APPROVED
Minute of Meeting of the NHS Grampian Clinical Governance Committee
held on Friday 25th May 2012 at 9.30am
in the Conference Room, Summerfield House, Eday Road, Aberdeen
Present: / Mr C Muir, Non-Executive Board Member (Chairman)Professor N Haites, Non-Executive Board Member
Mr T Mackie, Non-Executive Board Member
Professor V Maehle, Non-Executive Board Member
Mr M Scott, Non-Executive Board Member
In Attendance: / Dr J Callender, Clinical Governance Lead-Mental Health Services
Mr A Coldwells, Assistant General Manager, Acute Sector(Agenda Item 10.4)
Mr Michael Coulthard, Quality Informatics Manager(Agenda Items 5.1)
Dr R Dijkhuizen, Medical Director
Dr J Fitton, Clinical Governance Lead – Aberdeenshire
Dr N Fluck, Interim Clinical Governance Lead, Acute Sector (Agenda Item 10.4)
Mrs P Harrison, Infection Control Manager
Dr J Hogg, Clinical Governance Lead, Moray CHP (video conference)
Councillor W Howatson, Chairman, NHS Grampian
Mrs Therese Jackson, Consultant Occupational Therapist in Stroke (Agenda Item 8.2)
Mr Mark McEwan,Service Planning Lead (Agenda Item 3.2)
Ms Anne McKenzie, AHP Sector Lead Moray CHSCP(video conferenced for Agenda Item 3.1)
Mrs Linda Oldroyd, Nurse Consultant in Patient Safety & Experience (Agenda Item 5.1 & 5.2)
Dr C Provan, Clinical Governance Lead, Aberdeen City CHP
Ms H Robbins, Head of Quality, Governance & Risk
Mr D Shaw, Dental Practice Adviser
Mrs E Smith, Director of Nursing & Quality
Mrs E Tait, Professional Lead for Clinical Governance
Mrs N Urquhart, Public Representative
Ms S Webb, Clinical Governance Lead, Public Health & Planning
Dr B Welsh, Project Clinical GP Lead(Agenda Item 7.1.2)
Ms K Dickson, Administrator (shadowing Mrs Shepherd)
Mrs F Shepherd (Committee Secretary)
The Chairman welcomed everyone to the Committee and introduced those who were attending by video conference and for particular agenda items.
The Chairmaninformed the Committee thata closed session would take place following the full meeting today. In order to make time for this the full Clinical Governance Committee meeting would finish at 1.45pm.
Item
/Action
- 1
Apologies were received from Mr R Carey and Mr A Pilkington.
MINUTE OF MEETING HELD ON 24th OF FEBRUARY 2012
The minute of the meeting held on 24th February 2012 was accepted as an accurate record.
NHSG CLINICAL GOVERNANCE COMMITTEE – AREAS OF ASSURANCE PLAN FOR 2012 (Strategic risk 853)
3.1 / Falls and Bone Health Update
The Chairman welcomed Ms McKenzie, AHP Sector Lead Moray CHSCP, to the Committee to present the update paper on Falls and Bone Health.
Ms McKenzie gave a brief introduction to the paper summarising the cost and consequences that falls and fragility fractures place upon older people and Grampian’s Health and Local Authority services.
Ms McKenzie stated that the aim of the report was to inform the Committee of the plans and projects which were currently operational and the overall strategic aim to reduce the impact of falls and fractures within both communities and hospitals.
The key points highlighted included:
- The falls strategy, which had originally been written in 2006, had now been refreshed to combine both falls and bone health following recommendations in HDL 13 in 2007. This combined strategy was now awaiting endorsement by NHS Grampian. Ms Robbins confirmed that she had met with Mrs Smith and a plan was in place for taking forward endorsement for the refreshed strategy with the Clinical Operational Management Team.
- It was noted that further guidance and discussion regarding recommended care bundles to improve the process for care and patient outcomes would take place at the NationalIn-patientFalls event in June. Ms McKenzie mentioned that a meeting had taken place with Ann Murray, National Falls Lead, who had also provided support to NHS Grampian as the single Scottish pilot site for implementation of the care bundles associated with people who experience falls in the community.
- While reducing the number of falls and subsequent harm within hospitals was a key piece of work, it was anticipated that service improvement methodswould drive improvement and improve reporting within the organisation. The Committee expressed particular interest in intentional rounding which had been shown to have a positive impact.
- The main challenges for this piece of work included ensuring an organisational approach to the falls and bone health work, with short-term funding.
The Chairman thanked Ms McKenzie for attending the Committee, following which she left the meeting. / AM
3.2 / Prison Health Update
Mr McEwan, Service Planning Lead, introduced the above report, which built on the previous paper submitted to the Clinical Governance Committee on the 27th May 2011.
The Committee wasreminded that, in November 2011, responsibility for delivering healthcare services to prisoners in Scotland transferred from Scottish Prison Services (SPS) to NHS Boards.For NHS Grampian this involved HMP Aberdeen and HMP Peterhead. Over the next 18 months the configuration of prisons and the prison population in Grampian will change with the opening of a single HMP Grampian based in Peterhead. This establishment will house all Grampian prisoners and will be Scotland’s first ‘community-facing’ prison. The 550 inmates will include male and female prisoners, young offenders and children. There is significant prisoner movement between prisons presently and this not only results in a fluctuation inthe number of prisoners presently in the two prisons within Grampian but also significantly alters the types of prisoners, resulting in changes in health service requirements. This primarily affects HMP Peterhead which no longer houses thesex offender population and hada significantly increased substance misusing prison population.
Mr McEwan highlighted the key risks from the report and the Committee raised concern around the number of financial risks to NHS Grampian resulting from the transfer, as it had been clear from the outset that the transferred budget was unlikely to cover the cost of the service inherited. These include costs for providing Out Of Hours medical care within existing prisons and the change in the types of prisoners. It was noted that NHS Grampian had made provision to cover the identified cost pressures and that the budget shortfall was currently the subject ofdiscussion between NHS Scotland and Scottish Prison Services. Mr Scott expressed concern over the finances and resources required to support this project and asked if NHS Grampian had an overview of the budget. Dr Dijkhuizen mentioned that there was a national forum where these issues were raised. However, the Chairman stated that the Committee would require assurance that the financial issues were being actively managed.
The Committee was pleased to note that NHS Grampian was hosting the national prison IT health system (Vision) and praised the work of NHS Grampian IT service. The Committee was also pleased to note that the external audit report produced by Price Waterhouse Coopers had stated:
‘There was effective joint working and partnership within NHS Grampian for instance between Planning, HR, Finance and IT’.
‘The production of a comprehensive operational plan which set out milestones relating to the transfer of responsibility from SPS to NHS Grampian, including the assignation of responsibilities within Grampian and deadlines for completion of action’.
Staff and services transferred to NHS Grampian from Scottish Prison Services and private providers were mentioned, including Medical, Nursing, Optometry and Dental and those not transferred, including Pharmacy and Enhanced Addiction Contracted Services. It was noted that NHS Grampian was working with NSS National Procurement and other affected NHS Boards to review these arrangements before making any decisions for future provision. However, it looked likely that the current addiction service arrangements would continue until March 2013.
In connection with the key risks, Dr Provan brought to the attention of the Committee the concerns with prison staffing, due to sickness absence, vacancy advertising and training, as stated in the Aberdeen City CHP Sector Report. Dr Provan mentioned that it had been difficult to attract staff to these posts but that interviews had taken place, staff had been moved on a temporary basis from Peterhead prison and community nurses interested in working in the prison were being trained. Queries were raised regarding security issues around adequate staff levels on back shift. However, the Committee was assured that this was not a major risk due to the volume of work that occurred at this time.
Dr Callendar expressed his concern over the involvement of Mental Health Services. However, Mr McEwan mentioned that the involvement for Mental Health Services would be incorporated into the Service Plan.
It was noted that none of the risks highlighted was significant and that all were being managed.
The Clinical Governance Committee noted the excellent progress to date and asked for further updatein connection with mental health and finance at a future meeting. It was noted that a health needs assessment would inform the discussion.
The Chairman thanked Mr McEwan for attending the Committee, following which he left the meeting.
The Committee agreed to report this item to the Board. / MMcE
HEALTHCARE ASSOCIATED INFECTION REPORT (Strategic risk 853)
Mrs Harrison referred to the update report for Healthcare Associated Infection.
The report summarised the work of the Infection Prevention and Control Team (IPCT) and staff throughout NHS Grampian. Mrs Harrison read through the report and highlighted each of the main points on pages 1 and 2, additional comments noted included:
- December and January saw the highest numbers of Staphylococcus Aureus bacteraemia for 6 months in patients under 65. Each case was investigated and no common cause/link was found.
- There had been no cases of MRSA bacteraemia for 8 months in Aberdeen Royal Infirmary.
- The hand hygiene audit results for Woodend of 90% had proved to be due to reporting issues. The issue had now been resolved with March results being 98%.
While talking through the graphs on page 8 of the report Mrs Harrison stated that NHS Grampian was ahead of the HEAT target with reference to Clostridium Difficile Infection cases and in line with the HEAT target with regard to the Staphylococcus Aureus bacteraemia rates.
Issues with cleaning monitoring compliance at WoodendHospital had been shown to be mainly due to the age of the hospital but a recent root cause analysis exercise had started to have an impact.
The Committee discussed the low level of Norovirus across Grampian sites compared with the rest of Scotland. Memberswere interested to hear about the recommendations that had been implemented following a recent Tuberculosis incident and the measures taken to increase the awareness of Tuberculosis in the community, such as the ‘Think TB campaign’.
Recommendations following a suspected case of Legionella within Aberdeen Royal Infirmary were confirmed as being taken forward by the Legionella Group.
The Clinical Governance Committee acknowledged receipt of this report and waspleased to hear of the continued progress being made across all NHS Grampian sites.
Queries were raised with reference to Salmonella and Ecoli reporting and it was confirmed that all infections were appropriately recorded with Public Health and escalated.Following discussion, it was noted that information reported to Public Health in sectors was not pulled together to evidence trends. It was suggested that this be a topic for a future Clinical Governance Development session.
The Clinical Governance Committee acknowledged receipt of this report and whilst being pleased to hear of the continued progress being made across all NHS Grampian sites, emphasised the importance of not becoming complacent about the results.
PERSON CENTRED (Strategic risk 853)
5.1 / Joint Incident, Feedback and Claims Report
The Chairman welcomed Mrs Oldroyd, Nurse Consultant Patient Safety & Experience, and Mr Coulthard, Quality Informatics Manager, to the Committee to present the paper on Joint Incident, Feedback and Claims.
Mrs Oldroyd and Mr Coulthard referred to the report and highlighted some of the key points as detailed below:
- There was an increase in one of the Top Five incidents reported for the stage of care; infrastructure or resources. Mr Coulthard would be investigating why this had increased so dramatically.
- The Top Five complaints issues reported for the complaint ISD Type; Staffing issuesand waiting times had significantly increased. Mr Coulthard would be investigating these two increased complaint categories.
- Page 2 illustrated the overall number of incidents reported with no harm, which had increased to over 400 incidents reported on Datix.
- Page 3 measured a ‘good’ reporting culture the target of 20% or less, our Incident Reporting Culture result were slightly above. This increase might be due to incidents more likely being reported that had caused actual harm and less likely to report incidents that had not caused harm. Patient related incidents had a slight increase, the harm to no harm outcomes would be investigated to look into why.
- Page 6 showed thatcompliments received in 2010 were 32%: 2012 reflected a significant decrease to 17.5%. This was due to a back log of compliments that had to be included on the system.
- The re-design of the Feedback Service had resultedin a delay in entering feedback on the web-based module which resulted on sector response targets not being met.
Professor Maehle asked if it was reassuring to see the ‘harm’ ‘no harm’ outcome. Mrs Oldroyd explained that the severity scoring had recently changed to reflect that no physical harm could mean psychological harm.This could result in a change in the scoring of the incident as complaints which had been categorised initially as severe could then be altered after the outcome had been identified.
Mrs Smith referred to the Ombudsman complaints under review that stemmed back to 2010. Mrs Oldroyd explained that these reviews could be quite time consuming and could be delayed if additional evidence was being investigated.
Ms Robbins referred to the previously mentioned pieces or work that would be undertaken and looked forward to receiving the outputs.
The Committee noted the report and agreed the recommendation.
5.2 / Inpatient Experience Survey – Better Together Update
Mrs Oldroyd provided an update on the Inpatient Experience Survey for Better Together. She referred to the report and highlighted the key points for the Committee as detailed overleaf:
- The bottom 5 results for 2011 were the same as those for 2010.Thiswas to be expected as the second round of surveys had beenundertaken before actions from the first round had been implemented.
- The areas that had improved were cleanliness and the effectiveness of information given to patients prior to admission to hospital.
- Areas of under –performance included the provision of help with transport for going home from hospital and not being told the waiting time in Accident and Emergency.
- Top 5 results for 2011 were slightly changed from 2010and highlighted that more doctors introduced themselves to patients and families.
- Sectors developed action plans to address their bottom five results and regular updates were sought throughout the year to measure improvements for discussion and commented on by the Better Together Public Involvement Group.
- The free text comments recorded by respondents were available. They had proved very useful in bringing alive real patient experiences and had also been used to good effect in different groups across the organisation.
- The 2012 in-patient survey was currently live. NHS Grampian’s response rate at the time of reporting was 55%. The survey closed on 18th May 2012. Survey results were expected in July 2012.
- The 2011 GP survey results would be available this month. A communication strategy would be required as would some form of direction from NHS Grampian in relation to using the results for improvement.
Mrs Oldroyd concluded that, with over 4000 responses to the in-patient survey last year, it was incumbent on the organisation to make best use of both the statistical and free text results and to also take account of the GP survey and maternity survey results to inform improvement activity and to develop improvement plans which had a positive impact on reported patient experiences of care.