PUBLIC
Minutes of the Quality Committee, 13 May 2015
Quality Committee
Minutes of the meeting held on
13 May 2015 at 09:00in the Boardroom, Chancellor Court, Oxford OX4 2GX
Martin Howell / Trust Chair (Chair of meeting until the end of item 18) (MH)part meeting
Clive Meux / Medical Director and Director of Strategy (Chair of meeting from item 19) (the MD/CM)
Ros Alstead / Director of Nursing and Clinical Standards (the DoN/RA)
Rob Bale / Clinical Director – Adult Directorate (RB)
Stuart Bell / Chief Executive Officer (the CEO/SB)
Mike Bellamy / Non-Executive Director (MB)
Anne Grocock / Non-Executive Director (AG)
Pete McGrane / Clinical Director – Older People’s Directorate (PMcG)
Mike McEnaney / Director of Finance (the DoF/MME)
Yvonne Taylor / Chief Operating Office (the COO/YT)
In attendance:
Justinian Habner / Trust Secretary (JCH)
Mike Foster / Acting Deputy Director of Nursing (MF)
Hannah Smith / Assistant Trust Secretary (Minutes) (HS)
1. / Welcome and Apologies for absence / Action
a / Apologies for absence were received from: Jonathan Asbridge, Non-Executive Director; Wendy Woodhouse, Clinical Director – Children and Families Directorate; and Tehmeena Ajmal, Head of Quality and Risk.
2.
a
b
c
d
e
f
g / Minutes of the meeting held on 13 February 2015
The Minutes were approved as a true and accurate record of the meeting.
Matters Arising
Item 2(f) Triangulating learning across disciplinary, grievance and whistleblowing cases
The DoF to present a report on triangulating learning across disciplinary, grievance and whistleblowing cases to the next meeting in July 2015.
Item 5(c) Buckinghamshire services reporting a higher level of incidents relating to confidentiality, undelivered letters or errors in posting/contacts
The DoN reported that the Improving Access to Psychological Therapies (IAPT) services had a high number of information governance incidents but also saw a high number of patients – approximately 8,000 patients a year. MF and the Head of Information Governance were scheduled to meet with both IAPT services for a review of information governance incidents.
Item 15(a) Safety Quality Improvement Committee annual report
The DoN to present to the next meeting in July 2015.
Item 4(b) Quarterly Quality Account updates to be presented at team meetings by team managers and made available to everyone in the Trust
The DoN and TA to consider and action for the next available quarterly Quality Account updates (which may be September 2015).
Item 5(d) Integrating actions from serious incident investigations into Trust-wide improvement work around themes, trends and action programmes
MF and the MD noted that the Weekly Review Meeting (Clinical Standards) provided a way of joining up and integrating learning from incidents. MB noted that it would still be helpful if panels reviewing the outcomes of incidents were also regularly provided with a list of the themes which had been identified so that they could be reminded to allocate recommendations under relevant themes at the time. The Trust Secretary noted that the Board had agreed in late 2014 that themes should be developed and was expecting an update on this. The MD and the DoN to report back on work to integrated actions from serious incident investigations into Trust-wide improvement work around themes, trends and action programmes.
The Committee confirmed that the rest of the actions from the 13 February 2015 Summary of Actions had been actioned, completed or were on the agenda for the meeting: 3(b); 4(c); and 19(a). / MME
RA
RA/TA
CM/RA
QUALITY IMPROVEMENT AND PERFORMANCE
3.
a
b / Declaration on system for visual display in patient bedrooms of names of responsible consultant and named nurse
The MD provided an oral update and confirmed that all wards across all directorates now visually displayed in patient bedrooms the names of the relevant patient’s responsible consultant and named nurse. The relevant declaration had also been made to Monitor to confirm this. Some flexibility was available as to how to visually display this information therefore forensic services were using laminate notices to ensure that they would not be damaged by patients.
The Committee noted the oral update.
4.
a
b / Quality Account report
The DoN provided an oral update and noted that a final version of the Quality Account would be presented to the Board at the end of May 2015. Comments on the most recent version of the Quality Account had also been received from Governors at a meeting yesterday; once these comments had been incorporated then the latest version of the Quality Account would be circulated to the Committee for review.
The Committee noted the oral update. / TA
5.
a
b
c
d
e
f
g / Safety sub-committee update and Serious Incidents report, Q4 2014/15
The DoN noted that an escalation report from the Safety sub-committee integrating various reporting lines would be developed for future meetings. MB noted that this would be useful so that this Committee could review the Safety sub-committee’s conclusions and assess whether they were sufficiently robust. For this meeting, separate reporting was still provided on serious incidents. The DoN presented Paper QC 20/2015 which provided an update on serious incidents requiring investigation and high level trends and assurance against Care Quality Commission (CQC) Outcomes 18, 19 and 20.
The DoN highlighted that:
- the highest number of deaths had been reported in Q4 compared to previous quarters in 2014/15. AG noted that there was a discrepancy on the front page over the number of deaths reported in Q4. The DoN to check;
- progress had been made to reduce the number of incidents in web holding;
- the report set out, on pp. 5-6, themes which had been identified from reviews of serious incidents in terms of both issues and good practice;
- good progress had been made in implementing the process for the new statutory Duty of Candour and work would continue to take place to ensure that this was embedded at team level. MF added that more detailed guidance was being prepared for circulation to all team managers to support this; and
- a staff psychological debriefing service to support staff after critical incidents had been set up and was being overseen by the Head of Spiritual & Pastoral Care.
AG referred to page 30 of the report and the risk note which had been issued in relation to End of Life Care and the recent internal audit. AG asked what progress was being made to respond to the recommendations from the internal audit. The DoN replied that the work was being led by the Head of Nursing for the Older People’s Directorate; progress was ongoing and would be reviewed at a future Executive or Extended Executive meeting.
MB referred to page 1 of the report which stated that 43 unexpected deaths in Q4 had not met the criteria for investigation as serious incidents. MB asked whether the Committee should review the criteria which determined which unexpected deaths were escalated for further investigation as serious incidents requiring review to be assured that they were reasonable. PMcG added that some patients died unexpectedly due to deterioration in their physical health. HS noted that deaths were notified to the relevant Coroner to ensure that inquest investigations were undertaken as appropriate where determined by the relevant Coroner. The DoN noted that this would be a good time to review the Trust’s criteria which determined which unexpected deaths were escalated for further investigation as serious incidents requiring review as NHS England had recently published a revised definition. The DoN and MF to review and report back to the next meeting.
The Trust Chair noted that the Board also separately received reporting on serious incidents and requested that the timing of these reports be reviewed so that the Safety sub-committee or this Committee could input into them first before they were escalated up to the Board with a greater focus on thematic clustering of action plans and assurance issues. The DoN to review the timings of the reporting on serious incidents to the Board and dovetail with the future meetings of this Committee on 17 July, 09 September and 17 November 2015, and the future meetings of the Safety sub-committee, as appropriate.
The Committee noted the report. / RA
RA
RA
RA/MF
RA
6.
a
b
c
d
e / Older People’s Services Safety Report
The DoN presented Paper QC 21/2015 which was an example of a directorate safety report which could provide this Committee with more detail on safety and quality developments within directorates and service lines. The Committee was asked to consider whether each clinical directorate should submit similar quality/safety reports to this Committee on the basis of one comprehensive annual report and update or highlight reports throughout the year. PMcG added that since the Older People’s Directorate had integrated its business and performance teams, it had enhanced its ability to analyse quality data. The quality issues which were most significant for the Older People’s Directorate, as set out in the report, were pressure-related incidents, medication and falls.
The Committee discussed the report and noted that although it provided a valuable level of detail and assurance as to actions taking place at directorate level, this should be provided for information to the Committee and taken as read, not discussed in detail during meetings subject to questions or focus on particular issues. The CEO recommended that these reports should also be circulated and used by the quality sub-committees, as part of Directorate Performance Review processes and more widely within directorates, especially at team level. Future reporting could set out in the section of the Committee’s coversheet on “governance route/approval process” which other meetings had reviewed these reports. PM noted that this report would be submitted to quality sub-committees in the future and received within the Older People’s Directorate at senior management team meetings on a quarterly basis but there were no plans as yet to disseminate further to team level, especially as the report may become larger and more detailed.
AG and the COO referred to the measures in the report and suggested for this Directorate that additional measures be considered in relation to:
- caring measures, such as family and carer involvement;
- responsive measures, such as waiting times and actions taken; and
- well led measures, such as retention and development of staff.
The Committee noted the report and AGREED that directorate safety reports should be presented to the Committee for information and assurance. / PMcG
RB/
WW
7.
a
b
c / Caring and Responsive sub-committee escalation report and Complaints and Patient Advice and Liaison Service (PALS) annual report 2014/15
The COO presented Paper QC 22/2015 on the work of the first meeting of the Caring and Responsive sub-committee and Paper QC 23/2015 which set out complaints and outcomes/learning, PALS contacts and compliments received for 2014/15 and provided assurance against CQC Outcome 17.
The DoN noted that prior to publishing the report on the Trust’s website, it should be revised to include: the impact of the Trust no longer providing some services into HMP Bullingdon; more outcomes from the parliamentary ombudsman; analysis of the reasons why the number of complaints in Buckinghamshire was so close to the number in Oxfordshire, although few services were provided in Buckinghamshire. MB added that it would also be useful if a revised version of this report and/or future reporting on complaints included analysis of whether action plans were addressing common themes.
The Committee noted the report and, subject to the comments above, AGREED that it could be published on the Trust’s website without needing to be presenting to the Board for further review first. / RA
8.
a
b
c / Well Led sub-committee escalation report
The CEO provided an oral update of the most recent meeting of the Well Led sub-committee and highlighted:
- the development of regular team leader meetings in each geographical area;
- the recent discussion at the Executive meeting on embedding Aston Team based working principles in the organisation and identifying what constituted “teams”; and
- the need for a whistleblowing guardian, following the Francis report recommendations on whistleblowing.
The Committee noted the oral update. / SB
9.
a
b
c / Effectiveness sub-committee report
The MD presented Paper QC 24/2015 which summarised the business transacted by the Effectiveness sub-committee and provided a copy of the minutes of its meeting on 14 April 2015. The MD highlighted that:
- two new sub-groups reporting into the sub-committee had been created around public health and physical health;
- the Mental Health Act office had developed a useful document describing the changes to the Mental Health Code of Practice for staff;
- more assurance was required against NICE guidance and a gap analysis had therefore been commissioned of the NICE guidelines and technology appraisals;
- clinical audits would take place of safe and supportive observations and Do Not Attempt Cardiopulmonary Resuscitation;
- a sub-group had been set up to focus on updating relevant clinical policies; and
- recruitment and staffing issues had been considered and would be discussed further as part of the private Board meeting focusing on strategy in May 2015.
The Committee noted the report. / CM
10.
a
b
c
d / Clinical Audit Policy
The MD presented Paper QC 25/2015 which set out the revised Clinical Audit Policy.
AG noted that the policy applied to patients and asked how they were informed of the existence of the policy and its relevance to them, especially as the policy at Appendix A set out that NHS Boards should ensure that patient involvement was considered in all elements of clinical audit. The MD replied that this was a valid challenge and he would consider and report back on informing and engaging patients in a meaningful way in clinical audit. A patient briefing document and publication of this and other relevant polices on the Trust’s website may provide a starting point. The MD noted that issues with patient involvement and engagement also applied to other policies which would need to be considered more widely by the Executive.
The Committee reviewed the policy and requested that section 6.9 be revised to clarify who would follow-up action plans or be responsible for this, as opposed to monitoring action plans.
Subject to the comments above, the Committee APPROVED the revised Clinical Audit Policy. / CM
CM
11.
a
b
c
d / Clinical Audit Report
The MD presented Paper AC 26/2015 which provided an update against the Clinical Audit Plan 2014/15 and monitoring of clinical audit action plans and also included the Clinical Audit assurance report which had been provided to the Audit Committee in April 2015. The MD highlighted:
- the improvement in directorate monitoring of action plans and the decrease in the number of out-of-date actions; and
- further work required in the following areas, although the overall audit ratings for each of these areas had been “good”: Community Hospitals documentation; Care Programme Approach and the sharing of care plans with service users and GPs; and Essential Standards in relation to removing old Section 17 paper forms once out of date.