Confirmed at meeting 10 February 2014 Cambridge University Hospitals NHS Foundation Trust Minutes of the meeting of the Governor and Director Working Group for Quality and Public Engagement held on Thursday 7 November 2013 from 16:00 to 18:00 in the Boardroom, Addenbrooke’s Hospital Present Governors Directors Mrs Georgina Pharaoh, Chairman Mrs Wendy Menon, Vice-Chairman Ms Helen Burchmore Mrs Judy Ewer, Lead Governor Mrs Gill Francis Mrs Elizabeth Howe Ms Liz Hunt Mr Peter Lester Mr Eric Revell Prof Patrick Smith Mr Brian Walker Mr Tom Bennett, Director of Operations Mrs Carol Heesom-Duff, Interim Assistant Director, Risk and Patient Safety Mrs Brenda Hennessy, Director of Patient Experience and Public Engagement Dr Sue Robinson, Deputy Medical Director Prof Pat Troop, Non-Executive Director and Trust Vice Chair In attendance: Ms Zoe Fritz, Consultant Physician and Wellcome Fellow in Bioethics Ms Sharon McNally, Interim Deputy Chief Nurse Mrs Helen McGhee, Deputy Trust Secretary, minutes Mrs Rachel Northfield, Head of Liaison and Development, Estates and Facilities Mr Fraser Rogers, Head of Public Engagement Apologies: 45/13 Governors: Mr Fred Jacobsberg, Professor Andrew Lever, Mr Jonathan Nicholls, Ms Ciara Moore, Directors: Dr Jag Ahluwalia, Dr Ann Alderton, Ms Ann-Marie Ingle, Ms Oonagh Monkhouse, Dr Mike Knapton, Dr Peter Southwick. Minutes of the meeting held on 9 September 2013 Ms Liz Hunt should be listed as a governor present; with this amendment the minutes were agreed as a correct record. 46/13 Review of action tracker and matters arising Received and noted: Action tracker 47/13 Integrated quality, finance and performance report – quality element Received Integrated report to September 2013; C.difficile report from task and finish group (A) C.difficile report from task and finish group Prof Pat Troop, group chair, reported. Noted 1. The task force had examined the actions being taken by the C.difficile taskforce. 2. It was important to maintain the availability of side rooms to facilitate isolation of suspected cases, but this was difficult given the hospital’s estate. Currently 88% of suspected cases were in side rooms at the point of sampling, with the intention to increase this percentage. 3. Maintenance of the deep clean programme was essential. 4. The communications programme was considered essential and should be maintained. 5. The key finding was that the position was being controlled, not cured, and it was important to maintain the programme at a high level, including communication. Capacity issues had an effect on the ability to deliver the programme. The issue remained high on the Board of Director’s agenda. 6. The Board would review the position in three months’ time Agreed Governors supported the Board in retaining the issue at the top of its agenda. (B)Never Event Dr Sue Robinson, Deputy Medical Director, reported. Noted 1. The never event reported in September involved a retained guidewire. Investigation had revealed that this had been inserted by a proficient individual but working outside their normal area of activity which was thought to be a contributory factor. A draft report had been prepared and this would be reviewed by the never event committee, to ensure that the Trust revisited actions necessary, including ensuring that the checklist for guidewire removal was correctly used, to ensure that the never event was not repeated. 2. A previous report by the University Department of Engineering had identified that the system design for guidewires could be improved as there was nothing to prevent the guidewire from being retained. There was also variation in the design of the devices. 3. The report had been sent to the MHRA (Medicines and Healthcare products Regulatory Agency) with a request for engagement with manufacturers regarding the design of the devices. The Trust was not aware that this had been taken forward. The Trust viewed this as a case for national level action on learning. (C)Other issues Noted 1 The Trust’s score on HSMR was was third in the East of England and sixth in the country. 2 The Council of Governors would receive the report to the end of September which would also be considered by the Board at its next meeting on 13 November. The process of collecting and integrating necessary information took around one month. 3 Governors discussed targets. It was noted that the net promoter score could vary between -100 to +100. Waitrose’ score was 46. However the Trust remained concerned about its score. The Trust had failed to meet the A&E target in October and also in November. Governors noted that the score for mandatory training was low. Local induction was not well reported. 4 Governors sought clarity about how issues discussed at the Workforce Committee of the Board would be considered within working groups; Ann Alderton’s advice would be sought. Minute Ref 47/13 48/13 Action Lead Secretary to seek clarity regarding consideration by working groups of issues discussed at the Workforce Committee Ann Alderton Target date Meeting 10 February Quality improvement strategy Received: Final Quality Strategy October 2013 Dr Sue Robinson and Carol Heesom-Duff reported. Noted 1. Governors welcomed the final strategy. 2. Dr Robinson thanked Glenn Pascoe and Marianne Monie for their work in developing the strategy. The first implementation group would be held tomorrow to discuss how the strategy would be embedded in the work of the organisation and how priorities would be monitored. The aim was for the Trust to become a high reliability organisation. 3. The new post of Director of Quality had been identified, but the appointment could not yet be formally announced. Agreed 1. Governors welcomed the strategy and the appointment to the key post of Director of Quality. 2. The group would be updated on progress with strategy implementation at its meeting in February. Minute Ref 48/13 49/13 Action Lead Update to be received 10 February meeting Dr Jag Ahluwalia Target date Meeting 10 February Quality Account mid-year review Received: Quality account mid-year review and monitoring data Sue Robinson reported Noted 1. The target for knee PROMS (patient reported outcome measures) had not been achieved and the payment of £600k was at risk. 2. The Trust was meeting all standards for the CQC quality profile. 3. Governors would be involved in the establishment of the Quality Account for 2013/14. 4. Governors noted that there were 60 delayed transfers of care at present. Agreed A report on progress against the Quality Account 2013/14 and the development of the Quality Account 2014/15 would be an item for the group’s agenda in February 2014. Minute Ref 49/13 50/13 Action Lead Agenda item on Quality Accounts 2013/14 and 2014/15 to be included for 10 February meeting Dr Sue Robinson Target date Meeting 10 February Universal form of treatment options (UFTO) Tabled: UFTO form Dr Zoe Fritz gave a presentation. Noted 1. Dr Fritz introduced the form which had been designed for use with all patients. It was intended to remove ‘ad hoc’ decision making and improve communications with patients. 2. The form had been developed through consultation with patients including a focus group meeting, and through piloting with West Suffolk. It had also been shared with the Cambridgeshire Clinical Ethics Forum. Early recognition of the need for palliative care reduced the potential harm to patients. This had been found to be a very effective intervention, and was supported by divisional directors. It would aid clinical decision making in terms of the medical process. 3. The intention was to introduce the form by the end of January. 4. Governors commented that the form would encourage forward planning and facilitate discussions with patients; a leaflet had been produced to contextualise the process and would be circulated to governors. 5. The form would be signed by the consultant with nurses being informed. It could also be used in the community. 6. The form would be open access. Agreed Minute Ref 50/13 1. The form was welcomed by governors as addressing an essential quality issue for patients. 2. Governors would receive an initial update to their meeting in September 2014, when the form had been in use for some time and there had been a measure of its effectiveness. Action Lead Governors would receive an initial update to their meeting in September 2014; secretary to schedule. Dr Zoe Fritz Target date Meeting 10 February 51/13 Update on discharge process (A) Report from Director of Operations Tom Bennett reported. Noted 1 Timely discharge was crucial to resolving the Trust’s capacity issues. Establishing an accurate estimated date of discharge was key, as was the timely provision of tablets to take out (TTOs). The target was for 40% of discharge letters to be signed the day before discharge. The ‘home by lunch’ initiative also aimed to reduce length of stay. A further initiative was nurseled discharge, which was intended to empower nursing staff. 2 Governors noted that information was given to patients about who to communicate with following discharge. In oncology, 80% of chemotherapy was not now given on the same day as a clinical appointment. (B) Report from focus group 1 October Received: Report from focus group 1 October Sharon McNally reported. Noted 52/13 1 This had been a very useful group, which had not resulted in any surprises but had reinforced the importance of good communication. 2 The output of the group was being shared widely. One attendee was being invited back to give their patient story, an initiative which governors supported as being very effective. 3 Length of stay and variation of care were all part of the transformation programme. The Trust was looking at ways of improving the speed of provision of tablets to take home (TTOs) and hence discharge. Capacity issues Tom Bennett gave a presentation. Noted 1. Capacity continued to be a major issue for the Trust. 2. There had been a surge in activity in September which had reduced the ability to release capacity from length of stay and use of Addenbrookes@home. The current number of patients who were delayed transfers of care was 60. 3. The actual numbers of patients treated by Addenbrookes@home, in a hostel as a step down facility or in ambulatory care were not as great as planned and efforts were being focussed on increasing these numbers. 4. Short term actions were in place around discussions with local GPs about clinical governance, deep cleaning overnight to release ward facilities, using ward G3 as a surge capacity for winter, together with the ‘ready for winter’ project using additional therapists, enhanced weekend diagnostics and opening a children’s ward overnight. 5. Over the next one to five years it was envisaged that there would be significant growth in activity expected above population growth. This would require a significant increase in facilities going forward. Trust business planning must take this into account. 6. The trust was moving towards taking care of patients in their own homes and ‘re-ablement’. 7. The nurses for Addenbrookes@home were recruited by Medihome, the Trust’s partner, but worked under the Trust clinical governance structure. Their time was scheduled but the imperative was that they cared for patients appropriately. Agreed Governors welcomed the update and confirmed that this should remain a standing item on the agenda. 53/13 Report of governors/trust staff following focus groups (A) Outpatient focus group 30 August Received: Notes of outpatient focus group. Liz Hunt reported. Noted 1. The group had been very helpful. It was key to take patients forward in transformational change. 2. Patients had expressed concern to ensure that planned opening hours were published, and were as extensive as possible. 3. There had been problems with some of the outpatients plasma screens and a new supplier was being sourced. 4. A further focus group was planned following the establishment of the new outpatient appointment centre and streamlining of the process. Agreed The group would receive a report following the next focus group, and would receive a full report to its meeting in May 2014 on the progress of the outpatients transformation programme. Minute Ref 53/13 Action Lead The group would receive a report following the next focus group, and would receive a full report to its meeting in May 2014 Liz Hunt (B) Intermediate dependency area focus group 10 October Sally Walters and Vicky Smoothie were unable to attend due to operational requirements to maintain patient safety, so this report was not taken. 54/13 Patient led assessments (PLACE) Tabled: Report on mini-PLACE reviews Rachel Northfield reported. Target date By May 2014 Noted 1. The annual report and action plan for PLACE would be taken to the board of directors for agreement and was expected to be available for the group’s next meeting in February 2014 . 2. The report before the group showed the results of mini-PLACE reviews undertaken between September and November. One issue identified in some areas had been poor hand hygiene. The department was following up with nursing colleagues to ensure that gel was always available. 3. Areas were being encouraged to remove out of date signage and other clutter. Agreed Governors welcomed the audits and looked forward to receiving an update at their meeting in February 2014. Minute Ref 54/13 55/13 Action Lead The group would receive an update to its meeting in February 2014 Rachel Northfield Target date Meeting 10 February 2014 Governor Communication Group report Tabled: Notes from the Governor Communications Group meeting 30 October 2013 The group chair, Patrick Smith, reported. Noted 1. The communications strategy would be considered by the board of directors at its December meeting, following which the timetable for the implementation of actions arising from the governor communications and engagement strategy review would be confirmed. A governors’ communications kit was in development. The next staff governor surgery would be held in the food court on 20 November to encourage attendance. 2. The Trust would be taking part in the Cambridge Science Festival in 2014. 3. A taskforce to establish ways of increasing the governors’ profile with members and the public, was being established by the Trust Secretary. 4. The group was meeting monthly. Agreed Governors welcomed the increased role of this group in view of governors’ responsibility to communicate with members and the public. 56/13 Equality and Diversity Steering Group report This group’s meetings had been postponed and there was therefore no report. 57/13 Items to report to the Board of Directors and Council of Governors Members agreed that the chair should decide on these. 58/13 Date of next meeting Monday 10 February 2014 from 16:00 to 18:00 in the Boardroom. 59/13 Any other business This was Brenda Hennessy’s last meeting as she would be leaving the Trust in mid-January. The Chairman thanked her for her hard work and commitment to this group and indeed to the public engagement and patient experience across the Trust as a whole. Governors showed their appreciation in the customary manner.