Quality Review Service Board Meeting · Joined by telephone conference: Dr Nick Coleman (NC),...

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.

http://www.qualityreviewservicewm.nhs.uk/


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


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


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.


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.

http://[email protected]


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

http://www.fabnhsstuff.net/


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.


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.


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


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


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


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.


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.



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.


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.


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.



Recommendations: The Board is recommended to note the contents of this report.


Appendix 5a West Midland Work Programme 2019/20

2019/20 WMQRS West Midlands Reviews - September 2019

Key: x

Health Economy

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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


Appendix 5a Compliance with QRS Standards 2019/20

Return to Agenda

2019/20 Work Programme

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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


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.


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.



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.


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


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.


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.



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.


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.

https://www.wipo.int/classifications/nice/nclpub/en/fr/?basic_numbers=show&class_number=44&explanatory_notes=show&lang=en&menulang=en&mode=flat&notion=&pagination=no&version=20190101


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.

http://www.ipo.gov.uk/tmjournal


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.



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.


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.



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.



Recommendations:

The Board is asked to note the contents of the report.


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.



Recommendations:

The Board is asked to note the current in year financial position.


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.



Recommendations:

The Board is asked to note the contents of this report.

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