted and (subject to the
site visit) QRS have been reaccredited to the UKAS standards
Name Change
Historically, West Midlands Quality Review Service was registered with UKAS as NHS Business Services Authority –
West Midlands Quality Review Service. This has made identifying the organisation through a search difficult, as the
first part of the name would not be recognised as QRS.
UKAS have agreed, in changing the name to the new identity to reorder the certificate, which now reads ‘Quality
Review Service – NHS Business Services Authority.
The new certificate is embedded in this report.
20190925 QRS Board Papers - September 2019 V1 for Web 27
20190925 QRS Board Papers - September 2019 V1 for Web 28
Return to Agenda
Financial, Human Resources & Legal Implications: Ongoing UKAS registration is an important asset to the ability
of Quality Review Service to deliver an effective programme.
Equality impact: QRS review programmes improve quality of health services
and reduce inequalities in access to and quality of care.
Recommendations:
The Board is asked to note the contents of the report.
20190925 QRS Board Papers - September 2019 V1 for Web 29
Aᴘᴘᴇɴᴅɪx 10 QRS Finance report
Purpose of Report:
This report updates the Board on the 2019/20 in year financial position.
Background.
Board members will recall that along with the monthly budget from the CSU; the Quality Review Service derived
financial overview of all I&E is also included.
This allows the Board to have oversight of the whole programme.
Month 4 Budget position
There is a meeting between Quality Review Service and the CSU finance lead on 23 September, and a verbal update
of reconciliation will be made at the board.
In summary, the QRS end of year position is currently showing a £20,000 deficit.
However there are two programmes in pipeline income that are expected to be approved. These will generate
around £17,000.
The QRS budget is predicted to break even this year.
Return to Agenda
Financial, Human Resources & Legal Implications: Financial balance is a key duty of NHS organisations.
Equality impact: QRS review programmes improve quality of health services
and reduce inequalities in access to and quality of care.
Recommendations:
The Board is asked to note the current in year financial position.
20190925 QRS Board Papers - September 2019 V1 for Web 30
Aᴘᴘᴇɴᴅɪx 11 Director’s update
Purpose of Report:
This paper updates the Board on other items of note and of interest since the previous Board that are not included
elsewhere.
Learning Event
A learning and sharing event was scheduled for late October 2019. Historically, QRS have run these on a
programme basis and all delegates are part of the same programme. In this future event we will be attempting to
share learning across programmes. A little more time is required to make this effective. We plan this for January
2020.
Return to Agenda
Financial, Human Resources & Legal Implications: The Board seeks to discharge its financial and legal duties
through a robust programme of governance.
Equality impact: QRS review programmes improve quality of health services
and reduce inequalities in access to and quality of care.
Recommendations:
The Board is asked to note the contents of this report.