DRAFT NOTTINGHAM UNIVERSITY HOSPITAL NHS TRUST QUALITY ASSURANCE COMMITTEE

DRAFT NOTTINGHAM UNIVERSITY HOSPITAL NHS TRUST QUALITY ASSURANCE COMMITTEE MINUTES OF THE MEETING HELD ON 16 MARCH 2016 IN THE BOARD ROOM, TRUST HQ, C...
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DRAFT NOTTINGHAM UNIVERSITY HOSPITAL NHS TRUST QUALITY ASSURANCE COMMITTEE MINUTES OF THE MEETING HELD ON 16 MARCH 2016 IN THE BOARD ROOM, TRUST HQ, CITY CAMPUS Present: Professor H Sewell Dr J Tabreham Mr D Cartwright Ms M Sunderland Dr S Fowlie Mrs C Shaw

Non-Executive Director (Chair) Non- Executive Director Non-Executive Director Chief Nurse Medical Director Chief Operating Officer

In Attendance: Mr A Chatten Ms N Hill Mr O O’Sullivan* Dr K Girling* Mrs R Medcalf* Mrs B Dorman* Mrs A Packham* Mrs K Kirkwood Mr M. O’Daly*

Director of Estates and Facilities Management Director of Human Resources Director of Strategy (for agenda item 2.1) Divisional Director for Surgery (for agenda item 2.2) Medicines Governance Lead Pharmacist and Medicines Safety Officer (for agenda item 2.2) Adult Safeguarding Lead Nurse (for agenda item 2.3) Children’s Safeguarding Named Nurse (for agenda item 2.3) Associate Director of Assurance and Committee Secretary Trust Secretary (for agenda items 5.1 and 5.2)

*Present as indicated

Cumulative Record of Quality Assurance Committee Members’ Attendance (2015/16) Name Ms L. Scull Professor H. Sewell Dr J. Tabreham Mr D. Cartwright Dr P. Homa Dr S. Fowlie (or deputy) Ms M. Sunderland (or deputy) Mr T. Guyler Mrs C Shaw

Possible 8 12 12 12 12 12 12 1 6

Actual 8 12 8 7 9 12 11 1 5

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2016/054 Introductions / Welcome 08:30 The Chair welcomed all present to the meeting. 2016/055 Apologies for Absence Apologies for absence were received from:  

Ms L Scull Dr P Homa

(Trust Chair) (Chief Executive)

2016/056 Declarations of interest on agenda Items Nil. 2016/057 Minutes of the meeting held on 17 February 2016 The minutes of the meeting held on 17 February 2016 were agreed as a true record. 2016/058 Review of committee action log The committee reviewed the committee action log and noted the progress reports against the actions due to have been completed ahead of this meeting. In relation to the infection, prevention and control action on page 3 of the log, Dr Fowlie confirmed that the information about the UHL protocol for testing now being the same as NUH’s was correct. 2016/059 Matters Arising from the Minutes 08:35 Schedule for reporting on progress with the implementation of the NUH dementia strategy - Dr Fowlie reported that the NUH dementia strategy was currently being revised and the new strategy would be complete by early summer. The new strategy was being informed by the CQC inspection findings and the data on staff assaults by patients with a behavioural disturbance. These incidents would be used as a stimulus to change practice as part of a Trust-wide action plan. Timeline for addressing estate infrastructure risks – Mr Chatten reported that he had met with Mr Mart following the last QuAC meeting to follow-up the fire safety infrastructure issues highlighted in the fire safety report. Fire risk assessments for each of the three NUH campuses would be complete by the end of March 2016 when an accurate costing of the financial investment required would be known. In terms of the wider estate infrastructure risks, the Trust was required to have a plan for the eradication of critical backlog maintenance and Mr Chatten outlined the magnitude of this and the need for 2

an estate transformational plan to halve the period to resolution by new build and extensive refurbishment, triggered by external business case derived capital. In response to a question from Dr Tabreham, Mr Chatten confirmed that the estate issues from the 2006 merger had been triangulated with previous and current backlog data and the estate transformation plan would be based on a current and externally verified infrastructure backlog schedule. Mr Chatten confirmed that the highest estate risks which required investment were:     

Low voltage Water Gas Ventilation (theatres) Fire

The Chair thanked Mr Chatten for his report. Training room capacity – Ms Hill reported that there was a shortfall of c. six rooms needed for training. Three applications had been made to the space committee which were being considered along with a plan for a new build. There was an option linked to the partnership with Sherwood Forest Hospitals, especially in relation to accommodation for exams. Dr Tabreham suggested that exploring options in the community might also prove fruitful.

2016/060 Seven day services quarterly report 08:55 Mr O’Sullivan attended the meeting to present the quarterly seven day services report to the committee. He highlighted three main points: 

 

The requirement to conduct a prospective notes audit between 30 March and 5 April (280 sets of notes) which will provide a clear indication of how NUH is performing against the four key clinical standards for seven day working and where improvement is required The NUH requirement for all Divisions to include within their annual plans for 2016/17 an outline of how they will move to providing seven day services The Trust’s participation in the East Midlands Acute Hospitals Seven Day Services Leads group which had jointly developed a dashboard of key indicators regarding seven day services

Mr Cartwright asked about the percentage figure relating to deaths by day of discharge. Dr Fowlie suggested caution when interpreting these figures in terms of a causal relationship as there were considerably fewer discharges from hospital at the weekend. The Chair thanked Mr O’Sullivan for a very clear paper. He asked about the 3

views of staff on seven day working and it was confirmed that the views of consultants would be captured through the prescribed audit. Mrs Shaw stated that it was important to understand the context of this requirement. NUH was well served in relation to services running seven days a week with a flexible workforce. If all services were to run over seven days however (eg. out-patients) there would be huge financial implications. The committee received and noted the report. 2016/061 Medicines bi-annual assurance report 09:05 Dr Girling and Mrs Medcalf attended the meeting to present the mid year medicines assurance report to the committee. The Chair thanked Mrs Medcalf for a very clear paper and for highlighting the key issues of:    

Progress with the implementation of the medicines optimisation strategic objectives The pilot of the medicines safety thermometer An update on the MHRA inspections Talk about medicines week

Dr Tabreham asked about the collaborative working with community colleagues. Mrs Medcalf explained that progress had been slow as the initial meeting with CCG representatives has shown their focus had been on financial savings with medicines rather than medicines optimisation, however, there was commitment to working together on this issue. Mrs Shaw raised the issue of differing requirements externally in relation to ‘tto drugs’ and their impact on delaying discharges from hospital. Mr Cartwright asked about the medicines safety thermometer pilot. Mrs Medcalf explained the data collection issues and the resource intensiveness associated with the national tool and the fact that it could lead to false assurance being given. She added that the value of the thermometer pilot had been the answers to the more pertinent Trust questions which had been added to the national tool. It was agreed that in future there would be quarterly reporting to the committee based on a set of medicines metrics, aligned to the sign up to safety plan, with the regulatory assurance reports built into these. 2016/062 NUH response to Goddard inquiry 0920 Mrs Dorman and Mrs Packham attended the meeting to brief the committee on the independent inquiry into child sexual abuse being chaired by Justice Lowell Goddard, which would include cases from Nottinghamshire.

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The purpose of the inquiry was:     

To consider the extent to which State and non-State institutions had failed in their duty of care to protect children from sexual abuse and exploitation. To consider the extent to which those failings had since been addressed. To identify further action needed to address any failings identified. To consider the steps which it is necessary for State and non-State institutions to take in order to protect children from such abuse in future. To publish a report with recommendations

The inquiry had been commissioned in response to an increasing number of reports of child sexual abuse in a number of institutions, including the BBC, the NHS, in children’s homes and in schools. In relation to health, the NHS was expected to learn from the well-publicised Bradbury and Savile inquiries. Issues for NHS organisations in relation to the inquiry include:     

Records management and destruction of records The quality of investigations into disclosures of or suspicions about child sexual abuse relating to patients attending the hospital Evidence of learning from investigations into child sexual abuse Meeting the needs of victims/survivors of child sexual abuse Participation in the child protection information sharing scheme (CPIS)

The Chair thanked the presenters for a very succinct and helpful presentation. In response to a question from Dr Tabreham, Mrs Packham confirmed that a VIP policy was in operation at NUH (a recommendation from the Savile inquiry). Mr Cartwright asked if the Trust was confident it had the right safeguarding policies and procedures in place and was assured that it had. The committee took significant assurance from the report and gave its support for the CPIS link up. 2016/063 Quality of the emergency pathway quarterly report 0940 Mrs Shaw presented the quarterly report into the quality of care for patients on the emergency pathway. The report had been re-worked to give more focus on the quality of care in the emergency pathway, especially as there were higher numbers of patients waiting longer in the emergency department (ED) compared to the same period in 2014/2015, with a focus on the number of patients spending up to 8 and over 12 hours in ED. A focused piece of work had been undertaken looking at two categories of harm – falls and pressure ulcers. The outcome of these reviews suggested poor adherence to Trust policy/guidelines designed to avoid these harm 5

events occurring. The ED senior nursing team was already concerned that the impact of peak numbers in ED, long waits and the numbers of patients waiting for beds each morning was adversely affecting patient care as the department is not designed to effectively cater for these patterns of activity. A set of actions had been put in place by the Deputy Chief Nurse, with the urgent development of a set of nursing metrics specifically for ED along with an establishment review. Dr Tabreham requested that the report would benefit from including a set of patient experience indicators. The Chair added that the experience of outliers also needed to be captured and it was agreed that this would be included in the elective pathway indicators. Mrs Shaw summarised the committee’s discussion as follows – future reports to decrease the amount of performance information and focus on quality indicators with a clear link to patient satisfaction and clinical outcomes. The report to be presented by the Divisional Nurse. 2016/064 Serious Incident Log 0955 Dr Fowlie presented the updated log. There were no new additions to the log and the proposals for removal were approved by the committee. The committee received and noted the report. 2016/065 Outcome of serious incident investigation 0957 The committee received and noted the report of the serious investigation into the wrong route administration of oral morphine. The number of recommendations reflected the complexity of this case, linked to the involvement of the university. The committee agreed that the recommendations were robust and appropriate and implementation would be monitored not only through the clinical risk committee but also through the NUH/UoN liaison arrangements.

2016/066 Nurse Staffing Levels Monthly Report 1000 Ms Sunderland presented the monthly report. She apologised for the lateness of the paper. The production of the paper was becoming problematic owing to the UNIFY data deadlines. It was hoped that the monthly upload requirement would cease from 1 April 2016, but this had not yet been confirmed. Once confirmed, the committee agreed to receive a simplified, more in-depth quarterly report. The highlights from the report were: 

No wards had dropped below the 80% fill rate 6

   

A review of the NHS choices data on infection control and cleanliness was being undertaken Compliance with the staffing app was improving There had been a decrease in agency spend but the cap was not yet being reached The Trust was successfully recruiting nurses, but the newly qualified nurses would not be available to start work until September 2016

The work being undertaken on retention of staff would be included in the next report. Ms Hill needed to better understand the reason for fill rates of

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