Minutes of the Quality Committee, 8Th February 2017

PUBLIC

Minutes of the Quality Committee, 8th February 2017

Quality Committee

[DRAFT] Minutes of the meeting held on
8th February 2017 at 09:00in the Ascot Room, Corporate Services, Littlemore Mental Health Centre, Oxford OX4 4XN

Present:
Martin Howell / Trust Chair (Chair of meeting) (MH)
Stuart Bell / Chief Executive Officer (SB)
Mark Hancock / Medical Director (MH)
Ros Alstead / Director of Nursing and Clinical Standards (RA) part meeting
Dominic Hardisty / Chief Operating Officer (DH)
Anne Grocock / Non-Executive Director (AG)
Mike Bellamy / Non-Executive Director (MB)
In attendance:
Wendy Woodhouse / Clinical Director, Children and Young People’s Directorate (WW)
Susan Haynes / Deputy Director of Nursing (SH)
Martyn Ward / Interim Director of Performance, Contracting and Business Intelligence (MW)
Kerry Rogers / Director of Corporate Affairs & Company Secretary (KR)part meeting
Hannah Smith / Assistant Trust Secretary (HS) (Minutes)
Laura Smith / Executive PA to Medical Director (LS) (Minutes)
Sula Wiltshire / Director of Quality & Innovation and Lead Nurse - Oxfordshire CCG (SW)
1. / Welcome, Apologies for absence and Quoracy / Action
a / Apologies for absence were received from: Mike McEnaney, Director of Finance; Jonathan Asbridge, Non-Executive Director; and Rob Bale, Clinical Director -Adult Directorate.
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c / Minutes of the meeting held on 09 November2016
The Minutes were received as a true and accurate record of the meeting.
Matters Arising
The Committee confirmed that thefollowing actions from the 9th November 2016 Summary of Actions had been completed, actioned or were on the agenda for the meeting:2(c) - on the agenda; and 6(e) - completed.
The actions against items 5(c) and 10(d) had been progressed and reporting against them would be held over to the next meeting.
The Director of Corporate Affairs and Company Secretary joined the meeting.
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i / Care Quality Commission (CQC) post-inspection improvement plan update
The Deputy Director of Nursing provided an oral update and explained that a robust post-inspection improvement plan was in place and that she was assured that most actions had been completed. She said thata series of peer reviews had been set up for community hospitals andfurther areas hadbeen identified for ad hoc peer reviews.
The Deputy Director of Nursing explained that the focus of the IC5 group would now be to move the Trust to an “excellent”rating and toidentifypriority areas for improvement. She noted that the focus of the CQC had changed toconcentratemore on the Well-Led domain and physical health.
The Deputy Director of Nursing explained that due to CQC capacity the Trust wasstill waiting for a follow up inspection for community hospitals.
The CQC report from the Out of Hours Service inspection had not yet been received. The CQC had confirmed that the Out of Hours rating wouldnot affect the Trust’s overall rating of “good”.
The Chief Executive reported that over the Christmas period Out of Hours contacts increased by 20% compared to the same period in 2015, with 30% more home visits. The Chair noted that media attention was focused on pressures in A&E and that it was important for the Trust toraise awareness of pressures in Out of Hours.
Ros Alstead, Director of Nursing,joined the meeting09:15.
The Director of Nursing reported the biggest issues in community hospitals relate to use of the Electronic Health Record (EHR)and medical input. The Chief Operating Officer explained that the Chief Information Officer was working with the Directorate on EHR and provided a regular update into the Board meeting in private. He said that Robbie Dedi, Deputy Medical Director, was taking a lead on reviewing the medical cover arrangement with Oxford University Hospitals NHS FT (OUH).
Mike Bellamy noted the move in the right direction and was impressed with the level of assurance being put in place and the work being done on the peer review programme and the Trust’s internally-generated ideas for improvement.
The Committee noted the update.
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g / Mental Health Homicide and Domestic Homicide Reviews in the last 5 years – discussion on assurance
The Director of Nursing presented paper QC 02/2017 which had previously been circulated with the agenda andwhich provided a summary of all homicides in Oxfordshire and Buckinghamshire since April 2011 where the perpetrator or victim was a current or former patient.
The Director of Nursing noted that it would be helpful to have assurance from Rob Bale (Clinical Director – Adult Directorate) that he wassatisfied actionswerebeing met.
The Chief Executive said that the number waslikely to increase with the roll out of IAPT (Improving Access to Psychological Therapies) services as this may increase the number of people in contact with mental health services.
The Director of Nursing highlighted challenges in engaging with victims’ families and the impact upon them. Sula Wiltshire said it was important to look at getting contact with the victims’ families right at an early stage, and emphasised how external partners couldhelp. The Trust had run events and workshops with One Hundred Families to raise staff awareness of family involvement.
The Chief Executive noted that there were particular challenges regarding deaths of patients with addictions, given that the Trust no longer ranaddiction services which were separately provided and commissioned. The Chief Operating Officer noted that, following recent discussion with Oxfordshire Clinical Commissioning Group (OCCG), work would take place to establish an aligned NHS position and then engage with partners such as the county council on this. Sula Wiltshire added that the work of the Vulnerable Adults Mortality Group would also feed into this.
The Chair acknowledged that in some cases there could be differences of opinion over a clinical judgement which had been made. He expressed concerns regarding potential blame being placed on individuals for making such judgements.
The Committee noted the report / RB
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u / Safety sub-committee escalation report
Incidents and Patient Safety report
The Director of Nursing presented the reportQC 03/2017 which had previously been circulated with the agenda. She reported that there remained a high number of incidents in web holding. The Chief Operating Officer added that there had been a concerted effort to reduce these within the Directorates however most of the incidents appeared to be in Corporate Services.
Anne Grocock said that concerns were raised at Audit Committee with regard to timeliness of actioning incidents inweb holding and that incidents werenot being acted on. The Director of Nursing said that incidents werereviewed at various levels, other than by the owner in web holding, and felt confident that there wereno serious incidents waiting. The Chief Executive said that the focus should be on improving the process and not just clearing out older incidents; he emphasised the importance of understanding and learning from incidents and why there may have been delays in the process and not making the running of a smooth processthe goal itself or unnecessarily adding to bureaucracy.
The Director of Nursing said that violence and aggression was the highest reported incident type and work was underway to reduce this. She noted that the level of racial abuse towards staff was high and stressed the need to support staff when they wereexperiencing this.
The Director of Nursing congratulatedNokuthula Ndimande, Modern Matron/Unit Manager – Adult Directorate, on being shortlisted for the British Journal of Nursing award for mental health nurse of the year for her work reducing instances of patients going Absent Without Leave.
The Director of Nursing reported that the number of falls had increased however there were low levels of harm caused. She acknowledged that more work was needed to prevent falls.
The Director of Nursing highlighted that a couple of wards in Buckinghamshire had experienced ahigh number of medication incidents, serious incidents and complaints. This was being reviewed bythe Clinical Director and the Service Director for the Adult Directorate, and an action plan wasbeing developed which wouldalso be reviewed by the Executive. The Director of Nursing noted that leadership at the point of care was being taken very seriously and the Deputy Director of Nursing was also providing regular support. Sula Wiltshire recognised the importance of the Trust picking up early warning signs and workingto get ahead of the issues.
The Director of Nursing highlighted high staffing pressures on Older People’s Mental Health wards.
The Director of Nursing reported that Mazars work wasprogressing well and that this work would lead to a significant increase in deaths reported in the quality accounts which may generate press interest. She was working closely with the Clinical Commissioning Groups to manage this. The Medical Director and Trust Chair were scheduled toattend an NHS Improvement event ‘Learning from Deaths in the NHS’ in March.
The Director of Nursing highlighted the inpatient ward death and confirmedthat care and service delivery improvement recommendations were being acted upon. Jo Riley, Respiratory Nurse, wasgivingtraining in community hospitals and further work would take place in mental health wards.
The Chief Executive suggested looking at how the Oxyhealth equipment being piloted on other wards could be used to detect respiratory issues and raise an alarm. The Director of Nursing agreed to follow up.
The Trust Chaircommended the decrease in the number of ligature incidents.
Anne Grocock noted that,looking at Serious Incident (SI) themes, lack of documentation around risk assessment appeared to be highlighted. The Medical Director replied that attendance at training for risk assessments was improving and this was now part of induction so new clinical staff would receive this training early; the risk assessment form had been updated with fewer drop-down boxes to navigate so it was quicker to complete.
Sula Wiltshire notedthe good work being done by the Quality and Risk Team, particularly around prone restraints. She said that racial violence and aggression wasalso a concern and staff support needed to be addressed. The Director of Nursing confirmed that staff were supportedand there were very active debriefing sessions post-incident but there were sometimes differences between wards in terms of the threshold for what amounted to a SI which may need to be considered.
Mike Bellamy noted that the report highlighted the amount of work taking place and the staff time devoted to quality. He was reassured by the Trust’s investigation processes and ability to analyse incidents but queried whether more needed to be done around follow up of actions, particularly around the six key themes identified from SI investigations and listed in the report.
Mike Bellamy also asked about ongoing plans for the roll-out of PEACE (Positive Engagement and Caring Environments)training.The Director of Nursing confirmed that this would continue to be rolled out and said that the training had gone well at the pilot site, the Highfield, but that it had been difficult to release staff in other areas to carry out group training. The PEACE group werere-assessing how this should be rolled out and were working on developing PEACE champions on wards as an alternative way of delivering the training and upskilling staff. Mike Bellamy noted that it would be useful to receive more information on the progress made by PEACE champions and to be assured that this new approach had a clear roll-out plan within the organisation. More detail on the roll-out of PEACE training would be included in the next report.
The Director of Nursing reportedthat the Pressure Ulcer Steering Group waslooking at how safer care work wasprogressing in pilot teams. Capacity issues wereimpeding work and some teams hadhad to halt work due to capacity. The Director of Nursing wouldprovide more detail on the pressure ulcer prevention plan to thenext Quality Committee meeting. She explained that this wasa priority for the Older People’s Directorate.
Fire Safety Report
The Director of Nursing presented the report QC 04/2017 and explained that smoking cessation work was underway to try and reduce the number of smoking related incidents.
The Trust Chair noted the high number of false alarms and asked if these could be prevented. The Director of Nursing confirmed that some of these wereexpected, some wererelated to patient incidents and some weredue to faulty systems (particularly on the oldest site, the Warneford). Anne Grocock asked whether training levels should be higher in areas with faulty systems, The Director of Nursing replied that fire drills and evacuation practices were more frequent on such sites.
Anne Grococknoted the low levels of fire awareness and fire marshal training and asked what was being done to improve this. The Director of Nursing replied thatthis was mainly due to capacity of staff and that teams needed to make sure that this training was prioritised.
The Committee noted the report / RA
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g / Caring and Responsive sub-committee escalation report
The Chief Operating Office presented the report which had been tabled at the meeting. He highlighted that the Trust’s two-star accreditationunder the Carers’ Trust Triangle of Care had been renewed;the Trusthad been commended on being a best practice exemplar.
He noted that CPA (Care Programme Approach) audit results were improving and suggested that this becelebrated through the Communications Team with examples of work and statistics.
He said that there had been a reduction in complaints, however there was not enough data to show whether this wasa trend.
The Chief Operating Officer highlighted that areas of unsatisfactory compliance or risk were: the Trust’s position on the national Stonewall Index;complaints around communication and staff attitude;Delayed Transfers of Care (DToCs) in community hospitals; and governance around performance against theOxfordshire OutcomesBased Contract (OBC). He noted that a thematic review was underway for complaints relating to communication. A separate paper would also be brought to the Well-Led sub-committee to provide further assurance that action plans had been implemented in relation to the governance around OBC performance.
The Trust Chair noted in relation to the OBCthat measuring of outcomes was always going to be challenging, andthat it was important to ensure that the Trust worked well with third sector colleagues. He noted that partnership working wasincreasing and this presented governance challenges which organisations needed to adapt to. The upcoming Well Led review wouldhelp the Trust to explore this further. The Interim Director of Performanceadded that information sharing between partners would be a significant development area for the Trust and noted that it was positive that partner organisationshadalready agreed to use the Trust’ssystem and input data directly into it which would avoid reporting individually and avoid unnecessary duplication.
Complaints and Patient Advice and Liaison Service (PALS) Q2 report
The Director of Nursing presented the reportQC 05/2017 and explained that complaints appeared to be increasing in Adult Mental Health Teams and it was importantto understand why;she would ask the Head of Complaints and PALS to report on this.
The Committee noted the report. / DH
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i / Well Led sub-committee escalation report
The Chief Executive presented the escalation report which had been tabled at the meeting. He highlighted the complexity and challenges of the Trust’s mental health partnership work and relationships and the need to bring together a systematic catalogue of relationships and to work through their governance mechanisms. The Performance Management Project which the Interim Director of Performance was leading was already building good foundations in this area.
He reported that Jill Bailey had been appointed as Associate Directorof the Centre for Quality and Safety.
The Chief Executive notedthat the staff survey results had beendiscussed and would be reported on further at the upcoming Board Seminar.
The Chief Executive reported that the following policies had been approved:the Whistleblowing policy;the Medical Disciplinary policy; and the Nursing Revalidation policy. The Nursing Revalidation policy was a new policy and wouldtherefore be circulated to the administrators of the Quality Committee for onwards transmission for approval.