Quality and Patient Safety Meeting Part 1 9 th October 2015 12:30pm 3:00pm Thurrock Civic Offices Present: Dr L Grewal (LG) Quality & Patient Safety Committee Chair, Thurrock CCG Jane Foster Taylor (JFT) Russell Vine (RV) Lesley Buckland (LB) Dr N Raj (NR) Stephen Mayo (SM) Linda Smart (LS) Ria Walsh (RW) Alana Stokes (AMS) Chief Nurse, Thurrock CCG Practice Manager, Thurrock CCG Lay Member, Thurrock CCG GP Board Member and Safeguarding Lead Deputy Chief Nurse, Basildon & Brentwood CCG Deputy Chief Nurse, Thurrock CCG Administrator, Thurrock CCG Minute Taker, Thurrock CCG Apologies: Helen Horrocks Public Health Sue Cleall Laura Davis Quality & Patient Safety Manager, Thurrock CCG Lead Nurse, Thurrock CCG 1. Welcome & Apologies Jane Foster-Taylor welcomed everyone to the meeting on behalf of the Chair. The apologies were noted above. No conflicts of interest were declared, other than those recorded in the Register. Minutes of the meeting held on 11 th September and Action Log The minutes of the previous meeting held on 11 th September were accepted as an accurate record. Update Joy Joses had previously been asked to update online copy of the Adult Safeguarding action plan. LG requested to have everything in one place on the Thurrock website as a one stop for GPs. LS advised that a gap analysis would be completed for what needs to be updated. The group were advised that Dr Grewal had been appointed as the new Adult Safeguarding lead for Thurrock CCG. Action: Christine Celentano to add Nicola Meeks to November CEG agenda for presentation of Policy for Policies. LG to be reminded for Constitution discussion on CEG Action Log 24/15 Nicola Meeks to attend the November CEG meeting to share the Policy for Policies. 29/15 JFT advised that the quality team would visit once the patient moves had been completed and review any big changes. The team have also requester sight of Arden GEM s
Quality visit findings. 30/15 JFT advised that the Infection Control information folder had been checked and was updated a year ago on the Thurrock website. The folder will be reflected for all four CCGs in the area. Jo Mayhew had advised that this should also be promoted on the Medicines Management website. 31/15 SEEDs provided flu cover for South West Essex patients. JFT noted that Thurrock CCG will have to commission NELFT to undertake this action. South Essex currently use SEPT for this process. The cover is not provided for in the commissioning intentions. Action: JFT to email Mark Tebbs. 32/15 Recruitment to the Designated Medical Officer post will continue to be progressed as Claire Blair will be staying in her role for three month as a consultant. 33/15 Previously update by LG - Accountability & Assurance Framework (Adult Safeguarding) Action Plan to be shared on the Thurrock CCG website. An update was shared on behalf of Laura Davis for the Sharps issue progress. It was suggested that assurance of the mechanism put in place would be needed as well as a communications process to be agreed for practices to be made aware. It was noted that the Local Council are leading on communications. The Sharps issue was explained to the attendees and discussed. 2.1 Patient Experience Report LS shared the executive summary from the Patient Experience report and noted the NELFT items to be reviewed. NELFT s overall activity was reduced but they were understaffed on eight separate shifts. The Friends & Family response showed a 95% achievement in satisfaction but LG noted that the response rate was 1% and queried if this can be improved. It was advised that the responses were previously a CQUIN and the issue had been raised at the CQRG meeting. Increasing vacancy rates were highlighted on the wards and there is a corresponding rise in PUs and falls. NELFT s overseas nurses may be moving to other countries due to recent government requirement to earn 35,000 or more. There are on-going issues with recruitment and retention of nurses. LG queried if the current PUs may correspond to a slowing down in hospital discharges, it was confirmed that this should not happen as they would be managed by community teams. BTUH Friends & Family results were benchmarked against other trusts and proved to be below average for A&E but some other topics were above average. There was a 25% response rate recorded. It was noted that there were some negative reviews for BTUH on NHS Choices. The hospital has asked for direct contact to discuss the experiences with patients. A possible Never Event was discussed that was recorded as a patient experience story in a comment on the website. The patient s family detailed an issue of a minor possibly being taken into theatre without parental consent. Action: SM to review and update the Committee at the next meeting. LS noted there had been issues reported with the PALs service. LG queried if Healthwatch are involved in the process. LS clarified that patients go through Healthwatch after PALs if they are not satisfied with the result. BHRT safer staffing. SM attends CQRG issues with x-ray, CTs etc. have raised as an SI
doing harms review. LG what is the scale of the issue and ask for a solution. LG assuming that 2 week waits are separate? The Committee were informed of an issue with cancer patient two week waits as these should be separated from other waiting lists to enable tracking of cancelled appointments. James Buschor was advised that this had been resolved but there was another cancellation of a cancer two week wait appointment. The SEPT safer staffing fill rate is currently below 90% for some areas. Action: LS to discuss with Tricia D Orsi and Amanda Murphy The Committee noted a further response rate that had been recorded as 1% and asked for this to be addressed with Tricia D Orsi. The recent Care Home data presented within the report was reviewed and LS advised that the Coach House update had been provided within a separate paper. SEPT had updated regarding their staffing crisis and through addressing the issue with job fairs and other solutions, they were able to employ 100 new staff members. LG expressed concern that the Adult Safeguarding Board meeting do not currently have sight of suicide prevention data for deaths out of the area etc. RV advised the group that the CQC will be changing their process again. The Committee complimented the new format used for the Patient Experience report. 2.2 Serious Incidents Report LS advised the group that the Serious Incidents report format had been changed as Sue Cleall had taken over the lead role. The numbers of recent incidents for the providers were reviewed. 2.3 Medicines Management JFT noted that the report from Medicines Management, recognising that it is some time since the last report was received, advised the Committee that these themes would be reported more regularly, along with the Medicines Management meeting minutes. LG advised the group that Françoise Price would include a summary for Joy Joses to share with GPs within the Thurrock CCG newsletter on behalf of the Medicines Management team. Action An issue was raised regarding an SI and possible Never Event that would be discussed in Part 2 of the meeting as it related to the Controlled Drugs Accountable Officer. 3.1 Performance and Quality Indicators Report The Performance and Quality Indicator report from James Buschor was shared for information and the group reviewed the summary. Bullet points were reviewed for current breaches and the cumulative breach for Cdiff. There were Ambulance report breaches, including red calls. The Committee were advised by LS that there had been slippage on red 1s and red 2s. JFT noted that the data for 4 hour waits had dropped slightly in the recent months. Issues were also highlighted for the Cancer pathways. Action: The group queried the data entries that showed 0% and JFT advised that she would confirm with James Buschor if this was a typo.
JFT suggested the report be shared with the Thurrock CCG Board with a note regarding where the information is currently being reviewed. The Committee were informed that BTUH has been on black alert on a frequent basis since August 2015. LG commented that alerts are shared with the GPs but practices are using the RRAS service appropriately, the hospital should be looking to make improvements in its processes. JFT noted the difference between BTUH and Southend Hospital when calling black alert, this could have a negative impact as GPs could become less sensitive to the issues, as black alert occurs so frequently. RV advised that he was aware that since BTUH have had Tom Abel and Michelle Stapleton in their new roles, a new member of staff, Kate Waterton, who was a former Practice Manager, has also started their role and is employing positive changes. She was seconded in and is communicating well with GP practices, as well as beginning mapping exercises of the federation AMU West is closed for building work, resulting in limited escalation capacity. JFT advised that she was not made aware of this issue and queried how long this would be in effect. Action: SM to confirm when building work is due to finish for full capacity to be reinstated. The Committee were advised that the 18 weeks target had missed the standard but would be closely monitored. There was also a two week wait pathway breach reported. It was agreed that the performance report summary would be shared at the Governing Body meeting as an exception report. 3.2 Complaints report The Thurrock CCG Complaints report was reviewed for information. JFT highlighted that the 20 day targets are not always being met and advised this would be escalated to the complaints lead for clarity of why it is not being met. The report now includes the common themes of the complaints that have been shared. This information will be used to set a benchmark across services and agencies. SM suggested the benchmark could be set regarding the complexities of individual cases. The group discussed a case involving an NHS 111 investigation of the hygiene of an attending GP. It was confirmed that issues regarding GPs are signposted to NHSE or back to GP surgery to deal directly with the complaint. LB queried who in the CCG leads on clinical aspects of complaints. LS advised that she is involved in all Quality themes and the complaints team lead on all other themes. 3.3 Issues escalated to other Committees and Board There were no issues escalated. 3.4 Issues escalated from other Committees and Board There were no issues escalated. AOB LB updated the group regarding recent PPI developments. There CRG meeting now has volunteer Chairman, Alan Hudson, who is a member of the public. The next CRG meeting time
and location have been changed and it will continue to vary to meet the needs of the public. It was advised that Sue Cleall would be leading on Patient Experience as an item for the next CRG An advert for a Thurrock CCG Board Lay member had been publicised again today. LG expressed concern that the CCG do not want to lose any of the current participants in the CRG group due to changes in the meeting time and location. LB assured that the changes fit the needs of the public. JFT advised that the Francis and Berwick workstreams would be removed from the workplan. It was noted that the current Adult Safeguarding Policy requires a refresh. The Quality team have met with Yvonne Anarfi as several of the workstreams straddle both the Adults and Children s services. The intention will be to use the same information from the Children s Safeguarding policy in the refreshed document. LG asked for Joy Joses to share the Safeguarding documents on the Thurrock website. JFT advised that there is a hold on the workstream. Action: JFT advised that the team would be taking the Quality & Patient Safety and Safeguarding documents to the Thurrock CCG Board meeting soon, then the website could be updated with the most recent documents. Date of Next Meeting 13 th November 2015 12:30pm 3:00pm Thurrock Civic Offices