PUBLIC
Minutes of the Quality Committee,9th November 2016
Quality Committee
Minutes of the meeting held on
9th November2016 at 09:00in the Ascot Room, Corporate Services, Littlemore Mental Health Centre, Oxford OX4 4XN
Martin Howell / Trust Chair (Chair of meeting) (MH)
Stuart Bell / Chief Executive Officer (SB)
Anne Grocock / Non-Executive Director (AG)
Mark Hancock / Medical Director (the MD/CM)
Sue Haynes / Deputy Director of Nursing (SH) (deputising for Ros Alstead, Director of Nursing and Clinical Standards) part meeting
Pauline Scully / Service Director, Adult Directorate (PS) (deputising for Dominic Hardisty, Chief Operating Officer) part meeting
In attendance:
Rob Bale / Clinical Director, Adult Directorate (RB)part meeting
John Campbell / Head of Nursing, Older People’s Directorate (JC) part meeting
Jane Kershaw / Acting Head of Quality and Safety (JK)
Pete McGrane / Clinical Director, Older People’s Directorate
Kerry Rogers / Director of Corporate Affairs & Company Secretary (the DoCA/CS)
Hannah Smith / Assistant Trust Secretary (HS) (Minutes)
Teresa Twomey / PA to Director of Corporate Affairs & Company Secretary (Minutes)
Martyn Ward / Interim Director of Performance, Contracting and Business Intelligence
Sula Wiltshire / Oxfordshire CCG(SW)
1. / Welcome, Apologies for absence and Quoracy / Action
a / Apologies for absence were received from: Mike McEnaney, Director of Finance; Dominic Hardisty, Chief Operating Officer; Ros Alstead, Director of Nursing and Clinical Standards; Jonathan Asbridge, Non-Executive Director; Mike Bellamy Non-Executive Director; and Wendy Woodhouse, Clinical Director, Children and Young People’s Directorate.
2.
a
b
c / Minutes of the meeting held on 08 September2016
The Minutes were receivedas a true and accurate record of the meeting.
Matters Arising
The Committee confirmed that the actions from the 8th September 2016 Summary of Actions had been completed, actioned or were on the agenda for the meeting:2(c), 2(d), 2(e), 2(f), 6(j), 12(d)/(h).
The action against item 2(a) would be held over until the next meeting:
80% of complaints having issues relating to communication and links to staff attitude/behaviour
Action for a thematic review of issues relating to communication and links to staff attitude/behaviour to be picked up via the Caring & Responsive quality sub-committee. / DH
3.
a
b
c
d / Care Quality Commission (CQC) post-inspection improvement plan update
The Deputy Director of Nursing presented paper QC 62/2016 which had previously been circulated with the agenda and explained that good progress had been made in completing actions across the directorates, with most having been completed successfully. She outlined those which remained in progress.
Anne Grocock asked whether the action relating to records management was being directly addressed and not just attributed to issues arising from the implementation of Carenotes.
Pete McGrane explained that many of the issues actually did relate to Carenotes and these were raised in risk registers. He said that issues were being addressed butthis needed to happen more quickly. He added that he was working with the Chief Operating Officer to resolve this.
The Committee noted the update.
Pauline Scully and Rob Bale joined the meeting.
4.
a
b
c
d
e
f / Quality Account Q2 Report
Jane Kershaw presented paper QC 63/2016 which had previously been circulated with the agenda and outlined the positive developments across the Trust such as an increased number of apprentices, active health and well-being groups, the successful peer review programme, PEACE training, and the launch of the Buckinghamshire Recovery college. She also highlighted the challenges faced in areas such as recruitment and retention, agency use, technical issues with Electronic Healthcare Records, and tackling pressure ulcers. Finally, she noted that some initiatives had been delayed, but were due to start by the end of the year.
The Trust Chair asked where the frustrations lay for users of the Carenotes system. Rob Bale explained that there was a dichotomy between clinical utility and performance with the system in that there was improved navigation of forms, many of which had been refined, but they still took too long to complete. He acknowledged, however, that progress was being made.
The Medical Director explained that he had met with Advanced Health & Care and there were good developments in the pipeline with, for example, electronic discharge systems to GPs in hand, and patient access planned for the longer term.
Anne Grocock asked how staff development pathways were being progressed, noting their value in the recruitment and retention of staff.Jane Kershaw explained that although work on the development pathways had stalled, a task and finish group chaired by the Associate Director of Clinical Education and Learning had been established to try and move the pathways forward.It was hoped the pathways would start to be implemented from early 2017.
Anne Grocock asked how issues relating to Out of Area Transfers (OATs) were being addressed. Rob Bale explained that there was a lack of beds available locally and significant pressure on inpatient wards. He said that beds needed to be used efficiently and differently and teams were being asked for ideas on how to do this creatively.
The Committee noted the report
5.
a
b
c
d / Nursing Strategy Update
The Deputy Director of Nursing presented paper QC 72/2016 which had previously been circulated with the agenda. She said that overall progress had been slowed by the CQC visits which had taken up time previously allocated to this.
The Deputy Director of Nursing explained that there were 60 actions in progress,with only 5 yet to commence.Of those, nurse revalidation had been fully progressed as a priority and a rolling programme of revalidation videos and training awareness was to be made available on the intranet.
The Committee discussed the strategy and commented on the number of
different elements. It was suggested that the strategy be brought back to a future meeting with 5 clear priorities identified so that directorates could focus on achieving them.
The Committee noted the update / SH/RA
6.
a
b
c
d
e
f / Safety sub-committee escalation report
Incidents and Patient Safety report
The Deputy Director of Nursing presented paper QC 64/2016 which had previously been circulated with the agenda and explained that whilst the number of reported incidents had increased, this was positive as it meant that the reporting culture was open and evaluative.She explained that the most common incidents related to violence and aggression, skin integrity, and communication /confidentiality.
It was noted that there had been an increase in serious incidents, although no particular pattern had emerged with regard to cause. Pauline Scully explained that there had also been an increase in suicide interventions and that she had met with the Director of Nursing and Clinical Standards to identify themes, as well as try to understand risks and how it might be possible to work with people differently, for example, through the introduction of family therapy workers on wards.
The Trust Chair noted that communication had been raised again as amongst the highest incident rate issue. Rob Bale explained that the Triangle of Care initiative had been reinvigorated in order to address this and to re-engage patients and carers fully in communication.
Pauline Scully and Pete McGrane left the meeting. John Campbell joined the meeting.
Reported incidents involving physical restraint
Jane Kershaw presented paper QC 65/2016 which had previously been circulated with the agenda and explained that there had been a reduction in prone restraints. She said that this practice had been analysed by the Patient Experience Group in order to understand, post experience, how it felt for the patient. It had also been considered by the PEACE steering group.
The Chair asked about the length of stay for patients in long term seclusion and the Medical Director explained that there was a lengthy waiting list for patients to be transferred on to other secure hospitals. He said that he had raised the issue with the CQC. The Chair said that it would be useful for future reporting to reflect issues with delayed transfers and actions being taken to address.
The Committee noted the report / JK/RA
7.
a
b
c
d
e / Caring and Responsive sub-committee escalation report
Paper QC 66/16 which had previously been circulated with the agenda was presented. The Chair highlighted the area of concern raised with regard to non-compliance with the National Accessible Information Standard and Jane Kershaw explained that the Equality & Diversity Officer was working with the CQC to understand the requirements.
Complaints and Patient Advice and Liaison Service (PALS) Q2 report
Jane Kershaw presented QC 67/2016 which had previously been circulated with the agenda and noted that whilst there had been an increasing number of complaints, many of these were lower level and referred to, for example, waiting times.
Anne Grocock asked about the types and levels of complaints that were made about communication and Rob Baleexplained that many related to a lack of information provided during transition between services, over use of technical language, attitude of staff, as well as poor communication between services and across boundaries.
Pauline Scully noted that there was work underway in Buckinghamshire to address some of those issues that arose during transition between services.
The Committee noted the report and agreed that the breakdown of information by complaint was not required for future meetings.
8.
a
b
c / Well Led sub-committee escalation report
The CEO provided an oral update on the recent discussions at the Well Led sub-committee. He noted the work being completed by the Interim Performance Director, the imminent start of the new HR Director, whose focus would initially be on recruitment and retention, as well as the launch of the Quality and Safety Improvement Academy. He explained that this latter organisation provided a vehicle for building on the work of the AHSN (Academic Health Science Network) by bringing together a number of resources within the Trust. He said it was an important part of the response to issues of safety raised by the CQC.
The CEO noted a review of resuscitation training across the Trust, designed to ensure consistency and to bring it into line with best practice elsewhere, and he also highlighted the recent Conference on Health and Faith which he said had been well attended by leaders from local faith communities.
The Committee noted the update
9.
a
b / Effectiveness sub-committee escalation report
The Medical Director presented paper QC 68/2016 which had previously been circulated with the agenda and highlighted the attendance at the recent Effectiveness Committee of a representative from the Clinical Ethics Advisory Group, the technical issues surrounding the completion of Patient and Personal Safety Training, as well as issues surrounding future CRN funding.
The Committee noted the report.
10.
a
b
c
d
e / Clinical Audit Q1 Report, summaries of completed audits
The Medical Director presented paper QC 69/16 which had previously been circulated with the agenda and which summarised the range of clinical audits taking place across the Trust. He said that the Trust was currently up to date with Q1 audits but out of time with Q4 audits from last year. He said that the audit plan had been revised and reduced from 77 to 70, and that this would be discussed again in January.
The Medical Director noted the National Audit on Psychosis which had set a two week deadline for mental health patients to be allocated a care co-ordinator following initial assessment. He also highlighted the need for monitoring of physical health prior to prescribing Valproate.
The Medical Director explained that documentation surrounding the Mental Health Act had changed and Jane Kershaw noted that matrons and teams within community hospitals were undergoing training and being encouraged to take responsibility for ensuring consistency when completing documentation.
Anne Grocock noted that Internal Audit had raised concerns in their audit of medicines management with regard to controlled drugs. Sula Wiltshire asked that information/an update on anti-microbial prescribing be supplied in future reporting.
The Committee noted the report. / MHa
11.
a
b
c / Annual Clinical Audit Report
The Medical Director presented QC 70/2016 which had previously been circulated with the agenda.
There were no questions pertaining to this from the Committee.
The Committee noted the report
12.
a
b
c
d / End of Life Care
John Campbell presented QC 71/2016 which had previously been circulated with the agenda. He highlighted areas of best practice which had been implemented across the Trust including training via the End of Life Link Nurses network, workshops on having difficult conversations, and the amalgamation of resources and information on End of Life and Palliative Care onto the Trust’s intranet.
John Campbell noted the need to complete work around care plans for patients with learning difficulties, and the clinical challenges in terms of communication between hospitals and community nursing staff. He said, however,the End of Life Service review had established End of Life Care at the centre of care provision within Integrated Localities and the pivotal role of Community Matrons for End of Life and Supportive care has been recognised within this.
Anne Grocock asked about the speed of training roll out for the syringe driver referred to in the report and John Campbell explained that the company had initially given support with training but this was now being completed by End of Life Care nurses. He said that a training needs analysis was now needed in order to ensure complete coverage of all relevant staff.
The Committee noted the report
13.
a
b
c
d / Operational and Strategic Risks Discussion – including Trust Risk Register and Board Assurance Framework
The DoCA/CA presented QC 73/2016 which had previously been circulated with the agenda. The Assistant Trust Secretary identified the key risks facing the Trust and explained that a process of revising and rerating was underway and would be addressed in more detail at a future Board Seminar.
The Committee agreed to reduce the target risk rating for BAF risk SO 7.1 on Estates as the net risk rating achieved had improved on the target risk rating. The new target risk rating would have an impact rating of ‘3’ (moderate), likelihood of ‘2’ (unlikely) and overall target of ‘6’ (medium).
The Committee noted that the target risk ratings for the 3 extreme BAF risks in relation to non-delivery of Cost Improvement Programme Savings a SO 2.3; inadequate planning for future workforce requirements at SO 5.1A; and inability to fill vacancies at SO 5.1B may also need to be increased in the future. The target risk rating for the high risk around collaborative planning at BAF SO 4.2 may also need to be increased.
The Committee noted the update
14.
a
b / Registered Non-Medical Practitioners requesting plain x-rays policy
The Medical Director presented paper QC 74/2016 which had previously been circulated with the agenda and which set out the policy regarding non-medical practitioners requesting plain x-rays.
The Committee approved the policy.
15.
a / Any Other Business
S.75 Joint Management Groups (JMGs)
Pauline Scully noted that work was taking place focusing on the Oxfordshire JMG to develop an action plan. She had set up monthly meetings in Adult social services to review. There were no particular concerns with the Buckinghamshire JMG.
The meeting was closed at: 11.30am
Date of next meeting: Wednesday 8th February2017 09:00-12:00
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PUBLIC
Minutes of the Quality Committee,9th November 2016
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