Agenda and minutes

The Overview, Scrutiny and Localism Manager reported that Mr C G Findlay had replaced Mrs E M Tweed on the Committee.

RESOLVED that the Minutes of the meeting held on 17 October 2008 are correctly recorded and that they be signed by the Chairman.

A Picture of Health for Outer South East London

(1)               The Overview, Scrutiny and Localism Manager reported that since the last meeting of the Committee the Joint Committee of London Boroughs and the County Council had referred the reconfiguration proposals for a Picture of Health for Outer South East London to the Secretary of State for Health as had the London Borough of Bexley separately.

(2)               Notification had been received from the Secretary of State for Health that this matter had been referred to the Independent Reconfiguration Panel for consideration.

Accessing Healthcare – Transport

(3)               The Overview, Scrutiny and Localism Manager reported that a commitment had now been received from the two Primary Care Trusts in the administrative county of Kent, the acute Hospital Trusts, Social Services and transport planners to this piece of work.  A half day workshop to identify clearer service delivery objectives was being prepared for early February.

(4)               In the spring it was hoped that an initial action plan for taking this work forward would be reported to the Committee.

(1)               The Committee had before them a briefing note prepared by the Research Officer to the Health Overview and Scrutiny Committee which set out the key points for the Annual Health Check and the Committee’s interest in looking at three core standards in detail relating to the Hygiene Code which included:-

·        C4a – Infection Control;

·        C4c – Decontamination; and

·        C21 – Clean, well designed environment.

(2)               The Committee noted that assessment of the Core Standards forms part of the “Quality of Services” score in the Annual Health Check.  Any commentary from a Health Overview and Scrutiny Committee will form part of the evidence the Care Quality Commission (CQC) uses to cross reference the declarations made by each individual Health Trust.  In the early part of 2009 NHS Trusts will have to register with the CQC.  Registration is contingent on compliance with the Hygiene Code.  There will be a separate assessment of Primary Care Trusts as providers of services and commissioners for 2008/2009.  Between 15 April and 1 May 2009 Trusts will be asked to submit self declarations on how compliant they are against the Core Standards, including the three relating to the Hygiene Code.

(3)               These Core Standards were derived from the 2004 Department of Health publication “Standards for Better Health” which set down 24 core standards and described the minimum level of service all Health Trusts were meant to provide.  In October 2009 the CQC will publish the results of the Annual Health Check for 2008/2009.

Mr M Devlin, Chief Executive and Mrs I Smith, Director of Infection Prevention and Control were in attendance for this item.

(1)               Mr Devlin and Mrs Smith made it clear that they did not want to say much in the way of introduction but leave the majority of the time for questions from those Members present.  However, by way of introduction the Chief Executive indicated he had struggled with a low tolerance for infection control and in particular MRSA.  The Trust allowed for 12 cases of MRSA per year and that included community acquired infections detected at hospital.  However, the numbers of MRSA cases to date were 30% lower than the previous year.  The Trust had taken a much higher profile with regard to prevention in terms of hand hygiene and alcohol gels. 

(2)               A programme of deep cleaning had been undertaken and was a continuous, on-going programme. 

(3)               In answer to a question about the risks associated with infection control in an emergency or for elective surgery.  Colleagues from the Trust responded and talked about the processes that they had in place at the Dartford & Gravesham NHS Trust which included the pre-assessment clinics for elective surgery.  Since July 2007, screening had taken place for all routine admissions of all adults.  This had resulted in the reduction of post operative ward infections, e.g. levels of MRSA and had therefore been a successful strategy.

(4)               The Committee were informed by Trust colleagues that screening would be extended to include emergency screening in accordance with the Departmentof Health advice by 2011.

(5)               The Trust informed the Committee that by the end of March 2009 screening of all elective cases would begin.  Guidance was still being issued and work was also be undertaken to assess the amount of inpatient days patients stayed which gave a measure of success for the pre-assessment.

(6)               In answer to a question about the amount of time that it took to do the screening, Mrs Smith informed the Committee that with pre-assessments there was enough time to have the swab analysed.  This generally took 2 days.  However, there was provision, which was very expensive, to analyse a swab within 4 hours.  This was particularly important in higher risk areas such as the Intensive Care Unit (ICU).  The Trust continued to look at the use of new technology to assist in this process.

(7)               The Committee noted that within the document that the Trust had prepared in advance for the Health Overview and Scrutiny Committee one of the sections related to success and challenges.  The Trust had identified that the success of the IP Management pathway had been extended to urinary catheters as they were recognised as being a source of hospital acquired infection (HAI).

(8)               Mrs Smith responded that the IV lines Management pathway had been a great success.  She spoke about the importance of education and training, recognising new diseases and auditing what was going on.  She said that there had been one incident of canula  ...  view the full minutes text for item 4.

Sara Mumford, Director of Infection Prevention and Control, Flo Panel-Coates, Director of Nursing and Claire Roberts, Head of Quality and Governance were in attendance for this item.

(1)               Attached as an appendix to these Minutes is a copy of the presentation that the Trust had prepared but was not delivered to the Committee and a Healthcare Commission press release which was positive for the Maidstone & Tunbridge Wells NHS Trust.

(2)               All those Members who asked questions of colleagues from the Maidstone & Tunbridge Wells NHS Trust were very pleased to acknowledge the hard work of the Trust which had resulted in the Healthcare Commission press release and they hoped that this was reflected in the local community and by the local press.

(3)               In answer to a number of specific questions the Trust were invited to explain to the Committee the development of the C Difficile Integrated Care pathway.

(4)               In answer to a question about the screening processes within the Trust and the different processes in terms of those patients who present in an emergency situation at Accident & Emergency and elective care Ms Mumford answered in terms of the two organisms of major concern.  Turning first to MRSA Ms Mumford advised the Committee that patients that were attending the hospital for elective treatment were screened and pre-assessed.  For those patients presenting in an emergency setting not all of them were screened.  Then it was an issue of identifying those areas of greater risk, i.e. orthopaedics, surgery patients, those that require coronary care, intensive care, whether the patients were at risk of bringing in a community acquired infection, for example from a nursing home setting or whether they had any chronic wounds that made them of higher risk, such as ulcers.

(5)               Mrs Stockell said that the Trust must not become complacent.  She had certainly noticed people within the Hospital that were not using the alcohol gels or hand washing and she asked how working together there could be a campaign for the public on the importance of using the facilities provided in a hospital to avoid infection as well as working with schools to change the culture and educate young people.  Ms Mumford responded that it was important that the public were constantly reminded of the importance of using the facilities to avoid infection as a means of infection control within the hospitals.

(6)               The Trust had recently introduced new signage which was much more noticeable but she said they could not force the public to use the facilities available but they could be encouraged. 

(7)               Staff had spent time, sometimes up to an hour at a time, welcoming and greeting members of the public to advise them of the importance of using the gels or hand washing but it was not an optimum use of time to do this all the time. 

(8)               In answer to questions about staff walking from one ward to another and not using the facilities and the new culture that  ...  view the full minutes text for item 5.

Sarah Andrews, Director of Nursing and Infection Prevention & Control, Karen Benbow, Deputy Director of Provider Development and Assurance Carol Cassam, Head of Infection Control from Eastern & Coastal Kent PCT and Philip Greenhill, Chief Operating Officer, Sue Baldwin, Assistant Director of Adult Clinical Services and Joan Maudsley, Head of Infection Prevention from Eastern & Coastal Kent Community Services were in attendance for this item.

(1)               Ms Andrews introduced the team attending the meeting and explained that they represented the two arms of the Primary Care Trust as commissioners through the Eastern & Coastal Kent Primary Care Trust and as a provider through the Eastern & Coastal Kent Community Services.

(2)               Mr Greenhill informed the Committee that they, Eastern & Coastal Kent Community Services, were a separate organisation and employed some 3,500 people.  They were largely a home based service.  The Community Services organisation had their own management and governance arrangements. 

(3)               In answer to a Member question about screening Ms Andrews said that it was appropriate that screening took place in context.  As a commissioner it was about having clear standards in place and looking at all opportunities to increase screening.  She added that the Eastern & Coastal Kent PCT were on track for universal screening.

(4)               Ms Maudsley referred the Committee to a letter which set out new guidelines for screening.  She said that screening is not a control mechanism.  She added that there were no cases of MRSA in the community hospitals.  80% of MRSA is transferred into the community hospitals from the Acute Trusts and others come straight from the community.

(5)               In answer to a question about C Difficile the Committee were informed that within the Eastern & Coastal Kent PCT boundaries there were six community hospitals and there had been 18 cases of C Difficile in two years, seven last year and this year five cases.  Asked by a Member how many of those five patients were out of a total the Committee were informed that that information was not readily available at this meeting.  The Member was keen to explore the incidents of cases of infection within Eastern & Coastal Kent PCT area community hospitals with the community hospitals in other parts of the county. 

(6)               In answer to a series of questions about prevention and how the Trusts could be more proactive in training staff about good practice in terms of hygiene and hand washing Ms Andrews answered that there was very little extra funding available for this activity.  However, the Trust were working with the care home sector and recognised that education and training on the Hygiene Code were key.  Ms Andrews referred the Committee to the establishment of the Care Quality Commission as from 1 April 2009 which would have clear standards set out for providers.  She added that patient through-put through hospitals was quicker than it had been in the past and the length of stay briefer.   The challenge was to undertake the best of the modern world and some of the better aspects of the past.  ...  view the full minutes text for item 6.

Comments in the plenary session included:-

• The role of Public Health in running a campaign about the importance of hygiene in terms of infection control. 

• Promoting hand hygiene in schools.

• It was refreshing to hear how nurses were being trained, particularly by Eastern & Coastal Kent Primary Care Trust, and that ignorance was not an excuse. 

• The Committee recognised the importance of undertaking a root/cause analysis when outbreaks of infection occurred was reiterated. 

• It was unclear what Primary Care Trusts responsibilities were when an outbreak of infection occurred and when patients needed to be isolated as to what the policy was in standards across Kent.

• The need to understand the relationship between Adult Social Services and nursing homes in terms of infection control