To note the Wye Valley NHS Trust Quality Accounts for 2013/14.

The Committee received a report on the Wye Valley NHS Trust Quality Accounts for 2013/14 from Ms Michelle Clark, Director of Nursing and Quality and Mr Peter Wilson, Medical Director.

During the presentation, the following issues were raised:

·         That the priority for 2012-13 had included the intention to eliminate all avoidable pressure ulcers.  These had been substantially reduced by instigating new and accurate documentation systems, ensuring that patients were moved onto appropriate equipment in a timely manner, and increasing the training that the skilled and unskilled workforce within the Trust received.

·         Health and Safety issues that had been addressed.  This included the improved management of C Difficile and MRSA infection.

·         Complaints procedures had been improved, and there was a target of 25 days to deal with any complaints that were received.

In reply to a question, the Director of Nursing and Quality said that there had been no change in terms of the cleaning regime at the hospital, but ward closures had resulted from the admission of patients with norovirus infections.  Staff needed to be vigilant in order to spot the symptoms in order to prevent outbreaks.  Fogging was being used as a new cleaning system to neutralise norovirus outbreaks.

She went on to say that the documentation that had been used by the hospital had been too complex, and all documentation was being reviewed.  This had worked in one ward, where the amount of time spent on paperwork had been halved.

In reply to a further question, she went on to say that lean systems thinking was being rolled out throughout the hospital, and was very much part of the Trust’s ethos. 

It was noted that there was enormous pressure on Accident and Emergency units in the West Midlands, and the numbers of patients coming to A&E was growing.  The Trust was working with the Herefordshire Clinical Commissioning Group to review out of hours care and to triage patients away from A&E if they did not actually need to be there.  A report back on the progress of this initiative would be provided to the Committee in the future.

In reply to a question concerning the opening times of Minor Injury Units (MIU), the Medical Director said that whilst the MIUs had caused concern, monitoring over the last 6 months had seen no change in numbers treated by the Units.

In reply to a question concerning pressure sores, the Director of Nursing and Quality said that the cost to the Trust of a single Grade 4 pressure ulcer was £14k, and whilst these arose for a multitude of reasons, there was a need to educate the social care workforce in how to look after those under their care.  There was an aging population in the County and a greater risk of pressure ulcers occurring as a result.

In the ensuing discussion the following points were made:

·         That it was difficult to analyse exactly how many A&E attendances were inappropriate, but that the figure was probably around 15-20%.

·         That the service offered by a Community Matron was an enhanced version of that offered by District Nurses.

·         That the temporary increase in complaints in February 2013 matched the increase pressure on A&E as a result of cold weather.  A new complaints process had been brought in on the 1 May which was designed to reduce the time taken to reply to complaints.

·         That work was underway to ensure that all patients who were triaged to the out of hour’s service would be accepted to see a GP.  There was a necessity to ensure that Primecare understood their obligations under the out of hour’s contract.

·         That a system of care pathways was in place in order to ensure that there was a suitable environment for a patient to be discharged into.

The Chairman thanked the Director of Nursing and Quality for her report.