Quality Assurance Committee Update Trust Board Item: 12.2 28th January 2015 Enclosure: Q Purpose of the Report: To report on the main areas of discussion at the Quality Assurance Committee meeting held on the 14th January 2015. For Information Assurance Discussion/decision Performance For Approval Sponsor (Executive Lead): Chris Streather, NED, Chair of Quality Assurance Committee Author: Jacky Bush Head of Quality Governance Author Contact Details: 020 8934 3846 jacky.bush@kingstonhospital.nhs.uk Risk Implications – Link to Assurance Framework or Corporate Risk Register: Links to Strategic Objective 1 in the Board Assurance Framework Legal / Regulatory / Reputation Implications: N/A Link to relevant Corporate Objective Strategic Objective 1: to deliver quality, patient centred healthcare services with and an excellent reputation. Document Previously Considered By: n/a Recommendations: The Trust Board is asked to: 1. 2. 3. Note the main areas of discussion at the January 2015 Quality Assurance Committee meeting and the assurances gained Note that the next meeting of the Quality Assurance Committee is due to take place on 4th March 2015 Note subject of the March 2015 deep dives 1 Kingston Hospital NHS Foundation Trust – Trust Board – January 2015 Enclosure Q Update to Trust Board January 2015 QUALITY ASSURANCE COMMITTEE (QAC) HEADLINES This report provides the Trust Board with an overview of the key risk issues discussed and assurances given at the Quality Assurance Committee (QAC) meeting held in January 2015. The QAC noted that the key quality risks continue to have significant managerial attention and focus, and that there continues to be close monitoring of quality indicators. The Committee received a presentation on End of Life Care, the details of which are given below. As discussed at the October 2014 meeting, to ensure that the Committee is adequately sighted of emerging risk issues associated with performance it was agreed, where required, that the exception reports would include the following three stage management approach: Identification of the ‘issue’, agree the actions and implement them, and in the next quarter review the results of the actions taken and outcomes. The Committee did not identify any new areas of significant risk; however, it wished to highlight the following issues.    The inclusion of the three stage management approach on the exception report slide The importance of saying ‘Thank You’ to all staff (clinical and non-clinical) for their tireless efforts and dedication shown over the recent weeks to ensure patients receive a quality service despite the significant pressures in the health economy The fact that despite the current pressures, there is still a quality focus with improvements being made against the quality KPIs The Quality Assurance triangulation presentation continues to be well received by the Committee. Risk Issues Discussed Actions / Update / Comments Overview of Clinical Quality The overview of clinical quality, risks and assurances presentation (and and Safety data pack) aims to provide the committee with triangulation of data and intelligence for assurance purpose. The presentation covered an overview of operational pressure points, and areas of concern, the Clinical Quality Report, Quality Risks on the Corporate Risk Register, Nursing scorecard, the December 2014 Care Quality Commission Intelligent Monitoring Report, the Sign up to Safety project, as well as, the quality data published on NHS Choices and updates from each Divisional Director . The Committee also received an update on the Length of Stay area of work, as requested at the November 2014 Trust Board meeting. Updates were also given on VTE assessments, Governance structure, in patient menus, missing patients, red rated audits and the CIP process. The key areas of concerns and challenge were highlighted as food and nutrition, pressure ulcers and the impact of the recent car parking changes on Patient Experience. The Committee discussed the concerns, the quality triggers and gained assurance around actions being taken to address them. Wards of concern were also discussed, as were the actions being taken to address the concerns, which include the appointment of new Matrons, additional Senior Support and further Kingston Hospital NHS Foundation Trust –Trust Board – January 2015 2 Enclosure Q recruitment. The presentation also included information from each Divisional Director on key quality achievements and top risks to quality and the actions being taken to address these risks. The Committee received information on the Sign up to Safety project launched by NHS England. They noted that the Trust had been identified as a ‘trailblazer’ and gained support from the Sign up to Safety Team to develop their Safety Improvement Project plans. The Trust has also agreed to be a case study for the period of the scheme. The Committee noted concerns escalated by the Clinical Quality Improvement Committee, the Compliance and Risk Committee and the Patient Experience Committee, and the actions being taken to address these. Quality Account 2013/14 Duncan Burton, Director of Nursing and Patient Experience gave a progress and plan for presentation on the Quality Account and the process for identifying the 2014/15 priorities for the coming year, which included surveying staff, Healthwatch, Clinical Commissioning Groups, Members and Governors. It was noted that the deadline for this had been extended to improve the response rate. Duncan Burton highlighted the key milestones, noting that the date of the external audit had been bought forward following learning from last year’s process. The draft high-level priorities and a reminder of this year’s priorities were presented and considered. It was noted that the priority measures will need to be identified. Members were asked to provide any further feedback or suggestions on new priorities to Duncan Burton or Jacky Bush, Head of Quality Governance. Deep Dive on End of Life Fergus Keegan, Deputy Director of Nursing, gave a presentation on End Care of Life Care at Kingston Hospital. He provided an overview of the service including Specialist Palliative Care, the vision for End of Life Care and governance arrangements. He also highlighted the successes including the replacement of the Liverpool Care Pathway with the Decision Support Tool, and the current challenges for the service. It was agreed that that an update on the challenges, particularly around DNAR would be given to the March 2015 QAC meeting. It was also agreed that, in order to improve Board visibility, it would be included in the Clinical Quality Report on a quarterly basis. March 2015 forward plan meeting The Committee agreed the following items would be discussed at the March 2015 meeting:    Deep Dive into Post Infection Review actions Deep Dive in to Sepsis Quality Account update Kingston Hospital NHS Foundation Trust –Trust Board – January 2015 3