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NOTE of MEETING of the
AREA CLINICAL FORUM
Board Room, Assynt House, Inverness /05 August 2010 – 1:30 pm
Present Mr Quentin Cox, Area Medical Committee, Chair
Dr Moray Fraser, North Highland CHP, Professional Secretary (VC)
Mr Duncan Martin, Patient Representative
Dr Malcolm Steven, Raigmore Hospital
Ms Catherine Beaton, Area Pharmaceutical Committee
Mr Angus Venters, Mid Highland CHP
In Attendance Ms Heidi May, Board Nurse Director
Dr Ian Bashford, Medical Director
Dr Ken Proctor, Associate Medical Director (Primary Care)
Ms Alison Binns, Board Committee Administrator
1 Welcome and Apologies
Apologies were noted from Ms Chrissie Lane, Dr Andrew Evennett, Dr Sheelagh Rodgers, Mr Ray Stewart, Ms Cathy Lush, Dr Anne Pollock, Mr Fraser Brunton, Mr Ian Rudd, Ms Katrina Flannigan, Ms Pat Wells, Ms Mary Wilson, Dr Iain Kennedy, Ms Judith Catherwood and Dr Roger Gibbins.
The Chair welcomed those present. Noting that the meeting was inquorate, the Chair proposed that the Forum have an informal discussion on the under noted topics and defer the other agenda items to the next meeting. This was agreed.
2 INFECTION CONTROL UPDATE
Ms Heidi May informed the meeting that Dr Andrew Hay was currently away from the office and this was unlikely to change for at least the next three months. As a result of this interim arrangements were now being put in place and she was working with Dr Darrel Ho Yen and Kenny Steele to implement these. It was hoped that a locum would be available however in the interim Dr Ho Yen would deal with the logistical day to day management of Dr Hay’s area of work with Ms May herself covering the rest, consulting others as necessary.
Ms May turned to the Infection Control Update which was in a new format, as dictated by the Scottish Government. The indicies had remained unchanged however the way the information was organised allowed the rate of infection to be more easily identified. As a further adaptation, Ms May agreed to review the use of abbreviations within the document, aware of the fact that this could cause some confusion for Forum / Board members.
A new target had been set for Staphylococcus Aureus Bacteraemias (SAB) of 46 by the end of year, 14 cases had been identified so far. Ms May advised that clinical directors needed to focus on these in order to lessen levels across the Board. Good scrutiny was required locally along with thorough root cause analysis. Concentration on this issue would also be continued at Raigmore with further training to be provided for junior doctors and nurse practitioners and packs for taking blood cultures available. Dr Venters requested that these packs be made available to peripheral hospitals as well as Raigmore.
Dr Hay had been invited to the Area Clinical Forum to advise on the SAB strategy and how this was being rolled out. Ms May advised that she would ask either Emma Watson or Marilyn Davidson to come to both the Area Clinical Forum and the AMC to update the committees.
In respect of CDI, the Scottish Government had announced that all Boards would now be expected to achieve a minimum 50% rate reduction among patients age 65 and over by 31 March 2011. In terms of numbers this meant that NHS Highland must not exceed 130 cases. Increased attention was being paid to antimicrobial prescribing which had been identified as a major cause during root cause analysis.
Mr Cox noted that Surgical Site Infections had not been included on the report, Ms May agreed to check whether this had been missed, if not she would approach the Scottish Government questioning why this was no longer included in the report. Mr Cox advised that in respect of the SPSP data collection currently underway in orthopaedics, mentioned on page 8 of the Infection Control Report, he would consult with Alison MacDonald.
Mr Cox further raised a question around decontamination. Mr Hart had recently written to Mr Cox and the Chief Dental Officer expressing his concern, and those of his primary care colleagues, in this area. Dr Bashford advised that Mr Hart should raise this matter further within NHS Highland and that Mr Seago’s input would be valuable. It was agreed that copies of Mr Hart’s letters would be passed to both Ms May and Dr Proctor.
3 HEI INSPECTION – CAITHNESS
Ms May reported on the HEI inspection visit to Caithness hospital. The visit had generally gone well with the HEI team commenting on the clean hospital, well informed staff and the excellent relationship that seemed to exist between estates, facilities and charge nurses. A problem had been identified in maternity, the resuscitation trolley was found to contain out of date items and, due to the installation of cupboards the night before, some dust had been found in the department. The visit had resulted in four requirements and four recommendations. The requirement to appoint an infection control manager was being addressed. The HEI did question NHS Highlands approach to education and reiterated its position that mandatory training should be provided every 18 months in respect of infection control.
Three hospitals in NHS Highland had not, so far, been visited, the Belford, the Mackinnon and Lorn & Isles. With unannounced visits due to start in October, Ms May asked that Clinical Directors ensure that all preparations had been completed prior to this.
A full copy of the written report would be available for the next meeting which would be considered in more detail.
4 NHS HIGHLAND QUALITY AND PATIENT SAFETY FRAMEWORK
The Chair advised that he had recently attended a national quality workshop where considerable emphasis had been placed on primary care and providing patients with holistic care. A second meeting of the NHS Highland quality group was scheduled for 10 August 2010 and dates were to be fixed for alternate months.
Ms May stressed importance of getting quality discussions fed back to the professional advisory committees. Dr Bashford informed the Forum that scorecard headings had been agreed by the Scottish Government, comments from Boards had been fed in however a decision had been yet to be taken. Dr Bashford commented that further indicators could be added by the ACF if they felt it was necessary. The Chair requested that the Area Clinical Forum get copies of all reports along with any other relevant information and Dr Bashford agreed to ask Rachel Hill to provide this.
Ms May referred to the recent publication of the Scottish Inpatient and GP surveys the results of which were excellent across Highland. The response in respect of Raigmore had been high at 59% with positive comments including patients feeling listened to and involved in their care, receiving a good explanation of their care, enjoying a clean environment and both privacy and respect throughout their care. Negative comments included noise and uncertainty as to who was in charge. Ms May advised that these issues would be considered as would possible remedial actions. Despite the negative comments NHS Highland still rated above the national average in all areas.
Ms May advised that the intention was to repeat the questionnaire, at a Board level, yearly although this may not be in exactly the same format. The Forum discussed how the information provided by the survey could be used and it was agreed that Ms May would pick up any central themes. CHP’s would also be to make use of the information locally. Local questionnaires were being used both by Raigmore and the CHP’s. Some thought was required to consider the governance of this information and how it could be fed back to staff locally. It was noted that local questionnaires had generally been developed independently with little validation or comparability. Mr Cox agreed to raise this at both the next Quality Strategy Group meeting and Board meeting.
Dr Proctor reported that the response to the GP survey had also been excellent; a number of freehand returns had not been made available to the public. The results were very positive however confidentiality at reception, issues with small / single handed practices and some communication issues had been identified. A small number of practices had recently, prior to the results of the survey, carried out significant improvement work, as the survey will be reflected in their QOF points, those practices which felt comments did not accurately reflect their current service had the option to repeat the survey.
5 INDEPENDENT INQUIRY INTO CARE PROVIDED BY MID STAFFORDSHIRE NHS FOUNDATION TRUST, JANUARY 2005 – MARCH 2009
The Chair noted that NHS Highland had reviewed the adequacy of local arrangements to detect and act on serious shortcomings in standards of care in response to the publication of the inquiry into care provided by Mid Staffordshire NHS Foundation Trust. A report had been produced which provided a summary of the outcome of an NHS Highland Review which described the current systems in place and identified where further improvements could be made. Whilst it was agreed that the review demonstrated that a number of areas could be identified that were not perfect, Highland was not, in any way, in the same place as Mid Staffordshire.
Wide ranging discussions had been held across many of the professional advisory committees however feedback had so far been minimal. Action was required to ensure that clinicians were aware of the myriad channels they could use to raise concerns / complaints and to overcome any reluctance to raise these concerns.
Dr Steven noted that many of the problems highlighted within Mid Staffordshire seemed to relate to the basic care of elderly patients. He suggested that the care provided to this group should be considered from the bottom up. Ms May drew the attention of those present to the Acute Adult Establishment Review Tool used by all hospitals as a means of identifying best practice. Whilst this did not provide information at individual ward level it did give more general indications around staffing levels etc. Releasing Time to Care, being piloted in five wards across Highland, was looking at how clinicians could reduce the amount of time spent on unnecessary tasks and provide more direct patient care. The key challenge for this scheme was finding the money to roll this out further.
Further areas discussed included ensuring that communication channels were open and maintained, the risks attached to redesign, the general reduction in the amount of doctor / patient time and work currently being undertaken in relation to discharge management.
6 GENERAL ITEMS FOR NOTING
Mr Cox advised that the minute of the meeting held on 27 May 2010 would be considered at the next quorate meeting.
Dr Bashford reported that considerable work had been done by Mr Fraser Brunton and Dr Anne Pollock over the last three months to establish the Healthcare Scientists Forum.
In respect of Rheumatology, Dr Steven reported that an initial meeting had been held with Elaine Mead, a further meeting was scheduled for two months time. This item would be included on the next Area Clinical Forum agenda.
The Chair advised that the ACF portion of the Annual Review went well, this would be discussed further at the next meeting.
The Chair undertook to write to all Forum members reminding them that deputies could be sent to the meeting if they were unable to attend.
Other agenda items were held over to the next meeting.
7 BOARD STRATEGY EVENT / ROLE OF ACF
The Chair referred to the Board Strategy Event, due to take place on Tuesday 07 September 2010, which he was unable to attend. In his absence, responsibility for coordinating the ACF contribution would pass to the Vice-Chair. The meeting discussed the opportunity presented by this event to raise the profile of the Area Clinical Forum highlighting where it sat in the organisation, its role and remit and how it could make a difference going forward. In the following discussion a number of points were highlighted including:
· the route the ACF provided, outwith management, to the Board
· that membership of the professional advisory committees should be encouraged as a useful developmental role for clinicians
· that it was apparent that there was a certain lack of knowledge about the role of the Board, as well as the ACF
· that the role of the ACF required strengthening in order to make it more effective and to enhance discussion / decision making around the changes facing the NHS in Highland
· that the ACF had a valuable role to play in the redesign process and the move to differing models of care
· the importance of both clinical and financial planning was stressed
· that much of the work of the ACF was currently centrally driven with many issues put forward by the Board / management.
8 Date of Next Meeting
The next meeting would be held on Thursday 30 September 2010 at 1.30pm in the Board Room, Assynt House, Inverness.
The meeting closed at 5.10 pm
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