Minutes of the Quality Committee Meeting

held at 13.00 hrs on Thursday 16 June, 2015

Boardroom A, Farm Villa, Maidstone, ME16 9PH

Present:Professor M AndrewsNon-Executive Director, Chairman

Mark BryantNon-Executive Director

Mr R AshurstNon-Executive Director

Mrs P BarberDirector of Nursing and Governance

Dr C KinaneExecutive Medical Director, Quality

Mrs N OathamHead of Psychological Services

Mrs D BrayTrust Professional Lead for Allied Health

Professions

Jon Stock Chief Pharmacist

Ms S SadasivamQuality Intelligence Analyst

Ms C BrodiePractice Support Manager, KCC

Mr S NormanPatient Safety Manager

In Attendance:

Mrs S ChalmersRisk Manager and Health & Safety Lead

Miss A BedfordAssistant Trust Secretary (minutes)

Ms M BrownInterim Company Secretary

Mr K HalpinDirector, Forensic & Specialist Services Service Line

For item QC/15/114

Dr L LockerbieLead for Psychological Practice & Quality, Forensics

For item QC15/114

Mrs D EldridgeDeputy Director of Nursing, for items QC/15/116 & 117

Ms M PalmieriSenior Performance Officer, for item QC/15/118

Apologies:Mrs C FentonHead of Mental Health Social Work,

Kent County Council

MIN NO

QC/15/108CHAIRMAN’S WELCOME, INTRODUCTIONS AND HEALTH AND SAFETY

The Chairman welcomed members to the meeting. The Health and Safety and fire evacuation arrangements for the building were not explained as all those attending werefamiliar with the arrangements.

The Chairman noted that this was Mr Bryant’s last meeting as a member of the Committee and she thanked him for his invaluable contribution. Mr Bryant said that working on the Committeehad given him an excellent opportunity to learn about a wide range of the Trust’s work. The Chairman noted the Quality Committee needed to maintain a formal link with the Finance and Performance Committee and she would be discussing this further with the Trust Chairman.

QC/15/109APOLOGIES FOR ABSENCE

Apologies for absence were received as noted above.

QC/15/110NOTIFICATION OF ITEMS FOR DISCUSSION NOT ON THE AGENDA

There were no items notified for discussion which were not on the agenda.

QC/15/111CONFLICTS OF INTERESTS

None raised.

QC/15/112MINUTES OF THE LAST BOARD MEETING HELD ON 19 MAY2015

The minutes of the last meeting held on 19 May 2015 were accepted and signed as a correct record. It was noted that Ms Brown had now left the Trust so the action at QC/15/101 needed to be changed to Ms Bedford.

QC/15/113MATTERS ARISING

The Committee noted the updates on the matters arising from previous meetings and agreed the closures as listed. Updates on items QC/15/27g and 32b, linked to the Patient Safety Committee, to be circulated by email before the next meeting.

RISK MANAGEMENT

QC/15/114Forensic and Specialist Services Service Line (Forensic & SS SL)

The Chairman noted that this would be Mr Halpin’s last appearance at the Quality Committee prior to his retirement and thanked him for his contribution to the work of the Committee. Mr Halpin advised that Dr Lockerbie would be acting as the interim Service Line Director when he left the Trust.

Mr Halpin said that the report summarised the risk governance process in the service line; he noted how valuable Kate Bisham’s role was to the service line in keeping their focus on risk. The strategy in place looked at local and business risk, feeding into the overall service line risk register and avoided duplication. The Specialist Services had been embedded into the service line since the last presentation to the Committee. Mr Halpin said that in general the feedback following the CQC Inspection visit to his areas had been positive, although concerns had been raised in relation to medication storage, now resolved, and the seclusion areas.

Mr Halpin invited questions and the following issues were raised.

  • The Chairman asked when the decision would be taken about continuing use of seclusion rooms in the women’s areas. Mr Halpin said that there needed to be further local debate before a decision was taken.
  • In response to an observation from Mr Bryant, Mrs Barber confirmed that the good practices demonstrated in the Forensic & SS SLwere shared across the Trust.
  • In response to an enquiry from Mr Ashurst, Dr Lockerbie confirmed that she would have capacity to continue her existing governance and risk duties as well as undertake the interim Director role; skills were being developed among other members of the team to provide the necessary support.
  • Mr Halpin confirmed that the Service Line was looking into the issue of blank boxes on medication charts. He agreed that it should be added to the risk register.

ACTION: Mr Halpin

  • Mr Halpin noted that risks relating to the MIMHS had been added to the register and reminded the Committee that there had been a presentation on the service to the last meeting of the Board. Mrs Barber acknowledged the issues and suggested that it would be helpful to arrange a cross service line workshop to ensure that the Trust had done all it could to address the problems. She asked that Mr Halpin ensures that the risk has been shared with the CCGs.

ACTION: Mr Halpin

  • Dr Lockerbie noted that there were similar issues with the Personality Disorder service.
  • The Chairman asked about progress with the Fire Risk Assessments. Mr Halpin said that six assessments remained outstanding and he was confident that colleagues would schedule these as quickly as possible within their current priorities.
  • Mr Halpin noted that commissioning of a local provision for Tier 4 patients for the Eating Disorder Services was now likely; current arrangements were not compliant with NICE guidance.
  • With respect to providing physiotherapy support for neuropsychiatric patients; Mrs Barber said that a local SLA should be established.
  • Mr Halpin noted his concern that the service being commissioned from KMPT in diagnosing autism was insufficient in that there was no provision for supporting newly diagnosed patients.
  • The Chairman commented that the dashboard was a useful document, giving an ‘at a glance’ view.
  • Mr Ashurst wondered about the relatively low number of complaints received by the service line. Mr Halpin said that the service line focussed on taking action to prevent issues from escalating.

The Committee discussed and noted the report.

QC/15/115Quality Risk Register:

Mrs Chalmers noted that there had been some risks removed from the register and new risks added, which was a positive indication of an active risk management process. There had been some risk movement, although more was anticipated when the register was presented to the July meeting as all the risks on the register were in the process of being reviewed using the control calibration tool.

The following points were raised in the discussion.

  • 3736 Medicines management – Mrs Barber asked whether the risk rating was too low given the issues raised by the CQC in their inspection report. Mrs Chalmers agreed to review.

ACTION: Mrs Chalmers

  • 4042 this risk needed to be expressed in the IF/THEN… format.
  • 3998 seemed to be a duplicate of 3748 – it was agreed to merge the risks if the controls were the same.
  • Mr Bryant commented that looking at the risk log and the Littlestone report seemed to point to some systemic issues. Mrs Barber said that there would be an action coming out of the report to look at this in more detail.

The Committee discussed and noted the report.

QC/15/116QUALITY DIGEST

Integrated Complaints and SI Data:

The Chairman noted that the report read well and that the quality of the report had generally improved.

Dr Kinane noted that the Trust was now submitting information to the CCGs using the new paperwork and were in dialogue with them about closing the backlog cases. Mr Norman was trying to ensure that the Trust was invited to closure meetings as it was then possible to answer any queries raised at the time and resulted in better closure rates. Mr Bryant noted that the number of open SIs seemed to be increasing and asked if there was a trajectory to bring this down. Dr Kinane explained that the decision to close an SI was in the control of the CCGs; the Trust was not in a position to manage the process and had completed all Trust based processes.

Mrs Barber noted that the complaints report provided a further breakdown of concerns raised under the All Clinical Treatment category – care planning and responsiveness were the highest. The Chairman said that it was pleasing to see the number of complaints about staff attitude falling.

Dr Kinane noted the inclusion of data on Duty of Candour letters. Mr Norman said that the model for handling these in the Acute SL was working well. In July the datix system would be adapted to include an area to record that a letter had been sent. He was currently working with clinicians to ensure that names and addresses of next of kin were entered into the RiO record.

Dr Kinane said that the restraint and seclusion data indicated that progress was being made. Mrs Barber commented that this was the second year running when the Trust had shown an annual reduction in the number of incidents of violence against staff.

Mrs Barber advised the Committee that there had been one instance of a 17 year old patient being admitted to an adult ward. The circumstances of the case were such that this had been the more appropriate action to take and the patient concerned had been almost 18.

Ms Sadavisam advised the Committee that the number of seclusions in April had been revised to 16. The Committee agreed her suggestion that the number of falls on in-patient wards could be added to the digest.

The Committee discussed andnoted the report.

Nursing metrics:

Mrs Eldridge advised the Committee that meeting the 72 hours target for physical health checks had been discussed at length at the Matrons Meeting, when she had stressed the importance of meeting the target. There was some work to be done to ensure staff completed the RiO screen correctly in order for data to be pulled through into reports. Mrs Eldridge said that, by August, she was planning to present the CQUIN data to demonstrate the seven domains of the physical health assessment to assist in analysing the Trust’s performance and the governance of the process.

Mrs Eldridge said that the figures for violence & aggression and self harm had been challenged and were shown to be under reported. This was also due to data not being pulled through properly into the reports and training was being planned. Mrs Eldridge confirmed that these were internal reports only. Dr Kinane raised concerns that medicine errors may not be correctly reported. It was agreed that this issue would be raised with the datix team.

ACTION: Mrs Eldridge

Mrs Barber commented that the safety thermometer would be a good tool to enable the Quality Committee to keep sighted on key issues, especially given the concerns around medicines management. Mr Stock noted that the thermometer was not well suited to use in a mental health services environment. Mrs Barber asked that he and Mrs Eldridge consider this further outside of the meeting.

ACTION: Mrs Eldridge

The Committee discussed and agreed the report.

QC/15/117SMOKE FREE UPDATE

Mrs Eldridgesaid that Mrs Worsfold continued to work with teams across the Trust to embed the policy. There was some negativity from some staff teams, who believed that the policy would not work. There were also anecdotal reports that patients were disconnecting smoke alarms; this had been investigated and no evidence found thatthis had occurred. Mrs Chalmers said that she would look into this further and report back to the Committee.

ACTION: Mrs Chalmers

Mrs Eldridge said that patients were congregating outside of the Canterbury site and there had also been problems outside of Priority House, with patients smoking around the bench. The Chairman noted that the paper had asked for the Quality Committee to make decisions relating to these two situations. It was her view that these were both operational issues so it was outside of the role of the Committee.

Mr Stock advised that the cost of nicotine replacement therapy had been £5K for a two week period, which equated to £120K per annum. This was within the projected cost range. Mrs Eldridge said that there had been fewer than ten complaints received about the no smoking since April.

It was agreed that, as the policy was embedding well into the organisation, monthly reporting was no longer required. Further updates on the policy would be provided via the quarterly performance reports on the Quality Accounts priorities.

The Committee discussed and noted the report and referred the items for decision back to the operational team.

QC/15/118EQUALITY AND DIVERSITY METRICS REPORT

Ms Palmieri explained that the paper presented to the Committee gave three options for the metrics which could be produced to provide an insight into the performance against equality and diversity requirements across the Trust. She explained that the reference to restrictions on data availability mentioned in section 2 relate to practical obstacles, not restrictions on access.

The Committee agreed option 3, noting that the report may not fully populated until datix updates had been received. The report should be provided on a six monthly basis as part of the regular Equality and Diversity reporting.

The Committee discussed the report and agreed option 3, for six monthly reporting.

QC/15/119PROPOSAL FOR THE USE OF CCTVs

Mrs Barber explained that the current Trust Policy for the use of CCTV did not include a Trust position statement; decisions were at the discretion of local teams. The report summarised the current situation for the Quality Committee to consider whether a policy was required.

Dr Kinane saidthat, in her view, CCTV use should be focussed in areas of high risk, such as the 136 suites. She could see no reason for CCTVs in out patient areas. Dr Kinane added that CCTVs must not be used for therapeutic purposes. A key point had to be that staff were aware that the TVs were in place. Mr Norman concurred with this view.

Mr Curtin noted that signage relating to the presence of CCTVs tended to vary across the Trust. It was agreed that checking signage relating to the use of CCTV should be added to the 15 step checklist. He drew members’ attention to the guidance from the CQC about CCTV usage.

ACTION: Mrs Eldridge

The Committee agreed that use of CCTV would remain at the discretion of the Service Lines and requested that the CCTV policy be reviewed to ensure it was compliant with the CQC guidance and clear about signage.

ACTION: Mr Curtin

QC/15/120SIGN UP TO SAFETY

Dr Kinane advised that the report provides details of the pledges that the Trust has made in response to the national Sign Up to Safety campaign. These had been chosen based on the 200 plus responses to a questionnaire sent out. Dr Kinane noted that the areas in red related to measures that were not yet in place. The Quality Committee would be provided with six monthly update reports.

The Committee received and noted the report.

QC/15/121REPORT ON POLICIES MANAGER BY THE QUALITY COMMITTEE

The Committee noted the report.

QC/15/122ITEMS REFERRED TO OTHER COMMITTEES

There were no items referred to other Committees.

QC/15/123ITEMS TO REPORT TO THE BOARD

It was agreed that the following items would be included in the Committee’s report to the next Board meeting.

  • Consideration of the issues facing the MIMHS, as requested by the Board.
  • Smoke free update.
  • Equality and diversity metrics
  • CCTV update
  • Sign up to safety

QC/15/124ANY OTHER BUSINESS

Mrs Barber advised the Committee that the CQC’s thematic review report, ‘Right here, Right Now’, had been published. A summary was being produced and would be brought to the next meeting of the Committee. This had been a multi-agency review and the action plan was being taken forward way the Crisis Concordat Group. The Chairman noted that the report included some positive comments about the work in Kent; the Trust had not been specifically named. Mrs Barber commented that she anticipated that there would be some symmetry between the thematic report and the Trust’s inspection visit report.

QC/15/125DATE OF NEXT MEETING

The nextmeeting would be held at 13.00 on 21 July 2015 in theBoardroom, Trust Headquarters, Farm Villa, Hermitage Lane, Maidstone, ME16 9PH

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