Non Executive Director. Named Professional for Safeguarding and Welfare of Children. Interim Chief Executive Officer

Transcription

1 WELSH AMBULANCE SERVICES NHS TRUST Minutes of a meeting of the Clinical Governance Committee of the Welsh Ambulance Services NHS Trust held on 13 May 2010 at HQ, St Asaph, Vantage Point House, Cwmbran and Thanet House, Swansea. PRESENT: COMMITTEE MEMBERSHIP Mr J Morgan Mr M Cassidy Mr D Jackland Non Executive Director (Chair) Deputy CEO Director of ICT COMMITTEE REPRESENTATIVES Ms R Beaumont Wood Mr M Cassidy Mrs N Cockburn Mrs J Davies Mr T Eckley Mr I Hollard Mr J Huxley Mr A Jenkins Mr S Johnson Mr R John Mr D Jones-Morris Mrs A Kedward Mr C Moore Mrs C Powell Mr N Waskett Named Professional for Safeguarding and Welfare of Children Deputy Chief Executive Officer Corporate Support Officer Director of HR National Risk and Health and Safety Manager Clinical Support Officer (Infection Prevention and Control Lead) Assistant Corporate Secretary Consultant Paramedic Patient Safety/Risk Coordinator Staff Side Representative (UNITE) Regional Director North Associate Nurse Director Governance Integration Manager Senior Nurse, Clinical Manager Medical Advisor APOLOGIES Mr E Price Morris Ms K Charters Dr K Fitzpatrick Mr W Harris Mr P James Ms S Jones Mr R Lee Mrs N Maher Mr M Graham Mr S Pryor Mr G Roberts Mr J Williams Interim Chief Executive Officer Staff Side Representative (UNISON) Non Executive Director Financial Director Non Executive Director Director of Unscheduled Care/Clinical Director Regional Director, C&W Health Informatics Manager CHC Representative Director of Ambulance Services Acting Regional Director, SE Medical Advisor

2 Prior to the formal business of the meeting, the Committee noted the appointments the Trust Board of Dr K Fitzpatrick, as Chairman and Mr P James and Mr J Morgan as Non Executive members of the Committee. 14/10 PROCEDURAL MATTERS RESOLVED: That the minutes of the meeting of the Committee held on 3 March 2010 be approved, subject to the amendments and matters to note as detailed below: (a) Amendments to the Minutes Minute 03/10, end of paragraph 2, add the wording and being developed across the NHS in Wales. (b) Minute 72/09 Serious Adverse Incidents (SAI s) Rapid Response Vehicles (RRV) Standing Operating Procedure (SOP) The Regional Director for the North confirmed that the RRV and Lone Worker Policy was in the process of being reviewed and a Task and Finish Group had been established to complete the review by the end of July. (c) Minute 04/10 Patient Safety Risk Register It was noted that it was difficult to adopt a co-ordinated response to risks across the Trust until the completion of the Management Review and until the Operations Directorate had discussed how its risk register was to be developed at the meeting on 8 June. (d) Minute 06/10 Complaints and Claims Update The Associate Nurse Director reported that she had met with Regional Directors regarding complaints, claims and adverse incidents and further meetings with the Senior Managers were to be held in the near future to implement the transfer of this work to the Clinical Directorate. (e) Minute 13/10 Immunisation/Vaccination Update It was reported that the Occupational Health contract was currently being negotiated on an all Wales basis to achieve a common standard, therefore, the Trust was not tendering on its own for this service. Immunisation/vaccination arrangements would be included in the new contract which was expected to be formalised by the end of May. A further report would be presented to a future meeting.

3 15/10 PATIENT SAFETY/1000 LIVES PLUS The Consultant Paramedic, on behalf of the Director of Unscheduled Care/Clinical Director presented a detailed report on the Patient Safety/1000 Lives Plus Campaign and other patient safety initiatives within the Clinical Directorate. It was noted that the Clinical Directorate Team had an extensive remit that focused on improving the healthcare for the people of Wales. The Committee was advised that the 1000 Lives campaign had ended on 11 May 2010 and the 1000 Lives Plus was launched immediately. It was noted that following on from previous work conducted in relation to cleaning of ambulances, the Trust had introduced a cleaning sign off sheet on vehicles as a Plan Do Study Act (PDSA) scheme. Ambulances had been spot checked for cleanliness in the Bridgend area and would be extended to other areas on a phased basis. The Committee requested that information from the spot checks and comments from Operational staff should be brought to a future meeting of the Committee. The Committee also discussed what definition was appropriate to describe a clean vehicle because research did not appear to be conclusive on this matter. Furthermore it was important that the Trust was clear what it wanted to achieve and decide the best way to meet the target. The Committee requested that the current procedures/checklist be sent to all members. It was acknowledged that a session on Patient Safety and Clinical Risk had been incorporated into the Clinical Team Leader Development Courses. Confirmation was received that sessions had taken place in Central and West and the North Regions although delays had occurred in the South East. The HR Director agreed to provide the Regional Director, North with the agreed programme. The Committee was informed that, in conjunction with St John Ambulance, a Working Group had been set up, including all relevant senior staff to review the current Memorandum of Understanding (MOU), identify Serious Adverse Incidents (SAI s), the deployment plan and other documentation, to ensure fit for purpose. The Committee reviewed the position with regard to the discussions the Trust was currently having with St John in relation to future protocol arrangements and the governance aspects of surrounding operational collaboration. It was acknowledged that the findings of the review would need to be discussed in detail before any firm proposals could be developed in relation to the MOU and it was hoped that those funding would be available at the end of July. The Committee noted that any future action would be suggested in the contest of learning lessons and seeking an improved service. (1) the contents of the report be noted;

4 (2) the Committee continue with executive patient safety walkrounds; (3) a report be presented to a future meeting of the Committee providing data/information on the spot checking of ambulance vehicles for cleanliness which commenced in Bridgend in May of this year; and (4) the current procedures/checklist relating to the cleanliness of vehicles be sent to members of the Committee. 16/10 UPDATE FROM EMERGENCY CALL PRIORITISATION ADVISORY GROUP (ECPAG) MEETING The Unscheduled Care Lead and Senior Nurse for Practise and Development had attended a meeting of the Emergency Call Prioritisation Advisory Group (ECPAG), as observers, which was an advisory body to the Department of Health on issues of ambulance call categorisation. The report to the Committee provided an update on ambulance services such as specific work undertaken on potential changes to Category B Medical Priority Dispatch System (previously named Advanced Medical Priority Dispatch Systems, (AMPDS) determinants (or codes) and generic discussion and strategic reference to future use and function of medical priority dispatch system. The Medical Advisor made observations relating to the data provided in the agenda of ECPAG and confirmed that the Trust s MPDS Group would review the future work of this Group. It was noted that the London Ambulance Service s Category B trial had been reviewed and further evaluative work was required to inform the efficacy of the trial. The trial aimed, to not completely stop an ambulance response to certain Category B codes, but, through Clinical Telephone Assessment, determine a more suitable time frame for response. (1) the contents of the report be noted; (2) WAST representatives continue to attend ECPAG meetings (in the capacity as observers, as per agreed terms of reference) to ensure that the Trust is kept up to date with UK best practices; and (3) (a) the Committee sponsor its Medical Priority Dispatch System (MPDS) Steering Group to undertake task and finish work that would examine the function and use of MPDS; (b) this work be utilised to inform both the strategic recommendations relating to the Efficiency Review (implement a front loaded model ), and the clinical contact centre strategy; and (c) it be noted that the rationale for this work is that the MPDS is the first assessment undertaken when a patient contacts the 999 ambulance service, and therefore, the correct

5 application of the system is critical to the effective management of a modern ambulance service. 17/10 CLINICAL DIRECTORATE RISK REGISTER The Lead Officer for each Directorate had updated the Risk Register for all Directorate s and an amended register for the Clinical Directorate was presented to the Committee for consideration. The Committee noted the risks indicated as red on the Register and the actions taken. Specific reference was also made to the NHSDW Business Plan and being unable to recruit sufficient nurses with appropriate skills. No additional funding had been made available to support the development of the nursing roles. By trying to establish new nursing roles from the existing funded establishment, performance in the delivery of core services would be compromised. Reference was also made to the training arrangements with regard to the implementation of the Safeguarding Children Training Strategy. Due to operational demands the release of staff had proven difficult and therefore progress had been slow. The Director of HR confirmed that a training plan was now in place and the training team were optimistic that all training would be completed within a year. (1) the contents of the Clinical Directorate Risk Register be noted; (2) it be noted that Risk 007 Protection of Vulnerable Adults (POVA) requires updating to confirm that a POVA database currently exists including assessment processes: and (3) Regional Directors be asked to ensure that all operational staff should be reminded that Patient Clinical Record Forms need to be completed to improve the quality of the referral process. 18/10 PATIENT SAFETY RISK REGISTER The Committee received the Patient Safety Risk Register which had been updated by each Directorate. The Committee noted the (red) risks recorded on the register and considered a summary of the action being taken to address these risks. The Deputy Chief Executive Officer confirmed that Patient Handover Policy had been rewritten for the admission of patients to Elderly Mentally and Infirm Units (EMI) and was to be circulated to key staff for comment in the near future. Also it was acknowledged that some of the dates stated in the register required review and amendments. (1) the contents of the report be noted; and

6 (2) the on-going work facilitated by the Risk and Health and Safety Manager to update the Directorate Risk Register which, in turn, informs the Patient Safety Risk Register, be acknowledged. 19/10 NHS DIRECT WALES CLINICAL GOVERNANCE QUARTERLY REPORT The report presented updated the Committee on key Clinical Governance issues and activities for NHS Direct Wales (NHSDW) for the period 1 January to 31 March The report covered a wide range of subject areas within NHSDW and members of the Committee raised individual issues in response to the information in the report. After discussion it was agreed that the section entitled Human Resources Sickness Absence would be removed from this report unless there was a Clinical Governance issue relating to this subject. This topic is fully reported to each Directorate and the HR Committee. It was noted that a more appropriate name for this agenda item going forward would be Telephone Services. (1) the contents of the report be noted; and (2) it be noted that future reports regarding clinical governance in NHSDW will not include information about sickness absence because this is reported on a whole Trust basis to the HR Committee, unless there are specific issues which the Clinical Governance Committee should be made aware. 20/10 SPECIALIST PARAMEDIC PROGRESS UPDATE The Consultant Paramedic presented a report updating the Committee on the progress of the key clinical areas associated with the implementation of the Specialist Practitioner (SP) role. It was acknowledged that an organisational implementation plan had been developed and introduced to progress the SP role and as part of this implementation plan, a number of clinical areas of work had been identified as key priorities. The Committee noted that three successful regional clinical seminars had been held across the Trust providing individuals with an opportunity to gain an understanding of the completed and ongoing clinical work, gaining clarity on areas of SP practice and development.

7 (1) the progress made since December 2009 on the key clinical priorities associated with the Specialist Practitioner development and implementation process be noted; and (2) the likely potential for associated costs of producing and implementing the Specialist Practitioner Clinical Record (SPCR) be noted. 21/10 HEALTHCARE STANDARDS An oral update confirmed that the Healthcare Standards Self Assessment had been completed and would be approved using Chairman s action procedures before submission to Health Inspectorate Wales (HIW). It was noted that the 2010/11 Improvement Plan would be further refined when feedback had been received from HIW. (1) the oral update be noted; and (2) a further report be presented to the next meeting of the Committee. 22/10 INTERNAL AUDIT OF CLINICAL GOVERNANCE ARRANGEMENTS An oral report was given confirming that internal audit had conducted into the clinical governance arrangements within the Trust. Internal Audit had developed on template to produce a draft report and had also met with key staff to check the processes and build up the draft report. This had not yet been completed fully and audit staff intend to meet Regional Directors in the near future. It was anticipated that a report would be available for discussion at the meeting of the Audit Committee in June. That the oral update be noted. 24/10 MINUTES OF OTHER BODIES RESOLVED: That the minutes of the Partners in Healthcare Panel held on 9 March 2010 be received.