NHS GRAMPIAN
CLINICAL GOVERNANCE COMMITTEE REPORT
Introduction
The following key agenda items were discussed at the NHSG Clinical Governance Committee meeting on Friday 25th February 2011 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 Control plan as per 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. They 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
- Update on Safe Affordable Workforce (SAW)
This relates to strategic risk 853 Patient Safety
The Committee had asked for this item to be on the agenda to receive a report from the Director of Human Resources as the SAW process had now been in place within NHS Grampian for 12 months. This process had been agreed at Grampian Area Partnership Forum (GAPF) in February 2010 and stated “it is essential we review the workforce to ensure it is safe, affordable and able to meet the challenges ahead.” The SAW work progressed using generic principles including ensuring continuing safe clinical care by staff and these were then cascaded through the organisation. A “whiteboarding”exercise was used within each sector to evaluate their current workforce structures and design a new structure which was both safe and affordable. Once structures had been developed they were presented to challenge meetings where there was opportunity to discuss risks around patient safety. Key risks have been indentified including the risk that final structures once implemented may not be fit for purpose. The continuing need to balance the financial situation against patient safety has been woven into the process to ensure that neither outweighs the other. The Committee acknowledged the progress so far and noted the key risks.
- NHS Grampian Partnership with Independent Contractors
This relates to strategic risk 856 Support from Independent Contractors
The Committee received a paper detailing the ongoing work with independent contractors to achieve strategic objectives as outlined in the NHS Grampian Health Plan. Throughout the area, General Practitioners have worked with NHS Grampian to form geographic clusters which will provide a forum to mutually discuss the needs of the local population and how that impacts on the local Health Plan. It is hoped that the national changes to the GP contract will allow more flexibility locally to agree outcomes with NHSGrampian and replace the existing National Quality outcomes for GP practices. The paper also discussed progress made with other independent contractors including the local success of the emergency ophthalmology service. This was managed by the independent ophthalmologistsand it was noted that there had been a decrease of 40% in the attendance at the hospital for emergency services. The Committee noted the activity around this work, accepted that the risk was low and asked for a further report in 12 months time.
3. Healthcare Associated Infection Report.
The Committee received a Healthcare Associated Infection report and were assured that infection rates and interventions are monitored and appropriate action was being taken to reduce the number of healthcare associated infections in NHS Grampian. The Committee was pleased to note that a significant decrease was seen in the number of all infections across Grampian and that the production and publicising of the antibiotic guidelines had been beneficial in reducing Clostridium Difficle Infection(CDI)rates. The Committee will continue to be kept fully informed of the ongoing improvement work.
4. Extra Corporeal Membrane Oxygenation (ECMO)
The Committee was pleased to note that the acute sector had formally become part of theUK wide surge capacity for the H1N1 outbreak during December 2010 till February 2011. Although the work around staffing and equipment capacity continues to be directed by Leicester, 5 patients were treated in ARI over 34 days. As part of the commitment to the potential ongoing provision of Extra-Corporeal Membrane Oxygenation (ECMO), opportunity had arisen to recruit a further 10 nursing posts in ITU. The opportunity also exists as part of the Scottish network to transfer patients to other Scottish Centres if the need arises. The Committee were asked to note this success.
Recommendations
The Board is asked to note the above extracts from reports placed before the Clinical Governance Committee and acknowledge that the Committee’s role and responsibilities are being met
Charles Muir
Chairman of Clinical Governance Committee
February 2011