Quality & Safety Committee
Minutes of the Meeting held on Thursday 3rd July 2014
in Ysbyty Gwynedd, Bangor
Present:
Ms J Dean
Rev HM Davies
Dr P Higson
Mr H Owen-Jones
Cllr E Roberts
In Attendance:
Mrs F Giraud (FG)
Mrs M Hanson (MH)
Mr D Harries (DH)
Mrs A Hopkins (AH)
Mrs L Jones (LJ)
Dr A Jones (AJ)
Mr M Joyce
Ms J Kember
Mr G Lang (GL)
Mr T Lynch (TL)
Prof M Makin (MM)
Mrs V Morris (VM)
Mrs V Nelson (VN)
Mrs H Owen (HO)
Mr S Pyke (SP)
Dr G Roberts (GR)
Dr M Savage (MS)
Dr B Tehan (BT)
Mr A Thomas (AT)
Independent Member (Chair)
Independent Member (part meeting)
BCUHB Chairman (part meeting)
Independent Member (part meeting)
Independent Member (part meeting)
Associate Chief of Staff, Nursing (part meeting)
BCUHB Vice Chair
Head of Internal Audit
Executive Director of Nursing, Midwifery & Patient Services
Head of Corporate Affairs
Associate Chief of Staff, Nursing, MHLD (part meeting)
Member of the public (observing)
Interim Vice-Chair of the Healthcare Professionals Forum
Executive Director of Primary Care, Community & Mental Health
(part meeting)
Interim Chief Operating Officer
Executive Medical Director and Director of Clinical Services (part)
Interim Director of Quality Assurance (part meeting)
A4C Staffside Lead
Business Manager (part meeting)
Associate Chief of Staff (part meeting)
Associate Chief of Staff, Operations (part meeting)
Consultant Psychiatrist,representing Dr G Harborne (part meeting)
Assistant Medical Director (Secondary Care)
Assistant Director of Therapies and Health Science
Agenda Item
Action
By
QS14/82 Declarations of Interest
Ms Dean declared that, in respect of agenda item QS14/85, her substantive post was
in the Women’s Services CPG.
QS14/83 Apologies for absence
Mrs H Stevens, Dr C Tillson, Mr I Mitchell, Mr A Jones, Mrs G Lewis-Parry, Dr T
Shambrook, Dr M Adke and Mrs J Hughes.
QS14/84 Clinical Programme Group (CPG) Quality & Safety Monitoring Report –
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Mental Health & Learning Disabilities (MHLD) CPG
QS14/84.1 Mr S Pyke, Mrs H Owen, Dr M Savage and Dr A Jones attended to speak
to this submission. Mr Pyke introduced the item, and highlighted the key points of the
report provided. Dr Jones explained that the CPG had legacy issues in relation to
outstanding serious untoward incidents (SUIs) as well as complaints response times,
and he described measures taken over the past few months to address these. He
confirmed that, by mid September, the legacy backlog would be addressed. He went
on to explain that the CPG is working to build a learning culture, for example, by
including Senior Doctors and Managers on SUI scrutiny panels to ensure that lessons
are learnt. Dr Jones reiterated that the CPG recognised that it had been slow in
responding to the challenge posed by the concerns legacy backlog, however, he
stressed that there was now a clear commitment to address the matter.
QS14/84.2 Mrs Owen gave further details on steps taken to improve investigation of
SUIs and concerns, although she pointed out that there was still further work to be
done. She explained that there will be a focus on lessons learned over the next 12
months. Mr Pyke added that the CPG is progressing Royal College of Psychiatrists’
accreditation, and that the Safe Wards initiative had been piloted in the Hergest Unit.
In response to Mr Owen-Jones, Mr Pyke outlined the range of community mental
health services provided by the CPG, and stated that current variation within the
community mental health teams (CMHTs), would need to be tackled, to bring each
team up to the same high standard. Indicators will need to be developed for
consistency. A piece of work is also required to determine appropriate staffing levels.
Dr Savage explained changes that had taken place since the Health Board’s
inception. She stated that more checking procedures were required in the CPG, with
perhaps further development of services for the elderly.
QS14/84.3 Mr Pyke stated that more local ownership was helping to develop better
services, but there was a need to ensure that they all developed consistently. Mr
Owen-Jones asked if managing more clients at home would reduce pressure on the
secondary care units such as Hergest. Dr Savage responded that this was a logical
conclusion, however, pressures on Hergest and Ablett remained due to the
increasing number of referrals. Dr Jones updated on older persons’ mental health
services, which, he stated are not currently integrated with local authorities. He
explained that a review is currently underway and should provide a roadmap for
future development of services. Inventive solutions must be found. Cllr Roberts stated
that she would like to see more information on partnership with the local authorities.
Mr Pyke explained the budget complexities and issues relating to moving towards
pooled budgets. Cllr Roberts stated that she would like the Committee to be kept
updated on progress on pooled budgets.
QS14/84.4 Mrs Hopkins raised the issue of measuring quality in community services.
She asked how quickly outcome measures and indicators could be introduced. Dr
Jones explained Excellence in Care and other safety metrics already collected, to
support the Mental Health Measure. Mrs Hopkins asked what audits were undertaken
to check that staff are using their skills appropriately, and to check how many people
have care plans. Dr Savage responded that this was partially done but, in common
with the rest of Wales, there was no single audit that could demonstrate overall
quality of care plans. Mrs Hopkins asked if multidisciplinary team (MDT) reviews were
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taking place. Dr Savage confirmed that there were MDT meetings once a week. Mr
Pyke added that there was also an element of peer review required. In respect of
measuring quality, Dr Jones stated that the number of clients in employment could be
collected, as this was generally considered to be a good indicator of normalisation
and recovery. The importance of service user feedback was noted.
QS14/84.5 Rev Davies stated that the report supplied did not provide him with
adequate assurance. He observed that the document contained very little information
on the therapeutic activities available, and he had received feedback from clients
stating that they want more activities to be provided. Rev Davies also queried how
BCU could manage an all-North Wales community plan, and recounted other
feedback received regarding concerns about pressures resulting from low staffing
levels. Rev Davies advised the Committee that the 6-bedded Heddfan unit in
Llangefni had clients who had resided there for years without moving on, contrary to
the purpose of the unit. This was preventing others from being admitted to the unit.
Mr Lang agreed to discuss this matter with Dr G Harborne. Prof M Makin joined the GL
meeting. Dr Jones acknowledged that more activities were needed for clients, and
added that the CPG was working to improve this. He acknowledged the gap in
provision of psychological therapies. Clinical psychologist posts have now been
approved to address this gap.
QS14/84.6 Mr D Harries pointed out that the CPG’s risk register showed no evidence
of a risk review date being recorded. Dr Savage explained that the risk register was in
the process of being transferred to Datix web, and she had regular meetings with Ken
Dawes from the Risk Management Department. Further discussion ensued. Dr
Higson explained the balance of risks approach taken to risk assessment in mental
health. He queried the approach taken to risk tolerance. Dr Savage responded that
the approach adopted by the CPG tied in with individual consultants and nurses, and
the leadership they provide. In response to a question on restraint from Dr Higson, Dr
Jones stated that risks were higher with prone restraint in particular, hence this
aspect was closely monitored. He added that Prof P Lepping was in the process of
collecting all Wales data on this. Dr Higson asked if the CPG was participating in
benchmarking in respect of seclusion. Dr Jones stated that there had been some
benchmarking with a unit in the North West of England. Reporting arrangements and
the need for more service user involvement was discussed.
QS14/84.7 In response to a question from Dr Higson, Dr Jones stated that he held no
personal view on nurses dressed in scrubs, though he noted that some pockets of
mental health services had responded to client feedback from those who preferred
nurses to be in uniform so that they are recognisable as staff. Dr Jones added that
staff should dress appropriately, for example, mental health liaison teams visiting
wards should observe ‘bare below the elbow’ and other requirements. Mr Pyke
reiterated the point that uniforms helped people to identify nurses. Mrs Owen added
that service user preferences could be picked up via the forthcoming Picker survey
and work with Unllais. Dr Higson commented that work of this nature should be done
more widely across the Health Board.
QS14/84.8 Mrs Hanson questioned page 13 of the report, covering improving
dementia care. She observed that this section indicated that BCU had deviated from
aspects of the 1000 Lives care bundle, and she pointed out that if the whole bundle
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was not delivered, the full benefits would not be seen. She also pointed out that the
statement on health promotion mentioned Motiv8 events and occasional health and
wellbeing days, however she was disappointed that the CPG had not thought through
in more detail the programme for building mental health and wellbeing. She asked
how the new mental health strategy would build in wellbeing, in order to improve the
quality of mental health services. Dr Jones stated that post-diagnostic support
needed to be focused upon; benchmarking was taking place and was demonstrating
improvement. He explained that the vehicle for delivery of more diagnostic capacity
would be more memory clinics. He acknowledged the gap and the need to improve.
Mrs Hanson pointed out that his response did not address what she had asked. She
stated that some support services were non-existent, with certain aspects of previous
services, for example Admiral nurses, stripped out. She again queried the deviation
from parts of the 1000 Lives care bundle, adding that Welsh Government (WG)
should be informed if the reason was that the bundle was not working. Dr Jones
responded that Sean Page, Consultant Nurse, had liaised with WG. He went on to
describe progress made on dementia through initiatives such as the Butterfly
Scheme. He alluded to difficulties in relation to prescribing anti-psychotics, and the
challenge of rolling out good practice such as the carers’ questionnaire designed by
Prof Bob Woods. Dr Jones acknowledged that more needed to be done to engage
with carers within community services.
QS14/84.9 Mrs Hanson queried health promotion. Mr Pyke explained the approach
being taken and stated that he links mental wellbeing with physical wellbeing. He
drew attention to the need to embed more pathways. Mrs Hanson suggested liaising
with Public Health colleagues to improve engagement with the preventative agenda.
Dr Savage stated that the range of ongoing initiatives needed to be tied together into
a coherent strategy. Mrs Morris stated that care coordination was a recurring theme
in serious incidents, and she asked the CPG team to describe what had been done in
this area. Dr Jones responded that training had taken place, plus measured risk
assessment. Information systems were recognised as a risk. Mrs Morris stressed that
care coordination is a requirement. Mr Pyke agreed there was a need to improve
performance management.
QS14/84.10 Cllr Roberts raised the issue of Ty Llywelyn. She commended the
activities taking place there, particularly the gardening project. However, her
walkabout had highlighted delays in acting on some crucial areas such as ligature
points. Mr Pyke responded that funding had now been provided for initial
improvements, and the overall mental health estates business case would be
submitted to the Board in due course. Cllr Roberts pointed out that the issues brought
to her attention should have been on the risk register. Ms Dean summarised the
discussion, noting that the Committee had received a mixed picture on quality &
safety assurance. There was a need to develop a number of strategies and plans,
however, she acknowledged that the CPG had demonstrated self-awareness in
respect of the need for improvement. Ms Dean pointed out that assurance on
Learning Disability (LD) services and their outcomes was missing from the report; she
was aware of good work going on, but felt that LD seemed to be an ‘invisible’ area.
She stated that this issue would need to come back to the Committee, either directly
or via the Quality Assurance Executive (QAE), in order to provide some assurance on
LD. Mr Pyke agreed, but added that there were very few reportable elements in LD
services. He outlined some of the work done and undertook to submit a report in
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September, in accordance with the cycle of business. Ms Dean concluded that
agreement needed to be reached on LD quality indicators that could be monitored by GL
the QAE, and she asked Mr Lang to progress this.
QS14/84.11 Ms Dean stated that the Committee would now turn its attention to the
Hergest and Tawel Fan ward update. Dr Jones reminded the Committee of the
background and steps taken in response to reviews. He confirmed his belief that the
actions taken would result in benefits. Prof Makin queried how the risks associated
with non-engagement of doctors would be mitigated. Dr Savage responded that the
nursing team was strong and this provided mitigation. Prof Makin queried trainee
doctor recruitment risks. Dr Savage replied that a General Medical Council (GMC)
survey showed that trainees were less happy in Hergest than the other 2 units.
Processes had been put in place to ensure that rotas were covered, in order to
sustain all 3 units. Mr Pyke drew attention to the fact that electroconvulsive therapy
(ECT) now takes place in the Ablett unit.
QS14/84.12 Dr Higson commented that it felt as though the 3 psychiatric units were
not fully integrated. He added that assurance was urgently required on this, as the
issue was resolvable. In respect of Appendix 28, Dr Higson noted another reference
to approaching WG for capital funding, and he queried why BCU could not identify its
own funding. Dr Savage replied that funds of over £5 million would be required to
make the necessary improvements to the accommodation. Mr Lang explained that
this was being addressed as a proper strategic solution, hence the reference to WG.
Dr Higson pointed out that immediate issues of patient safety such as ligature points
could not be delayed and must be funded by BCU.
QS14/84.13 In respect of a frailty unit, Mrs Hanson stated that there was a need for
immediate action, as an unannounced inspection could take place at any time. She
sought assurance for the Committee that an inspector would not discover practices
relating to the care of elderly people that could lead to negative criticism. Dr Jones
responded that older people should be admitted to their own ward, therefore in
Hergest a specific dormitory area had been identified. However, he conceded that
there was a need to develop a functional older person’s ward. He gave an assurance
that the CPG would be looking for solutions and seeking guidance from local
clinicians. Mrs Hanson stated that the service model could be altered quicker than the
physical environment, and she stressed that ethical and dignity in care arguments
called for rapid change. She pointed out that she had not received an answer to her
request for assurance on the question regarding inspectors discovering negative
practices. Mr Lang clarified that the inspectors would say that the environment in
Hergest is not ideal, however, the fundamentals of basic care should still be in place,
even in a sub-optimal environment. He stated that part of the issue was how
confident the Health Board was that BCU could not be portrayed in the manner
reminiscent of Trusted to Care.
QS14/84.14 Dr Higson commented that in the Ablett unit, it was picked up that it was
routine to prescribe night sedation. He added that checking for over-prescription of
this type should take place within days to provide the Committee with further GL
assurance. Mrs Hanson asked whether people could summon help. She stated that
she had been involved with the Trusted to Care response, and requested sight of the
CPG’s report on the 4 main points referred to in that document. Ms Dean
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summarised that some immediate assurance was needed in relation to safety,
specifically regarding ligature points. A simple assurance statement was requested GL
within a week. Ms Dean concluded that, in terms of ongoing monitoring, she did not
feel ready to revert to routine monitoring. It was agreed to bring a further report on the
Hergest action plan back to the Committee in December, with more frequent reports
to QAE and the Executives in the interim, including escalation where necessary. Mr
Lang stated that there should be a clear indication of progress by December, though
it was unlikely to be possible to guarantee sustainability at that point. However,
although he stated that this issue would run beyond December, Mr Lang suggested
that the intensity of the monitoring could become less heightened. Dr Jones, Mr Pyke,
Dr Savage and Mrs Owen were thanked and they left the meeting. Dr Higson left the
meeting.
QS14/85 Clinical Programme Group (CPG) Quality & Safety Monitoring Report –
Women’s Services CPG
QS14/85.1 Dr G Roberts and Mrs F Giraud attended to present this item. Dr Roberts
gave a presentation setting out the CPG’s management team changes, leadership
and governance structures. Mrs Giraud gave an overview of the reporting structure
and various groups established within the CPG. She also described operational
leadership, communication and scrutiny arrangements, including senior walkabouts
and team meetings. She explained how clinical and operational effectiveness is
monitored via dashboards, a balanced scorecard and regular reporting to Welsh
Government. Mrs Giraud went on to describe initiatives to promote good practice and
meet standards in safety, including a serious incident review programme and lessons
learned from complaints. In respect of workforce issues, Mrs Giraud highlighted that
the CPG is Birthrate Plus compliant. Dr Roberts updated on the junior doctor
situation, explaining that 1:9 rotas were in place, with a move towards 1:11. Some
recruitment vacancies still existed, but plans were in place to address these. Dr
Roberts outlined the steps to be taken to manage August pressures, including use of
locums experienced in working in BCU, and restricting Consultant leave. Mrs Giraud
explained work ongoing on the themes of training, sickness, appraisal and the staff
survey. In respect of patient experience, she set out the initiatives and objectives
relating to putting the woman and her family at the heart of service delivery. Dr
Roberts led the Committee through the CPG’s key risks, and explained the mitigating
actions. He emphasised the major challenges resulting from the Deanery’s removal
of junior doctor training places at Ysbyty Glan Clwyd.
QS14/85.2 Prof M Makin queried medical staffing appraisal rates. Dr Roberts
responded that improvements had been seen and the 100% was almost achieved.
Prof Makin raised the issue of the August medical staffing contingency plan and the
residual degree of risk. He asked what the fallback position would be. Dr Roberts
stated that the service could be delivered across 2 sites if necessary – Bangor and
Wrexham. This would create some capacity issues, but these could be overcome. He
stated that all plans were in place. Prof Makin raised the issue of risk associated with
locum usage; he asked if arrangements were in place to avoid having rotas entirely
staffed by locums. Dr Roberts confirmed that arrangements were in place, and that
these had worked before. In respect of the major haemorrhage policy, Mrs Giraud
confirmed that all locums were familiarised with this as part of their induction.
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QS14/85.3 Mr Owen-Jones queried the situation regarding complaints and concerns.
Mrs Giraud explained the reporting arrangements in more detail. Mr Owen-Jones
noted that progress had been made. He asked how some 2 day acknowledgements
were missed. It was clarified that responsibility for sending acknowledgements lies
with the corporate team. Mr Owen-Jones drew attention to the CPG’s poor
performance on response times. Mrs Giraud replied that there was a backlog, but this
was improving. Mrs Morris commented that she was confident that the CPG would
achieve its end of July deadline for clearing the backlog. In response to a query from
Mr Owen-Jones in respect of some outstanding claims dating back as far as 2001,
Mrs Giraud explained that the complexity of some cases sometimes caused this to
happen; also, children reaching the age of 18 become eligible to make a claim in their
own right, and this too could result in cases dating back many years.
QS14/85.4 Rev HM Davies raised the issues of Welsh language and staff morale. He
noted that only a quarter of the CPG’s midwives were Welsh speakers, which he
viewed as a risk. Mrs Giraud explained that the CPG has a Welsh language
champion, and the language issue had been discussed with the University in relation
to seeking to recruit students who could provide a Welsh language service. She
added that staff were also presenting themselves for Welsh language training. Rev
Davies stated that he believed there should be a target relating to this. He also
recounted feedback from a midwife whose morale was low due to having insufficient
breaks at work. Mrs Giraud confirmed that she would relay these issues back to local
management.
QS14/85.4 Mrs Hopkins highlighted appendix 10, setting out the training programme
and the complexity of the areas covered by the CPG. She commended the CPG and
stressed that it was not simply about delivering babies. In relation to the fact that 17
out of 24 outstanding complaints sit in Ysbyty Glan Clwyd, she stated that the
Committee was well sighted on the issues in the department there. She asked Mrs
Giraud and Dr Roberts to describe the initiatives underway to support progress and
improvements. Dr Roberts explained that meetings were taking place on a weekly
basis with the Consultants, additional recruitment had taken place, and work on job
plans was underway, as were other initiatives. Mrs Hopkins added that Aston Team
Coaching was being utilised to support the team. Mrs Giraud explained progress
made on securing commitment from Consultants on reducing c-sections. Ms Dean
queried support provided to the non-medical staff on the team. Dr Roberts explained
the actions taken to guide and support the staff members concerned. Cllr Roberts
observed that the report did not contain much information on service user
involvement in relation to stillbirth or pregnancy loss. She also alluded to recruitment
problems with Flying Start. Mrs Giraud explained the situation as regards local
authority issues. She also described the facilities for bereaved parents. Rev HM
Davies left the meeting.
QS14/85.5 Mrs Hanson raised concerns about women in labour who may be in a
position to travel to a choice of maternity units by virtue of where they live. She
highlighted the associated risk that not all services may be provided at the site at
which these women present themselves. Dr Roberts outlined the situation regarding
women in this position. Mrs Hanson asked how the CPG in the East was dealing with
the number of women delivering babies whose first language is neither Welsh nor
English. Mrs Giraud explained that independent translation services were available,
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though she pointed out that demand for such services was falling.
QS14/85.6 In respect of previous issues discussed regarding Ysbyty Glan Clwyd, Mr
Lang queried labour ward cover resilience, gynaecology rounds, and the leave and
absence situation. Mr Owen-Jones left the meeting. Mrs Giraud explained the
situation regarding handover on labour ward, and gynaecology ward rounds. Dr
Roberts stated that progress had been made on leave and absence, and the robust
approach being taken had resulted in some Consultants losing leave days due to
carry-over limits. Mr A Thomas commended the CPG’s commitment to Clinical Audit
and lessons learned. He suggested having the Clinical Audit plan as a stand-alone
document. He asked if appendix 14 was replicated on all sites. Mrs Giraud confirmed
that it was, as a Welsh Risk Pool standard requirement.
QS14/85.7 Ms Dean queried service user involvement in gynaecology. Mrs Giraud
highlighted the questionnaires in use, but acknowledged that this area was less
developed than maternity services. Ms Dean asked if a Women’s Forum had been
developed as outlined last year in the CPG’s submission to the Committee . Mrs
Giraud responded that it had not. Mrs Morris pointed out that the Quality
Improvement Strategy would translate the CPG’s strategy into practice. Ms Dean
summarised that a clear picture of actions and work ongoing had been provided to
the Committee, with evidence of risk mitigation. She asked the CPG if it required any
additional support from the Committee. Dr Roberts responded that the mechanisms
were in place for the CPG to request support if required. Mrs Hopkins congratulated
Mrs Giraud on her appointment as Chair of the All Wales Heads of Midwifery Group.
Ms Dean invited the CPG to provide feedback on the Committee’s performance as
appropriate. Mrs Giraud and Dr Roberts were thanked and they left the meeting. Mr
Lang and Mrs Nelson left the meeting. The Committee had a break then reconvened.
QS14/85 Committee Workshop:
The following agenda item was taken out of sequence.
Actions arising from the workshop were captured by the relevant individuals, with all
being due for completion in time to meet publication deadlines
QS14/85.3 Quality Improvement Strategy (QIS) 2014-17
QS14/85.3.1 Mrs Hopkins introduced this item by explaining that Mrs Morris had
made every attempt to allow everyone to have an input into the document, however
no comments had been received from the Committee other than those provided by
Ms Dean despite a reminder being sent. Mrs Morris introduced the item and
described the processes, pointing out that the public health aspects required further
work. Dr Higson re-joined the meeting. He commented that Board and Committee
structures would be examined as part of John Bullivant’s Good Governance work,
and he queried the functioning of the Quality Assurance Executive (QAE). Prof Makin
explained the background to QAE, and estimated that it was 60-70% functional. Mrs
Morris added that the clinical engagement with QAE was good. She advised against
over-burdening the group with too many issues, which would adversely affect its
functioning. Dr Higson stressed that the QIS would have to be approved by the QAE
before submission to the Quality & Safety Committee. Ms Dean commented that the
Committee was not well sighted on all issues, including some wider risk management
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matters. Mrs Morris explained in more detail how the QAE dealt with such matters. Dr
Higson stated that, in time, the Board would be setting risk tolerance parameters. He
intended to steer the Board towards seeking assurance rather than drilling down into
the detail. Mrs Hopkins stated that there was a need to improve QAE reports and set
a cycle of business. Mr Thomas reminded the Committee that issues of significance
from the previous quality & safety sub-committees would now be submitted directly to
the Committee, for additional assurance.
QS14/85.3.2 Mrs Morris went on to describe in more detail the principles for shaping
the future as set out on page 9 of the document. Discussion ensued. Dr Higson
pointed out that these were not governance processes, just elements of a process.
Inputs and outputs were needed. Dr Higson suggested that the paper’s title should
refer to ‘safety’. Prof Makin stated that the word ‘quality’ can mean different things to
different people. Dr Higson wondered whether the title suggested that services are
not currently safe. Prof Makin stated that ‘invisible’ risk was the most significant. Mrs
Morris stressed that the QIS was about year-on-year improvement. Mrs Hopkins
stated that BCU was on a continuous improvement journey. Dr Higson stated that
there was a danger of seeing quality as an adjunct. Dr Tehan suggested that BCU
should aim to exceed expectations rather than just meet them. It was noted that the
foreword from the Chief Executive and Chairman would need revisiting, and
straplines considered. Public health and primary care inclusions were discussed. Prof
Makin suggested adding 10 high impact changes in primary care. Mrs Kember
observed that the QIS was very much secondary care focused; more thought was
required in respect of primary and community care, not just GPs. Proxy measures
were discussed. Dr Higson suggested looking at patient satisfaction feedback from
the community rather than just in the hospital setting. Commissioning for quality,
drawing in specialised services, national data on GPs, complaints data and
contractual issues were discussed. Dr Higson suggested conducting a trawl to see if
any proxy measures were already in system. Ms Dean reported on comments
received from Dr M Adke, which Mrs Morris would be working through. Dr Higson
suggested adding a section on the role of the Board. Patient stories presented at
meetings were discussed; it was agreed that DVDs had a better impact and therefore
a patient story DVD would be presented at the beginning of each Board meeting. Mrs AH
Hopkins agreed to work with the Communications team to arrange this.
QS14/85.1 Annual Quality Statement 2013-14
Mrs Hopkins presented this agenda item. She reminded the Committee that the
Statement was a public-facing document. Ms Dean gave her view and reported on
feedback from Mrs G Lewis-Parry, highlighting omissions. Mr Harries stated that
Internal Audit would not be permitted to comment on content or compliance with WG
guidance – he would simply be triangulating evidence. Dr Higson commented that the
‘Healthcare in North Wales is Changing’ section did not fit well within the Statement.
He also noted that references to the 3 year plan should be removed, as the Board
currently only has a 1 year plan. Further discussion ensued. Ms Dean pointed out
some errors of detail. Mrs Morris left the meeting.
QS14/85.2 Standards for Health Services
Mrs Hopkins presented this agenda item, and led the Committee thorough the paper.
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The star chamber approach was discussed. Mrs Hopkins outlined suggestions for
releasing Independent Member (IM) time. Ms Dean commented that there was likely
to be support for the Governance and Accountability module being dealt with by a
workshop approach, but she stated that several of her IM colleagues felt they needed
to continue to attend some star chambers. Mrs Hopkins accepted Ms Dean’s
comments and added that there would need to be a proper process in place for
selecting core standards, as different opinions exist on what constitutes ‘core’. Prof M
Makin left the meeting. Mrs Hopkins suggested having an integrated governance
committee. Dr Higson suggested seeking intelligence on the Equality Bill. It was
noted that, as the paper presented was being discussed as part of a workshop
session, plus the meeting was no longer quorate at this point, it was not appropriate
for those present to agree any of the recommendations listed. Following discussion,
Ms Dean drew the meeting to a close.
QS14/86 Date of Next Meeting
4.9.14.
Signed:
(Chairman)
Date:
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