Quality and Clinical Governance Committee Date Chair Minutes 18 July @ 3.00pm 4.30pm Surrey Heath House, Knoll Road, Camberley, Surrey GU15 3HD Michele Harrison, Quality Manager Members Present Gareth Jones (GJ) Andy Brooks (AB) Anas Salah (AS) Lay Member, PPE Chief Officer, GP Clinical Quality Officer In attendance Invited speakers Apologies Kevin Solomons (KS) Helen Blunden (HB) Amanda Boodhoo (AB) Ann Cooper (AC) Fiona Andrews (FA) None Head of Medicines Management Designated Nurse for Safeguarding Vulnerable Adults Designated Nurse Safeguarding Children Interim Governance Support Admin Manager minute-taker Alison Huggett (AH), Dr Rachel Darroch (RD), Dr Steve Williams (SW), Jon Beresford (JB), Linda Gilbert (cannot make any future meetings) 1. Welcome, Introductions and Apologies MH welcomed members, and noted the apologies received. 2. Declarations of Interest There were no additional declarations of interest made. 3. Minutes of last Quality & Clinical Governance Committee 20 June These minutes were AGREED by the committee. 4. Matters Arising Not on the agenda There were no matters arising discussed. 5. Quality Reports Quality Dashboard AS provided members with an overview of the month s Quality Dashboard, Page 1 of 10
noting the new additions and highlighting key factors such as the infection control data and the CQC inspection 2 nd Wave visit at SABP. Under Domain 3 Emergency Re-admissions were discussed. FPH presented the re-admissions audit at this week s CQRM and reported that some of the readmissions were due to inaccurate coding. Action: MH to circulate the audit on surgical re-admissions. MH AB questioned whether further work needs to be done in relation to the readmissions and triangulating with length of stay to see if there was any correlation. AH will be sighted on the issue when back from AL. Under Domain 5 Treating and caring for people in a safe environment, it was noted that the percentage for Frimley Park Hospital patients decreased by 4% in May. Royal Surrey County Hospital (RSCH) numbers also decreased by 2% and Surrey and Borders Partnership Trust (SABP) also managed to improve on the percentage of surveyed patients by 1%. AB asked if there was a benchmark for these targets and AS acknowledged that this would be looked into. Infection Control Update-HCAI Report (May) C Difficile: Surrey Heath CCG recorded a further 2 incidents in June, breaching the monthly trajectory totalling 4 this year. However there had been an improvement in May. MRSA Bacteraemia Surrey Heath CCG recorded zero incidents throughout April, May and June. Appendices Appendix 1 listed the Friends and Family Test and Ward level data. This was useful information and some variation was noted. GJ raised a concern about whether the CCG should publish on the website what is being done about health issues of concern eg shortage of mental health beds-is it an issue in this area and if so what we are doing about it. Discussion re where to focus capacity but thought to be an interesting area. GJ to raise at the Public Patient Engagement (PPE) meeting next week. 6. Safeguarding Children s update and Exception report Amanda Boodhoo updated the committee on the monthly exceptions report summarising safeguarding children activity in the last month. Page 2 of 10
- Child Health information Systems Following the accidental death of a child in East Anglia a comprehensive audit of Child Health Information systems (CHIS) within providers has begun to determine if the issue extends across NHS England. National piece of work. - Section 11 Audit The Section 11 audit tool has been circulated by the Surrey Safeguarding Children s Board to all providers and CCG s. Returns are due by 31 July and AB and MH have worked together to compile a first draft. This needs to be signed off by AH. - Serious Case Review Significant work going ahead with four active cases. - GP Conference Attendance There have been issues with attendance, this seems to be improving. - Dashboard/reporting to CCG s Agreed changes and dashboard will be amended. Reports will be twice yearly consisting of an annual report, a six month update and monthly exception reports. Child V MH updated the committee on the recent case where the father has been prosecuted and sentenced last week. There is likely to be some media response and CCG s locally have worked with West Hampshire CCG on a consistent media response. Safeguarding training with North Hampshire Urgent Care (NHUC) and GP s will be monitored via CQRM. Safeguarding Vulnerable Adults Update HB updated the committee. There is a Serious Case Review being held with regard to North West Surrey CCG and an attempted murder. Mental Capacity Act: Looking at discharge pathways within the community. Frimley Park Hospital: Frimley Park Hospital recently held their safeguarding meeting which HB attended. DOLS Ruling: in March-7 day ruling and social services not getting there in time. Stroke Ward: Investigations going ahead looking at no written consent, restraints and repeated procedures. Proposal: - More effective pathways and documentation. Page 3 of 10
- Threshold patients being seen within the 7 days. Ensure that bed rails and crash mats are in wards and that these are robust. 7. Medicines Management overview & update KS presented an update on Antibiotic Prescribing to the committee, highlighting that the CCG has a relatively low rate of antibiotic prescribing against national, Area Team and local CCG s. The use of high risk antibiotics is higher than a number of comparable CCG s and appears to be associated with a small number of practices. The presentation looked at Surrey Heath overall and practices within the locality. Three practices, Frimley Green Medical Centre, Lightwater and Station Road all had higher incidences of antibiotic prescribing. The committee agreed that this was useful data and KS will update the committee on a quarterly basis. The Area Team are developing a Memorandum of Understanding for CCG s to support the Controlled Drugs Accountable Officer (CDAO) which will include prescribing monitoring and supporting investigations. Quality improvements to be supported in commissioned services. Frimley Park Hospital will also do some of the INR audit. Action: KS to speak to Julie Curtis regarding primary care in commissioned services. KS Medication errors: Looking at establishing local mechanism for reporting errors in primary care through NRLS. Potentially could come via care home reporting. KS went on to highlight the Medicines Optimisation Dashboard which would look at further improvements. Action: KS to circulate presentation to attendees. KS Prescribing Clinical Network Recommendations KS informed the committee of a summary of decisions to be made and ratification by the committee. There were two highlighted PCN s that could not be ratified today: PCN-91- Relvar Ellipta for COPD postponed and being reconsidered at July PCN meeting. No action required and not ratified. PCN-98- Osteoporosis guidance Safety concerns raised. Agreed clinically on this basis but recommend that this is presented at the next Clinical Planning & Delivery Committee whether pathway changes should be applied and if GP s should be reimbursed. The Quality & Clinical Governance Committee NOTED and AGREED at the other recommendations. Page 4 of 10
There were two negative decisions made on PCN 100- and PCN 101- with the Prescribing Clinical Network not supporting the use of these drugs. The Quality & Clinical Governance Committee NOTED and AGREED this recommendation. KS tabled NICE technology appraisals, which are NHS directions and legally binding. The committee AGREED these recommendations. 8. Serious Incidents Requiring Investigation (SIRIs) Report Monthly Report AS provided the committee with an overview of Serious Incidents across Surrey Heath commissioned services. During the period 1-30 June, 18 incidents have been report. There were none for Surrey Heath CCG. SABP Monthly SI Briefing NE Hants & Farnham CCG continue to work with SABP to manage the backlog of open and overdue Serious Incidents. Around 20 cases have been closed and the backlog is due to be completed by September. 9. Dermatology Service Andy Brooks updated the committee on this item. A paper recently circulated to members of the Quality & Clinical Commissioning Committee outlined concerns from Frimley Park Hospital and the CCG s response. It was noted that all attendees received this confidential paper. The committee members confirmed that they believed that sufficient evidence was provided to give confidence that any clinical governance risks have been mitigated. The proposal recommended going ahead with the dermatology pilot but in the short term excluding basal cell carcinomas (BCC s) as currently the service is not a member of a local multidisciplinary team (MDT). AB highlighted that under no. 3 in the document Coherence with network wide protocols would also be added into the specification by the CCG. The Quality & Clinical Governance Committee CONFIRMED that they are satisfied that all other clinical governance concerns initially raised by Frimley Park Hospital have been mitigated. 10. Terms of Reference (TOR) - QCG Committee AC informed the committee that all Terms of Reference for committees are currently being reviewed for the CCG. The QCG TOR is now due for its Page 5 of 10
annual review and needs to reflect what the committee is doing on a monthly basis. Any comments to be forwarded to AC and AH. 11. CQUIN/Quality Contract updates No updates. 12. Stakeholder Engagement GJ updated the committee. The next PPE meeting is being held on Wednesday 23 July and a public health consultant will be attending the meeting. GJ is planning to attend a national Lay Members meeting in London and will report back in due course. 13. Clinical Risk Register This document will be brought back to this committee on a monthly basis and presented at the Audit Committee and Governing Body meetings for information. Action: AC to circulate the risk on 111. AC 14. Items for Governing Body Report - Paper on Community Dermatology Pilot - Appointment of Nurse and GP representative for this committee. Action: AC to add lack of representation to the committee on the Risk Register. 15. AOB HB informed the committee that there was a GP Lead for Safeguarding who worked alongside Amanda Boodhoo, Safeguarding Children s. AC AS stated that he is working on the Serious Incidents Policy which will be brought back to this committee in September. Time and date of next meeting: Quality & Clinical Governance Committee 21 August : 2.00pm-4.00pm Venue - TBC FOI NOTICE Freedom of Information: Those present at the Governing Body meeting should be aware that their name will be listed in the minutes of this meeting, which may be released to members of the public on request under Freedom of Information. Page 6 of 10
Action Tracker Page 7 of 10
Meeting Agenda item Action 20 th June 20 th June 18 July 18 July 18 July 18 July 18 July 5 - Quality Reports 9 - Medicines Management 5 Quality Reports 7 Medicines Management overview 7 Medicines Management overview 13 Clinical Risk Register 14 Items for Governing Body Report Action: KS to share C.Diff and use of antibiotics at GP level data with JB Action: AH and KS to meet to discuss the agreed medicine management process. Action: MH to circulate the audit on surgical re-admissions Action: KS to speak to Julie Curtis regarding primary care in commissioned services. Action: KS to circulate presentation to attendees. Who Action owner Deadline Date to be completed KS 18/07/ KS / AH 18/07/ MH August KS August KS August Action: AC to circulate the risk on 111. AC August Action: AC to add lack of representation to the committee on the Risk Register. AC August Update and follow up Include date Status Date completed In progress Actions noted on action tracker In progress Actions noted on action tracker Page 8 of 10
Complete Actions Meeting Agenda item Action 20 TH June 20 th June 20 June 8 - Dermatology Service 10 - Terms of Reference - QCG Committee 13- Clinical Risk Register Action: Add Dermatology Services to next meeting agenda (to note decision) Action: Add item to next agenda Action: AC to circulate updated risk register Who Action owner Deadline Date to be completed Update and follow up Include date Agenda Item 18/07/ complete Agenda Item 18/07/ complete AC 18/07/ complete Status Date completed 20 June 13 Clinical Risk Register Action: Add Clinical Risk Register to next agenda Agenda Item 18/07/ complete Page 9 of 10
Minutes signed and agreed: Chair: Date: Print Name: Page 10 of 10