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MINUTE of MEETING of the
AREA CLINICAL FORUM
Board Room, Assynt House, Inverness /30 September 2010 – 1:30 pm
Present Mr Quentin Cox, Area Medical Committee, Chair
Ms Mary Wilson, Area Allied Health Professions, Vice Chair (VC)
Dr Moray Fraser, North Highland CHP, Professional Secretary
Ms Pat Wells, Patient Representative
Ms Chrissie Lane, Area Nursing & Midwifery Committee
Mr Duncan Martin, Patient Representative
Dr Andrew Evennett, Area Medical Committee
Mr Ian Rudd, Area Pharmaceutical Committee
Ms Catherine Beaton, Area Pharmaceutical Committee
Ms Anne Pollock, Healthcare Scientists
Mr Fraser Brunton, Healthcare Scientists
Mr Ray Stewart, Employee Director
Dr Angus Venters, Mid Highland CHP
Dr Iain Kennedy, SE Highland CHP
Ms Judith Catherwood, Area Allied Health Professions
In Attendance Dr Ian Bashford, Medical Director
Dr Helen Bryers, Head of Midwifery
Dr Margaret Somerville, Director of Public Health and Health Policy (for item 8)
Mr Douglas Seago, Head of Facilities (for item 6.3)
Ms Alison Binns, Board Committee Administrator
1 Welcome and Apologies
Apologies were noted from Ms Cathy Lush, Mr Adrian Hart, Ms Katrina Flannigan, Dr Ian Bashford, Ms Heidi May and Dr Roger Gibbins.
2 MINUTE / NOTE OF PREVIOUS MEETINGS
2.1 Meeting held on 27 May 2010
The minute of the meeting held on 27 May 2010 was approved.
2.2 Meeting held on 05 August 2010
The Area Clinical Forum noted the report of the meeting held on 05 August 2010.
The last meeting of the Area Clinical Forum had not been quorate. The Chair reminded members that they should nominate deputies from their professional advisory committees if they found they were unable to attend.
The Forum· Approved the Minute of the meeting held on 27 May 2010
· Noted the report of the meeting held on 05 August 2010.
3 MATTERS ARISING
3.1 Healthcare Scientists
Mr Fraser Brunton reported that a series of roadshows had been held at Raigmore followed by a workshop for healthcare scientists interested in participating in the Healthcare Scientists Forum. A draft constitution had been prepared, with the assistance of Ms Pam Cremin, which would be circulated for consultation shortly. The first meeting of the Forum was planned for December at which, it was hoped, the constitution would be agreed. It was intended that frequency of meetings would be tied to the Area Clinical Forum.
3.2 Review of Rheumatology Services
It was agreed that this item, in the absence of Dr Steven, be deferred to the next meeting of the Area Clinical Forum on 02 December 2010. A Board paper was due to be presented to the next Board meeting on 07 December 2010.
The Forum· Noted the progress towards establishment of the Healthcare Scientist Forum
· Agreed that an item on Rheumatology Services be included on the agenda for the next meeting.
4 CHAIR ATTENDANCE AT PROFESSIONAL ADVISORY COMMITTEES
The Chair reported that he had not recently attended any Professional Advisory Committee meetings but hoped to attend a meeting of the new NMAHP Committee shortly.
The Forum Noted the update.5 AREA CLINICAL FORUM CHAIRS GROUP
The Chair reported that he had last attended a meeting of the ACF Chairs group in August, a meeting with the Cabinet Secretary had been held on the same day. Discussion with the Cabinet Secretary had centred on the new ACF guidance, which had generally been well received, the Quality Strategy and the Annual Review process. With the majority of Annual Reviews complete, the Cabinet Secretary noted that ACF’s generally appeared to be functioning well. The content of the Annual Reviews was discussed in some detail with the Scottish Government seemingly fairly relaxed in relation to changes to the agenda to discuss immediate concerns. The Cabinet Secretary was concerned that some momentum had been lost in relation to the quality strategy. She asked that this be addressed and welcomed feedback. The Chair advised that he had raised the difficulties experienced by NHS Highland in relation to immigration regulations and the employment of medical staff.
Other items of note from the meeting included a presentation to the Chairs Group made by Mike Martin from the Joint Improvement Team of the Reshaping Care for Older People Programme. Dr Kennedy noted that, along with Martin Wilson, he had recently attended a conference, held as part of the public engagement phase now coming to an end, in relation to the programme. In addition, the possibility of a further Area Clinical Forum Conference was discussed however this was considered unlikely prior to the elections in May 2011. The Chair advised that QIS had agreed to sponsor such an event however this was probably now to be later in 2011. It was likely that QIS would send a representative to the ACF Chairs Group going forward.
The Forum Noted the update.6 AREA CLINICAL FORUM ANNUAL WORK PLAN
6.1 Infection Control Update
In the absence of Ms Heidi May, Dr Helen Bryers, Head of Midwifery, gave the Infection Control Update that would be presented to the Board the following week. All Boards had been asked to reduce SAB case numbers by an additional 15% by March 2011, this meant the year’s target for NHS Highland was less than 46 cases, a considerable challenge. Between April and August 2010, 20 cases have been identified, two MRSA and 18 MSSA. Work was ongoing with Health Protection Scotland (HPS) to reduced SAB numbers; three priority areas for current and future actions had been identified as follows:
· optimising invasive device use
· optimising blood culture taking
· preventing soft tissue infections becoming SAB’s.
The Forum noted that MRSA funding was due to end in March 2011. No advice had yet been received from the Scottish Government that this would be extended but the assumption had been made that this would not be the case. Further consideration of this matter was required and Dr Bryers agreed to bring this to the attention of Ms May.
In respect of Clostridium Difficile Infection, Dr Bryers noted that the previous reduction in cases had been sustained. A number of initiatives had been undertaken including:
· the promotion of good hand hygiene across all staff groups and general public
· attention to environmental cleanliness
· attention to antimicrobial prescribing.
Mr Ian Rudd advised that the response to antimicrobial prescribing initiatives had been satisfactory with audit results well received. The previously discussed end of funding in March 2011 would also have implications for the second antimicrobial pharmacist post currently in post, this post could either be cut altogether or have its hours severely reduced. Dr Bryers agreed to raise this with Ms May and Ms McClurg.
The NHS Highland Hand Hygiene Rolling Monthly Audit Programme continued across all areas; cleaning compliance averaged over 95% during July and August 2010. Target compliance remained 90%.
Dr Bryers reported that no outbreaks had been reported during July and August 2010. One death had occurred within 30 days of diagnosis of Clostridium Difficile infection; this had been recorded as a contributory factor on the death certificate. The Scottish Government Health Directorate and Health Protection Scotland were informed at the time.
Caesarean Section Surgical Site Infections continued to cause concern, triggers had not been breached but the number of cases continued to fluctuate greatly. Dr Bryers advised that the notes of all patients with infections had been audited but no common theme had yet been identified. Similar fluctuations were evident in Orthopaedics and a number of areas were in the process of being investigated.
In respect of education and training, a workshop on HAI responsibilities had been held on 23 August 2010 for Senior Charge Nurses and Midwives; 68 had attended from across NHS Highland and the event had been well received. The final draft of the policy for Mandatory Training for Prevention and Control of Healthcare Associated Infection was now available and would be presented to the December meeting of the Control of Infection Committee for ratification. Dr Bryers further reported that Ms Liz McClurg was still in post as Interim Infection Control Manager.
The Forum discussed the training of new staff for invasive procedures and universal passports. Mr Duncan Martin advised that he had attended the HAI Taskforce Development Day, held on 02 September 2010 in Edinburgh, at which a presentation was given by Janice Stevens which had proved to be informative; a copy would be provided to members for further information.
6.2 HEI Inspection – Caithness
Dr Bryers referred to the announced HEI inspection at Caithness General Hospital on 8 and 9 July 2010 which had generally gone well. The visit had resulted in four requirements and four recommendations, those noted in maternity services were now complete with the others underway. The Belford, Lorn & Isles and Skye hospitals had all had pre-inspection reviews, learning from the experiences in Caithness and Raigmore, in advance of the unannounced inspections due to start shortly.
In response to a query concerning the inspection of community hospitals, Dr Bashford advised that there was currently no information relating to when inspection of these premises might take place although he did believe it would be in the next two years or so. Some consideration had been given by the Scottish Government to other health board premises however there had been no specific mention of GP practices as yet. A realistic review of community premises was required to ensure that they were fit for purpose and met the required infection control and quality standards. Dr Bryers considered that two major issues had emerged from the recent inspection, the need to declutter areas and ensure that sterile equipment / stock was rotated with the associated adequate levels of scrutiny, and ensure the fitness of purpose of the building.
6.3 Decontamination
Mr Douglas Seago attended the meeting to provide an update on the issues currently surrounding decontamination for dental practices. An update had been provided to the Dental Clinical Governance Committee, a copy of this update would be made available to the Area Clinical Forum. Mr Seago noted that a number of the issues were not particularly new. Alex Fraser and Cathy Lush had volunteered to assist dental practices with several of the highlighted issues however a number had still to be resolved. A number of standards and already been implemented and six out of eight LDU’s were now built to the required standard. There was, however, still some lack of clarity of some issues and a national group would be meeting on 12 October 2010 to clarify these. With the picture still somewhat uncertain it was difficult to provide any further advice at this stage.
Following a query as to whether patients were being put at risk as a result of these issues, it was noted that this did not appear to be the case. Mr Seago advised that the equipment and environment was generally very complex with CDU standards generally set very high. Going forward it was necessary to balance out the risk of problems against the costs of implementing the standards, a question could also be raised over whether unrealistic standards have been set. Mary Wilson informed the meeting that similar issues had been faced within podiatry, although this only affected the managed service as the NHS does not contract with private podiatrists, with considerable work undertaken by Mr Seago and his team to try and resolve these.
6.4 NHS Highland Quality and Patient Safety Framework
The Area Clinical Forum had discussed the 2009 / 2010 Inpatient and GP Patient Experience Surveys in detail at the previous meeting both of which had produced very good results for Highland. The Chair noted that work continued to address the issues raised including, for the inpatient survey, ward noise and identification of who was in charge of wards. GP surgeries had the option to repeat the survey next year if their results were less than 100%, across Scotland it was likely that 150, out of a total of 500, would do this; in Highland a small number of surgeries were looking at specific issues raised by the survey. The cost of the surveys had been centrally borne and amounted to around £¾ million; whether this was cost effective going forward had yet to be addressed; further work was required to identify other methods of gathering patient opinion. Ms Wells suggested extending the use of patient diaries, The Patient’s Council had been using these. The Forum generally agreed that a relatively small scale exercise that could be monitored and evaluated was required, concentrating on specific items where results could be identified was seen as key.
An area highlighted as one of particular concern related to meal times and ensuring that those patients who were unable to feed themselves had some help. Currently NHS Highland implemented a no visiting policy during mealtimes, the Forum noted that this was not helpful for some patients. Ms Catherwood explained that the protected mealtimes policy was not designed to apply to all visitors, it should be at nurses discretion to allow relatives to visit during mealtimes, especially if they need assistance with their food. Ms Catherwood agreed that she would refer the discussion to the Food, Fluid and Nutritional Care Group, of which she was a member. The wording of the signs could be changed to encourage relatives to be involved in feeding if necessary, the Group had also been looking at the possibility of using volunteers to assist however further work was required to ensure that staff were capable and aware of their feeding responsibilities.