NHS GRAMPIAN
CLINICAL GOVERNANCE COMMITTEE REPORT
Introduction
The following key agenda items were discussed at the NHSG Clinical Governance Committee meeting on Friday 25th May 2012 and it was agreed they should be reported to NHS Grampian Board.
Strategic context
The Clinical Governance Committee acknowledged it had a role in seeking assurance for the clinical risks extracted from the Strategic Risk Registerplan, as per its remit below:
Clinical Governance Committee.This Committee has the responsibility, on behalf of the NHS Grampian Board, for reviewing and challenging risks that are on the strategic or corporate risk registers in respect of clinical governance issues. It should be satisfied that all clinical risks have been appropriately identified and that the control measures that are in place and that are planned to be in place are adequate to manage the risk identified.
The relevant clinical risks include:
- 853 Patient safety culture is not adequate and is not evidenced in practice.
- 586 Community and independent contractors (support from independent contractors is required to take forward strategic objectives e.g. shifting the balance of care.)
Discussion
- Prison Health Update
This relates to strategic risk 853: Patient Safety
- The Committee wasreminded that, in November 2011, responsibility for delivering health care services to prisoners in Scotland transferred from Scottish Prison Services (SPS) to NHS Boards.For NHS Grampian this involved HMP Aberdeen and HMP Peterhead.
- Over the next 18 months the configuration of prisons and the prison population in Grampian will change with the opening of a single HMP Grampianbased in Peterhead. This establishment will house all Grampian Prisoners and will be Scotland’s first ‘community-facing’ prison. The 550 inmates will include male and female prisoners, young offenders and children. There is significant prisoner movement between prisons presently and this not only results in a fluctuation of the number of prisoners presently in the two prisons within Grampian but also significantly alters the type of prisoners,resulting in change in health service demand. This primarily affects HMP Peterhead which no longer houses the sex offender population exclusively and has significantly increasedits substance misusing population.
- The Committee raised concern around the number of financial risks to NHSG resulting from the transfer. These include costs of providing Out Of Hours medical care within existing prisons, owing to a shortfall in budget allocation. This is currently the subject of discussion between NHS Scotland and SPS.
- The Committee was pleased to note that NHSG is hosting the national prison IT health system (Vision) and that the external audit report produced by Price Waterhouse Coopers stated:
‘There was effective joint working and partnership within NHS Grampian for instance between Planning, HR, Finance and IT’.
‘The production of a comprehensive operational plan which set out milestones relating to the transfer of responsibility from SPS to NHS Grampian, including the assignation of responsibilities within Grampian and deadlines for completion of action’.
The Clinical Governance Committee noted the excellent progress to date and asked for further updates at future Committee meetings.
- Scottish Patient Safety Programme in Primary Care (SIPC2)
This relates to strategic risk 853 Patient Safety
The Committee received a report on the Patient Safety Programme in Primary Care. In January 2011 NHS Grampian was successful in a bid to join the SIPC2 project and was tasked to look specifically at communications from Out Patient clinics at Dr Gray’s Hospital to GP practices in Moray and then ultimately the patient.Over the lifetime of the project the key achievements had been to develop an approach to assessing the safety and improving the reliability of a high risk and key interface area. This approach had already led to improvements, particularly in the timeliness and content of Out Patient letters, and in GP practice processes. Significant skills had been developed in the area both by the 5 participating practices and by the facilitating team. The use of the Trigger Tool to detect harm in Primary Care is a new development and one that GPs have found useful and are keen to continue using, particularly as part of appraisal. There will be an opportunity for this programme to be progressed across Moray and ultimately Grampian ahead of the National roll-out in April 2013.
The Clinical Governance Committee acknowledged receipt of this report and supported the intention of rolling out the programme across NHS Grampian.
- Health Care Associated Infection Report
This relates to strategic risk 853 Patient Safety
The report summarised the work of the Infection Prevention and Control Team (IPCT) and staff throughout NHS Grampian. The Committee noted the following comments:
Monthly ward hand hygiene audit results showed that compliance had remained above 95% across NHS Grampian as a whole since April 2011.
Cleaning and estates monitoring compliance remained stable and above the 90% target.
Clostridium difficile infection (CDI) cases dropped to a 5 month low in January to 10 cases.
December and January saw the highest numbers of Staphylococcus Aureus bacteraemias for 6 months. Each case was investigated and no common cause/link was found.
Only one case of MRSA bacteraemia had occurred in the last 3 months.
The Committee members discussed the low level of Norovirus across Grampian sites compared to the rest of Scotland and were interested to hear about the measures taken to increase the awareness of Tuberculosis in the community.
The Clinical Governance Committee acknowledged receipt of this report and was pleased to hear of the continued progress being made across all NHS Grampian sites.
- Stroke Managed Clinical network (MCN) Update
This relates to strategic risk 853 Patient Safety
This paper was presented to the Clinical Governance Committee to provide an update on the stroke variation and length of stay as reported in the full Stroke Managed Clinical Network report presented to the Committee in February 2011. The report also updated the Committee on the HEAT target and service provision throughout Grampian. The Committee was informed that Stroke Services in Grampian had an identified pathway. However, access to acute services and rehabilitation is inequitable and thus impacts on patient flow through the system.The length of stay is significantly shorter in some hospitals across Grampian and thrombolysis in Aberdeen continues to exceed national targets. There is a telemedicine link to support activity in Moray but data are not being fully completed and, therefore, shows limited provision at Dr Gray’s Hospital. Patientsat Dr Gray’s Hospital who require thrombolysis are cared for within the high dependency unit. There has now been an agreement to establish a designated integrated unit which is deemed the most appropriate pathway for patients in Moray. Work is ongoing to improve the data collection within Moray.
The Committee noted this report and asked to be kept informed via future updates.
- Mental Health Review
This relates to strategic risk 853 Patient Safety
The Committee was updated on a critical incident which had been verbally reported at the meeting in February 2012. A full investigation into a young person’s death had raised questions over the admission of adolescents into adult wards across NHS Grampian. With no current specific facility in Mental Health for adolescents, and the prospect of one 4 years away, there was support within the Committee for short- term solutions to be found.The key risks were around the admission of under 18s to adult mental health wards,which in turn pose further risks arising from contact with older adult patients within Mental Health Services.The Committee was pleased to hear a variety of risk mitigations, including the recruitment of an additional staff nurse and nursing assistant for Crathes ward. All under 18 year old admissions continue to be reported as per national requirements to the Mental Welfare Commission and all young people admission cases continue to be monitored by the Child and Adolescents Mental Health ServesManagement Team and Adult Mental Health Services Directorate Team.This matter had been discussed in detail in the course of a meeting with the Mental Welfare Commission at the end of last year and a further report had been requested bythe Procurator Fiscal in Tayside. Dr Pauline Strachan will be providing this on behalf of NHS Grampian.
The Committee noted the update and asked for further updates at future meetings.
Recommendations
The Board is asked to note this report from the Clinical Governance Committee and acknowledge that the Committee’s roles and responsibilities are being met.
Charles Muir
Clinical Governance Committee Chairman
May2012