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Minutes of a Meeting of the Health/Nhs Overview and Scrutiny Committee Held on 6 March 2013 at 10.00 Am at County Hall, Chelmsford

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Minutes of a Meeting of the Health/Nhs Overview and Scrutiny Committee Held on 6 March 2013 at 10.00 Am at County Hall, Chelmsford MINUTES OF A MEETING OF THE HEALTH/NHS OVERVIEW AND SCRUTINY COMMITTEE HELD ON 6 MARCH 2013 AT 10.00 AM AT COUNTY HALL, CHELMSFORD County Councillors present: Mrs J M Reeves (Vice- A Hedley (substitute) Chairman and Chairman of Mrs S Hillier the meeting) R Howard Mrs M A Miller (Vice-Chairman) E Johnson J Baugh R Madden W Dick (substitute) J Schofield Mrs M Fisher Borough/District Councillors present: N Offen (Colchester) County Councillor A Naylor (Cabinet Member, Health and Wellbeing), J Aldridge (Cabinet Member for Adults Social Care) and J Carr from LINk were also in attendance. The following officers were present in support throughout the meeting: Graham Hughes - Committee Officer Christine Sharland - Governance Officer 1. Apologies and Substitution Notices Apologies for absence had been received from County Councillors G Butland, R Boyce (for whom Councillor A Hedley was attending as substitute), L Mead (for whom Councillor W Dick was attending as substitute), and Epping Forest District Councillor A Mitchell. 2. Declarations of Interest The following standing declarations of interest were recorded: Councillor J Baugh Personal interest as wife works at Mid Essex Hospital Services NHS Trust Councillor W Dick Personal interest for item 6 as a current patient of Southend University Hospital NHS Foundation Trust Councillor M Fisher Personal interest for Item 5 as daughter-in-law works as a matron at Colchester Hospital University Foundation Trust Councillor S Hillier Personal interest as governor of Basildon and Thurrock University Hospitals NHS Foundation Trust Councillor M Miller Personal interest as a member of the Patient Reference Group for a Great Baddow GP surgery Councillor N Offen Personal interest as a Governor of Colchester Hospital University Foundation Trust and also due to being in receipt of an NHS Pension. Councillor J Reeves Personal interest as a member of a local GP Patient Participation Committee Councillor J Schofield Personal interest as a governor of Basildon and Thurrock University Hospitals NHS Foundation Trust John Carr, LINk, who sat with the Committee, declared a personal interest as being a member of the Transformation Board for West Essex, a member of the West Essex Patient Reference Group and being an ex-Trustee of St Clare Hospice. 3. Minutes The minutes of the meeting of the Health Overview and Scrutiny Committee held on 6 February 2013 were approved as a correct record and signed by the Chairman. 4. Questions from the Public There were no questions from the public. 5. Colchester Hospital update The Committee considered a report (HOSC/05/13) from Colchester Hospital University Foundation Trust (CHUFT). Dr Sally Irvine, Chair, Dr Gordon Coutts, Chief Executive, and Dr Sean MacDonnell, Medical Director were in attendance to introduce and supplement the report and to answer questions. (i) Background The report was to provide an update on the overall performance of CHUFT within the context of the Francis report on the failings surrounding Mid Staffordshire NHS Foundation Trust and the Prime Minister’s recent announcement to review 14 hospitals who had had persistent outliers on mortality indicators. As a result of being named as part of the review, CHUFT had quickly briefed local stakeholders, including local Members of Parliament, to try and put the announcement into context particularly as it only related to one particular mortality measure (the Standardised Hospital Mortality Index) and CHUFT met all other performance quality measures in relation to mortality (see below). (ii) Mortality measures There were currently at least four measures of mortality in the NHS. Both Crude Mortality, representing the number of deaths at the Trust's hospitals (Colchester General Hospital and Essex County Hospital, Colchester), and the Crude Mortality Rate, which measured the number of deaths compared to the number of patients, had declined year-on-year. The Hospital Standardised Mortality Rate (HSMR) measured in-hospital death rates comparing the actual number of deaths with the expected number of deaths. A number of adjustments were made to obtain the expected number of deaths. The HSMR was at the expected level. It had been CHUFTs Standardised Hospital Mortality Index (SHMI) that had been a persistent outlier which led to CHUFT being included in the Keogh Review. SHMI compared the actual number of patients who died following hospitalisation with the number who would be expected to die, given the characteristics of the patients treated. The SHMI categorised them in the following categories: ‘as expected’, ‘higher than expected’ or ‘lower than expected’. It differed from other mortality indicators as it considered all deaths that took place at the Trust as well as those taking place within 30 days of discharge. Fewer adjustments were made to this measure compared to HSMI and excluded amongst others palliative care, deprivation and the interaction between age and pre-existing medical conditions. (iii) Actions being taken to improve mortality rates The level of variance in the CHUFT performance between SHMI and the three other mortality indicators had been a matter of concern for the CHUFT Board. CHUFT had commissioned a report from the independent Dr Foster group and had jointly developed a Joint Mortality Action Plan with the North East Essex Clinical Commissioning Group to monitor, analyse and investigate mortality rates and implement improvements. CHUFT were working to understand the root causes that contributed to unexpected deaths and had implemented a comprehensive set of improvements to patient care and increased capacity, including increased consultant cover in the two hospitals, particularly in A&E, where the consultants worked until midnight seven days a week, and admitting wards. Members queried that disclosed A&E waiting time measures seemed to be regularly on or very near the national 4 hour target and CHUFT representatives confirmed that they were continually meeting the four hour standard and were reviewing ways to reduce times further. CHUFT representatives also emphasised the importance of looking at qualitative as well as quantitative measures at the Trust including observing the positive and transparent culture operating at the organisation and that stakeholders retained confidence in the hospital. CHUFT had been encouraged by the significant improvements in the last 12 months in patient experience and the other national mortality indicator (HSMR). Patients now reported that their experience of care at Colchester Hospital Trust was among the best in the country and the results of the piloted NHS Friends & Family Test had confirmed this. (iv) Demographics Members queried whether local demographics were taken into consideration in determining acceptable mortality measures in an area. In particular, the Tendring area had a disproportionately older population demographic. CHUFT representatives acknowledged this and stressed that it was important to continue discussions that had already started with the local Clinical Commissioning Group and the County Council on the provision of End-of-Life care in the community, including facilitating those that wished to die at home, and to minimise inappropriate admissions to the hospital. (v) Infection control Yearly targets for reducing C-difficile cases were set based on CHUFT’s previous performance. As the Trust had been relatively successful in reducing this infection they had been given a target which they felt was challenging to achieve. There had been 27 confirmed cases against a ceiling of 25 for the year ending March 2013. There was no evidence of the cases being linked and other outcomes from infection control measures were considered effective. However, CHUFT were making further changes to their cleaning programme. Whilst some patients would have been admitted into hospital already with c-difficile, CHUFTs reported figures related to those that had been infected within 48 hours of entering the hospital. (vi) Accident and Emergency There had been three extra surges in demand in December, January and early February. Consultants had been able to increase their presence on the wards as a result of CHUFT using contingency beds, staff working flexibly and the rescheduling of clinics. (vii) Capacity Over the past two and a half years the Trust had invested extensively in new capacity. A new children’s ward paediatric care block had been built in 2010 which included a GP assessment and day care areas and emergency surgery on the top floor. There had also been a major build for a radiotherapy centre. The CHUFT Board had also committed that the next major capital project would be investment in Accident and Emergency with plans due to be finalised during 2014/15. (viii) Transparency Dr Irvine stressed that transparency was part of the CHUFT culture with senior management required to be visible to staff, often using ‘walkarounds’, so that they could give and receive information and gauge what was happening at an operational level in the hospital. Staff surveys had shown that a high percentage of staff recommended CHUFT as a good employer. Under the Clinical Area Assessment Programme, monthly unannounced visits were made to clinical areas by staff from other areas of the hospital to give a ‘third party’ view of the standard of total care in that particular clinical area. (ix) Care Quality Commission The Trust had also recently participated in a ‘scheduled’ Care Quality Commission (CQC) inspection as part of their unannounced annual inspection programme. It was agreed that a copy of the CQC report, once published, would be forwarded to Members. (x) Conclusion The Cabinet Member emphasised that these were particularly challenging and emotive times for CHUFT, although there were many other indicators suggesting good performance, and that CHUFT senior management needed the support of the County Council at this time. The supportive roles of the HOSC (albeit as a critical friend) and the Health and Wellbeing Board, with input from Health Watch, would remain important whilst it was also essential that the patient remained the focus of attention.
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