Agenda and minutes

The Overview and Scrutiny Manager informed the Committee that Lord Bruce-Lockhart was continuing to make good progress following his recent operation and hoped to be back chairing the Committee soon.

RESOLVED:- that a further letter be sent to Lord Bruce-Lockhart on behalf of the Committee expressing their best wishes for a speedy recovery.

The Vice-Chairman sought and gained the approval of the Committee to discuss the agenda and papers for the meeting as urgent business. This was because the requisite statutory notice had not been given for the meeting, as a result of the short notice in trying to assemble a great deal of written evidence following the Committee’s last meeting on 12 October 2007.

RESOLVED that:- the Minutes of the meeting held on 12 October 2007 were correctly recorded and that they be signed by the Vice-Chairman, subject to the deletion of Mrs E M Tweed from those shown as present.

            (Mr A D Crowther declared an interest as a member of Medway NHS Trust)

(1)       The substantive item of business before the Committee was as indicated at the last meeting (Minute 54 of 2007 refers). The Vice-Chairman stated that the Committee would be asking a series of questions of a range of people today, and at the next meeting of the Committee, following the recent Healthcare Commission report relating to the investigation into the outbreaks of Clostridium difficile within Maidstone & Tunbridge Wells NHS Trust. The recent ratings awarded by the Healthcare Commission to each Health organisation against a set of 24 Core Standards were also relevant.

(2)       The Vice-Chairman reminded the Committee, those watching the webcast and those present at the meeting that the purpose of the meeting was to look at lessons to be learned from the publication of these two reports. He hoped that the question-and-answer process would help in restoring public confidence in the safety of the public using the services of the acute hospitals across Kent and Medway. 

(3)       Since the last meeting a number of Members of the Committee had visited the three hospitals within the Maidstone & Tunbridge Wells NHS Trust – namely the Kent and Sussex Hospital, Tunbridge Wells; Pembury Hospital; and Maidstone Hospital – to see at first hand those wards and areas which were mentioned in the report.

(4)       The Vice-Chairman invited the Overview and Scrutiny Manager to hold up for those present a file containing written evidence that had been sought from a range of stakeholders across the Kent and Medway Health economy which had not been published as part of the papers for the meeting.

(5)       Finally the Vice-Chairman informed the representatives of the Patient and Public Involvement Fora, parish councils and members of the public present that, if time permitted, after all Members of the Committee had asked their questions he would invite questions from anyone else present.

(6)       In addition to the agenda and papers, Members had received a series of briefing materials from the Committee’s Research Officer which included:-

(a)       a chronology of events;

(b)       a briefing note on the NHS Scrutiny, Patient and Public Involvement, and Complaints mechanisms;

(c)        a briefing note on NHS targets on healthcare associated infections (HAI);

(d)       a briefing note on statistical data on Clostridium difficile in the NHS;

(e)       statistics relating to the number of death certificates mentioning Methicillin Resistant Staphylococcus Aureus (MRSA) in England as well as the annual counts of glycopeptide-resistant enterococcal (GRE) bacteraemia (bloodstream infection) for NHS acute trusts in Kent and Medway;

(f)         a briefing note on the NHS star rating system for 2000 to 2005;

(g)       a briefing note on the Healthcare Commission Annual Health Check ratings;

(h)        statistical information on the performance of NHS trusts in Kent and Medway on Core Standards relating to Infection Control;

(i)         a briefing note on Patient Environment Action Team (PEAT) cleanliness scores; and

(j)         the auditors’ local evaluation scores for NHS trusts in Kent and Medway for 2006/2007.

(7)       Additional evidence was tabled at the meeting, received from the Healthcare Commission, the Chief Executive of the South East Coast Strategic Health Authority, West Kent Primary Care Trust, Eastern & Coastal Kent Primary Care Trust, and the Health Protection Agency.  During the meeting a facsimile letter was received from Roger Gale, MP which was summarised for the Committee by the Overview and Scrutiny Manager.

Meradin Peachey Director of Public Health for Kent will give evidence to the Committee.

(Item 4)

(In attendance for this item were Dr Mathi Chandrakumar, Director of the Kent Health Protection Unit; Meradin Peachey, Director of Public Health; Mark Devlin Chief Executive and Iris Smith, Director of Infection Control, Dartford & Gravesham NHS Trust; Glenn Douglas, Interim Chief Executive, Amy Page, Chief Nurse and Gail Locock, Lead Nurse for Infection Control, Maidstone & Tunbridge Wells NHS Trust; Matthew Kershaw, Chief Operating Officer, Julie Pearce, Director of Nursing and Sue Roberts, Deputy Director of Infection Prevention and Control, East Kent Hospitals Trust and Jacqueline McKenna, Director of Nursing and Strategic Planning and Linda Dempster, Head of Infection Control, Medway NHS Trust)

The Committee asked both Meradin Peachey and Dr Chandrakumar a range of questions and supplementary questions, as set out in Appendix 1 to these Minutes.

(1)       Each Trust had been invited in advance of the meeting to provide written evidence in the form of answers to a series of questions.  The responses of each Trust were published in the Committee’s papers.  The questions were:-

(a)       A request to see the management structure for Infection Control within the Trust;

(b)       What was the process within the Trust for dealing with MRSA and Clostridium difficile?;

(c)        What was the management structure for the nursing profession within the Trust?;

(d)       What was the process for training nurses in the importance of Infection Control within the Trust?;

(e)       How were the patients and visiting public kept informed of the importance of Infection Control?; and

(f)         Was the cleaning in the hospital(s) undertaken by an in-house contractor or an external contractor and what were the standards of cleanliness required?

(2)       In addition to the written evidence the Committee then raised a series of questions with each individual Trust’s representatives, as set out in Appendix 2 of these Minutes.

The opportunity to contribute to the Healthcare Commission Annual Health Check on Infection Control

Sheona Browne, Area Manager for Kent of the Healthcare Commission will be in attendance for this item.

(Sheona Browne, Healthcare Commission Area Team Leader for Kent, Medway and East Sussex and Sandra Tracey, Assessor, Healthcare Commission were in attendance for this item)

(1)       The Committee had before it a presentation regarding third-party commentaries on Trusts’ self declarations in respect of Healthcare Commission Core Standards – and the way that Overview and Scrutiny Committees, Patient and Public Involvement Forums, Foundation Trust Boards of Governors and Strategic Health Authorities could contribute to the Annual Health Check by this means.

(2)       Also before the Committee were details relating to the weighting of the information which the Healthcare Commission received from third party commentaries, as well as some examples of intelligence that had been extracted from 2006/2007 commentaries and “top tips” for those submitting commentaries, derived from previous Annual Health Checks.

(3)       The Committee noted that the most useful commentaries:-

a)         were written in a clear and concise way;

b)         contained information relevant to the current Annual Health Check;

c)         clearly related to one or more Core Standard;

d)         stated whether the third party thought that the Trust was compliant with the relevant Standard;

e)         contained supporting evidence from a range of sources;

f)          included detailed information, for example dates and outcomes;

g)         clearly demonstrated how the third party had been involved;

h)         used full names and avoided the use of acronyms; and

i)          focused on commenting on the Standards rather than the criticism of the content of Standards and the system of assessment.

(4)       The Committee were also informed that it helped if third parties contributing to the dialogue:-

a)         had regular interaction with the Trust;

b)         had access to Trust reports that highlighted patient concerns, e.g. patient survey reports, Patient Advisory Liaison Services reports, complaints reports, etc.;

c)         had attended Board and other Trust meetings where these issues were discussed;

d)         were familiar with current legislation and Trust policies on relevant issues, such as safety and equality;

e)         carried out their own surveys and reviews;

f)          witnessed at first hand where the policies and initiatives were being implemented;

g)         had been involved in the development of new initiatives; and

h)         felt able to challenge Trusts and influence change.

(5)       The Committee then proceeded to ask a range of questions of the Healthcare Commission representatives, as set out in Appendix 3 of these Minutes.

Conclusions and outcomes from evidence

(1)       The Committee concluded the session by agreeing that it would need to meet again to discuss this topic further on 27 November 2007.

(2)       The Overview and Scrutiny Manager reminded the Committee of some of the issues which had arisen during the day.  These items were only indicative of some of the discussion and were by no means exhaustive. The Committee would return to the conclusions and recommendations arising from thorough examinations of Infection Control across Kent and Medway following the next meeting, on 27 November. 

(3)       Some of the issues raised included:-

a)         the Director of Public Health’s statement that part of her  ...  view the full minutes text for item 64.