1. Preparation for the Upcoming CQC Inspection
Team Brief for All Teams in the Trust

2. What to expect from the CQC inspection
Minimum of 1 core service will be inspected, along with the Well-Led Review. The number of core services that CQC inspect will vary for each organisation.
All core service inspections will be unannounced. With some notification for the Well-led review.
Oxford Health FT issued provider information request (PIR) in December,2017 and this was submitted to CQC in the same month.
Inspections will happen within six months of issuing the Provider Information Request (data return). For OHFT we are expecting the core service visit, around January/February 2018, followed by the Well-Led review in February/March 2018.
CQC will inspect us on the five key questions: Safe, Effective, Caring, Responsive & well-led. Please see last slide for the updated Key Lines of Enquiries (KLOES) for each of these domains.
The size and make-up of the inspection team will be tailored to the service and the areas they inspect- again can vary for each core service.

3. The Trust’s self assessment
Safe
Effective
Caring
Responsive
Well-led
Comments
Provider wide
Requires Improvement
Good
Trust-wide we feel progress has been made on the RI requirements within the Safe Domain however due to the challenges with staffing we have still self-rated as RI. Planned staffing levels are generally met by additional use of temporary staff.
Community
Community inpatients
Adults community
Children, young people and families
Outstanding
CYP Community services delivered by OHFT (Oxford only). Includes 0-19 Universal services/ Community Nursing/ Integrated therapy service/ Phoenix team (including LAC/ YOS/ CSE)
End of life care
Clinical audit data did not provide sufficient assurance but new care plan is being piloted and plan to re-audit
Urgent care
Action plan in place

4. PMS (likely to be combined into one core service)
Mental Health
Safe
Effective
Caring
Responsive
Well-led
Acute Wards for adults of working age and psychiatric intensive care units
Requires Improvement
Good
Long stay/rehabilitation mental health wards for working age adults
Forensic inpatient
Outstanding
Child and adolescent mental health wards
Wards for older people with mental health problems
Wards for people with learning disabilities or autism (Evenlode forensic LD)
Community-based mental health services for adults of working age
Mental health crisis services and health-based places of safety
Specialist community mental health services for children and young people.
Community-based mental health services for older people
Community mental health services for people with learning disabilities or autism
Other Specialist eg EDS, psychiatric liaison services, complex needs service
PMS (likely to be combined into one core service)
GP OOH
Luther Street
Salaried dental
Adult Social Care
Other - ASC service

5. What to expect from the CQC inspection
Methods CQC will use to collate evidence, including:
Speak to patients and staff
Observe patient care being delivered
Look at individual care pathways
Review patient records.
Review documents and policies.
CQC will rate each key question and award a new overall rating after each core service inspection and overall Trust rating following the well-led review.
Please use this opportunity to highlight examples of any good and outstanding practice and any areas you are really proud of. CQC will highlight these in the report, which will be published.

6. Key areas to focus on for the next 4/6 weeks
Staffing - vacancies, turnover, agency use
Evidence of NICE implementation and impact of actions after clinical audits
Evidence of tangible clinical outcomes for patients
Mandatory training levels (overall for clinical teams 85%)
Appraisal levels (overall for clinical teams 70%)
Assurance around clinical supervision
Bed occupancy with leave high in mental health
Caseload sizes and oversight
Waiting times and oversight
Oversight of safeguarding referrals particularly adults in Oxon and Bucks
DOLs; the high number of applications not approved is due to delays in authorisations by the County Council.

7. Key Improvement Priorities- Adult Directorate
High re-admissions
Staffing levels, vacancies and agency use
Increase in use of restraint/seclusion
High bed occupancy with leave
Oversight of DNACPR
Review of Out of Area Placements- 18 people in last 12 months placed over 50 miles away.
Low Appraisal rate (less than 50%)
High ward-to-ward moves
Capacity of seclusion areas, sometimes individual wards use each other’s seclusion areas
High dose monitoring 3 monthly still needs improvement – action plan from recent audit
Access to emergency resus equipment and drugs – access on mental health wards, immediate available drugs will be with resus bags still being worked through for some wards
Fridge temperature monitoring - all wards have data loggers on fridges and ambient temperature monitors in clinic room but not working perfectly due to poor battery life
Some pharmacy policies are in the process of being revised, RT e-learning package not yet rolled out
Compliance of Wenric seclusion room regarding intercom system
How embedded LD services are into directorate governance structure
LD vision outreach team - care planning still being worked on
End of life care revised care plan template not yet evaluated - can demonstrate actions from Sept 2015 but outcomes from new care plan not evaluated or known yet

8. Key Improvement Priorities- Older People Directorate
Delayed Transfers of Care
Staffing levels, vacancies and agency use
Appraisal rate (less than 50%)
Vacancies (above 25%)
GP OOH- training levels for GP’s still poor
Witney MIU child friendly area of waiting room – funding now not available till 2018/19 (highlighted as recommendation by CQC during last inspection)
Community Hospitals- gap in patient notes being held in one place. Roll out of electronic notes recently, CQC likely to see new processes being embedded.
Management of paper records in community hospitals (build-up of more records from earlier action taken in Jan 2017) – project manager identified in Oct 2017 although little action has happened so far.
Work on medical gas storage and access to supply out of hours - recent audit identified issues
Currently not meeting CCG targets for DN’s: performance on named nurse seen patient F2F in last 3 months, YTD 48% against a CCG stepped target of 60-75%
Waits: PDPS (YTD 44% offered assessment date within 12 weeks of referral), Falls service (YTD 70% routine referrals offered appointment within 8 weeks), Oxon CHC (YTD 59% eligibility decisions within 28 days)
Oversight of DNACPR – audit planned
Access to emergency resus equipment and drugs – access on some wards, immediate available drugs will be with resus bags still being worked through for some wards
Fridge temperature monitoring - all wards have data loggers on fridges and ambient temperature monitors in clinic room but not working perfectly due to poor battery life
Some pharmacy policies are in the process of being revised, RT e-learning package not yet rolled out
End of life care revised care plan template not yet evaluated - can demonstrate actions from Sept 2015 but outcomes from new care plan not evaluated or known yet

9. Key Improvement Priorities- Children and Young People Directorate
High use of medic agency in CAMHS – Oxon and Melksham.
Vacancies (above 25%): CCNs, children’s integrated therapies South, HV service across Oxon, school nurses
Staffing levels, vacancies and high agency use, Highfield, Marlborough House Swindon
Use of restraints increased in last 12 months including prone and high use of RT; Highfield (mostly due to patient on HDU).
Appraisal rate (less than 50%): Highfield
Last inspection, found there were variable quality of risk assessments- need to ensure all risks to young people are properly recorded and managed
Quality of risk assessments, actions completed but more work to be done to make an impact
Review of caseloads in CAMHS teams and impact on safe patient care
Ensure all clinic equipment checked regularly and up to date portable appliance testing is in place
Knowledge of MCA- last inspection report stated knowledge was poor
To ensure the use of seclusion and long-term segregation at the Highfield Unit is in accordance with Mental Health Act Code of Practice definitions
To ensure patients have activities to take part in at weekends
Ensure checks of resuscitation equipment are carried out regularly in line with trust policy, recorded on the appropriate forms and that records are kept
Access to Emergency resus equipment and drugs – access on some wards, immediate available drugs will be with resus bags still being worked through for some wards
Last inspection- no infection control audits undertaken in children and young people’s services
To ensure all patients have same level of proactive support and assistance from advocacy service

10. Useful links
Updated Key Line of Enquiries (KLOES), includes rating characteristics:
Guidance on how providers meet regulations:
How CQC monitors, inspects and regulates NHS Trusts (from September 2017 onwards):