MINUTES OF A PATIENT SAFETY AND QUALITY COMMITTEE MEETING

Transcription

1 MINUTES OF A PATIENT SAFETY AND QUALITY COMMITTEE MEETING Held on Friday, 23 rd September 2016 between 9.30am and 11:30am in the Board Room, Fifth Floor, Ferguson House, St Helier Hospital PRESENT:- Pat Baskerville Non-Executive Director (Chair) Elizabeth Bishop Non-Executive Director Iain McPhee Non-Executive Director (via telephone) Aruna Mehta Associate Non-Executive Director Daniel Elkeles Chief Executive Ruth Charlton Joint Medical Director and Deputy CEO James Marsh Joint Medical Director Charlotte Hall Chief Nurse and Director of Infection Prevention and Control Caroline Landon Chief Operating Officer Peter Davies Director of Strategy, Corporate Affairs and ICT Tim Hamilton Director of Communications IN ATTENDANCE:- Mohit Abbi Corporate Governance Manager 1. INTRODUCTION AND GENERAL BUSINESS 1.1 Chair s Introduction The Chair welcomed all present to the meeting. It was noted that the meeting finish time had been brought forward by half an hour to accommodate a Performance Assurance and Risk Committee meeting which would be taking place straight after. 1.2 Apologies for Absence It was noted that apologies for absence had been received from Trevor Fitzgerald (Director of Estates, Facilities and Capital Projects), Kevin Croft (Director of People and Transformation), Rebecca Suckling (Associate Medical Director), Jill Down (Associate Director of Quality) and Sue Winter (Associate Director of Workforce). 1.3 Minutes of the Meeting held on 26 th August 2016 The minutes of the previous Patient Safety and Quality Committee (PSQC) meeting held on 26 th August 2016 were approved as a true and accurate record. 1.4 Action Log The action log was reviewed and noted. Last Minute Cancelled Operations It was noted that a report on last minute cancelled operations is scheduled to be presented to the PSQC meeting on 21 st October 2016, which would include findings of the investigation into the increase between June and July. Page 1

2 d. e. f. g. h. i. Mortality Dashboard It was noted that the draft Mortality Dashboard was on the agend Increase in Non-Clinical Incidents Ruth Charlton reported that, following investigation, the 200% increase in non-clinical incidents had been verified and equated to 36 incidents. However, investigation had found that there was a poor understanding about what qualified as being a reportable incident and action had been taken to remind staff of the threshold. After reassessing those non-clinical incidents reported, there had remained approximately 29 incidents. It was noted that following the action to remind staff, there was a degree of assurance that the reporting of non-clinical incidents would be more accurate and representative. Future of Patient First It was noted that an update on the Patient First programme was on the agend GP Communications It was noted that a verbal update on the process of submitting letters to the GP was on the agend Healthcare Safety Investigations Branch Expert Advisory Group It was noted that further information/clarification on the role and function of the Healthcare Safety Investigations Branch Expert Advisory Group was awaited. Readmissions Report It was reported that a verbal update on readmissions was on the agend Temperature Check of Staff Feelings on the Intensive Care Unit (ICU) It was noted that work to identify staff feelings and themes would be completed in September and reported back to the PSQC in October. James Marsh reported that a Critical Care Steering Group meeting had taken place last week. Metrics had been devised and the Lead Nurse had been asked to share those with the Executive Team. These would then be revealed to staff using Survey Monkey. 2. PATIENT SAFETY ITEMS 2.1 Integrated Performance Report Month 5 It was noted that the focus would be on those areas where the Trust s performance was particularly challenged and, following discussion at the Trust Board of Directors meeting earlier in the month, it was agreed that Board Committees should seek to provide assurance which will be demonstrated through minutes of meetings. Furthermore, it was noted that a cover report will be produced following Board Committee meetings that will accompany the Integrated Performance Report to Trust Board meetings highlighting exceptions or issues, any actions taken or planned and what assurances have been provided. Daniel Elkeles stressed the need for Board Committees to focus on indicators relevant to them to enable appropriate scrutiny from the relevant committees in sufficient detail. Safe Domain Ruth Charlton highlighted there were two key concerns around dementia and VTE assessments, which were reported one month in arrears. The PSQC noted that the dementia screening target of 90% had been missed at 69.1%, and the dementia risk assessment target of 90% had also been missed at 73%, both of which had deteriorated since the previous month, particularly the dementia screening. Ruth Charlton said sustaining performance with regard to dementia screening and risk assessment had proven very difficult over the past two to three months. There was a large amount of work being undertaken to recover and sustain performance, although it was not immediately obvious in the outcomes. Work was being undertaken across the medical and surgical specialties, both of which dealt with higher levels of patients at risk. As part of the work, there was concern that the decline in performance Page 2

3 may reflect a change in the role of OPAL Nurses who, although it was not included in their job description, had previously acted as unofficial chasers of assessments. It was noted that there was also an instance where dementia training at induction was cancelled at the last minute, which was potentially another factor that had led to the decline. Ruth Charlton said the Trust was mitigating all of those individual factors. There had been discussions at the Trust Executive Committee which emphasised: the need for a comprehensive analysis to better identify any other reasons for the decline that have not yet been mitigated; and to raise the profile of the issues within directorates and divisional teams. d. e. f. g. Ruth Charlton reported that, as with dementia risk assessments, there were similar challenges with regards to VTE risk assessments, with the Trust delivering 93.4% in July against a threshold of 95%. The breakdown of VTE risk assessments completed by specialty demonstrated that Gynaecology, Medicine and Surgery are key areas of concern. There had been discussion at the Trust Executive Committee meeting on Wednesday around combining dementia and VTE assessments. It was noted that whilst both were important in their own rights, not undertaking a VTE assessment posed a greater clinical risk to patients during their inpatient stay than not having a dementia risk assessment. As a result, the Trust Executive Committee agreed to particularly focus on VTE assessments without losing sight of dementia risk assessments and screening. Ruth Charlton reported that the lists sent out to clinicians with the uncompleted VTE assessments on a daily basis had been refreshed and redistributed. Moreover, VTE compliance and outstanding assessments were reviewed as part of the huddles. James Marsh added that that this was a good example of where transformation work could be used to help deliver the national KPI. Work had been undertaken with the Transformation Team on the patient flow project, part of which involves having daily huddles on the ward and developing whiteboard reviews at the start of each day. There had been discussions with the Transformation Team about incorporating an exception report by patient for those who did not have a VTE assessment completed in the daily whiteboard review on each ward. James Marsh reported that he had personally visited the Acute Medical Unit (AMU) where the highest volume of patients were and witnessed very positive engagement from consultants, junior medical staff, the Matron and Ward Sister. As a result, he said he felt confident that this approach would be embedded on AMU. It was noted that the Transformation Team would be rolling this out as a business as usual approach on each ward so that there is increased visibility and an expectation that assessments be completed in real-time at the whiteboard review. It was anticipated that there would be a step change of VTE compliance from October and it was likely that the Trust may not attain the 95% for September. The Chair observed that the data reported for VTE compliance was for July. Ruth Charlton confirmed that this was reported one month in arrears. James Marsh added that it was possible that some improvement may be observed leading up to October. Partial IT support had been implemented so where there is an inpatient who does not have a completed VTE assessment and a doctor or nurse requests an order, such as a blood test or investigation, an automated prompt appears asking the clinician to confirm that they are aware a VTE assessment has not been completed. The option of preventing orders being placed where VTE assessments had not been completed had been explored but was not technically possible in light of the current constraints with the IT system; but the approach in place could be re-explored. The Chair observed that dementia and VTE compliance were two areas that had been particularly challenged for some time and there was a real need to focus efforts on improving these. Iain McPhee agreed with James Marsh s assessment, noting that there was a greater risk of harm resulting from not completing VTE assessments appropriately when compared to dementia screening. James Marsh reported that the Trust s approach was a strong focus on VTE over the next couple of months while not ignoring dementia, reiterating that the higher priority was due to the greater risk it posed. Referring to the Serious Incidents (SI) Summary Report, Aruna Mehta observed that there was a VTE meeting SI criteria reported and sought clarification around this. Ruth Charlton provided background to the incident which tragically resulted in the death of a patient following an outpatient procedure. Responding to a query, she explained that whilst the incident was VTE related, the patient would not have met the threshold/national criteria for screening. However, Page 3

4 there was learning highlighted from the investigation. The Trust was considering in due course whether to triage outpatients undergoing procedures. Responding to a further query from Aruna Mehta on whether the risk had converted, Ruth Charlton advised that this was the first SI that related to VTE. She emphasised the more important point to note was that patients were being put at risk of lower level harm where VTE assessments were not completed and there was no room for complacency. James Marsh asked whether PSQC would find it helpful to receive data on hospital acquired thrombosis to review frequency and learning that comes from the root cause analysis. Aruna Mehta stated that given VTE assessments had been a persistent red, it was important to review this as a priority are The Chair concurred, emphasising that it was particularly important given that VTE was unlikely to demonstrate a significant improvement for the next two months. JM h. i. j. k. l. Elizabeth Bishop observed that emergency readmissions had not met the internal threshold of 5.8% or less, at 7.9% for July. Concerns were noted that emergency readmissions appeared to be on an upward trajectory and higher than in the previous year. Reviewing the percentage of emergency readmissions by discharge specialty, A&E had the highest percentage of readmissions. Two other areas that had a high proportion of readmissions were General Medicine and Paediatrics. Ruth Charlton advised that she had had a detailed analysis as part of the verbal update on readmissions. Following discussion, the Chair summarised that PSQC had agreed to put a very close watch on dementia and VTE. It had been agreed that data on VTE and outcomes would be reported to a future PSQC meeting and it was expected that VTE compliance would improve from October. The PSQC had received significant assurance that dementia and VTE were being actively managed. In relation to severe Postpartum Haemorrhage (PPH), Charlotte Hall reported that an audit was completed a few months ago and the second working part of that was taking place. Learning that had emerged included improving how blood loss was measured. There was now much better recording. It was also found that instrumental delivery was associated with higher blood loss and it was also linked to ethnicity. The Chair observed that Duty of Candour and RCA compliance remained challenged. Ruth Charlton said that both the Duty of Candour and RCA compliance related to Level 3 incidents and performance was in part a reflection of capacity constraints. The Trust was focused on looking to make sure that it was prioritising timely completion. It was reported that most of the learning came from Level 3 incidents and it was important to ensure these were all completed. However, Ruth Charlton said that it may be that the measure of what good looks like is completion in a longer timescale but properly rather than completion within the timeframe. She added she would bring back to PSQC what proportion, if any, of RCAs did not get completed. In response to a query, Ruth Charlton said that although there may be delays, the Committee needed to understand the distribution in terms of the timeliness of RCA completion. The Chair stressed the importance for RCAs to be completed, noting the possibility that key themes could be missed which may be preventing learning and resulting in repeat occurrences. Ruth Charlton proposed reporting to PSQC an analysis of Level 3 incidents, suggesting that it may be helpful for the Committee to be sighted on the themes, which was agreed. Reporting on infection control, Charlotte Hall noted that there had been one MRSA bacteraemia on CCU in August which was a direct transmission from the bed opposite. There were no side rooms. Charlotte Hall reported that although there had been three C. Difficile cases in August against a trajectory of two, she was confident that the Trust would remain within the national target of 39 cases by the end of the year. Results of the hand hygiene audit demonstrated an improvement on the previous month, with 89% of wards achieving 85% or above compliance. In relation to hand hygiene, the Chair shared that at another trust, one of the things they do is mark up on their whiteboard whenever they see someone not washing their hands. Charlotte Hall said that this was something that she would take forward. The Trust had appointed a Head of Infection Prevention and Control, and it was anticipated that they would be starting by the end of October. Charlotte Hall noted that infection control training had dropped to 77% and reports from the heads of nursing had been requested. RC RC m. Responding to a query from the Chair on hand hygiene on ITU, James Marsh reported that there is Page 4

5 an initiative on Intensive Care to have a system which enables automated monitoring to ensure staff are complying with the use of hand washes and gels. There were approximately five different providers who could supply some form of technology to facilitate this. The provider that the Trust initially believed it would go with was not pursued for technical and operational reasons. An alternative provider had been identified and it had been agreed that the Trust would trial the alternative process for three months on Intensive Care which would provide some real-time monitoring, the outputs of which could be reported back to PSQC. JM n. o. In relation to the level of assurance and PSQC s satisfaction with this, the Chair said that hand hygiene was absolutely key and, whilst it was amber, it underpinned the other infection prevention and control measures. PSQC were very concerned that this poor compliance with regards to infection prevention and control continues to be an issue but had been assured by the Executive Team that there had either already been improvements or improvements were expected. On the basis that improvements could be observed in some areas and further work was being pursued, there was reasonable assurance, although there was a need to review and continue to monitor this closely. Caring Domain Reporting on patient experience, Tim Hamilton noted that the Friends and Family Test (FFT) response rate for Maternity had dipped. There had been changes in leadership and meetings had been set up with regards to this. James Marsh commented that Maternity was a more complex area than others, particularly as patients were asked to rate the service at five different stages. Therefore, there may be a need for more bespoke solutions for Maternity which could be discussed by the Executive Team. The PSQC noted that the response rate for Complaints and PALs continued to improve, although there was a risk that performance in September may be affected by a vacancy in the Complaints Team. The post was now being recruited to. 2.2 Serious Incident (SI) Summary Report August 2016 Ruth Charlton presented the SI Summary Report for August 2016, noting that one SI had been reported in August and one previously reported incident had the Reason for Reporting changed to Never Event. Additionally, another SI reported had Incident Type changed from Pending Review to VTE meeting SI Criteria upon completion of the investigation, which had previously been discussed. The SI reported in August related to an incident in November 2015 which resulted in the tragic death of the patient five weeks after undergoing a procedure. Aruna Mehta expressed concerns about the transfer of this patient not only between wards but also from Epsom to St Helier. Ruth Charlton clarified that emergency surgery is only available at St Helier out of hours, and whilst it is the usual pathway to transfer patients from Epsom to St Helier if they require surgery, this applies only to a small number of patients. It was considered clinically appropriate given that it was the safest place to undertake the surgery and because it was the defined pathway. James Marsh commented that, from recollection, this was raised as a concern when the plans were initially developed, and it was important that incidents and bad outcomes be tracked. Responding to a query from Elizabeth Bishop, Ruth Charlton explained the pathway that the patient had followed. There were queries around the speed at which the transfer was requested and completed which was awaited. Iain McPhee noted that it was important that patients received the right care in the right place at the right time, and observed from the summary report of the incident that the patient had been moved to the right place before becoming critical. The Chair referred to an SI involving the failure to escalate a patient s clinical deterioration which contributed to the tragic death of a patient in April 2016, expressing concerns that the Hospital at Night Team had not followed the Managing the Acutely Ill Patient (MAiP) Policy, in which it should have been well versed. Charlotte Hall said that there were two consultants as part of the Hospital at Night Team and the Resuscitation Lead had presented to Caroline Landon, James Marsh and Charlotte Hall. This was scheduled to be discussed at the Chief Executive s Team Meeting on Monday given concerns around the MAiP Policy and Hospital at Night. It was reported that there Page 5

6 may be work to be done to address any issues or strengthen processes, and PwC may be asked to assist. Elizabeth Bishop queried whether this was a case of failure to escalate or failure to accept escalation. Ruth Charlton said typically the issue was failure to escalate. The Trust was proactively trying from day one to be clear, particularly with rotating Junior Doctors at induction, what the expectations were, and this had started from the August session. The Chair observed that in this case there was also a failure to have appropriate supervision and support for Junior Doctors. d. e. f. Elizabeth Bishop noted that there was now a system in place but sought assurance as to how the Trust would ensure that the system was operating as it should do. Ruth Charlton advised that the VitalPac Doctor Module was needed to provide objective data on this. This was an automated system not yet in place. James Marsh added that it was recognised the current medical model was not optimal and required work to improve this as part of the clinical service plan which would give Physicians the appropriate structure and adequate time to undertake supervising of their wards. There was a balance required between managing patients and managing wards. Responding to a query from Elizabeth Bishop on how new processes will be audited, Ruth Charlton reported that this would need to be through VitalPac or a similar system. It was noted that a lack of automation and hence the manual interpretation of the data was both time consuming and carried the risks of subjectivity and inaccuracy. In response to a comment from Elizabeth Bishop regarding PSQC s lack of visibility of Near Misses, Ruth Charlton reported that a very broad data set was needed to identify where issues, both current and potential, and pressures were. She added that medical wards were considered priority as James Marsh had articulated, but there was a need to obtain justifiable evidence to ensure that the Trust has got the priorities right and balanced. Aruna Mehta queried whether Hospital at Night and failure to escalate were recorded as risks. Charlotte Hall confirmed that failure to escalate was something that had been identified and was being managed through the CQC Action Plan. In relation to Hospital at Night, it was proposed that this be discussed at the Chief Executive s Team Meeting. Iain McPhee asked if there was a cultural issue, i.e. if the Consultant is not available/accessible, if the perception/culture of junior staff was to deal with the situation themselves. In any event, he emphasised the need for escalation to be encouraged. James Marsh commented that this may potentially be highlighted by VitalPac through identifying the level of competence of the responder. He added that softer cultural issues can be picked up with reference to the Guardian of Safe Working Practice reports. Ruth Charlton added that at induction the message to junior staff was if they have a concern, keep escalating this until it results in action as it is their duty to escalate. The Chair queried whether this message was being given consistently by senior staff as an active message would enable junior staff to feel more confident and any inconsistency may be resulting in a failure to escalate. 2.3 Readmissions Report Ruth Charlton reported that there was a large piece of work underway with divisions around readmissions. It was noted that Medicine was finding this most challenging due to capacity constraints and the time and resource required to conduct the audit. Medicine was progressing this but feedback had not yet been received about where the division had got to with their analysis. Turning to those areas where assurance had been obtained, SWLEOC had reviewed all of their readmissions and there were no clinical concerns identified. Reviews of readmissions were embedded within their processes. In Obstetrics and Gynaecology, there was a need to analyse the data because the internal rate quoted by the gynaecologists was 5.2% for Gynaecology and, combined with obstetrics, was 1.7%. The data was presented at Quality Committee meetings. Where clinical concerns were identified, cases were reviewed individually. There were no clinical care concerns flagged. It was noted that the quality half day programme was also being used. Page 6

7 d. e. In relation to Paediatrics, Ruth Charlton reported that combined with babies the readmission rate was 7.7%. Paediatrics had gone through every readmission in June. An area that had a high readmission rate was well babies. There was a possibility that this may reflect the early discharge in this are There had been a very helpful analysis which was being reviewed with the community team. It was also noted that a considerable proportion of those babies readmitted were born elsewhere but readmitted to receive postnatal care. It was noted that children with very complex needs and those with significant underlying health conditions also accounted for a considerable proportion of readmissions. Feedback had been received regarding Nephrology and it was found that they were very good at auditing every readmission. High readmission rates reported in Nephrology has been a long-term issue where it was known that patients would need to visit the Trust for treatment but, due because it was not possible to plan the date they would be attending for treatment, they were counted as an emergency readmission rather than a planned admission. James Marsh added that Nephrology patients were a high risk group of sick patients; therefore, one would anticipate the readmission rates to be higher than in some areas of General Medicine. However, a case by case review of every Nephrology readmission was undertaken. The Chair stressed that although it was recognised the readmission rate would be higher for this area, there was a need to watch the trend. James Marsh agreed and reported that no clinical concerns around unsafe discharging had been identified. Daniel Elkeles said that if treatment was planned, there was a need to change the coding otherwise, in accordance with the planning guidance which had been issued for next year, the Trust will be penalised. James Marsh explained that this had been a recurrent discussion for many years. If a clear and explicit block contract is established than that would be welcomed; however, historically the reason why this had not been encoded thus was around the income associated with planned and unplanned admissions. 2.4 GP Communications Update Caroline Landon provided a verbal update on GP communications, reporting that the Trust was required to turnaround 80% of patient letters within 10 days but was currently achieving 51% turnaround. In terms of administration services, there were 40 pods and there was inadequate supervision of both staffing and processes, which may be contributing to inconsistencies. It was anticipated that the turnaround would be improved by the changes the Trust proposed to make. In terms of the solution, Peter Davies reported that daily task lists and the Dictate IT solution were still being rolled out. There was also a third element about communicating with patients. It was noted that the Trust was procuring a managed print service. The rollout and implementation of the aforementioned would serve to provide an improvement, although all three elements were still a work in progress. The Chair asked if the Trust received complaints with regards to communication with the GP. Caroline Landon confirmed that a significant number of complaints were received. Ruth Charlton added that this could also be seen as an issue through Quality Alerts. Daniel Elkeles commented that whilst this was recognised as an issue, he considered the Trust s performance to be no worse than that of other trusts. Ultimately, he was of the view that communication should take place in realtime, which would make the process more efficient through significantly reducing delays and reducing an avoidable expense. There was a need to work out how to do this. The Chair asked if there was a plan in place to get to electronic communications via real-time. Peter Davies advised that the vehicle to deliver this was the Digital Strategy which was discussed at Board, but highlighted that there was a lot of work to do as this was a massive project. It was noted that some hospitals used electronic letters. James Marsh explained the various stages currently involved from seeing the patient to getting the letter sent out. Peter Davies said in the short-term there was a need to strengthen and streamline the existing process. In terms of the transformational work, this would take longer. Moving to digitalisation of letters would also require time. All of these areas of work had been identified and there was a need to develop a coherent plan to pull them together. Page 7

8 2.5 Mortality Dashboard Ruth Charlton presented the revised Mortality Dashboard, the purpose of which was to enhance mortality surveillance and enable PSQC to be sighted on this. Ruth Charlton informed PSQC that historically the Mortality Group would look at the dashboard in isolation. There were a number of different measures reported in the dashboard and she was satisfied the content was accurate. The PSQC were particularly asked to consider if this was a helpful document, both in relation to the content and its presentation, and if it was felt that other areas of mortality should be included. The Committee agreed that it was valuable. Iain McPhee noted that, in relation to VTE, this did not report specifically on thromboembolic deaths. Following discussion, it was agreed that it would be helpful to look at hospital acquired thromboembolic deaths. James Marsh proposed that it may be helpful to include data from the screening reviews of all deaths and the numbers where there are concerns. Ruth Charlton reported that the aim was to be sighted on the number of preventable hospital deaths. It was noted that the Mortality Dashboard presented was a draft and would continue to be developed. The Chair asked that this be reported to PSQC periodically. RS / RC RS / RC 3. PATIENT QUALITY ITEMS 3.1 CQC Action Plan Progress Report Ruth Charlton presented the CQC Action Plan, reporting that it was at a similar position to when it was reported earlier in the month at Board. There were a number of actions that were due to close on 1 st October 2016, which would subsequently be reported in the next iteration to PSQC. There was one action overdue relating to missing notes in the Outpatients and Diagnostic Imaging division, which required audit results as evidence to determine whether this was still an issue. There has been assurance gained from divisional teams and meetings with the Compliance Manager that the Trust is not going to enter October with a number of outstanding actions. Daniel Elkeles expressed concern that the CQC Action Plan was too large that it created difficulty obtaining assurance as an Executive Team and Board for all of those actions. Ruth Charlton reported that representatives from all divisions were attending the Clinical Quality and Assurance Committee meeting on 7 th October 2016, presenting a summary of progress and flagging where they require support. Following this, she added it may be helpful to review this in more depth. Daniel Elkeles suggested if possible the conversation from the Clinical Quality and Assurance Committee meeting should be presented to PSQC. It was noted that driving and embedding a culture change and more substantial changes in practice were expected to be areas outstanding on the action plan. Following discussion, Charlotte Hall suggested restarting CQC mock audits and devising a programme which would help to embed the learning. James Marsh noted that as there were so many actions, there was a need to have a helicopter view. Whilst all actions identified were important, he added that some were more of a priority than others. There was a danger that there would be more of a focus on working on those actions that were measurable. It was also recognised that some of the actions required a significant amount of work. Responding to a query from the Chair about whether Communications could be used as a medium to increase awareness and to remind staff what the CQC said about their divisions/areas, Tim Hamilton confirmed that it would be useful and that this could also be delivered through huddles. Ruth Charlton added that it was coming up to one year after the CQC inspection and it would therefore be a good opportunity to report one year on what had been achieved, whilst highlighting outstanding actions so not to lose focus of these. Moreover, it was noted that actions that had been marked green would not necessarily remain green in three or six months, thus there was a need to continue to monitor and seek assurance. Aruna Mehta queried if there was a role for the Guardian with regard to cultural change and receptiveness to this. Tim Hamilton agreed that the Guardian could help facilitate this. The Chair proposed that she and Daniel Elkeles should meet with the Guardian to encourage her to feel empowered. DB Page 8

9 4. MINUTES OF MEETINGS FROM SUB-COMMITTEES AND THE CLINICAL ASSURANCE PANEL 4.1 Clinical Quality and Assurance Committee The minutes of the Clinical Quality and Assurance Committee meeting held on 1 st July 2016 were received and noted. 4.2 Information Governance Committee There were no minutes to report. 4.3 Health, Safety and Risk Committee The minutes of the Health, Safety and Risk Committee meeting held on 29 th July 2016 were received and noted. The Chair noted from the minutes of the meeting that needle stick injuries remained high but there had been a reduction in the last two quarters. It was also noted that in Pathology there had been no collection of yellow bags and sharps bins for four days which deviated from the procedure and was reported as a RIDDOR incident. As a result, the member of staff had been spoken to and reminded of absolute need to follow the procedure. In relation to delivering against the Flu Plan for 2016, the Chair noted that the target was 75% to receive 100% of the money and the minutes of the meeting reported it would be a struggle to reach the target due to a shortage of peer vaccinators. Charlotte Hall advised that all nurses were to be trained on Monday. Responding to a query as to whether it was anticipated that the Trust would deliver the target, James Marsh noted that whilst it was a stretch target there were many ideas and initiatives being explored. Daniel Elkeles commented that James Marsh and Ruth Charlton would be drawing up all of the options for consideration. It was also noted that there would be discussion taking place at the Chief Executive s Team Meeting on Monday. 4.4 Improving the Patient Experience Committee The minutes of the Improving the Patient Experience Committee meeting held on 6 th May 2016 were received and noted. 4.5 Clinical Assurance Panel The minutes of Clinical Assurance Panel meeting held on 15 th August 2016 were received and noted. 5. ANY OTHER BUSINESS 5.1 Page 9 Future of Patient First Tim Hamilton presented a report on Phase 2 of the Patient First programme, noting that the Patient First programme was being developed to be the vehicle for change to more fundamental processes and activities that directly impact on patient experience. During Phase 2, Patient First would consider how aspects of the Transformation programme can improve patient experience and ensure that putting the patient first was a core objective of each workstream. It would also be the forum bringing together the information from all elements of patient experience including FFT, Complaints and PALS, with the information being used to formulate bespoke interventions to improve areas and processes identified as requiring direct focus. It was noted that the dashboard was under development. It was proposed that learning be incorporated into Patient First training

10 and staff be invited from wards where there are issues or concerns. The next step was to develop a PID setting out the objectives and key milestones of the next stage. The Chair commented that in her view, one of the strengths of Patient First was that it was bottom up. Staff felt that it belonged to them and there was an element of ownership. She queried how in Phase 2 the Patient First programme would continue to retain that that. Tim Hamilton confirmed that the Patient First Administrator was both visible and accessible and out on wards asking staff at all levels how things were, what was not working well and what could be improved. Daniel Elkeles added that lots of ideas came out on the first training day but that was as far as it went. Aruna Mehta asked if there was any value in the Patient First Administrator attending PSQC in 2-3 months. It was noted that this could be arranged. Daniel Elkeles suggested that FFT feedback provided a means of identifying issues and areas of concern, as a result of which this would prove a valuable use of the Patient First Administrator s time. The Chair stressed the need to maintain the brand. Aruna Mehta added that it was important to remember that FFT is about patients feeding back and not staff. 5.2 Any Other Business Junior Doctors Forum The Chair asked if the Trust still had a Junior Doctors Forum. James Marsh said that the new Junior Doctor contract had changed the emphasis of how hospitals arranged Junior Doctors Forums. The focus of the Junior Doctors Forum will be more of a trade union rather than about quality improvement. The Forums will be more structured and would result in direct benefits, and it may be the case that these are better attended. It was felt that the Guardian for Safe Working Practice s role would be beneficial, particularly as he is engaging well. It was agreed that the Guardian for Safe Working Practice would be invited to attend PSQC after a few months in post. RC 5.3 Items to Refer to Other Committees There were none. 6. DATE OF NEXT MEETING Friday, 21 st October 2016 between 9.00am and 11.30am in the Conference (Pink) Room at St Helier Hospital. Page 10