To receive an update from the Trust on various issues.

The Committee received an update from the Hospitals Trust on various issues.

A report from the Hospitals Trust had been circulated separately.  This commented on infection prevention and control in particular Clostridium Difficile (C Diff) and MRSA; bed occupancy and access targets; communication with patients; and the link to the Patient and Public Involvement Forum.

Mr M Coupe, Director of Business Development, presented the report.  He added that there had been one additional case of MRSA since August 2007 but the patient had brought the infection into the hospital.

In the course of discussion the following principal points were made:

·         Reassurance was sought on the position on infection prevention following a report by the Health Protection Agency in the summer that had shown high levels of infection compared with other Trusts.  Mr Coupe replied that the Agency’s report had not taken into account that the statistics on Hereford Hospital had been flawed because the hospital provided a testing service for all the GPs in the County and those cases had been included in the Hospital’s figures.  He also referred to a press release issued by the Trust’s Chief Executive.  Incidences of infection were lower than in the previous year and the Trust was reassured by the current position.  He added that where infection did arise the whole health community needed to work together to control the infection.  For example, the Trust needed to consider how best it could support nursing homes and other like facilities.

·         He reported that one of two wards closed because of the Norovirus had been opened that day.

·         In response to a question about suggestions that staff were not changing uniforms after dealing with cases of infection Mr Coupe said that whilst he could not comment on specific cases the hospital did have a very rigorous infection control policy and systems in place and encouraged all issues to be raised with the management team. 

·         Asked about bed occupancy Mr Coupe acknowledged that there were times when insufficient beds were available.  He referred to a range of steps that could be considered, including shortening lengths of stay, increasing day case numbers and removing blockages in the system.  The Trust was reviewing the number of beds needed.  Amongst other things this would take account of national guidance on spaces between beds, designed to reduce the risk of spreading infection.

·         It was asked whether consideration had been given to screening patients for MRSA prior to discharging them, say, to Community Hospitals.  Mr Coupe said that with an average length of stay of 4 1/2 days the vast majority of patients who would manifest MRSA would have already had it when entering the hospital and the benefit of pre-discharge screening for MRSA was therefore questionable. 

·         It was asked how cleaning arrangements today compared with those in the past.  Mr Coupe that there was now a much greater science in monitoring cleanliness than there had been 25 years ago, with a national monitoring regime in place.  The Trust’s contract with its contractor was monitored.  There were systems in place which included a role for the Ward Sister in identifying any problems.  It had to be recognised that there would be instances where things did go wrong.  The key was to have systems in place that could address them.  Hospital environments were now safer on that ground.

·         Mr Coupe said that it had to be recognised that there would be outbreaks of infection from time to time.  The challenge was to do everything possible to avoid outbreaks and to be able to demonstrate that the Trust had done so.

·         In relation to communication with patients, the decision to seek advice on customer service principles from the Regional Customer Services Manager of John Lewis was commented on and the relevance to the hospital environment questioned.  Mr Coupe said that the Trust was not entering into a contract with the firm but drawing on its expertise.  Amongst other things the Trust expected to learn from the coherent approach to processing complaints and develop ways of changing staff attitudes and behaviours.  There were also comparisons to be drawn with John Lewis’s status as a co-operative and the Trust’s proposed move to Foundation Trust Status.

·         The establishment of a focus group of patients on Internal Communication was discussed. 

The Committee noted this update.