Quality, Safety & Experience (QSE) Committee. Minutes of the Meeting Held on Wednesday 29 th March 2017 in the Boardroom, Carlton Court, St Asaph

Transcription

1 1 Minutes QSE Public V1.0 Present: Quality, Safety & Experience (QSE) Committee Minutes of the Meeting Held on Wednesday 29 th March 2017 in the Boardroom, Carlton Court, St Asaph Mrs Margaret Hanson Ms Jenie Dean Mrs Lyn Meadows Independent Member (Chair) Independent Member Independent Member In Attendance and Observers: Mrs Kate Dunn Ms Jen French (part meeting) Mrs Gill Harris Ms Jackie Hughes Dr Evan Moore Ms Morag Olsen Miss Teresa Owen Professor Michael Rees Mr Andy Roach (part meeting) Mr Mark Thornton Acting Head of Corporate Affairs Director of Nursing, Mental Health & Learning Disabilities Executive Director of Nursing & Midwifery Staff Side Chair Executive Medical Director Chief Operating Officer Executive Director of Public Health Healthcare Professionals Forum Chair Director of Mental Health & Learning Disabilities Vice Chair, Community Health Council Agenda Item QS17/61 Chair s Opening Remarks Action By The Chair welcomed everyone to the meeting. QS17/62 Declarations of Interest None declared. QS17/63 Apologies for Absence Apologies were received from Cllr Cheryl Carlisle, Mr Chris Wright and Mr Adrian Thomas. QS17/64 Minutes of Meeting Held on for Accuracy and Matters Arising from the Summary Action Log QS17/64.1 The minutes were approved as an accurate record. A matter arising relating to potential harm for patients awaiting planned surgery was raised. It was noted that there were challenges in obtaining this data and in defining harm. It was agreed that EM

2 2 Minutes QSE Public V1.0 the clinical executives would scope a piece of work initially for the Quality & Safety Group (QSG) before presentation to the Committee. A further matter arising was raised regarding a previous patient story. QS17/64.2 Updates were provided to the summary action log. QS17/65 Corporate Risk & Assurance Framework QS17/65.1 Mrs Harris presented the paper which provided latest updates of corporate risks allocated to the QSE Committee. The Committee reviewed each in turn. QS17/65.2 CRR02 Infection Prevention & Control the Committee accepted the scores as presented. Concerns regarding consultant microbiologist support and a new model of service were highlighted, and would be referenced in the Chair s report to Board. In terms of infection rates, the Committee noted challenges to sustain the reduction in clostridium difficile rates and to address recurring issues in the East relating to norovirus. QS17/65.3 CRR03 Continuing Health Care concern was expressed that the desired outcomes were not being achieved despite a range of actions being implemented, and the position was not sustainable. There was a lack of confidence that the actions justified the reduction in the risk score as noted in the report, and a discussion took place regarding elements of crossover within this risk with the Finance & Performance Committee. The point was also made that the description did not currently articulate the risk as to whether there was sufficient continuing health care and social health care to provide for the needs of the population. Mrs Harris undertook to review and re-quantify the risk to determine if needs to be a clearer overarching risk, or elements separated out and reporting to different Committees. QS17/65.4 CRR04 Maternity Services the Committee accepted the scores as presented. The Committee were reminded that maternity services were an area of focus under special measures. Mrs Harris reported back on a range of strategic and national meetings pertaining to the maternity workforce which had identified three key issues to address including better performance within the recruitment market, creation of longer term workforce plans and responding to the implications of Brexit. It was noted that there were ongoing conversations with the division regarding an organisational development plan which would be shared at the next Committee meeting. With regards to culture within the service, there was evidence that this was improving under strengthened leadership arrangements. Discussion ensued regarding ongoing recruitment challenge and sustainability of consultant middle grade posts. QS17/65.5 CRR05 Patient Experience the Committee accepted the scores as presented. It was highlighted that there was evidence of learning from complaints was shared at performance accountability reviews. It was noted that would likely be changes to the executive ownership of this risk pending the outcome of the consultation on dissolution of the directorate of corporate services. QS17/65.6 CRR13 Mental Health Services noted. Discussion on risks as part of the mental health assurance report later on the agenda. QS17/65.7 CRR16 Safeguarding the Committee noted the scores as presented, but

3 3 Minutes QSE Public V1.0 queried whether the risk impact had actually changed. Members were reminded of previous concerns regarding gaps in the safeguarding workforce and that work to mitigate this risk had been undertaken over the past few months. It was confirmed that the corporate safeguarding risk register had been scrutinized and reviewed in detail at the Safeguarding Group including participation by staff and Public Health Wales. The Committee were assured at the level of activity to address safeguarding risks and that the risk had reduced, however, it was noted that a significant level of risk remained including some gaps within the team. It was confirmed that training via Manchester University had been secured for best interests assessors, and that matrons and ward staff were now reporting higher levels of confidence with regards to process and awareness of who to contact with safeguarding issues. There was an acknowledgement that Deprivation of Liberties Safeguards (DOLS) legislation was extremely complex and that the risk raised at Board previously related to compliance with the legislation, not directly to an impact on patient care. It was confirmed that the annual safeguarding report would now be submitted to the Board. QS17/67 Quality Dashboards Presentation [Taken out of order at Chair s discretion] QS17/67.1 Mrs Harris delivered a presentation which provided an overview of the quality dashboard with examples of reporting for healthcare acquired pressure ulcers, falls and medication. She explained that the principle of the dashboard would be to enable readily accessible triangulated data and intelligence on critical areas of harm to determine if there were areas of concern requiring further investigation. The dashboard would also enable wards to compare their RAG status against other wards. QS17/67.2 A discussion ensued. In response to a question as to whether wards would be named, Mrs Harris indicated that where quality issues were identified, the ward / team would be given an opportunity to improve and move forward before this was more widely shared. It was noted that the dashboard would over time be able to pull in data from other sources on safe staffing indicators, and work would be undertaken to develop escalation trigger points. Quality data audits would continue and would be developed to incorporate bespoke indicators for children s services, maternity and community. It was felt that clinicians and staff would need to engage fully with the dashboard for it to deliver the most benefit, and it was noted that the Healthcare Professionals Forum were very supportive of the approach. Mrs Harris indicated that a launch date was dependent on solutions to some informatics issues but the aim would be for June. Details regarding the public facing screens on wards would need to be finalised, but the information displayed at that level would be bilingual. The Committee welcomed the update, and also requested an update in due course on the real-time patient experience pilot. QS17/66 Mental Health Assurance Exception Report [Mr Andy Roach and Ms Jen French joined the meeting] QS17/66.1 Ms French presented the paper which provided an update in terms of monitoring arrangements across mental health and learning disability services and with regards to the development of a Mental Health Strategy. She highlighted there had been a good level of involvement with partners in developing the Strategy to date, and that the Strategy Partnerships & Population Health Committee were due to receive a draft at its meeting on the A copy would be provided for QSE members, with the AR JF

4 4 Minutes QSE Public V1.0 understanding it was not yet in the public domain. Ms French referred to the work carried out in defining the governance framework and committee structure, and undertook to discuss Trade Union input into the range of subgroups outside of the meeting. QS17/66.2 Ms French reported on improved statistics for Putting Things Right and Mr Roach indicated that trends analysis work on serious incidents would be undertaken. A wider discussion ensued regarding the use of learning from incidents in a patient story format and Mrs Harris was asked to develop a proposal for a programme of stories linked to serious incidents and other patient experiences across a range of services. With regards to safeguarding, it was noted that previous concerns around timeliness of responses was being addressed and there was an improved visibility of the corporate safeguarding team as per earlier discussions. With regards to the range of external inspections and reviews, the question was asked how the Committee could be assured whether the actions outstanding were significant. Ms French indicated she could provide a higher level of detail in future reports but she gave assurance that anything urgent was addressed straight away if possible, although she noted that some actions were reliant on strategic change. Mrs Harris confirmed that Healthcare Inspectorate Wales reports, and other external inspection reports, would undergo scrutiny at the Quality & Safety Group (QSG) and there should be an overview summary provided to the QSE Committee perhaps twice a year for monitoring purposes. She would follow this up to amend the cycle of business accordingly. She also undertook to circulate a copy of the QSG terms of reference and 2017 meeting arrangements, and extended an invitation to any QSE member to attend if they so wished. AR JF [Dr E Moore left the meeting] QS17/66.3 Progress in terms of the Delivery Unit follow up visits was acknowledged although there were still some issues to be addressed. A request was made to include the percentage of job plans undertaken in the next report. It was also noted that the redevelopment of Community Mental Health Teams would be outlined in the Strategy and a level of detail included within the next report to the Committee including the relationships with cluster leads. On this point it was suggested that the division make contact with Dr Liz Bowen. Reference was made to the infection prevention key standards and it was acknowledged that the bare below the elbows target and access to training were the areas of most challenge. The low uptake of flu immunisation within the division was of concern and Miss Owen indicated there would be a focused programme for improvement in the next year. AR JF QS17/66.4 Ms French reported that the Mental Health Act (MHA) Committee had reviewed compliance with the Mental Health Measure and agreed a range of actions including delivery of more meaningful care and treatment plans. The MHA Committee had also expressed concern at the numbers of under 18 year olds being seen under Section 136 arrangements which was unacceptable. Ms French reported there had been a recent meeting with the Police and Child & Adolescent Mental Health Services to identify an alternative for this age group. The matter would be escalated to the Corporate Risk & Assurance Framework. A discussion ensued around patient flow, bed management and the approach to crisis care particularly out of hours and weekends. QS17/66.5 A discussion took place regarding the need to deliver care differently and to

5 5 Minutes QSE Public V1.0 modernise the workforce as part of the mental health strategy. Recruitment performance across the areas was highlighted and it was noted that generally there was a rich skill mix but there were recruitment challenges requiring different ways of working, for example an extended use of Healthcare Support Workers. Mr Roach also noted that the continuing health care team had recently rejoined the division and whilst there was a programme of work being developed this remained a high risk area for the Health Board. QS17/66.6 The Committee noted the report. Mr Roach and Ms French left the meeting. QS17/68 Update on Infection Prevention and Control Across BCUHB Summary of Progress and Improvement QS17/68.1 Mrs Harris presented the summary report, highlighting that 67% of relevant staff had now completed competency assessed training and that clostridium difficile outbreaks had reduced significantly. It was noted that whilst MRSA bacteraemia cases had reduced slightly, BCUHB was still an outlier compared to other areas. Mrs Harris suggested that tackling this would require sustained focus on microbiology, culture and individual behaviours. QS17/68.2 The Committee noted that report and requested that the next report provide further information on the Wrexham norovirus challenge, and solutions. QS17/69 Draft Annual Quality Statement (AQS) Mrs Harris indicated that feedback from other groups continued to be received and incorporated. It was noted that Ms Dean was attending the editorial panel meeting on the and had requested a hard copy of the latest version in advance. TC AW QS17/70 Radiation Protection Subgroup Annual Report QS17/70.1 Mrs Harris presented the report. She highlighted that: the number of radiation incidents had decreased in 2015; there had been a satisfactory visit by Natural Resources Wales to the Bangor site; a successful audit of the radiotherapy quality system had been undertaken; a range of tasks had been identified for completion in QS17/70.2 Ms Hughes wished to acknowledge the amount of work put in by Mr Peter Hiles and his team. QS17/70.3 The Committee welcomed the update on this important area of work, but suggested that the annual reporting from this sub-group could be more timely. A wider discussion took place regarding the range of annual reports that came to QSE Committee and Mrs Hanson and Mrs Harris would reflect on future scheduling. MH QS17/71 Issues Discussed In Previous In Committee Session Noted. QS17/72 Documents Circulated to Members The items listed as having been circulated since the last meeting were noted.

6 6 Minutes QSE Public V1.0 QS17/73 Issues of Significance to Inform the Chair s Assurance Report Following the meeting, the issues below were agreed with the Chair: Assurances received that the corporate safeguarding risk register had been reviewed in detail by the Safeguarding Group (including representation of staff and Public Health Wales) Concerns over capacity of advocacy services which would support safeguarding arrangements Concerns regarding consultant microbiologist support The Committee welcomed the update on the development of Quality Dashboards, noting that a launch date was dependent on some informatics issues QS17/74 Any Other Business None raised. QS17/75 Date of Next Meeting at 9.30am in Carlton Court. Meeting closed 1.30pm