Agenda and minutes

There were no declarations of interest made at the meeting.

There were questions from the member of the press present at the meeting.

Caroline Webb, Senior Scrutiny Adviser reported the following:-

 

Children’s Cardiac Surgery Review

The Prime Minister had announced that the process in terms of the potential closure of Leeds and a number of other surgical centres had been halted although the future arrangements around Children’s Cardiac Surgery would be revisited at some point in the future.

 

Further details of the implications of this announcement are awaited from the regional Joint Health and Overview Scrutiny Committee. These would be circulated in due course.

Consideration was given to the minutes of the previous meeting of the Health Select Commission held on 18th April, 2013.

 

Resolved:-  That the minutes of the previous meeting be agreed as a correct record.

 

It was noted that the sub-group had been established and held its first meeting (Minute No. 77 Urgent Care Review – NHS Rotherham refers).

-        Minutes of meeting held on 8^th May, 2013

Consideration was given to the minutes of the meeting of the Health and Wellbeing Board held on 8th May, 2013.

 

Resolved:-  That the minutes be noted.

1)         Health, Welfare and Safety Panel

            One Member plus a substitute

            Meets quarterly on a Friday

            (next meeting on 21st June)

 

(2)       Recycling Group

            One Member

            Meets quarterly on a Tuesday at 10.00 a.m.

            (next meeting 18^th June)

 

 

Resolved:-  That the Select Commission’s representatives for the 2013/14 Municipal Year be as follows:-

 

Health, Welfare and Safety Panel

Councillor Wootton

Councillor Dalton (substitute)

 

Recycling Group

Councillor Beaumont

-        Chair and Acting Chief Executive to report

The Chairman welcomed Michael Morgan (Interim Chief Executive), Peter Lee (Trust Board Chairman), Juliette Greenwood (chief Nurse), George Thompson (Medical Director) and Dr. Tricia Bain (Executive Health Informatics Officer) to the meeting.

 

Michael gave the following presentation:-

 

-          The Trust had been able to comply with all Monitor’s requests for information

-          Strategic plan to be submitted to Monitor by the end of September that completely underpinned the recovery for the organisation over the next 3 years.  The first year of the plan was in the process of being put into place

-          The next 2 years would see a complete revamp of the organisational structure, especially on the clinical side.  As a result 135 individuals from the Trust had met with the Executive to look at restructuring the organisation

-          Proposed move from 11 to 4 Directorates – Planned Care and Surgery, Emergency Care and Medicine, Women and Children and Diagnostics and Support – would allow for agile working

-          Would provide a real oversight of the management of the organisation from the standpoint of accountability

-          Community and acute services are not yet fully integrated  – hopefully the new structure and Directorates would see a full integration

 

Discussion ensued with the following issues raised/clarified:-

 

·           The Directorates would be clinically lead across a range of disciplines

 

·           The Senior Nurses and Midwifery Committee met monthly to discuss issues.  The Committee would be pulling together a strategy on how the Trust was going to change areas in the acute part of the hospital/work differently  

 

·           Community Nursing was a very important aspect.  The Trust included health care and the patient care path in the acute hospital and in the community setting

 

·           The proposed structure would be considered by the Board at the end of June.  There would then be 30 days consultation

 

·           The provisional leadership roles in the new structure were quite different e.g. matrons would not just manage Wards but would be looking at the pathway of care and if there were the right colleagues working with the right leadership and right representation.  It recognised the uniqueness of professionals that worked in the Community and ensured they were heard.   A staff engagement strategy was being developed.

 

·           Staff morale was low, ranked within the bottom 20% of acute trusts, could this have any potential impact on services?  In a recovery situation communication with staff had to be improved, having an inclusive and participative leadership style contributes towards this.

 

·           Important to reiterate that the Trust had to take almost 25% out of the operating budget, and that there were some fixed costs so radical change was required in how front line teams work

 

·           The Government was clear that tele-health had a key part to play in the future.  The Trust echoed this and said it would play a part in reducing  barriers between hospital and community.

 

·           There was a working group working across the region looking at collaboration with other hospitals.  Already Weston Park Hospital provided specialist cancer services and the Hallamshire  ...  view the full minutes text for item 7.

-        Chief Nurse

Juliette Greenwood, Chief Nurse, gave the following powerpoint presentation:-

 

Local Operational Challenges

-          Workforce Challenges

High vacancy factor

Ongoing utilisation of ‘flex beds’

Corporate workforce consultation

Corporate adult inpatient recruitment

HV availability v workforce trajectory

-          Media and Reputation

-          Demographics – deprivation, dementia, children and young people, safeguarding complexities, high risk maternity

 

Significant National Failures

-          Winterbourne View

Abuse of patients with complex learning disabilities and missed opportunities (A&E, health assessments)

-          Francis Report (2013) and concerns

Standards of care …. Compassion

Accountability

Nurse leadership

Professionalism

Specific needs of older people

Listening and responding to patients and families

Nursing workforce – numbers, skills and competency

 

Impact and Location Actions

-          CQUINS – National and Local ‘Francis Focus’

Friends and Family Test

Safety Thermometer

Patient Experience

Complaints

Safeguarding

Nurse Leadership

Dementia

Death Certification

 

Nursing Staffing

-          Twice per year Boards (in public session) to receive, confirm and publish assurance of safe nurse staffing levels via agreed evidence based tool

-          To adopt recommended Safer Nursing Care Tool (SNCT) (via Assistant Chief Nurse Workforce)

-          National development of Community SNCT and A&E SNCT

-          To look to re-run Birthrate+ (3 years since last review)

-          Children and young people workforce – PANDA, PABM, new national models for HV and School Nursing

-          Following a year’s work and ongoing scrutiny

Investing in adult inpatient wards 50 wte

Investment in additional RN and HCSW resource align general adult inpatient skill mix against national ‘best practice’ of 65:35 ratio

Ward Sisters/Charge Nurses to be supernumerary

 

Impact

-     Role of the Ward Sister/Charge Nurse – key

Leadership not ‘office based’

Tools for the job e.g. Ward Nurse Accreditation Scheme, local audit program, engage with patients/relatives, Ward rounds

Minimise bureaucracy – enabling time to care and time to lead

Support to staff, students and patients and family

Clarity about professional and personal accountability

-     Introduce intentional rounding – impact

-     Transparency Agenda

 

Francis Implications

-          Patient Safety Nurse – new Ward level focus

-          Nursing Quality Indicators – dashboard – EWS

BoD required to publically discuss in detail twice per year

-          Line of sight of immediate risks – HarmFree meeting

-          The Emotional Labour of Care – e.g. Schwartz Rounds/Cultural Care Barometer – staff need time and space to reflect

-          All student nurses serve Y1 as a Health Care Assistant (pilots in situ)

-          Staff engagement strategy – Friends and Family Trust

-          Values based recruitment

Consider patient/governor involvement in senior clinical appointments

Appraisal programme – nursing input, patient feedback leading to nurse revalidation

 

Compassion in Practice 2012-15

-          National strategy and implementation plans

6C’s of Care, Compassion, Competence, Communication, Courage, Commitment

Principles of Nursing Practice (December 2012)

TRFT Nurse and Midwifery strategy development (annual work plan)

-          Dementia

TRFT Strategy as part of Rotherham Strategy

Dementia Champions ‘Ward to Board’

Workforce development

Carers audit

Environment

 

Patient Experience

-          National Patient Surveys – A&E, Inpatient, Midwifery, Outpatients, Children and Young People

-          Friends and  ...  view the full minutes text for item 8.

-        Dr. Trish Bain to present

Dr. Tricia Bain, Executive Health Informatics Officer, presented the submitted report on the Trust’s Quality Account for 2012/13.

 

The following issues were highlighted:-

 

-          The report would be available on the NHS website on 13^th June, 2013

 

-          Improved on last year  and staff should be credited for this

 

-          Work had taken place on Dementia but was included again in the improvement programme

 

-          Significant improvement on the Medication Programme and would not be set as an improvement programme for 2013/14

 

-          Staff morale – the main areas of concern remained the same as last year – learning and development and job satisfaction having scored the lowest of all categories

 

-          Patient feedback and patient experience strategy had been reviewed throughout the year.  There had been success in increasing the volume of complaints to obtain more feedback whilst also reducing the overall severity of complaints.  Whilst the principal theme related to medical care there had been a significant increase in complaints relating to administration and appointments.  This has been attributed to issues arising soon after the implementation of the Electronic Patient Record system

 

-          Care Quality Commission had visited the previous week, carrying out 50 patient interviews, and been very positive.   The report was due in two weeks.

 

-          Work next year would focus on intra-operative fluid management, improving data quality, review of death certification and Dementia

 

Discussion ensued on the report with the following issues raised/clarified;-

 

·           Health Assessments for Looked after Children data was collected by the commissioners.  Data had been collected throughout the year but was unable to be validated

 

·           Information was reported through to the Safeguarding Board Quality and Assurance Committee who had tracked and monitored the information. There was an issue of Health Assessment for Rotherham Looked after Children who were being cared for outside of the Borough

 

·           The work was being linked through the Ward Nurses and Safeguarding work.  The work was still taking place but was not 1 of the key priorities for 2013/14

 

Dr. Bain was thanked for her report.

The Select Commission split into 2 groups and visited Medical and Surgical Wards.

Caroline Webb, Scrutiny Officer, presented a report that was to be considered by all the Select Commissions and by the Overview and Scrutiny Management Board with regard to the 2013/14 work programme.

 

The proposed programme for the Health Select Commission was as follows:-

 

Excess Medication

Continence Services

How to Improve Health in Rotherham

Access to GPs

Continuing Health Care for Children and Young People

 

Additional suggested areas of work were:-

 

Access to School Nursing

Sexual Health Services

Mental Health Services

 

Discussion ensued on the proposed programme:-

 

-          Both School Nursing Services and Sexual Health Services were very important with regard to child sexual exploitation and also following the NHS changes now came under the local authority – to discuss with Public Health colleagues

-          How to Improve Health in Rotherham – was it too wide?

-          Welfare reform was likely to have an impact on health as well as jobs

-          Issues with regard to capacity

-          Healthwatch – need to avoid duplication

-          Full reviews v spotlight reviews

-          Excess Medication and Continence Services – it was agreed to have initial reports to the commission first

-          Access to GPs was seen as this Select Commission’s top priority

 

It was noted that a meeting was to be held on 13^th June between the Cabinet and Select Commission Chairs to discuss the work programme followed by approval by the Overview and Scrutiny Management Board on 14^th June.

 

Resolved:-  (1)  That the 2013/14 work programme be noted.

 

(2)  That a meeting be set up between the Chairman, Vice-Chairman and Healthwatch to discuss priorities and any potential for overlap.

-       Thursday, 11^th July, 2013 at 9.30 a.m.

Resolved:-  That a further meeting be held on Thursday, 13^th June, 2013, commencing at 9.30 a.m. to be held at Rotherham District General Hospital.