ARGYLL & BUTE CHP COMMITTEE MEETING Wednesday 24 April ... · 4/24/2013  · ARGYLL & BUTE CHP...

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ARGYLL & BUTE CHP COMMITTEE MEETING Wednesday 24 April 2013 at 1pm Guide Hall, Kinloch Road, Campbeltown AGENDA 1. Chairman’s Welcome Robin Creelman 2. Apologies Robin Creelman 3. Conflicts of Interest Robin Creelman 4. Minutes from Previous Meeting 4.1 Minute –20 February 2013 (attached) Robin Creelman 5. Matters Arising 6. NHS Highland Organisational Issues 6.1 Highland NHS Board Media Briefing (attached) Robin Creelman 6.2 Director of Operations Report (attached) Derek Leslie 6.3 CHP Draft Annual Report (attached) Derek Leslie 7. Clinical Governance 7.1 Clinical Governance & Risk Management Report (attached) Pat Tyrrell 7.2 Infection Control Report (attached) Pat Tyrrell 7.3 Health Improvement (attached) Elaine Garman 8. Financial Governance 8.1 Finance Report (attached) George Morrison 9. Staff Governance 9.1 PDP/R and eKSF Implementation (attached) David Logue 10. Partnership Working 10.1 Draft Minute of CPP Management Committee 06-02-13 (attached) Derek Leslie 11. Performance Management 11.1 Balanced Scorecard Summary (attached Derek Leslie 11.2 Delayed Discharge Update (verbal) Derek Leslie 11.3 Operational Delivery Plan (attached) Stephen Whiston
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Transcript of ARGYLL & BUTE CHP COMMITTEE MEETING Wednesday 24 April ... · 4/24/2013  · ARGYLL & BUTE CHP...

  • ARGYLL & BUTE CHP COMMITTEE MEETING

    Wednesday 24 April 2013 at 1pm

    Guide Hall, Kinloch Road, Campbeltown

    AGENDA

    1. Chairman’s Welcome Robin Creelman 2. Apologies Robin Creelman

    3. Conflicts of Interest Robin Creelman

    4. Minutes from Previous Meeting 4.1 Minute –20 February 2013 (attached) Robin Creelman 5. Matters Arising 6. NHS Highland Organisational Issues

    6.1 Highland NHS Board Media Briefing (attached) Robin Creelman 6.2 Director of Operations Report (attached) Derek Leslie 6.3 CHP Draft Annual Report (attached) Derek Leslie

    7. Clinical Governance 7.1 Clinical Governance & Risk Management Report (attached) Pat Tyrrell 7.2 Infection Control Report (attached) Pat Tyrrell 7.3 Health Improvement (attached) Elaine Garman 8. Financial Governance 8.1 Finance Report (attached) George Morrison 9. Staff Governance

    9.1 PDP/R and eKSF Implementation (attached) David Logue 10. Partnership Working

    10.1 Draft Minute of CPP Management Committee 06-02-13 (attached) Derek Leslie

    11. Performance Management 11.1 Balanced Scorecard Summary (attached Derek Leslie 11.2 Delayed Discharge Update (verbal) Derek Leslie 11.3 Operational Delivery Plan (attached) Stephen Whiston

  • 3.30pm : Public Session

    12. Review and Redesign of Hospital, Community and Care Services in Kintyre (attached) Stephen Whiston 13. Mental Health Modernisation Update (attached) Derek Leslie 14. Papers for Noting: 14.1 Argyll & Bute CHP eHealth Steering Group Draft Minute 06-02-13 (attached) 15. AOCB*

    16. Date, Time & Venue for Next Meeting

    Wednesday 19 June 2013 at 10.30am J03-J07, Mid Argyll Community Hospital & Integrated Care Centre, Lochgilphead

    * to be notified to Chairman in advance of meeting

    The Committee meeting will be followed by:

  • Argyll & Bute CHP Committee Date of Meeting : 24 April 2013

    Item : 4.1

    MINUTE OF MEETING OF THE ARGYLL & BUTE CHP COMMITTEE

    Argyll & Bute Community Health Partnership Aros Lochgilphead Argyll PA31 8LB www.nhshighland.scot.nhs.uk/

    J03-J07, Mid Argyll Hospital,

    Lochgilphead

    20 February 2013

    Present Mr Robin Creelman, Chairman, Argyll & Bute CHP

    Mr Derek Leslie, Director of Operations, Argyll & Bute CHP Dr Michael Hall, Clinical Director, Argyll & Bute CHP Ms Pat Tyrrell, Lead Nurse, Argyll & Bute CHP Ms Elaine Garman, Public Health Representative, Argyll & Bute CHP Ms Mary Wilson, AHP Representative, Argyll & Bute CHP Ms Elizabeth Reilly, Area Dental Committee Representative Ms Glenn Heritage, CVO Representative Mr Duncan Martin, Chairman, Public Partnership Forum Mr Michael Roberts, Vice Chair, Public Partnership Forum Councillor Elaine Robertson, Argyll & Bute Council Representative Councillor George Freeman, Argyll & Bute Council Representative

    In Attendance Apologies

    Mr George Morrison, Head of Finance, Argyll & Bute CHP Mr David Logue, Head of HR, Argyll & Bute CHP Mr Stephen Whiston, Head of Planning Contracting & Performance, Argyll & Bute CHP Mr David Ritchie, Communications Manager, Argyll & Bute CHP Mrs Sheena Clark, PA to Director of Operations - Minute Secretary Ms Rose MacVicar, PA to Head of HR & Head of Planning Contracting & Performance Ms Tricia Morrison, CVO Representative, Argyll & Bute CHP Ms Dawn Gillies, Staffside Representative Ms Liz McMillan, Staffside Representative Jim Robb, Head of Service, Adult Care, Argyll & Bute Council

    1. CHAIRMAN’S WELCOME The Chairman opened the meeting by welcoming everyone to the Mid Argyll Hospital and Integrated Care Centre. 2. APOLOGIES Apologies for absence were noted as above. 3. CONFLICTS OF INTEREST No conflicts of interest were declared.

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    4. MINUTE FROM PREVIOUS MEETING 4.1 Minute of Meeting held on 19 December 2012 Page 1 - It was noted that Raymond Stewart, NHS Highland Employee Director was not in attendance at the meeting. Page 14 – Mr Creelman reported on a communication received from Mr Law, Hunters Quay Community Council representative regarding the interpretation in the Minute of his comment in relation to the appropriateness of referrals to Inverclyde. Mr Law wished it to be clarified that this was not a complaint regarding GPs’ referrals to Inverclyde. The Committee: Approved the content of the Minute of the meeting on 19 December 2012, with the above amendment and clarification noted. 5. MATTERS ARISING FROM PREVIOUS MEETING HELD ON 19 December

    2012 Aortic Abdominal Aneurysm Screening Mr Roberts raised concern about the uptake within the CHP not being accurately recorded. Ms Garman advised that this is a key performance indicator which has a 60% uptake target nationally. The national reporting will be on a yearly basis, however a request has been made for interim data. In the meantime speaking to local staff they estimate a 60% uptake within the CHP. Patient Management System (PMS) Mr Martin enquired if there had been further discussion with NHS Highland NHS Board regarding the implementation of PMS and the implications of this for Argyll & Bute patients. Mr Creelman gave assurance that this continues to be a focus of discussion in various forums and concerns were recently noted from the public health representative on the eHealth Group. Mr Leslie clarified that the specific concerns raised are in efforts to ensure that Argyll & Bute residents do not have equity of access to services compromised as a result of being managed through the Highland ‘instance’, whilst patient flows are, with very few exceptions, to NHS Greater Glasgow and Clyde and are being considered proactively. Mr Leslie stated that the CHP has acknowledged and will take responsibility for any resourcing issues which may arise. Mr Martin reiterated that equity of access for Argyll & Bute patients was non-negotiable.

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    6. NHS Highland Organisational Issues 6.1 Meeting of Highland NHS Board Meeting – Action Plan – 5 February 2013 Mr Creelman reported that with the exception of the amendment noted in 4.1 above, there were no actions for Argyll & Bute CHP. The Committee: Noted the above comment. 6.2 Director of Operations Report Mr Leslie provided a summary of points in the circulated report. Islay The challenges of providing safe and sustainable services on Islay continue, which has resulted in significant political interest, and a review of services is due to commence on 1 March 2013. An Islay Clinical Services Review Steering Group has been established and will be chaired by Mr Robin Creelman, NHS Highland Non-Executive and Chair of the CHP, with support from Gordon Peterkin, independent clinical expert, who was appointed following an inclusive recruitment initiative, with input from the local community and GPs. The CHP has agreed a further 1 year transitional support with the three GP practices to underwrite their participation in the Review, as a result of which the GPs formally notified the CHP of the withdrawal of their out of hours opt out notice. The Islay review has been promoted as part of a fundamental piece of work being undertaken by NHS Highland following a request from the Cabinet Secretary for Health and Social Care to develop and submit a proposal that will explore the development and testing of models for the delivery of sustainable person-centred, safe and effective primary care in remote and rural areas. Mr Whiston has been actively liaising with Ms Gill McVicar, who is leading on this project for NHS Highland, to inform the proposal and a bid has now been submitted to the Scottish Government, the outcome of which is awaited. The building works in Islay hospital outpatients’ department are now completed. The dental van is scheduled to return to the hospital site at end March 2013. Actions are continuing to alleviate the problems with car parking and access to the site for public transport. Ms Heritage reported that the voluntary car scheme is underway but at present this service is being under utilised. Mull & Iona Progressive Care Centre A public meeting was recently held on Mull, chaired by the Council Leader, to discuss and address a number of integration issues, particularly associated with the allocation of extra care housing.

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    Integrating Care in Argyll & Bute A paper was submitted for noting to the Highland NHS Board on 5 February 2013 to provide an update on the integration process and ongoing discussions between NHS Highland and Argyll & Bute Council. CHP Locality Updates Mid Argyll, Kintyre & Islay o At a recent bed modelling meeting agreement was reached that Campbeltown

    Community Hospital will operate with a total of 21 beds with effect from 1 April 2013. A contingency plan will be in place for the availability at short notice of a further 3 beds if required. Concerns highlighted by the Community Council regarding public engagement in the exercise are being examined.

    o The Board’s Director of Nursing recently visited Campbeltown Hospital and Mid

    Argyll Hospital, with positive feedback being given to both sites that reflected the Healthcare Environment Inspectorate (HEI) approach.

    o GP locum cover for Inveraray/Furnace practice has been secured for the period March-June 2013 to ensure service continuity. Dr Hall advised that the CHP are endeavouring to employ long term locums to ensure a consistent knowledge of the clinical systems in place within the practice and close monitoring of this is in place. He also advised that a local GP has been appointed as a locum to specifically oversee the review and updating of the current systems.

    Oban, Lorn & Isles o The Raigmore Operational Unit has committed to supporting the CHP Urology

    service at Lorn & Islands Hospital, Oban with the recruitment of an additional Urology Consultant to provide an outreach specialist service. The patient’s referral pathway to NHS Greater Glasgow and Clyde will remain unchanged.

    o Further discussions have taken place with the Taynuilt Community Council in

    relation to their interest in establishing a satellite hospital dialysis facility on Lorn & Isle Hospital. Mr Creelman gave a commitment that the CHP will continue to work with the community and to monitor hospital dialysis, and further review this and the potential location of a unit in 2015/2016.

    Mr Whiston reported that letters have been issued to individual dialysis patients to encourage them to contact the CHP directly to discuss their individual transport needs.

    Councillor Robertson expressed her thanks to Ms Kennedy and Mr Whiston for the considerable amount of work undertaken in reviewing the needs of dialysis patients.

    Cowal & Bute Cowal 24/7 Review – community engagement process is continuing around the contingency plan which is now in place to support the implementation of a unified out of hours service for Cowal with a mix of on duty and on-call staff.

    The Committee: Noted the content of Director of Operations tabled update.

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    7. Clinical Governance Ms Tyrrell highlighted the recently published report following the Mid Staffordshire NHS Foundation Trust Public Inquiry and referred the Committee to the executive summary which details the 290 recommendations in the report. She commented that there is a significant amount of learning and actions required by organisational and regulatory bodies referred to in the report. Ms Tyrrell advised that the report has been considered at the Argyll & Bute CHP Clinical Governance Group and a number of actions have been identified to be taken forward locally. Ms Tyrrell also commented on the forthcoming Health Environment Inspectorate unannounced visits to community hospitals. The Argyll & Bute hospital has in particular been the subject of a focussed action plan, completed by the allocation of non-recurring funds to improve control of infection compliance. 7.1 Clinical Governance & Risk Management Report Ms Tyrrell spoke to the circulated report and highlighted and summarised a number of items. Risk Management Incidents A total of 438 incidents were reported during quarter 3, which is a slight decrease in the 442 incidents reported in quarter 2. Broken down in locality : Cowal & Bute – 115 (26.25%) Helensburgh – 10 (2.28%) Mid Argyll & Kintyre – 183 (41.78%) Oban Lorn & Isles - 112 (25.57%) Outwith NHS Highland – 18 (4.11%) (patients transferred in) Ms Tyrrell advised that 74 incidents are awaiting grading and any significant grades will be carried forward for reporting in the next quarter. Slips, trips and falls remain the highest reported category of incidents for Cowal & Bute (33), Mid Argyll, Kintyre & Islay (51) and Oban, Lorn & Isles (43). The top category for Helensburgh was medication (4). Three incidents which occurred in Mid Argyll/Kintyre resulted in Significant Event Reviews. The learning from these reviews will be applied throughout the CHP. There were no RIDDOR reportable incidents recorded for the CHP in quarter 3. Pressure Ulcer Prevention Implementation of the NHS Highland Zero Tolerance approach to preventable pressure ulcers is continuing with a number of measures being taken to improve the identification and management of those patients at risk of developing pressure ulcers in all settings.

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    Ms Tyrrell stated that there is an increase in the number of frail and older people in the community and further work is planned to improve understanding and knowledge among carers and patients, as well as the wider community. Councillor Freeman queried if the reported incidents in Helensburgh were acquired in a hospital environment. Ms Tyrrell advised that they were community acquired and attempts are currently being made to obtain information from the Vale of Leven Hospital of any hospital acquired incidences of Argyll & Bute patients. Councillor Freeman asked if the CHP receives notification of patients with pressure ulcers prior to transfer from NHS Greater Glasgow & Clyde back to Argyll & Bute. Ms Tyrrell confirmed that details are incorporated in a patient’s care plan on transfer and there is regular liaison between the CHP Leads on pressure ulcer work and NHS Greater Glasgow & Clyde. Mr Creelman raised the issue of reporting of pressure ulcer incidents occurring in Care Homes. Ms Tyrrell advised that all incidences in residential homes, staffed by NHS staff, are reported on the NHS systems, with actions identified, i.e. risk assessment. There is also an ongoing focus on training of community carers, to include independent providers. Ms Garman asked what route of learning was in place following the investigation of incidents. Ms Tyrrell replied that investigations and outcomes are discussed by the Clinical Governance Group and outcomes and recommendations disseminated to managers and staff. She acknowledged the possible need to review this process to ensure adequate feedback and understanding of actions required. Councillor Robertson enquired about the overall training of Health Care Assistants and the process of liaison with different care providers. Ms Tyrell advised that this work is part of the Reshaping Care for Older People, which looks at :

    o a mapped out workforce o the careers framework o registered and unregistered Health Care Assistants o joint training

    Falls Prevention Ms Tyrrell reported that considerable work is ongoing to reduce the evidence of falls in both hospital and community settings. Application of evidence based interventions, in the assessment and management of risk in those likely to sustain falls is being tested in Lorn & Islands Hospital, Oban. Serious Untoward Incidents (SUI) Ms Tyrrell reported on one SUI occurred in relation to an unplanned discharge of a patient from hospital. The incident is being reviewed under the SUI management policy and a full report and action plan will be developed after the review meeting with staff involved due to take place in early March 2013. Complaints A review of overall performance in relation to complaints management is currently being undertaken in NHS Highland as part of the Highland Quality Approach. Ms Tyrrell reaffirmed the CHP process for conducting the investigation of complaints to ensure a full, accurate and informed response is provided to the complainant.

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    External Reviews Joint Inspection of Children’s Services in Argyll & Bute Ms Tyrrell advised that a joint inspection is due to commence in early March 2013 which will focus on users and outcomes. As part of the inspection, the Inspectors will be looking for an evidence base of positive outcomes. Nine position statements which identify the CHP’s progress in improving outcomes for children and young people in Argyll & Bute across a range of indicators have been requested by the Care Inspectorate, with two statements already submitted. From the information on 450 children and young people submitted to the inspection team, the records of 90 children and young people have been selected by the inspection team as part of the inspection scoping. The Inspection Team intend to meet with young people and their families, as well as conducting a number of focus groups with both senior leaders, managers and professionals from across the agencies. Initial feedback of findings will be presented to the Community Planning Partnership on 1 May 2013, followed by a written public report at end May. Agencies involved in the inspection will received a more detailed report. HEI Inspection of Community Hospitals Ms Tyrrell highlighted that the HEI have announced that as part of their plans for 2013, there will be unannounced inspections of community hospitals starting from mid 2013. Mr Creelman referred to HDL (2005) 07, which informs that the Senior Charge Nurses are responsible for ensuring safe working conditions within their clinical areas. This includes all aspects of environmental cleanliness. Ms Tyrrell commented that within the CHP there is a daily process for recording the completion, or not, of tasks and any identified risks to patients are recorded on Datix. The daily schedules are reviewed and signed off by the Senior Charge Nurse/Nurse in Charge in collaboration with the Domestic Services Supervisors. Compliance with the system is evidenced by regular auditing. MHRA Inspection of Lorn & Islands Hospital Laboratories Councillor Robertson enquired about the MHRA follow-up inspection of Oban laboratories, which Ms Tyrrell confirmed is due to take place. She also advised that the initial inspection had received a positive outcome and satisfactory accreditation. 7.2 Infection Control Report Ms Tyrrell referred to the circulated report which provided an overview for the infection prevention and control across NHS Highland, together with the results from cleanliness monitoring, hand hygiene audit results and surgical site infections. It was reported that as at end September 2012 NHS Highland infection prevention and control targets and performance data recorded achievement of the national targets for :

    o Clostridium difficile o Staphyloccoccus aureus bacteraemia

    The Committee: Noted the content of the Clinical Governance & Risk Management Report

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    o Hand hygiene o Cleaning o Estates o Antibacterial prescribing

    Staphylococcus Aureus Bacteraemia (SAB) The reported annual rate, unvalidated by HPS, for NHS Highland to end December 2012 is 21.8 per 100,000 occupied bed days (OBD). The national target for March 2013 is 26 cases per 100,000 OBDs. There have been no new cases of SAB in Argyll & Bute since the last report. A small number (6, 19%) of line related SABs constitute a significant and potentially preventable proportion of all SABs, with 4 being associated with Peripherally Inserted Central Catheters. A group recently met to lead on the reliable implementation of the central line insertion and maintenance bundle and the reliable implementation of a PICC maintenance bundle. The Infection Control Team will monitor progress of the validation results around PVC insertion and maintenance. Clostridium Difficile Infection (CDI) in Patients 65 years and over The reported annual rate, unvalidated by HPS, for NHS Highland to end December 2012 is 29.2 per 100,000 OBDs. The national target for March 2013 is 39 cases per 100,000 OBDs. Clostridium Difficile Infection (CDI) in Patients 15-64 years The reported annual rate, unvalidated by HPS, for NHS Highland to end December 2012 is 57.1 per 100,000 OBDs. There is no national target for this age group. NHS Highland has a slightly higher rate than the national average but remains well within expected levels. There have been no new cases of CID in Argyll & Bute since the last report. HEI Inspections NHS Highland Hand Hygiene Rolling Monthly Audit Programme continues across all clinical areas sustaining an average of 98% compliance for November and December 2012. The November 2012 National Hand Hygiene Audit report shows NHS Highland compliance as 98%, National compliance was 95%. Hand hygiene audits continue to be undertaken monthly by all clinical areas, the results displayed and any non compliance addressed. All areas in Argyll and Bute continue to demonstrate compliance with the standards. Cleaning & the Healthcare Environment Domestic Service teams continue to carry out monthly cleaning and estates audits as per NHS Scotland National Cleaning Services Specification sustaining an average of 96% compliance in November and December 2012 for domestic monitoring; the average Estates compliance was 96% in November and 97% in December 2012

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    In November 2012 Mid Argyll Hospital, Lochgilphead was below the target of 90% for Estates monitoring, 89.1%. In December 2012 Argyll & Bute Hospital, Lochgilphead was below the target of 90% for estates monitoring, 89.1%. Local action plans have been implemented in both areas. Outbreaks/Incidents

    Norovirus is prevalent in the community, with a high risk of transmission to hospitals. There have been no ward closures since the last report. If an outbreak occurs in a Care Home, staff there are given support by the NHS Infection Control Team.

    Unannounced HEI Inspection Visits

    The Board Nurse Director, CHP Lead Nurse and Infection Control Nurses have recently carried out visits to each of the mainland Argyll & Bute Hospitals. The visits were viewed as positive and provided support to managers and staff in continuing the delivery of improvements in the environment and in practice.

    Health & Safety Executive (HSE)

    The HSE confirmed in December 2012 that NHS Highland have complied fully with the Improvement notice in respect to infection control in the community. Managers from Lochaber will attend the March meeting of Argyll and Bute Infection Control Group to discuss the findings from the visit and the actions that have been taken.

    Healthcare Environment Inspectorate Annual Report

    The HEI published their third annual report in February 2013. As a result of the anonymous information from the patient survey responses, the improvements which the HEI consider matter most to patients include :

    � cleaner patient environments, for example wards � cleaner patient equipment � fewer maintenance, repairs and refurbishment issues � an increase in the number of staff complying with the national dress

    code, and � better access to training and education in infection control for all

    staff. Infection Control Risk Register

    The CHP Risk Register is currently being updated, with the addition as a risk of the CHP’s ability to ensure compliance with HAI standards in Primary Care settings.

    7.3 Health Improvement The circulated paper focussed on smoking cessation, child healthy weight and delivery of Keep Well.

    The Committee: Noted the content of the Infection Control Report

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    Smoking Cessation Ms Garman reported that performance to date for 2012/13 exceeded the targets set at end November 2012. As well as an agreed number of patients wishing to quit smoking, there has also been an agreed number from areas of socio-economic deprivation, although the recently reported figure for inequalities has shown a slight decline which is being reviewed by the Smoking Cessation Advisors. Child Healthy Weight The full X programme continues to be offered and run during 2012/13. During February and March 2013 swim passes will be given to those signing up for the X programme. Initiatives are in place to promote child healthy weight as part of healthy weight for all the family. Keep Well The CHP has undertaken a considerable programme of community development work to take forward the implementation of the Keep Well health checks in April/May 2013 in Campbeltown. The benefits of healthy eating are being promoted in collaboration with local food producers and events are being arranged to highlight the health benefits of good wholesome food. The aim is to tie in child health weight with adult healthy weight and the sign up to the X programme. 8. Financial Governance 8.1 Finance Report Mr Morrison spoke to the circulated report and advised that at end December 2012 the CHP recorded an underspend of £194,000, indicating that the CHP’s overall financial position is stabilising towards the end of the financial year. The budgetary analysis showed a number of overspends, in particular :

    o Medical locum cover for vacancies and a suspension in Dunoon o Medical locum cover for a vacancy in Lorn & Islands hospital

    Mr Morrison advised that the above overspends present an ongoing risk and the issue needs to be managed by the CHP.

    o Increased drugs costs at Lorn & Isles hospital o Overspend on hospital and community nursing pay costs on Bute o GMS budget overspend due to GP vacancies in Bowmore, Jura and Inveraray o Commissioned services overspend relating to increased referrals to Raigmore

    and Belford

    The Committee: Noted the content of the Health Improvement Report

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    The cost pressures of all the above overspends are being offset by the benefits of the reduced prescribing costs. Cost Improvement Programme 2012/13 Mr Morrison indicated that based on the current information, there is likely to be a shortfall against the savings targets. To avoid a recurring deficit being carried forward to 2013/14, action is required by managers to address any shortfalls. Forecast Outturn 20/12/13 Mr Morrison reported that a year-end underspend of £200,000 for the CHP is forecast. It is anticipated that the benefits from the prescribing cost reductions will be sufficient to compensate for the in-year cost pressures and any shortfall against savings targets.

    8.2 2013/14 Revenue Budget Mr Morrison summarised the budget setting process as detailed in the circulated paper. The proposed revenue budget relates to base recurring funding only, with the SGHD releasing a number of funding allocations during the course of 2013/14, most of which are non-recurring. These are outwith the scope of the CHP’s base revenue budget proposal. Mr Morrison commented that although the budget setting exercise is intended to be comprehensive, it should be noted that risks will exist within the budget setting, i.e. potential locum costs, individual patient treatment referrals, which may have a financial impact and will be reported as a cost pressure in finance reports during 2013/14. NHS Highland will receive a funding uplift from SGHD in 2013/14 of 2.8%, with the CHP receiving a share amounting to £4.072m. Any excess costs beyond the level of funding uplift provided will require to be met by the CHP from internal savings. Table 1 of the paper itemised the various provisions and challenges which are proposed for inclusion in the 2013/14 budget, totalling £6.472m, the detail of which has been previously debated at the CHP Core Team and Management Team meetings. Mr Morrison advised that if the forecast cost growth is agreed, a proposed savings plan of £2.4m, as detailed in Table 2, would also need to be agreed for 2013/14 in order to achieve a balanced budget. The savings targets will be owned by the budget managers who will report ways of delivering the proposed savings allocated to them. Councillor Freeman asked for clarification in relation to the prescribing budget. Mr Morrison advised that for Prescribing, the forecast growth has been set at £529k and a required savings target of £1m and acknowledged that in real terms this reflected a £½m reduction in the budget. The Committee Approved the provisions for the cost increases to b e included in the 2013/14 revenue budget (table 1) Approved the savings plan for 2013/14 to achieve a balanced budget (table 2)

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    8.3 Highlands & Islands Travel Scheme – Changes to Earmarked Funding Arrangements

    SGHD have now advised that the transfer of HITS from reimbursement to baseline funding has been delayed until 2015/16. From 1 April 2015 the CHP will be required to manage the costs of the HITS scheme and be accountable for any overspend on this budget. It is intended to carry out a redesign of services within the CHP to ensure best use of HITS funding.

    9. Staff Governance 9.1 PDP/R and eKSF Implementation Mr Logue reported that the CHP is making considerable progress in working towards achieving the NHS Highland target for 2012/13 that all Agenda for Change staff reviewed against a KSF post outline, with at least 80% of reviews being carried out and recorded online using e-KSF. Mr Logue commented that while the figures continue to be below the planned trajectory, they have significantly improved, reflecting the expected pattern of more reviews being carried out in the latter half of the year. This increased level of activity will need to be sustained, and accelerated, to ensure achievement of the end of year target. The e-KSF Lead is meeting Locality Managers to discuss the figures and particular issues in their areas to review progress and address any outstanding issues or difficulties and is available to answer questions from any member of staff or manager on the e-Ksf process. The CHP position at 2 February 2013 was reported as : (bracketed figures are those reported to previous CHP Committee meeting on 19 December 2012)

    o All AfC staff - 2043 o Review signed off - 814 (500) o % of AfC staff (all) - 39.84 (24.14) o % of AfC staff (excl Bank) - 54.74 (32.72

    Mr Logue highlighted the qualitative benefits of eKSF to staff, who regularly receive development reviews and agreeing personal development plans supports service quality, improvement, staff and clinical governance and advised on the need for a systematic approach by Managers in carrying out the reviews. Mr Creelman asked for confirmation that the views of staff on the eKSF process are acknowledged and form part of the focus group discussions. Mr Logue reported that discussions within the NHS Highland focus group had been positive and acknowledged that further work was needed with the CHP focus group to provide assurance around the process. Mr Creelman commented on the reported number of 135 posts without outlines. Mr Logue advised that the CHP Lead for eKSF is currently reviewing the list. Ms Heritage enquired if there would be any impact from the implementation of the Change Fund work, and the fact that people will be working differently, and whether or not this would slow the process. Mr Logue acknowledged that this would provide a further challenge but that eKSF should support the process.

    The Committee:

    • Noted the current progress against trajectory • Noted the actions being undertaken to monitor and a chieve progress

    against trajectory • Noted the qualitative aspects of e -KSF implementation

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    10. Partnership Working Mr Martin reported that representatives from NHS Greater Glasgow & Clyde (GG&C) attended a recent Partnership Forum (PF) meeting to advise on the Clinical Services Review currently being undertaken in Glasgow. This resulted in a good, informative and detailed discussion between the PF members and GG&C representatives. 10.1 Draft Minutes of Community Planning Partnershi p (CPP) - Full Partnership

    Meeting – 28-11-12 10.2 Draft Minutes of Community Planning Partnershi p (CPP) Management

    Committee Meeting– 12-12-12

    Mr Leslie advised that the Minutes of the above Groups will now be included as a routine agenda item to provide an overview of the business of the Community Planning Partnership. The Scottish Government are promoting cross partnership working across all Boards and Council areas, with a focus on the requirement for shared views and discussions. The Committee: Noted the content of the of the circulated Community Planning Partnership minutes 11. PERFORMANCE MANAGEMENT 11.1 Balanced Scorecard Summary Mr Leslie drew attention to the circulated document which provided the CHP with the opportunity to review the CHP’s performance against the Board position and the Scottish Government’s targets. He highlighted complaint responses as an area of concern but provided reassurance that the CHP carries out a thorough investigation of all complaints and the CHP Clinical Governance Manager scrutinises the level of openness in our responses. Councillor Freeman expressed disappointment in the short coming in performance against the breastfeeding target. Councillor Robertson commented on the CHP’s performance against DNA rates and was assured that two of the localities are meeting the target and steps are being taken for all localities to share good practice in an attempt to reduce DNAs. Press statements are regularly issued which highlight to the public the impact of DNAs on the appointing system and the cost implications. On completion of British Telecom taking over the contract for the CHP communications system, the CHP will consider the process for installing a patient phone reminder system. The Committee: Noted the content of the of the circulated Balanced Scorecard Summary 11.2 Joint Performance Report The circulated report provided an overall picture of the joint working between the CHP and Argyll & Bute Council.

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    Mr Leslie reported that the January delayed discharge census recorded 7 patients 6 weeks and 3 patients had exemption code 100, requiring discharge to a specialist facility. The CHP met the national target of zero delays for non-exempt patients at 6 weeks. The Committee: Noted the content of the of the circulated Joint Performance Report 11.3 Operational Delivery Plan (ODP) Mr Leslie advised that each CHP Operational Unit had been requested to produce and submit an operational unit delivery plan which will inform the Board Local Delivery Plan. The circulated CHP plan will also detail how the CHP will be implementing the Highland Quality Approach, including initiatives and organisational development. The CHP Service Planning Priorities for 2013/2014 will be aligned with budget proposals.. The final draft of the ODP will be considered at the NHS Highland Senior Management Team on 28 February 2013. The final OUD Plan will be considered by Highland NHS Board on 9 April 2013. The Committee: Noted the content of the of the circulated CHP Operational Unit Delivery Action Plan 2013/2014 12. Mental Health Modernisation Update The circulated report gave an update on the implementation of the modernisation of mental health services in Argyll & Bute. Mr Dreghorn commented on specific items of the report. Project Governance At the recent Capital Project Board it was reported that the review of the site and content of the support services building is due to be completed in February 2013. The outline business case is still under development, with the resubmission of the stage 1 report by Hubco expected in early April 2013. Inpatient Services A new Senior Charge Nurse has been appointed to the inpatient team. Community Mental Health Teams Vacant community posts have now been appointed to. Mr Martin enquired if the enhanced community mental health teams have had an impact on hospital admissions. Mr Dreghorn confirmed that the number of beds had reduced as had length of stay. However, the main impact would be evident in the longer term through reduced morbidity contributed to by increased Tier 1 and Tier 2 services, guided self help, Primary Mental Health Care Workers and enhanced access to talking/psychological services.

  • 15

    Transfer of Detained Patients The option appraisal exercise for the transfer of detained patients was concluded and the preferred option will be presented for approval by the Programme Board on 15 March 2013. Places of Safety Review visits to each site have been undertaken by Mr Dreghorn and Mr Wright, Service Manager, Acumen. The findings show that there are differences in the quality of facilities and in effective local arrangements for looking after patients awaiting transfer to Argyll & Bute Hospital. Additional work is required on staff training and development and the quality of facilities to ensure a consistent level of care and service in each locality. Mr Creelman stated his concern around the time issue for transfers and the availability of an appropriate level of care and safe transport of mental health patients. Mr Leslie advised that the work of the Highland Quality Approach will assist in introducing a consistency of approach in management and safety of patients. The Committee: Noted the current key issues and progress against the action plan. 13. Code of Practice for Joint Inspection of Servic es for Children The above document was circulated to inform on the process of the inspection due to commence in Argyll & Bute CHP in March 2013. The Committee: Noted the content of the document 14 AOCB There was no other business. 15 DATE, TIME & VENUE FOR NEXT MEETING: Wednesday 24 April in Guide Hall, Kinloch Road, Cam pbeltown 10.30am : Development session 1pm : Meeting

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    Argyll & Bute CHP CommitteeDate of Meeting : 24 April 2013

    Agenda item : 6.1

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    Argyll & Bute CHP CommitteeDate of Meeting : 24 April 2013

    Agenda item : 6.1

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  • Argyll & Bute CHP Committee Date of Meeting: 24 April 2013

    Item: 7.1

    Argyll and Bute CHP Clinical Governance and Risk Ma nagement Report Report by Pat Tyrrell, Lead Nurse and Fiona Campbel l, Clinical Governance Manager

    The CHP Committee is asked to:

    • Note the contents of the Clinical Governance and Risk Management Report.

    1. CONTRIBUTION TO THE BOARD’S CORPORATE OBJECTIVES The vision of the Highland Quality Approach is:

    • Better Health – improving the health of the population • Better Care – enhancing the experience of care for individuals • Better Value – controlling the per capita cost of care

    In order to achieve this the key elements of the Quality Strategy have been adopted: Person-Centred There will be mutually beneficial partnerships between patients, their families and those delivering healthcare services which respect individual needs and values and which demonstrate compassion, continuity, clear communication and shared decision-making. Safe There will be no avoidable injury or harm to people from healthcare they receive, and an appropriate, clean and safe environment will be provided for the delivery of healthcare services at all times. Effective The most appropriate treatments, interventions, support and services will be provided at the right time to everyone who will benefit, and wasteful or harmful variation will be eradicated. 2. RISK MANAGEMENT 2.1 Incidents The following information relates to incidents reported in Quarter 4, the period from January to March 2013.

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    FIGURE 1 Argyll and Bute Incidents Last 13 months

    FIGURE 2 Categories by Locality from January – Marc h 2013

    For Quarter 4, January to March 2013, the overall number of incidents reported through Datix in Argyll and Bute was 447 – an increase from 438 in Q3.

    The top 3 categories of reported incidents for Q4 are:

    - Slips, Trips and Falls

    - Disruptive, Violent and Aggressive Behaviour

    - Pressure Ulcers

    The increase in incidents related to self harming behaviour can be attributed to one patient.

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    FIGURE 3 Grade of Incidents by Locality January – M arch 2013

    FIGURE 4 Incidents with a Major or Extreme Conse quence January – March 2013

    Four incidents were graded as high in Q4 C&B: 1 MAKI:2 OLI:1

    There were 6 incidents with a major or extreme consequence in Q4: Maki: 4 C&B:2 Outwith NHS Highland:1

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    Figure 5: Category by Consequence January – March 2 013

    FIGURE 6 RIDDOR REPORTABLE INCIDENTS

    There was one RIDDOR Reportable incident in Q4.

    Major and Extreme Categories: Consent:1 Pressure Ulcer:1 Security:1 Slips, trips and falls:2 Transfer/Discharge:1

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    2.1.2 Pressure Ulcer Prevention Implementation of NHS Highland Zero Tolerance approach to preventable pressure ulcers continues with a range of measures being taken to improve the identification and management of those patients at risk of developing pressure ulcers in all settings. These include:

    - staff training using the NHS Education Scotland Module in Pressure Ulcer Prevention

    - more rigorous application of prevention standards - raised awareness and scrutiny by managers across all sites - increased availability of pressure ulcer prevention equipment - root cause analysis of each Grade 3 and 4 pressure ulcer

    In Argyll and Bute this work is leading to reduced numbers of hospital acquired pressure ulcers. In Q4 there were no Grade 3 or 4 hospital acquired ulcers in Argyll and Bute. Work continues with staff from NHS GGC to ensure that there is feedback and reporting on patients transferred back from Acute Services who have identified pressure ulcers. Further work is required across all community settings to raise the awareness of patients, carers and staff in all sectors to ensure that appropriate risk management is undertaken at all times. FIGURE 7 NHS Highland Number of Patients with Hospi tal Acquired Pressure Ulcers from

    March 2012 to March 2013

    The overall number of Hospital Acquired Pressure Ulcers in NHS Highland for Q4 was 129.

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    FIGURE 8: Operational Units: Numbers of Patients wi th Hospital Acquired Pressure Ulcers from March 2012 to March 2013

    FIGURE 9: Hospital Location where Pressure Ulcer De veloped March 2012 to March 2013

    From the overall number for NHS Highland 4 of these pressure ulcers were acquired in hospitals in Argyll and Bute

    Hospital acquired pressure ulcers in Q4 in Argyll and Bute: Islay Hospital:2 Campbeltown:1 Victoria, Bute:1

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    Figure 10: Total Number of Pressure Ulcers per mont h in Argyll and Bute from March 2012- March 2013

    Figure 11: Where Pressure Ulcer Developed by Sub Ca tegory

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    TABLE 1: Pressure Ulcers Rates per 1000 OBDs and CQ I Compliance Rates for each Hospital in Argyll and Bute CHP

    2.1.3 Falls Prevention As with Pressure Ulcer prevention considerable amount of work is underway to reduce the incidence of falls in both hospital and community settings. Application of evidence based interventions, in the assessment and management of risk in those likely to sustain falls, is being tested in Lorn and Islands Hospital in Oban. The graph below illustrates trends across NHS Highland. FIGURE 12 NHS Highland Patient Falls in Hospitals f rom March 2012 to March 2013

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    FIGURE 13: All Patient Falls by Operational Unit an d Consequence January to March 2013

    FIGURE 14: NHS Highland Patient Falls in each Hospi tal January- March 2013

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    TABLE 2 Rate of Falls per 1000 Occupied Bed Days an d Falls Prevention CQI Compliance Scores for each Hospital

    ** please note that from December onwards the rate per 1000 occupied bed days includes all falls. Prior to December the rate incl uded only falls with harm. 2.2 Serious Untoward Incidents (SUI) Significant Event Review was carried out in early March into failure to adequately plan for transfer of very elderly patient from community hospital to home. This has resulted in some significant learning and the implementation of key actions to address potential shortfalls in planning systems and processes as well as communication. 3 COMPLAINTS TABLE 3 Argyll and Bute Complaint Performance repo rt

    Target Amber Red Dec-12

    Jan- 13

    Feb- 13

    Number of complaints received 4 5 ~ 6 7 and over 4 4 6 Achievement against 20 day 80% 70 - 79% Under 69% 25% 25% 17% Number of complaints over 40 working days old * 0 ~ 1 or more 1 0 Number of further correspondence over 20 working days old * 0 ~ 1 or more 1 2 Number of complaints categorised as high risk 1 2 3 and over 0 0 0

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    Of the complaints received in January/February 2013 the causes of complaint can be categorised as follows:

    Access/Admission: 5 Communication: 1 Treatment Procedure: 1 Transfer/Discharge: 1 Attitude/Behaviour: 1 Policy: 1

    As part of the Highland Quality Approach, and in response to the Patients Rights Act, NHS Highland is reviewing its overall performance in relation to complaints management. In addition, we have introduced further system of scrutiny within the CHP to ensure that appropriate clinical/professional leaders view complaints and draft responses prior to final sign off to ensure that all key aspects of the complaint have been investigated and that the response to the complainant is of high quality. 4. EXTERNAL REVIEWS 4.1 Joint Inspection of Children’s Services in Argy ll and Bute The on site inspection, led by the Care Inspectorate, with inspectors drawn from range of partner organisations, commenced in March 2013 and is due to conclude at the end of April. This is a pilot inspection which is seeking to test the inspection methodology prior to carrying our inspections across all Local Authority areas in Scotland. Verbal feedback will be provided to members of Community Planning Partnership on May 3rd. The written report will be published in June 2013. 4.2 CPA Surveillance Inspection of LIH, Oban Labora tories Follow up inspection will take place in April 2013. 4.3 National Plans for Joint Inspection of Adult Se rvices A joint approach to the inspection of adult services is being undertaken by Healthcare Improvement Scotland in conjunction with the Care inspectorate to examine the effectiveness of collaborative working, primarily between health, social work and social care services for adults. The aim is to build on the previous experience of multi-agency inspections and the proposals for the integration of health and social care systems. We have been working closely together to develop the model and methodology for scrutiny and improvement that considers how well strategic partners work together to deliver support that maintains people in the community at home or in a homely setting. The initial inspections will consider the way in which better outcomes for older people are being jointly achieved, for example through early intervention and preventative support, speedier assessments when needs are identified, more effective setting up of care packages to support people at home, promoting self care and reducing delays in discharge from hospital. For the purpose of these inspections adults are defined as being 65 years of age and over.

  • 12

    The inspection model has been produced by bringing together the most relevant elements from the Care Inspectorate and Healthcare Improvement Scotland into an improvement model for services for adults. The model will look at 6 key themes:

    • jointly meeting needs through person centred approaches • key outcomes for people and carers • joined up delivery of services • management of whole systems and partnership approach • leadership and direction • capacity for improvement.

    During 2013/14 the Care Inspectorate is undertaking 6 joint inspection of adult services. Local Authorities and NHS Boards will be given 12 weeks notification prior to individual inspections. Inspection teams will be multidisciplinary and multi-agency and comprise inspectors from the Care Inspectorate and Healthcare Improvement Scotland and clinical expertise from nursing, medicine and allied health professionals. Nominations for Clinical Experts to join the inspection teams have been requested by HIS and this request has gone to a number of staff in Argyll and Bute. 5. QUALITY 5.1 Older People in Acute Care All hospitals in Argyll and Bute are working towards the implementation of the standards for Older People in Acute Care. Inspection visits using the national tools from HEI will be carried out in each hospital during May and June 2013. The purpose of these visits is to share learning across all sites and to ensure that we are focussed on the key priorities for improvements. 5.2 Food Fluid and Nutritional Care Recently the focus for improvement work relating to food fluid and nutrition has been targeted at achievement of the standards within the National Catering and Nutritional Services Specification. Argyll and Bute CHP recorded 100% compliance in the December 2012 audit. The CHP Food Fluid and Nutritional Care Group is currently refreshing its work plan. In addition to actions focused on monitoring and maintaining compliance with the national catering specification, new improvement actions have been identified. In particular there will be a focus on the nutritional elements of the HIS Older People in Acute Settings Standards and learning from National Inspection Reports. .

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    5.3 Scottish Patient Safety Programme Acute Services: Appendix One contains the latest information in relation to SPSP across NHS Highland Acute Hospital sites. This information is presented in different format from the previous dashboard and allows comparison across the four hospital sites. Lorn and Islands Hospital In Patient Raw Mortality: there have been 5 consecutive months above baseline; control chart shows 1 point beyond Upper Confidence Limit (UCL. Lorn and Islands Hospital HDU Mortality: 6 consecutive months above baseline, control chart shows 1 point beyond UCL. These figures have been scrutinised through the mortality monthly audit by senior nurses, consultants and managers and there are no identified adverse events. There have been a significant number of patients requiring palliative/end of life care admitted into Ward B and HDU side rooms. This has been caused by reduced side room availability in Ward I due to increase in number of patients awaiting discharge. This is under review with the Hospital Manager and Senior Nurses. Mental Health The roll out of SPSP in mental health is underway with the team from Argyll and Bute Hospital having attended two of the national learning set events in Glasgow. Using the improvement methodology the main focus is on reducing risk by improving communication; this will also include improving risk assessment and medicines management. Daily Board Rounds at the hospital have helped with internal clinical communication. The implementation of new care plans will help to address the issues in communication between inpatient and outpatient care since the same plan will be continued. These are being rolled out at present. Primary Care The Scottish Patient Safety Programme in Primary care was officially launched on 14/15 March by the Cabinet Secretary for Health and Wellbeing and the Chief Exec of NHS Scotland. Joyce Robinson, Primary Care Manager represented Argyll and Bute CHP at the launch. Two elements of the Primary Care Safety Programme are included in Quality and Outcomes Framework (QOF) of the GMS contract this year:

    • The Safety Climate Survey, and • Structured case note review using the Primary Care trigger Tool.

    Training for the GP practices in A&B is being arranged for early June with Dr Kirsty Vickerstaff, who was involved in the Safety Improvement in Primary Care Pilot Programme for NHS Highland.

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    5.4 Francis Report of Public Inquiry into Mid Staff ordshire Hospitals The CHP Clinical Governance Group, Partnership Forum and Management Team have reviewed the findings of the Mid Staffordshire public inquiry which was led by Robert Francis. This will be presented to the next CHP Committee Development Session. The recommendations of the report will have implications for all organisations; we will continue to work with people who use our services and with our staff to highlight and address areas for improvement. The report can be accessed through the following link: http://www.midstaffspublicinquiry.com/report 5.5 Supplementary Staffing Supplementary staffing is the term used to describe staffing which is additional to the employed establishment for any services and includes bank and agency staff as well as overtime, additional hours and on call. Considerable work has been undertaken by all managers across Argyll and Bute to reduce the level of supplementary staffing in our nursing and midwifery services. While there will always be a need for percentage of staffing to be delivered through supplementary routes, it is preferable for this to be kept below 10% where possible as this improves continuity and quality of care provided. Figures for Argyll and Bute showed sustained improvement throughout 2012-2013. FIGURE 15: NHS Highland Unit Comparison Nursing and Midwifery Total Supplementary Workforce Costs as % of Pays

    Unit ComparisonN&M Total Supplementary Workforce Costs

    Expressed As A Percentage Of Pays

    0.0%

    2.0%

    4.0%

    6.0%

    8.0%

    10.0%

    12.0%

    QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4

    2012-13 2013-14

    North & West

    South & Mid (Excl. NC)

    New Craigs

    Argyll & Bute

    NHS Highland Total

    Corporate

    Raigmore

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    FIGURE 16: Argyll and Bute Nursing and Midwifery T otal Supplementary Workforce Costs as % of Pays

    Argyll & ButeN&M Supplementary Workforce Costs

    Expressed As Percentage of Pays

    0.0%

    1.0%

    2.0%

    3.0%

    4.0%

    5.0%

    6.0%

    7.0%

    8.0%

    9.0%

    10.0%

    11.0%

    12.0%

    QTR1 QTR2 QTR3 QTR4 QTR1 QTR2 QTR3 QTR4

    2012-13 2013-14

    Bank

    Agency

    Excess PT

    Overtime

    Tot Supplementary

    On Call / Call Out

    6. HEALTH AND SAFETY 6.1 Cowal Community Risk Matrix The Cowal Community team have been developing a risk matrix to determine the risk and appropriateness for patient discharge from casualty to the patient’s home. The CHP health and safety managers have reviewed and provided input on the risk matrix, for consideration and incorporation. 6.2 Ward COSHH Control Summary Sheets In preparation for the new policy on COSHH and the associated audit process, the CHP health and safety managers have assisted Oban General Ward in completing the internal COSHH control summary sheets for the chemicals they are currently utilising. The same control sheets have been disseminated to other wards in Oban and in Cowal, so they may evaluate and amend as appropriate for their own circumstances. 6.3 Dentistry Risk Assessments The dentistry service has been working on completing general risk assessments for different dental staff groups, dental nurses, dentists and dental receptionists for the general duties and tasks performed by these staff. These assessments have been reviewed by the health and safety managers and comments provided. These assessments have been placed on the A&B CHP, Health and Safety intranet page to assist others in carrying out risk assessments.

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    7. FIRE SAFETY 7.1 Fire Risk Assessments Fire risk assessments carried out by the CHP Risk Advisor, Fire Safety, using the 3i system continue to progress. Garelochhead; Kilcreggan; Campbeltown, Islay and Lorn & Islands are now complete and have been issued. Action plans are now being progressed and will be reviewed. Cowal Hospital risk assessment has been carried out, the process of uploading the information to the 3i data base is underway and will be issued to managers in April 2013. Managers have been issued with draft pictorial reference sheet to highlight where prompt actions are required. 7.2 Compartmentation Survey Recent fire service audits have highlighted the need for compartmentation work to be undertaken. Sub-compartmentation of wards is a key priority. Work is well underway to upgrade the fire alarm systems to L1 standard in Dunoon and Oban. 7.3 Unwanted Fire Alarm Signals The number of unwanted fire alarm signals continues to fall. Emphasis is being placed on the timely investigation of incidents and implementation of actions to minimise the risk of recurrence. 7.4 Fire Service Audits The enforcing authority has now completed audits in Cowal, Rothesay and Islay hospitals. Duty holders have received letters of recommendations; no formal action has been issued. Audits of Lorn & Islands and Campbeltown Hospitals took place in April. The outcome of these visits is awaited.

  • Argyll & Bute CHP Committee Date of Meeting: 24 April 2013

    Agenda item:

    - 17 -

    Appendix One: Scottish Patient Safety Data

  • Argyll & Bute CHP Committee Date of Meeting: 24 April 2013

    Agenda item:

    - 18 -

  • Argyll & Bute CHP Committee Date of Meeting: 24 April 2013

    Agenda item:

    - 19 -

  • Argyll & Bute CHP Committee Date of Meeting: 24 April 2013

    Item No: 7.2

    INFECTION CONTROL REPORT Report by Pat Tyrrell, Lead Nurse The CHP Committee is asked to: • Note the contents of the report.

    1. Aim

    The purpose of this paper is to update CHP Committee members of the current status of Healthcare Associated Infections (HAI) and infection control measures in Argyll and Bute CHP and NHS Highland.

    2. Contribution to Board Objectives

    One of the Board key objectives is “to reduce to an absolute minimum the chance of acquiring an infection whilst receiving healthcare and to ensure our hospitals are clean”. This report presents a comprehensive view of HAI data and activities for scrutiny and feedback from the Board.

    3. New Staphylococcus aureus bacteraemia & Clostrid ium difficile National HEAT Targets

    From 01/04/2013, the National HEAT target for Staphylococcus aureus bacteraemia (including MRSA) cases is 24.0 or less per 100,000 acute occupied bed days by year ending March 2015. The National HEAT target for Clostridium difficile infections in patients aged 15 and over is 0.25 cases or less per 1,000 total occupied bed days by year ending March 2015

    4. Summary

    Table 1 NHS Highland Infection Prevention & Control targets and performance data Group Target NHS

    Scotland NHS Highland

    Clostridium difficile

    Age 65 and over

    39.0 (100,000 OBDs)

    29.2 For period January 2012 – December 2012.

    Green

    Staphylococcus aureus bacteraemia

    Age 15 and over

    26.0 (100,000) AOBDs

    22.5 For period January 2012 – December 2012.

    Green

    Hand Hygiene

    95% 95%

    98% Green

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    Cleaning 90% 95.7%

    95.9% Green

    Estates

    90% 97.3% 97% Green

    AMAU - 96%

    Green Antimicrobial prescribing

    Hospital-based Empiric prescribing

    95%

    Ward 4A – 95%

    Green

    Surgical antibiotic prophylaxis

    Compliant Yes Green

    Primary Care empirical prescribing

    Compliant Yes Green

    Source: - Health Protection Scotland/ISD/Local data.

    5. Achievements

    A fourth Consultant Microbiologist will be recruited; the creation of this post will enable additional Infection Prevention and Control support. This will also enable Infection Control Clinical Leadership to be delivered to Argyll and Bute CHP from NHS Highland rather than from NHS Greater Glasgow and Clyde.

    6. Challenges

    • To engage all clinical staff in hospitals and in the community to put in place and

    sustain initiatives to reduce device/healthcare related infections. • To have access to high quality data for all areas.

  • 3

    Argyll and Bute CHP Healthcare Associated Infection Report –

    April 2013

    Section 1 – NHS Highland Board Wide and Argyll and Bute Issues

    1. Staphylococcus aureus (including MRSA)

    1.1 New Staphylococcus aureus bacteraemia target From 01/04/2013, NHS Boards are required to further reduce healthcare associated infections so that by year ending March 2015, Staphylococcus aureus bacteraemia (including MRSA) cases are 24.0 or less per 100,000 acute occupied bed days. 1.2 Trends Altogether, 379 new S. aureus bacteraemia cases were reported to Health Protection Scotland (HPS) during this period. This is a decrease of 7.1% compared with the same quarter last year (October to December 2011) when 408 cases were reported and it is the second equal lowest number of cases reported since the start of the mandatory S. aureus bacteraemia surveillance programme. In the last year, January 2012 to December 2012, 1509 episodes of S. aureus bacteraemia were reported to HPS. This represents a decrease of 6.2% on the previous year , January 2011 to December 2011, when 1609 episodes were reported. The overall rate of S. aureus bacteraemias for Scotland was 29.9 S. aureus bacteraemia cases per 100 000 acute occupied bed days (AOBDs). This represents to a small increase of 1.6% compared to the previous quarter (from 29.4 to 29.9). This is, nonetheless, the third lowest S. aureus bacteraemia rate reported since the start of the mandatory S. aureus bacteraemia surveillance programme. In comparison with the same quarter of 2011, the overall S. aureus bacteraemia rate for Scotland has decreased by 7.1%, from 32.1 to 29.9 per 100 000 AOBDs.

    Staphylococcus aureus is an organism which is responsible for a large number of healthcare associated infections, although it can also cause infections in people who have not had any recent contact with the healthcare system. The most common form of this is Meticillin Sensitive Staphylococcus Aureus (MSSA), but the more well known is MRSA (Meticillin Resistant Staphylococcus Aureus), which is a specific type of the organism which is resistant to certain antibiotics and is therefore more difficult to treat. More information on these organisms can be found at:

    Staphylococcus aureus :

    http://www.nhs24.com/content/default.asp?page=s5_4&articleID=346

    MRSA: http://www.nhs24.com/content/default.asp?page=s5_4&articleID=252

    NHS Boards carry out surveillance of Staphylococcus aureus blood stream infections, known as bacteraemias. These are a serious form of infection and there is a national target to reduce them. The number of patients with MSSA and MRSA bacteraemias for the Board can be found at the end of Section 1 and for each hospital in Section 2. Information on the national surveillance programme for Staphylococcus aureus bacteraemias can be found at:

    http://www.hps.scot.nhs.uk/haiic/sshaip/publicationsdetail.aspx?id=30248

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    During this quarter, the S. aureus, MRSA and MSSA bacteraemia rates at all NHS boards were within or below the 95% confidence limits on the funnel plots. The annual rate for NHS Highland, January 2012 – December 2012 is 22.5 per 100,000 AOBDs (National target March 2013, 26 per 100,000 AOBDs) which means that NHS Highland is on track to meet HEAT target. Within NHS Highland there were 2 MSSA SABs in January 2013 and 8 SABs (2 MRSA and 6 MSSA) in February 2013. The causes were attributed to 2 x PICC lines, 1x skin & soft tissue, 1 x catheter related urinary tract infection and 1 which was probably not preventable, with root cause analysis to be completed for the remainder. In Argyll and Bute there have been no SAB cases reported during the last quarter of 2012- 2013. Figure 1 Staphylococcus aureus bacteraemia (MRSA an d MSSA) cases per 100,000 occupied bed days, all ages, with 95% confidence interval (v ertical lines), linear trend (Black line) and target (Red line) = 26, CI = Confidence Interval

    Figure 1 shows that SAB rates have remained stable at low levels between January 2010 and December 2012

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    Figure 2 shows that in the current reported quarter ending December 2012 that the Highland SAB rate was significantly lower than that of most other Scottish Boards.

    HG = Highland TABLE 2 shows the cumulative totals for SAB within Argyll and Bute CHP for the years since 2009-2010: Hospitals 09/10 10/11 11/12 12/13 13/14 Lorn and Islands, Oban 8 3 0 5 0 Victoria Hospital, Rothesay 1 1 0 0 0 Mid Argyll Hospital, Lochgilphead 0 1 0 0 0 Argyll & Bute Hospital, Lochgilphead 0 0 0 0 0 Campbeltown Hospital 0 0 0 0 0 Dunaros, Mull 0 0 0 0 0 Islay Hospital, Bowmore 0 0 0 0 0 Cowal Community Hospital, Dunoon 0 0 0 0 0 There have been no new cases of SAB in Argyll and Bute since the last report. 1.3 MRSA Screening A National Key Performance Indicator (KPI) tool has been developed by Health Protection Scotland (HPS) to monitor compliance with the National MRSA screening policy. There is a requirement to achieve a minimum of 90% compliance. All NHS Boards are now collecting data which will be reported annually by HPS. The effectiveness of the MRSA screening policy will be reviewed by HPS after 3 years (March 2015).

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    2. Clostridium difficile

    2.1 New Clostridium difficile Target

    From 01/04/2013, NHS Boards are required to further reduce healthcare associated infections so that by year ending March 2015, the rate of Clostridium difficile infections in patients aged 15 and over is 25.0 cases or less per 100,000 total occupied bed days. 2.2 Trends In total, 313 new cases of CDI in patients aged ≥65 years were reported to Health Protection Scotland (HPS) during this quarter. The overall incidence rate for Scotland was 26.7 cases per 100000 total occupied bed days. This is a 16% decrease from the previous quarter and is the lowest rate reported for this age group since the beginning of mandatory surveillance. In total, 120 new cases of CDI in patients aged 15-64 years were reported to HPS during this quarter. The overall incidence rate for Scotland was 34.4 cases per 100000 acute occupied bed days. This is a 17% decrease from the previous quarter . The year on year trend analysis comparing 2011 to 2012 shows a non-statistically significant decrease in the overall incidence rate for patients aged ≥65 years of 2.0% (95% CI: -15.2% to 13.3%). In patients aged 15-64 years, there was a non-statistically significant decrease of 10.6% (95% CI: -24.7% to 6.1%). October – December 2012 NHS Highland rate is 18.9 per 100,000 OBDs (9 cases). The annual rat