Minutes. Cardiff and Vale University Health Board Primary Community and Intermediate Care Clinical Board Quality and Safety Group

Transcription

1 Minutes AGENDA ITEM 2.1f Cardiff and Vale University Health Board Primary Community and Intermediate Care Clinical Board Quality and Safety Group Present: Vicky Warner Brendan Boylan Sue Morgan Helen Watkins Nicky Hughes Kay Jeynes Anna Mogie Sian Rowlands Gareth Hayes Lynne Topham Clare Evans Rhian Floyd Karen May Claire Watson Tuesday, 9 th September 2014 CRI Meeting Room 1 Clinical Board Nurse (Chair) Clinical Board Director Head of Operations & Delivery Head of Workforce & OD Locality Lead Nurse, Cardiff South & South East Locality Lead Nurse, Vale of Glamorgan Locality Lead Nurse, Cardiff North, West & South West Senior Manager of Performance/Clinical Governance Clinical Director of Clinical Governance Locality Manager, North & West Cardiff Head of Primary Care Services, Operations & Delivery Head of Primary Care Service Delivery Unit Divisional Pharmacist Primary Care & Community Clinical Governance Officer (Minutes) In attendance: Rosemarie Marnell Hayley Lewis Clinical Director, Cardiff Prison DRSSW 1 Welcome, Introduction and Apologies for Absence Vicky Warner welcomed everyone to the meeting. ACTION Apologies were received from: Denise Shanahan, Lynne Aston, Carol Evans, Rachel Thomas, Dawn Ward and Chris Darling 2 Minutes of the Previous Meeting and Matters Arising Following clarification on the discussion around the use of Midazolam in palliative care (anti-anxiety medication), the Minutes of the previous meeting held on 8 July 2014 were agreed as an accurate record. Members were reminded that minutes of the meeting will form part of the papers for the UHB QS&E Committee. Matters Arising from 8 July 2014 meeting: Matters arising will be picked up as part of the action log. 3 To Review Clinical Board Quality & Safety Group Action Log The Clinical Board Quality and Safety Group action log was reviewed. Members noted the content and were asked to send any outstanding updates to Claire Watson prior to the next meeting. PCIC Minutes September 2014 Page 2

2 Actions requiring further work: 220: Trusted to Care feedback on Corporate progress Details to be taken through LMC. 218: Slim-lining the Risk Management Process -. It was agreed to continue with the current PCIC CB Risk Management Plan until guidance is received from the Corporate Office. 216: Number of OOHs Staff requiring Flu Vaccination - Head of Primary Care Services, Operations & Delivery to follow-up with Senior Nurse Primary Care. 202: Art Governance Q&S Framework - Clinical Board Nurse to request a response from Medicine CB. 190: Pressure Ulcer Management For inclusion on November 2014 agenda. 188: Standards for Health Meeting arranged 1 st October CE KJ / CW 4 Any Other Business No items 5 Patient Experience and Feedback HMP Cardiff Dr Rosemarie Marnell, Clinical Director, presented on HMP Cardiff achievements over the last 2 years. The presentation included an update on blood borne virus control and a patient story, written by a prisoner who is now a volunteer peer advisor within the prison. Members thanked Rosemarie for the positive and informative presentation. [Full notes and/or copy of Rosemarie Marnell s HMP Cardiff presentation are available upon request] 6 Risk Management The system for version control is not working as well as expected. It was agreed that further work on version control would be looked into. / CD Review risk log using the 4 T s Risks that were highlighted in the meeting for further discussion were: QS&E : Delivering the Integrated Sexual Health Service Nicky Hughes advised that access is improved significantly through the service and work on the LIPS Programme is underway. It was noted that the service is making good progress, quicker than expected. It is anticipated that ongoing work will contribute to a reduction in risk score. The risk continues to be Treated and will remain on the PCIC risk register at this point. PCIC Minutes September 2014 Page 2

3 QS&E : Healthcare at Home Nicky Hughes advised that a number of complaints and incidents are still being received. There are no new patients receiving Healthcare at Home, only existing patient remain. The Medical Director is now involved in Healthcare at Home meetings. This risk continues to be Treated. QS&E : GP Referrals to Mental Health Services for Older People Scoring of this risk is much lower since the referral process was implemented. There have been no incidents received recently. Monitoring continues. It was agreed that this risk will be removed from the PCIC risk register. SR QS&E : GP Out of Hours Claire Evans advised of the progress being made in relation to rotas and managing the increased capacity. GP shifts are being back-filled with registered nurses and the effect of this is being monitored. OOHs are awaiting an outcome from the business case in relation to capacity and demand work. There has been positive news in relation to benchmarking on face-to-face pay rates this will bring some extra capacity into the clinical rotas so the team are currently working on how to implement more shifts. PCIC is looking at how to performance manage this and the effects on the service. For now the focus is on maintaining the OOHs service into winter as the service becomes more unpredictable with regards to planning. Sue Morgan advised that next steps will be dependent on the outcome from discussions at Board today around the unscheduled care plan. This risk remains high, and continues to be Treated and Transferred. QS&E : Interface Sian Rowlands advised that many different incidents are received some of which are high risks and others that are more easily classified into trends. There are systems in place to capture trends and feed them into the Taskforce Group, where improvement work is ongoing to address these. PCIC acts mainly as the Gatekeeper by capturing and transferring incidents, which are linked to other clinical areas in the UHB. Response is still an issue in terms of secondary care colleagues investigating and replying. In terms of CAMHS reporting only small numbers are being received however they are concerning cases. A review has taken place and findings have been escalated to Executive level. Again PCIC is acting as Gatekeeper for these CAMHS incident and is not directly responsible for the provision of the service. QS&E : Independent Sector Anna Mogie advised that the position remains the same. Some nurse assessor vacancies have now been recruited to, which has mitigated some of the risk. There is a need to look at capacity within current establishments, particularly within N&W Cardiff. The next action will involved putting a business case together. Further discussions will be held at SMT. QS&E: Prison Dr Marnell advised that the risk has been reduced as a result of the weekly referral meetings that are being held. The number of outstanding assessments has been cut by half, from 20 to 9 a week and the employment of extra nurses will contribute to further reductions. It was agreed the risk would be amended to reflect the lower scoring, and the risk will remain on the register until the MH review has finished. It was noted that the interim pathway is inline with the MH pathway, which complies with WG guidance. RM / RF PCIC Minutes September 2014 Page 2

4 QS&E : CHC Arrangements for POC Transferring Anna Mogie advised that the position remains the same regarding one particular package of care. The NW Team are meeting again with the individual and family this week. QS&E : CHAPS Rhian Floyd advised that the service is liaising with colleagues from Strategy and Planning, Communication, LMC, and CHC as part of the engagement exercise. However, CHAP is struggling to provide equitable GMS services, continuing with peaks and troughs in terms of demand. Given current world events the service is looking to engage with the Home Office in trying to predict the forecast on the numbers of asylum seekers that could be coming through. It is expected that the average coming through Cardiff will reach 250. The current average is approximately 160/170 which the service is already struggling to assess, so the service needs to be prepared for that level of demand. In terms of timescales, it is envisaged that the engagement exercise will go to full implementation in October, it is expected that the winding down of the GMS element will occur after December, then looking to start afresh on 1 st April. Bids have been submitted to WG to try and support the transition into mainstream services. It was agreed that this risk would be reviewed to reflect the current position. RF QS&E : Patient flow Risk added last month. The HB is continuing to treat on a daily basis. QS&E : Equipment Kay Jeynes advised that the additional stock received has made a positive impact and presently they are not aware of any delays. The new mattresses are actively being used, with a good response. Further work will be progressed with occupational therapy colleagues, looking at a system to highlight and resolve issues. / KJ Discuss any new risks PCIC Estates Clare Evans advised on changes which took effect last November in relation to the way in which PCIC Estates will be funded going forward. Previously PCIC would liaise with WG to take forward any PCIC developments and improvement grants, however this funding has ceased with immediate effect. The responsibility to fund PCIC estates has now transferred to HBs however the HBs did not receive any funding with the transfer of responsibility. The expectation is that HBs will fund from their existing allocations, this will be a further financial pressure for the organisation even though PCIC haven t got any estates being funded at present. PCIC will need to work through a process to understand how this work will be taken forward by the organisation, within capital planning and in regarding to revenue streams. In regard to impact PCIC have written their PCIC Estates Strategy and within that there are 12 PCIC developments which are time-lined over the next 3-4 years. There is no funding to take these developments forward which leaves PCIC with a major capacity gap in terms of patients accessing PCIC and also providing premises which are fit for purpose for GPs and community services to function from. Every HB across Wales is in a similar situation, one HB has funded some PC developments from within their allocation but this is an exception rather that a rule. There is no funding within PCIC or the UHB to take this forward which is why a risk escalation has been raised at PCIC Minutes September 2014 Page 2

5 management level, to try and understand where PCIC goes from here. The intention is to highlight concerns with WG, as it contradicts any strategic guidance and documentation that HBs have received on the way forward in planning services. There is a further risk in regards to the recently approved local development plan, which has in excess of 100,000 residents within Cardiff and Vale. PCIC have been trying to meet with WG to understand the next steps from their perspective. The meeting has been cancelled a number of times, so this risk requires to be raised with the Executive Team and will be put forward for the agenda at the next months Performance Review. Members agreed for the Risk to be added to the PCIC Risk Register. General Estates Lynne Topham raised concerns regarding the General Estates issue for Health Centres and Clinics, which is being raised in terms of fabric funding. Members agreed that an escalation report would need to be completed and taken through SMT. CE LT Safe Haven Rhian Floyd advised on the need to raise awareness regarding a new patient precedent which has been set on an individual. The patient was released from prison and considered by MAPPA to be such a high level risk (level 3) that it was felt they should go straight into the Save Haven. The patient has been managed through this process for some time however some recent concerns have been raised by MAPPA that the individual is not getting access to equitable healthcare etc. PCIC have been working through the risks and concerns and the escalation report has gone to Health & Safety, SMT and to Exec as part of the last performance review. This risk has been escalated mainly because there could be some criticism against the HB. There is a clear audit trail of why the decision was made, why the individual is still in Safe Haven, and why they are being managed in the process they are. Vicky Warner, who attended the last MAAPA meeting, advised that some of the pressure has now been reduced, with the individual being stepped down from MAPPA level 3 to level 2. Therefore it was felt that the risk would not need to be escalated onto the PCIC Risk Register. Rhian Floyd highlighted the concerns that this individual poses to staff and advised of the special arrangements being taken outside of Safe Haven to treat this patient. However it is the intention that if the patient behaviour continues to improve then the patient will be stepped down through Safe Haven. At present there is still an ongoing review and risk management process for this patient which needs to feature on the Primary Care Risk Register. PCIC CB Risk Escalation Report Members were advised that the PCIC CB Risk Escalation Report only needs to be completed for risks requiring quick escalation to SMT. CHC Anna Mogie advised on the increased number of complex patients in the community who are being looked after by agency. Five patients are being maintained by specialist care agencies that are providing qualified intensive care nurses to look after them. It was noted that there has been high usage of ITU nurses from those agencies in hospitals across Wales, which means there has been less availability of these nurses to support packages of care. There are two risks to highlight, the first being the increase in packages of care, and the second being the difficulty in finding nurses to cover these packages. It was felt that ITU nurses may prefer to work in a hospital setting rather than going into an unknown environment, however this means that packages of PCIC Minutes September 2014 Page 2

6 care are struggling to be maintained which is a risk to the patient. There are further concerns in relation to the time staff are spending trying to arrange cover and also where patients are being admitted to hospital where no cover is available. MPS and Richmond agencies have been contacted to try and establish the reason for the lack of nurses, as now the school holidays are over the problem is still increasing. It was agreed that a risk assessment would be completed and a discussion will be held at CB level about the shortage of critical care nurses across Wales, to try and understand where the demand is. Sue Morgan advised of the development of a Post Aesthetic Care Unit (PACU), which may provide an opportunity around recruitment of critical care nurses, however PCIC need to clearly document the stages that they have gone through prior to having to admit the patient to hospital. Anna Mogie agreed to set out clearly all the details in the risk assessment. CHC Access - Gareth Hayes enquired if reference to the Community Health Council report on access to Primary Care should be on the Risk Register. It was agreed that this should be risk assessed through the Primary Care Team. Retrospective CHC Reviews - Nicky Hughes advised of the escalation of the Retrospective CHC Reviews. Nicky had attended the National Meeting where it was agreed that all LHBs should have the Retrospective Phase 2 work on their risk registers. Vicky Warner agreed to take this to SMT for discussion following risk assessment although the risk is largely financial and therefore should be considered for the PCIC corporate risk register. AM / CE NH/ 7 Statutory & UHB Compliance Mental Capacity Act update Anna Mogie advised that the Mental Health Legislation & Mental Capacity Act Committee is now involved in this work, and the HB will be performance managed around training on MCA. It was noted that the E-Training is quite difficult to access but developments are underway to improve this. Anna Mogie advised members of the Cheshire West Judgement, around when to apply Deprivation of Liberty. This judgement related to a individual with a Learning Disability (who was not trying to leave their place of residence) in terms of the restrictions around their care package and the setting they were in. On review it had been found that this individual was actually being deprived of their liberty through the nature of the package of care. The judgement has highlighted a need for HBs to consider what restrictions are in place on patients, and to ensure that the restriction in place are legal, whether that be for MHA, MCA or DOLS. As a HB we have done quite a lot of work around the hospital setting, but there are concerns that from a PCIC perspective we have a number of individuals in the community being funded by CHC who haven t been considered as to whether they are being restricted or deprived of their liberty. PCIC have a small number of patients in residential school/home settings, who given the guidance and clarification, perhaps the HB should be considering whether there is a need to make Court of Protection applications, as DOLS would not apply under the ACT when they are in residential school/home setting. Anna met with Julia Barrel and the Legal Team and there are probably 2 or 3 patients who may require Court of Protection applications. It may be the PCIC Minutes September 2014 Page 2

7 Court of Protection will respond to say this is not required but it is felt to be within the patient s best interests to make the applications. Work is ongoing to gather the required information for submission to the Legal Team to progress this on the HBs behalf. Due to the costs it has been agreed this will be progressed through the Corporate budget. It is expected that this will be an ongoing process unless legislation is reviewed following the Cheshire West Judgement. It was noted that the number of Court of Protection acts has increase significantly to the point where HBs are now struggling to cope. Members were asked to be mindful of the MCA Training requirements and that work should be progressed to get PCIC up to speed. ALL 8 Concerns: Complaints, compliments and incidents Summary of themes and trends arising from concerns The complaints report was received for information. Members noted the content of the report. Gareth Hayes requested that where complaints are still open it would be useful to have an explanation as to why. It was agreed that topics and themes would be identified and headings would be altered to reflect the contents of the columns. Response due/closure dates will also be sought and reflected in the report. CW / Serious Incidents The Serious Incident Log was received for information. Sian Rowlands advised that where incidents have not been reported to WG this is a UHB decision. Some incidents have been reported as No Surprises which means they have been reported to WG but no Closure Form was required. All incidents that have been closed have been reviewed and where required action plans have been put in place. All Action Plans and Closure Forms have been brought to the meeting for information. Outcomes from Prison Serious Incidents are lengthy so it was decided not to duplicate information onto the PCIC Log. For governance reasons the Prison SI log has been included in the papers, which includes all Prison SI details. Where Prison incidents have been closed and reported to WG, the Closure Forms have been brought for information. A query was raised as to why historical SIs have not been captured on the PCIC SI log. Member were advised that the log had been developed to ensure the capturing and monitoring of outstanding incidents that have been reported to WG, where the Corporate Office has asked PCIC to respond and provide Closure Forms. Members were advised that some historic SI in relation to MH services, which may have come through as learning from the Coroner on a Rule 43, would not be registered to our CB and would not require a Closure Form to be completed by PCIC CB; therefore they would not be noted on the PCIC SI Log. It was suggested that for completeness these incidents could be included and marked as MH if required. Sian advised that the main point of the log was for PCIC to have an understanding as to the position the CB is at with closing down SIs, as historically the MH SIs would have gone down a different route for closure. PCIC Minutes September 2014 Page 2

8 It was agreed that a definition of what goes on the PCIC SI log would be added and historic SIs would be added as required. Sian Rowlands asked that SI Leads now take responsibility for their SIs, the Clinical Governance Team can support this process but the Leads are now required to take responsibility. Prison Action log Sian Rowlands advised on the anonymous Closure Forms relating to 3 prison deaths, most of the actions have now been completed and it was agreed at the last Prison Partnership Board that these were sufficiently progressed to close. Members agreed with this decision. It was noted that the Prison Action Log was developed to capture the high number of prison and health recommendations coming out of each death in custody. It was important for PCIC from a partnership perspective to ensure these were captured and covered off, so an exercise was undertaken to pull all the actions from the recommendations. The log is monitored by the Prison Partnership Board but has been brought to Quality and Safety Meeting from a governance perspective. Work is ongoing to close down the outstanding actions. Vicky Warner advised that the next action is to extract some of the lesson learnt, and an SBAR is being drafted which summarises some of the actions to take back to the next Performance Review. Members agreed that details of the SBAR will be brought to a future meeting for information. It was agreed that review dates will be altered and that prison health will continue to monitor the log, with actions being reported back to Q&S for closure. Primary Care Interface Incidents Sian Rowlands advised on the new process for Secondary Care to report incidents in relation to any potential issues with GP colleagues. Details have been submitted to the most recent HMSB, so all CBs are now aware. The process is effectively the same process where GPs are reporting about Secondary Care, but now this is being done the other way around. This will feed a larger piece of work on inappropriate requests, where at present GP colleagues are carrying out procedures which should have been carried out by Secondary Care colleagues. A behaviours document has been produced advising secondary care colleagues of what they should be doing and the appropriate route. The new process has been well received and it has been signed-off. PCIC are currently awaiting incidents to come through, in the last 3 weeks 3 incidents have been received from Medicine CB. One suspected Ebola, one OOHs and one in relation to process. It was agreed that details would be taken through Triumvirate Meeting in the morning. The Behaviours document is currently on hold awaiting population of the new section on Primary Care. Over the next few months trends will be identified within the document and then it will be circulated. SR RM E-DATIX Vicky Warner advised that PCIC CB are prepared for implementation but are currently awaiting installation on the E-DATIX system. It was noted that Sue Paul, Asst Locality Manager NW Cardiff, has agreed to be PCIC CB Super User. E-DATIX will be available for provider services but there is currently no PCIC Minutes September 2014 Page 2

9 intention to roll out to contractor services. 9 Clinical Effectiveness, Policies and Procedures Flu immunisation uptake for staff and patients Helen Watkins advised on the key actions and themes being identified in relation to flu immunisation for staff and patients. Work is continuing to be progressed with involvement from Nicky Bevan, Senior Occupational Health Nurse and Occupational Health Team. There is now a requirement to finalise details of the Flu Champions in the localities and other areas, work will then progress at looking at how many people need to be vaccinated per Flu Champion and targets will be identified from these figures. Members were asked to identify their Flu Champions and provide names to Helen Watkins. PGD Kay Jeynes requested that sign-up forms for the PGD, which were issued last week, be returned as soon as possible. Kay agreed to retain and store all forms for future reference. All Leads All Leads 10 Infection, prevention and control 5 Priority Actions Vicky Warner advised on the PCIC 5 priority actions that have been submitted to the IP&C for information. Leads have been identified and discussion will be held with Teresa Neate and Kay Jeynes about the training programme and how this will be progressed. The first priority is to seek IPC support from the Corporate Team, as without this there won t be sufficient support, resource or capacity. Rhian Floyd advised of an amendment to the 5 Priority Actions: Point 5: the Lead for CHAP and Prison should be the Clinical Lead and Senior Nurse. Kay Jeynes advised that links have been made with Sian Griffiths, Consultant in Public Health Medicine, to progress the action plan around Hand Hygiene. C&V UHB Escalation Plan Vicky Warner advised of the work undertaken by Eleri Davies to adapt the DoHs processes for alerting early in the season. Eleri has also been working on developing a further set of alerts should Noro Virus outbreaks start in Nov or Dec. A discussion will be held with the Community Directors about PCIC intention to send out correspondence to GPs in October, and around what the correspondence should say. The contents will mainly advise colleagues about what action to take, management of, and where to find support/advice if they are concerned that a patient may have signs/symptoms of Noro Virus. A letter will also be issued to Nursing Homes, and a separate one to Residential Homes which will go out via Social Services. There is also a letter for DNs from DoH but this may go out via a different route as DoH are currently understaffed. The intention is to use the toolkit this year to ensure that staff are better prepared this year to tackle Noro Virus. 11 Safeguarding Protection of vulnerable adults / Escalating concerns in Care Homes Nicky Hughes advised of anonymous information received about a S/E Cardiff PCIC Minutes September 2014 Page 2

10 Nursing Home (the home had previously been embargoed for 2 years). The S/E Team have carried out a number of assessments and have deemed the home safe, monitoring continues. A second S/E Home has had a recent spate of POVAs, in response to this the S/E Team has asked Social Care and CSSIW colleagues for an informal meeting to try and resolve the issues. Details have not been escalated yet, however monitoring and nurse assessor visits continue. Concerns have also been raised in relation to a third S/E Home the S/E team are continuing to monitor the situation. Details have not yet been raised with Social Care and CSSIW colleagues as the individual who raised the concern wants to address the concern with the home first. Monitoring arrangements have been put in place. The Speech and Language concern at this home has now been addressed. Anna Mogie advised of a concern within a N/W Cardiff Home which has been escalated this morning. N/W Cardiff Team is yet to meet to discuss these concerns however details will be brought back to a future meeting. Kay Jeynes advised of an embargo on a Vale Home which has been ongoing for some time. Concerns have been escalated in relation to a domiciliary care provider. It is understood that there are approximately 90 service users under this care provider, which the Vale Team have reviewed. 12 Information management and governance Alert notice: Keeping person identifiable information confidential, safe and secure Details received for information. Members noted the contents of the Alert Notice. 13 Clinical Audit No items 14 Business unit reports The update reports from the PCIC Business Units were received for consideration and agreement. Vale of Glamorgan For information Palliative Care For information CHAP Rhian Floyd advised on the work being undertaken by the Clinical Service Lead in preparation for potential cases of Ebola. Work ongoing with PHW and IP&C colleagues has highlighted concerns that the procedures within the service are limited. These concerns will be picked up as part of the ongoing review of polices and procedures. HMP Cardiff Rhian Floyd advised of the operational difficulties impacting on the performance of the service. A meeting is being held next week with PHW colleagues and a review of procedure will completed. North West Cardiff Vicky Warner highlighted significant concerns raised at various levels about DN capacity and workloads. A report on the increasing pressures in this PCIC Minutes September 2014 Page 2

11 service has been drafted and will be discussed at SMT tomorrow. Anna Mogie advised of a slight increase in incidents around medication, missed calls etc. There has also been an increase in short term sickness and stress related absence. South East Cardiff - South East Cardiff is yet to hold their Q&S Meeting. An update report will be brought to the next meeting. OOHs For information Members noted the issues that have been reported within the Business Unit reports and the actions agreed in response. Items for Information: MT Homicide Sian Rowlands asked members to note the publication of MT Homicide Report at the end of the month (25 th September 2014). In-light of the high media attention members were advised that this may be a high profile case. Prison Service Audit Review Final Report Comms Hub DN Triage Process Map Blood Borne Virus Testing Welsh Risk Pool Notice Advisory Board Risk Notice 16 AOB Members noted the items for information. No items 17 Date and venue of the next meeting: Tuesday, 11 November 2014, 1.30pm, CRI Meeting Room 1 PCIC Minutes September 2014 Page 2

12 AGENDA ITEM 1 Minutes Cardiff and Vale University Health Board Primary Community and Intermediate Care Clinical Board Quality and Safety Group Present: Vicky Warner Brendan Boylan Sue Morgan Helen Watkins Nicky Hughes Kay Jeynes Anna Mogie Sian Rowlands Gareth Hayes Lynne Topham Clare Evans Rhian Floyd Karen May Denise Shanahan Claire Watson Tuesday, 11 th November 2014 CRI Meeting Room 1 Clinical Board Nurse (Chair) Clinical Board Director Head of Operations & Delivery Head of Workforce & OD Locality Lead Nurse, Cardiff South & South East Locality Lead Nurse, Vale of Glamorgan Locality Lead Nurse, Cardiff North, West & South West Senior Manager of Performance/Clinical Governance Clinical Director of Clinical Governance Locality Manager, North & West Cardiff Head of Primary Care Services, Operations & Delivery Head of Primary Care Service Delivery Unit Divisional Pharmacist Primary Care & Community Consultant Nurse Older Vulnerable Adults Clinical Governance Officer (Minutes) 1 Welcome, Introduction and Apologies for Absence Vicky Warner welcomed everyone to the meeting. ACTION Apologies were received from: Lynne Aston, Carol Evans, Rachel Thomas, Dawn Ward, Rosemarie Marnell, Hayley Lewis and Chris Darling 2 Minutes of the Previous Meeting and Matters Arising The Minutes of the previous meeting held on 9 September 2014 were agreed as an accurate record. Matters Arising from 9 September 2014 meeting: Matters arising will be picked up as part of the action log. 3 To Review Clinical Board Quality & Safety Group Action Log The Clinical Board Quality and Safety Group action log was reviewed. Members noted the content and were asked to send any outstanding updates to Claire Watson prior to the next meeting. Actions requiring further work: 236: 5 Priority Actions Link for IPC: Discussions ongoing with IPC Team about a designated link. Item will also be picked up at Performance Review. 1

13 AGENDA ITEM 1 233: Prison Action Log Awaiting final closure of the Serious Incidents at the next Prison Healthcare Partnership Board. 231: Mental Capacity Act Training Due to the time required to complete the current training (approx 3hrs) Business Units are awaiting the rollout of the e- learning module before progressing. 230: New Risk (General Estates) Details have been taken to yearly Operational Health & Safety Committee. Work is progressing and an update will be brought to a future meeting. 229: Risk Register (QS&E Equipment) Process mapping workshop being held today with staff from wards and community. Awaiting recommendations. 223: Serious Incident (SI) Log: Awaiting Corporate feedback to be received. It was agreed that there is room for improvement in the sharing of lessons learnt. PCIC CB is beginning to share good practice with GPs via the PCIC CB quarterly newsletter, this includes learning from Regs 28/Homicide reviews, these are also picked up via practice development sessions. From the prison perspective PCIC CB share investigations following deaths in custody via the Prison Network. 220: Trusted to Care feedback on Corporate progress It was noted that a corporate response has been received by PCIC but not to the LMC. It was agreed that attendance at the LMC to discuss this will be offered. 219: CMHT Action Plan The MH Audit from the original action plan is outstanding. Contact has been made with MH CB but no further update has been received. The Closure Form has been signed-off by the Nurse Director and submitted to WG. Concerns were raised by PCIC CB in relation to the content of the submission to WG which seemed to be heavily based on PCIC CB response to the incident. The PCIC CB action plan was also submitted but there didn t seem to be much context from a MH perspective. This will be discussed with the Nurse Director. / RM All Leads SM / KJ Car. Evans /CW 218: Slim-lining the Risk Management Process -. Revised risk management documentation has been received from Corporate Office which still includes two risk assessment forms. As documentation has been agreed corporately it seems there is little that can be done at this stage to slim-line the amount of paper work and prevent duplication. 202: Art Governance Q&S Framework Still awaiting response from Medicine CB. The Bridging Audit has been sent through for comment. Will be raised again at triumverate 4 Any Other Business Western Vale Q&S issues 2

14 AGENDA ITEM 1 Update on complaint & recommendations 5 Revised Quality & Safety Structure for Primary Care Rhian Floyd advised members that Sian Rowlands, Senior Manager Performance & Clinical Governance, will be leaving PCIC CB on 26 th November 2014, to take up her corporate role on a full time basis. Rhian took the opportunity to thank Sian for the skills and expertise that she has brought to the role and systems and processes that she has put in place. PCIC CB will be looking to put systems in place to continue the good work that Sian has undertaken and the excellent position that she leaves the PCIC CB in. Members congratulated Sian and wished her well in her new role. The vacancy has been advertised on a temporary basis, mainly due to the number of changes going on within Primary Care as a result of staff vacancies and maternity leave. PCIC CB will be testing out a temporary structure for the next year, so have advertised for a Band 7 Primary Care Q&S Manager. The post went out to advert on Friday and the closing date is the 17 th November. The main focus of the role will be on contractors, the performance management of contractors and the Quality & Safety mechanisms across our provider services (i.e CHAP, Prison and Out of Hours). A copy of the job description is available on request. It is hoped that this role will provide increased capacity, as the Q&S agenda is constantly increasing in terms of contractor performance management, and getting the assurance that PCIC have the right systems in place within our provider services. The role will be lead and supported by Gareth Hayes, Clinical Director of Clinical Governance. This role will be tested and then reviewed next summer in terms of next steps. 6 Risk Management Vicky Warner advised of recent discussions at SMT regarding corporate and Q&S risks, and their review of all the Business Units individual risk registers. From discussions SMT had felt assured that all PCIC risks were now being covered off. Review risk log using the 4 T s Risks that were highlighted in the meeting for further discussion were: QS&E : Delivering the Integrated Sexual Health Service Nicky Hughes advised that work is progressing with DOSH around service improvements. There are some final senior staffing issues to resolve, so the risk continues to be Treated and will remain on the PCIC risk register. Gareth Hayes advised of a related risk regarding the withdrawal of GP training on dermal rods and coils. If GPs are not trained in this area then they won t be able to take this service off Sexual Health, enabling them to concentrate on the services they should be providing. Gareth was aware of two GPs who had wanted to get trained but couldn t. QS&E : Healthcare at Home Nicky Hughes advised that there hasn t been any formal patient complaint s recently, but it s understood that issues still continue, these are being worked through and details are with the 3

15 Medical Director. This is a service that impacts highly on patient care and therefore the risk continues to be Treated with an element of Transfer. QS&E : GP Out of Hours Claire Evans advised that significant improvements have been made in relation to meeting the standards, skill mix and covering the rota, however this still remains a high risk in relation to the unknown now that we are entering the winter period. This risk remains high, and continues to be Treated and Transferred. AGENDA ITEM 1 QS&E : Interface Sian Rowlands advised that interface incidents may transfer with her corporate role however this has not been confirmed. Even though interface incidents are currently being held in PCIC a lot of the risk is transferred to other service areas. Items falling out of this work, such as CAMHS, will be progressed under the corporate role. It was agreed that discussions will be held with the MD and COO to get a definite answer as to where this work will sit. Gareth Hayes advised that he was meeting with the MD later today and would pick this up as part of their discussions. GH/SR QS&E : Independent Sector The position remains the same. Nicky Hughes advised of a new home opening on C&V border (Marshfield) next summer. The HB will need to monitor this home, as it s likely that C&V patients will be based there. QS&E: Prison Rhian Floyd advised of a drop in the risk score from 16 to 12, this is a result of the engagement exercise undertaken in October between the Prison Healthcare Team and the Mental Health Team, and the development of a Primary MH Team. Unfortunately the individual who was put forward from the current In-Reach Team for one of the vacancies has taken up another position, so the service are having to recruit again to that post. The service is confident that with time a full team will be in place. Referrals have reduced due to the implementation of a referral review mechanism. This has been supported by an engagement exercise which was helpful in terms of current processes and service management. QS&E : CHC Arrangements for POC Transferring It was noted that work is progressing to resolve this risk and it s likely that the scoring will be significantly reduced at the next review. Members took the opportunity to commend Jean Hazelwood and Anna Mogie for their hard work, over a significant period of time, to reduce this risk. QS&E : CHAPS Update on today s agenda - Escalation Report. QS&E : Patient flow Discussions were raised at SMT in particular around unscheduled care. As a result of the demands being seen in the acute sector this risk has received a higher scoring of 20. Included in the risk is reference to some of the challenges that arise when secondary care make changes to their care pathways without engaging with the PCIC team. As a result of these changes there is potentially more demand for local services such as CRT or other community services. An example of this was seen recently in North West Cardiff where a secondary care pathway was altered and beds were closed, there was an expectation that the CRT could / SM accommodate the patients but this wasn t the case. Discussions are ongoing 4

16 with secondary care to try and resolve this risk. The HB is continuing to treat this risk. AGENDA ITEM 1 Nicky Hughes raised a concern that the expectations of the independent sector regarding community services go beyond things that can be realistically achieved. It was agreed that this message needs to be fed back to the independent sector and details would be raised at a future meeting. LLN QS&E : Equipment Kay Jeynes advised that additional stock has been agreed. There have been some DToC issues in relation to JES equipment which were escalated to SMT and resolved. There are ongoing concerns around performance as well as stock issues. Vicky Warner has requested a performance meeting with Stuart Young about JES, but no response has been received, this will be followed up. QS&E N/W : Complex packages of care: This is in relation to patients who are already transferred or who the HB are already caring for in the community, using mostly agency support. The HB is struggling at times to have the right level of staff to provide the care. This is still and ongoing issue for 2 /3 individuals. At the time the HB had very little alternative but to suggest that the patients go into hospital, which is not acceptable for them, or for the hospitals, but with no skilled staff to provide the care, its really all the HB can do to look after them. LT / Lynne Topham enquired about the Framework Contract. Vicky Warner advised that discussions have been held with Claire Salisbury and all the documentation is ready. It was agreed that further information would be shared with Claire, and then a discussion would need to be held with SMT about taking next steps. Kay Jeynes advised that there is a significant (24hr) need for care but there is a short fall of appropriately trained nurses at the moment. QS&E Primary Care Estates: Clare Evans advised that a further update to the log was required. PCIC have completed a risk escalation which will go to Exec Performance Review. PCIC have had a few closure applications which they are dealing with. A Performa Meeting will he held involving the Heads of Primary Care and PCIC are meeting with Welsh Government this Friday to discuss estates in general, and the plan going forward. PC has raised concerns with the Director of Strategy & Planning, and there is a meeting next week to discuss next steps. There is recognition now that this isn t just a primary care issue but an issue across the HB. PC is trying to move this work forward with the Estates Dept, with potentially two capital bids. QS&E District Nursing Escalation form on the agenda for discussion. QS&E Western Vale DN This risk has transferred from the corporate register, as its more Q&S than general risk. Kay Jeynes advised of an outstanding corporate issue with regard to 3000 patients registered with Bridgend GPs who are being cared for by ABMU DNs. PCIC CB are unable to take these patients back without the associated 5

17 AGENDA ITEM 1 resources. Historically these patients have always been supported by the Bridgend Nurses and PCIC do not want to take the risk of a caseload of patients transferring without any resource. This is unresolved but actions are progressing. KJ Discuss any new risks CHAP: Rhian Floyd reminded members of the increasing population of asylum seekers in Cardiff. Approx 6 weeks ago CHAP were advised of a potential further increase of 29-46%. This increase was a result of the number of asylum seekers coming into the UK and the number of cases being held in London, which they are looking to potentially move to Cardiff. The housing provider is looking to purchase additional accommodation to meet this demand. The escalation report was prepared to highlight the impact of that increased demand on the service. CHAP is undertaking a review, as they are aware of the link into GMS services that the service currently provides. CHAP have been engaging with a number of stakeholders regarding that review, with a view to moving the permanent patients currently registered with CHAP back to GMS practices. The beginning of the engagement has lead a number of stakeholders to advise on the impact that this would have on GPs practices in the south east locality, in terms of their capacity and current access arrangements, this is highlighted in the escalation report to the SMT. There are a number of risks highlighted in the escalation report, in terms of demand, capacity, financial and governance risks. CHAP have taken a number of actions to mitigate those risks as much as possible within the team, and in terms of the recommendations CHAP have asked for the skill mix and capacity/demand model of work that they have undertaken to be supported. CHAP is in an engagement exercise with stakeholders and the completed document will hopefully be circulated next week or the week after. CHAP have had meetings with stakeholders regarding the service changes and are potentially looking to commission an enhanced service for asylum seekers if its agreed to transfer them back to GMS services. There will be other financial implications as a result of this. It was agreed that the 3 key risks (the services provided to individuals, the public health risk in not meeting the need and the risk associated with GMS) would be highlighted on the register for sharing corporately RF District Nursing: Over the last 3 months there has been some concern raised by staff regarding the capacity within the District Nursing teams to respond to increasing demand and complexity. There are no validated tools for undertaking a safe staffing analysis that would be taken elsewhere (i.e. on wards). This is becoming increasing difficult as the patients become more complex and are discharged earlier from hospital. From previous discussion it has been noted that GPs are experiencing similar problems. It is difficult to size the impact it has, but closer working with GPs is one way of starting to address some of the issues.. Despite the significant amount of work and restructuring of staff, things are starting to settle. Gareth Hayes advised that the current recruitment system was almost set up to fail due to delays the process causes. Lynne Topham agreed that PCIC needed to be more sophisticated in their response to ensure there is resource, possibly by agreeing a level of over-establishment to cover up the gaps. It was 6

18 AGENDA ITEM 1 agreed that discussions around being ahead of the game and how to achieve this will be taken forward at SMT. Members were asked to put forward any suggestions. All Nicky Hughes advised of the national work being undertaken looking at a recruiting and work force tool, alongside the ones in the acute sector, which will look to provide recruiting levels. The tool will be tested and outcomes should be available in April Statutory & UHB Compliance Standards for Health: Sian Rowlands advised that the Standards for Health report hasn t been entirely sighted-off yet, however draft details on the 2014/15 proposal have been brought to the meeting for information. The intention is to have a more focused assessment, all 26 standards will continue to be reviewed corporately but there will be a reduced number of core standards for each Clinical Board to review. There will be 12 standards in total, which were agreed as a result of a review carried out at the QS&E Committee in November, where members had strong views about certain standard being included. A minimum of 12 standards were agreed but this was felt to still be more manageable. One of the key areas that Clinical Boards will be asked to concentrate on is the sign-off process, as this was found to be very weak across the UHB under the last submission. Clinical Boards will also be asked to look closely at their maturity rating scores ensuring that they have an understanding of their actual scores and what the score requires in terms of evidence. Sian advised that as part of her corporate role she will be supporting all CBs with this process. The four standards that PCIC CB has been asked to focus on, are one where the maturity rating scores were low (i.e. where scoring 2). A consultation period has commenced around how the standards will look going forward, in that the standards will be reviewed and revised to bring them inline with Fundamentals of Care, and to have one Total Standards Framework. It s thought that the wording of the standards will not change significantly. The consultation period ends in January Any comments are to be fed back to Sian Rowlands before January Comments should be sent in the first instance to Claire Watson and Vicky Warner for review. It was agreed that the consultation would be circulated to all members for their comments. ALL It is still not known who will be monitoring the standard for health returns, but things are progressing step by step. Final details in relation to 2014/15 reporting will go to the next HSMB and outcomes will be fed back. Sian will then be able to provide the required support to the CBs around their focus work and supporting them with their evidence and maturity rating. Previously CB haven t been equipment to do themselves justice but it is hoped that this year with the more focused approach improvements will be made. A Q&S S4H meeting will be set up in February 2015 to ensure signoff and to go through the evidence. 7