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Board of Directors Meeting

Meeting date: 12 December 2013 Enclosure J

Title: QUALITY AND PATIENT SAFETY COMMITTEE MINUTES

Purpose: To note the minutes of the meetings held on 4 & 11 November 2013

Summary: See attached

Recommendation: To note

Author: Mr Peter Wilson, Non-Executive Director & Chair of the Committee

Presented by Mr Peter Wilson, Non-Executive Director & Chair of the Committee

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Quality & Patient Safety Assurance Committee Minutes of the meeting held on 4 November 2013, at 2pm

Villa 10, Colchester General Hospital

PRESENT: Mr. Peter Wilson, Non-executive Director (Committee Chair) Professor Christine Temple, Non-executive Director Mr. Tom Fleetwood, Non-executive Director (items 1- 7, 9-14 & 16) Ms. Sue Barnett, Director of Operations/Deputy Chief Executive Mrs. Kathy French, Acting Director of Nursing (items 1- 7, 9-14 & 16) IN ATTENDANCE: Miss. Becci Hurst, Assistant Company Secretary (Scribe) Mr Barry Wheatcroft, Public Governor (Observer – items 1 – 16 only) Dr. T Elston, Director of Infection, Prevention & Control (item 5 only) Mrs Carrie Tyler, Falls Prevention Nurse (item 3 only) Mr Richard Needle, Chief Pharmacist (item 3l only) Dr Gillian Urwin, Divisional Clinical Director of CSS&C (for item 16 only) Ms. Anna Bjorkstrand, Associate Director of CSS&C (for item 16 only) Mr. Orlando Agrippa, Associate Director of Business Informatics (for item 7 only) 1. WELCOME & APOLOGIES FOR ABSENCE

Apologies for absence had been received from Dr Rudra, Gordon Coutts, Mel Brown and Sean MacDonnell.

Mr Wilson welcomed Mr Wheatcroft, public governor. It had been agreed that

selected Governors would now attend the assurance committees as observers to enable them to provide assurance to Council. Meeting papers would be provided to these governors in advance of future meetings.

The committee discussed minute taking support for the assurance committees and

that timely, comprehensive minutes were required in all cases. It was agreed that this would be discussed at the Board meeting on 14 November.

2. MINUTES OF THE MEETING HELD ON 1 OCTOBER 2013

The minutes were approved for signature.

3. MATTERS ARISING (a) Falls Screening Audit

Mr Wilson welcomed Carrie Tyler, Falls Prevention Nurse, to the meeting. Following discussion at its last meeting the committee had requested further information regarding the key themes identified from the Falls Screening Audit. Mrs Tyler provided the committee with further information relating to Falls Screening and analysis of Falls with Harm during 2012/13. At the start of the year discussions had taken place with the CCG that a CQUIN for Falls Prevention would be put in place however the suggestion was withdrawn. The Trust continued to measure its performance in this area and the NHS Safety Thermometer audit indicated that the Trust was consistently below the average score for falls with harm.

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The committee noted the sudden drop in Falls Screening in EAU in September and concluded that 1 in 4 patients were not being screened. Mrs Tyler, who worked across all wards in the Trust, explained some of the reasoning behind this and added that study days for the department had been cancelled in the past. The committee asked the Acting Director of Nursing strongly remind Matrons that falls screening must take place in line with Trust policy on all patients. The committee noted that falls across the economy were a problem and that the hospital had more admissions due to falls. Falls and injuries from falls had decreased within the hospital during the current year.

ACTION: ACTING DIRECTOR OF NURSING

(b) Patient Escort Policy Mrs French confirmed that the reviewed policy had been rolled out across the organisation. There had been one incident relating to a patient being escorted to X-ray without an escort – the responsible nurse had been suspended. EAU nursing rotas had been reviewed to provide enhanced cover during peak patient transfer periods.

(c) Improved Quality Targets

The committee had discussed the impact that the investment in nursing staff numbers should have on the quality targets. Mrs French explained that as the Trust moved towards making Band 7 nurses supervisory, it should see an improvement on the quality KPIs (i.e. Friends and Family, Merdian Tracker etc). Improvements should be seen from December/January and the use of bank and agency staff should also reduce once all the Spanish nurses were in post properly.

(d) Catheter Passport Bid

The Senior Infection Control nurse was discussing the bid with Finance to ensure it was accurate prior to submission to the CCG. It was unclear whether current funding had run out and whether or not the person was still in post. Mrs French agreed to confirm.

ACTION: ACTING DIRECTOR OF NURSING

(e) Outstanding SI Investigations Mrs French confirmed that the Risk Manager was following up the letter sent to all DCDs regarding outstanding SI investigations to ensure that they were aware of the high numbers of incidents that were overdue.

(f) Sepsis Care Bundle

Mrs French explained that following consideration it was felt that this would be a difficult measure to include as a Safety Cross. Not all patients needed to be put on the pathway so it would be hard to measure. It was agreed that a ratio scoring mechanism would be considered and that an update would be provided at the next meeting.

ACTION: ACTING DIRECTOR OF NURSING

(g) Coagulation and Haemorrhagic Disorder The committee requested a progress report on the audit undertaken.

ACTION: ASSISTANT COMPANY SECRETARY

(h) Format of Complaints Report The committee agreed that the Interim Complaints Manager be invited to attend the next meeting to discuss the required changes to the format of the report.

ACTION: ASSISTANT COMPANY SECRETARY

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(i) Porters Consultation The consultation had commenced 21 October for 30 days. New arrangements would improve patient experience and work/life balance for porters. The Bed Flow Policy and Contingency Ward Policy had been prepared in consultation with clinical staff and the Acting Director of Nursing. The policies outlined the responsible personnel for staffing the contingency ward, identifying patients for transfer to the ward, and for hospital Bed Flow. The contingency ward was currently open but the Isolation Ward closed. Ms Barnett had been working with DCDs to ensure that they understood their responsibilities and were addressing current and future bed shortages and patient flows in a timely manner. The move to 24/7 working needed be clinically led with the support of the corporate functions.

(j) Midwifery Retirement

Ms. Barnett had discussed this with the division and progress would be reported to POD as this was a Trust-wide workforce issue.

(k) EDS Portal

Ms Barnett had discussed with the project team. Updating the software in isolation of the clinical portal would take approximately 3 or 4 months and cost in the region of £150k. It would then need to be further amended when the clinical portal went live. Further discussions regarding the software would take place with the team later during the week.

ACTION: DIRECTOR OF OPERATIONS

(l) Medication Incidents Mr Wilson welcomed Dr Richard Needle, Chief Pharmacist to the meeting who had been invited to present his report that provided further detail on medication errors, particularly in relation to the 2 cases that related to delays in administration of antibiotics. The Trust was a high reporter of low and no harm incidents compared to other organisations - the Trust had embedded a culture of reporting incidents to create transparency and enable learning. However the committee was surprised to learn that there was no action plan in place to reduce the number incidents. Dr Needle explained that if analysis of incidents uncovered any trends these were investigated thoroughly. If trends related to the same member of staff making the same errors they would be disciplined and areas of competency would be addressed. The implementation of the pharmacy robot would address a small area of errors – those relating to the selection of drugs. The development of electronic prescribing (commencing in Chemotherapy in January 2014 following which procurement would commence for other areas) would also help to address errors. The robot cost in the region of £300k and would enable the Trust to reduce staffing levels by 5WTE. Dr Needle left the meeting.

4. NORTH EAST ESSEX MEDICINES MANAGEMENT COMMITTEE MINUTES the minutes of the September NEEMMC were noted by the committee.

5. TERMS OF REFERENCE

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The committee noted the amendment following discussion at the last meeting. RESOLVED: That the committee approved the terms of reference.

6. INFECTION CONTROL REPORT Dr Elston presented his report and the following points were noted:

There had been no MRSA Bacteraemia or CDiff cases attributable to the hospital during September;

The Trust’s performance for E coli Bacteraemia cases was average across the East of England. It was possible that the CQC would use this measure to assess hospitals for quality of care in the future;

Hand Hygiene compliance had been achieved all areas with the exception of Radiology. Far fewer observations were undertaken in this area however;

Following discussion at the last meeting, Antibiotic prescribing data for Breast Surgery had been sent to the team for explanation and action. An update would be provided to the committee

Similar data had been shared with the Obstetrics and Gynaecology Teams for explanation and action;

Some patients fell outside the prescribing guidelines due to clinical need but were given the most appropriate treatment. It was agreed that all such cases should be questioned;

SSI Surveillance continued and infection rates for large bowel had decreased and were now within the national average;

Cleaning standards were generally good across the organisation;

HICC membership review was outstanding but would be addressed RESOLVED: i. That the committee noted the content of the report.

ii. That the committee be advised of the action taken to address antibiotic prescribing levels within Breast Surgery.

ACTION: DIVISIONAL CLINICAL DIRECTOR/DIRECTOR OF INFECTION PREVENTION & CONTROL

iii. That the HICC membership be reviewed ACTION: DIRECTOR OF INFECTION PREVENTION & CONTROL

Dr. Elston left the meeting.

7. PERFORMANCE REPORT – MONTH 6 Mr Wilson welcomed Mr Agrippa to the meeting who had been invited to present the month 6 performance report. This reporting format would be used until the Quality Dashboard was in place. The following points were discussed:

Poor performance against the A&E 4 hour standard in September was noted. Ms Barnett explained that this had been due to a number of factors including 3 heavy days during the same week (2 of which were over the weekend) in the department, in-patients not being discharged to Clacton Hospital and long Length of stay patients within the hospital. The flow of patients in and out of the department required constant oversight and on this occasion, action had not been taken quick enough to maintain patient flow. Ms Barnett referenced the

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earlier discussion and emphasised the importance of staff understanding their roles and responsibilities. The committee noted that the longest wait had been in excess of 6 hours.

Readmissions within 30 days was a key area of focus for the Trust as part of the drive to improve patient outcomes. Levels had however slightly increased over the past 18 months;

The committee noted the level of late starts in theatres – Ms Barnett confirmed that this would be addressed via the new weekly performance meetings that were taking place with the divisions. Work was still underway on the Theatre Efficiency project.

The knife to skin to closure measure had decreased to 47.6% against an internal target of 65%;

New to follow-up ratio – there was now no financial cap for these cases in most specialties. The Trust had seen a positive shift in the ratio of first outpatient to follow up appointments from April 2012 to April 2013;

Stroke performance had deteriorated – Ms Barnett had discussed with the clinicians who had confirmed that the figures related to a small number of patients however the committee remained concerned about this performance. Ms Barnett agreed to discuss further with the clinical team.

The committee queried the progress of the quality dashboard – logistical sign off was required - Mr Agrippa agreed to discuss with the Associate Director of Service Improvement and Head of Business Informatics;

Ms Barnett circulated a report outlining RTT Backlog (long waits) which provided detail on the number of patients waiting for treatment in excess of 18 weeks, by specialty. The committee noted that admitted backlog had decreased from 311 in April 2011 to 135 in September 2013; Non-admitted levels (i.e. outpatients) had also decreased since April 2011 however levels had increased again from April 2013.

Admitted patients waiting longer than 26 weeks had decreased from 82 in May 2011 to 2 in June 2013. Numbers rose to 9 in July 2013 and since then have remained constant;

No patients had waited in excess of 52 weeks.

RESOLVED: i. That the committee noted the report.

ii. That Ms Barnett discuss deteriorating stroke performance with the clinical teams and report back to the committee.

ACTION: DIRECTOR OF OPERATIONS

iii. Progress with the quality dashboard would be reported at the next meeting. ACTION: ASSOCIATE DIRECTOR OF BUSINESS INFORMATICS

8. CANCER SERVICE STANDARDS & PERFORMANCE – MONTH 6 (due to time constraints the committee agreed that this item would be discussed at an extra meeting on 11 November 2013)

9. QUALITY REPORT (due to time constraints, the committee agreed to discuss this report at the meeting on 26 November 2013)

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10. PATIENT EXPERIENCE REPORT (due to time constraints, the committee agreed to discuss this report at the next scheduled meeting on 26 November 2013)

11. INCIDENTS REPORT (due to time constraints, the committee agreed to discuss this report at the next scheduled meeting on 26 November 2013)

12. INTEGRATED PALS, COMPLAINTS & LEGAL SERVICES (IPCLS) REPORT (due to time constraints, the committee agreed to discuss this report at the next scheduled meeting on 26 November 2013)

13. EXTERNAL AUDIT ACTION PLAN ON THE QUALITY REPORT (due to time constraints, the committee agreed to discuss this report at the next scheduled meeting on 26 November 2013)

14. KEOGH REVIEW ACTION PLAN (due to time constraints, the committee agreed to discuss this report at the next scheduled meeting on 26 November 2013)

15. DIVISIONAL REPORT – MEDICINE (due to the availability of the Divisional Clinical Director, this item would be discussed at an extra meeting on 11 November 2013)

16. DIVISIONAL REPORT – CLINICAL SUPPORT SERVICES & CANCER (CSS&C) Mr Wilson welcomed Dr Urwin and Ms Bjorkstrand to the meeting who had been invited to present the CSS&C divisional report.

The number of complaints received by the division was historically low however those received were often very complex in nature. The response rate in August was 87%. 3 complaints had been re-opened in September due to their complicated nature. The committee discussed the importance of accurate responses which addressed the complaints concerns. Mrs French agreed to speak to the Interim Complaints Manager to request advice regarding complaints management within the division.

NPSA compliance levels were noted and particular concern was raised regarding Radiology areas which were below the target levels. Dr Urwin confirmed that the CNS was addressing the issues within the Haematology Lounge and the Matron for Cancer Services was now also responsible for the Radiology areas and would address the issues therein;

There were no SIs recorded for September however those reported in the preceding months related to IG incidents. IG training levels were being addressed and Ms Bjorkstrand agreed to ensure that individual cases were dealt with appropriately;

The top incident type within the division was ‘inpatient falls’. There had been 15 in September – none of which had resulted in serious harm. All patients were assessed on admission and the Matron for the division was working with the Specialist Falls Nurse to identify further prevention methods;

The second most common incident type in the division was Radiation exposure. All cases were referred to the Trust’s Radiation Protection Advisor who assessed them and reported them to the CQC if certain criteria was met. The two cases related to 2 patients being inappropriately exposed to radiation. Patient

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identification process had since been tightened up. All incidents of this type were reported to the Executive Team.

The divisional quality dashboard highlighted non-compliance with the VTE Risk Assessment process. Dr Urwin explained that assessments were often not carried out on patients admitted to A&E then transferred to ECH. ECH wards expect the assessment to be undertaken as part of the emergency pathway but this was not always the case;

The X-ray and A&E departments had worked together to ensure the Escorted Patient Policy was adhered to. Radiographers now had a single point of contact in A&E to which they raised concerns. The policy had been audited and was working effectively. Escorts to Radiology from other areas out of hours however had been an issue. It was the referring department/ward’s responsibility to escort the patient if the risk assessment deemed it necessary but out of hours it was sometimes difficult to release a nurse from the ward/department;

100% compliance with the Hand Hygiene audit was noted;

The division had developed a LEAP following the CQC’s visit in August and progress with the actions as outlined in the report was noted;

The peer review process was being tightened up and the Clinical Leads were now responsible for addressing concerns. The committee asked for more detail regarding deadlines for completion of actions within the next report. Ms Barnett reminded the division of the extended deadline for sign off of the recent peer reviews and that these need to be signed off by the Medical Director and CEO;

The committee asked that future reports explain in greater detail how issues are being addressed so that it can assure the Board. It was agreed that the divisional template be circulated to committee members for comment.

The committee asked for further information on audit findings and actions taken to address the findings.

The committee reviewed the divisions’ risks as outlined in the report. Dr Urwin & Ms Bjorkstrand outlined their top areas of concern:

o The level/detail of information required and volume of work around the Cancer PTL

o The Radiology Department Operating Model, lack of interventional radiologists and junior level doctors coming through

o Lack of long term Strategy to enable the division to provide the right levels of service for the number of patients requiring treatment.

o On-going delays to the TPP project

o Implementation of 7/7 working

Ms Bjorkstrand agreed to consider these areas and report on progress at the next meeting;

The divisions priorities for the next few months were discussed:

o Support for staff during difficult times;

o Intensive Support Team commencement of work to streamline pathways

o Pharmacy move which was on track

o Cancer Ward business case – Ms Bjorkstrand and Mrs French would be discussing the staffing model. The impact of the potential to delay the move for 6 months needed to be considered by the division

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o Address challenge of AQP contracts in therapies

o Business planning process taking into account the discussions around risk above

o Maintain financial performance and deliver year-end surplus

The committee noted divisional performance via the scorecards

RESOLVED: i. That the committee noted the divisional report.

ii. That the Acting Director of Nursing asks the Interim Complaints Manager to support the divisional in improving its complaints management process.

ACTION: ACTING DIRECTOR OF NURSING

iii. That future reports provide more information on how issues and audit findings were being addressed to enable Board assurance.

ACTION: DCD & AD

iv. That the divisional reporting template be circulated to the committee for comment.

ACTION: ASSISTANT COMPANY SECRETARY

v. That the divisions’ areas of risk be considered and progress made in mitigating them provide to the committee at its next meeting with the division.

ACTION: DCD & AD

vi. That the Associate Director and Director of Nursing discuss the staff model of the Oncology Ward.

ACTION: AD & ACTING DIRECTOR OF NURSING

17. ANY OTHER BUSINESS The committee discussed the length of the agenda and the requirement for more time to enable all items to be discussed. It was noted that a significant amount of time had been spent at the last 3 meetings on Matters Arising. Ms Hurst agreed to provide an Action Checklist covering all actions which may help the committee receive updates in a more timely manner.

ACTION: ASSITANT COMPANY SECRETARY

The committee further agreed that its meetings should be extended in length and future meetings would commence earlier than 2pm. It was also agreed that a December meeting of the committee be scheduled.

18. DATE OF NEXT MEETING Extra meeting on 11th November 2013, 2pm, Top Floor, Villa 10 Tuesday 26th November 2013, 1pm, Trust Offices New Date - Friday 20th December 2013, 9am, Trust Offices

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Quality & Patient Safety Assurance Committee Minutes of the meeting held on 11 November 2013, at 2pm

Villa 10, Colchester General Hospital

PRESENT: Mr. Peter Wilson, Non-executive Director (Committee Chair) Professor Christine Temple, Non-executive Director Ms. Sue Barnett, Director of Operations/Deputy Chief Executive IN ATTENDANCE: Miss. Becci Hurst, Assistant Company Secretary (Scribe) Dr Charles Bodmer, Divisional Clinical Director of Medicine (item 1 only) 1. WELCOME & APOLOGIES FOR ABSENSE

Apologies for absence had been received from Tom Fleetwood, Kathy French & Sean MacDonnell.

The meeting had been convened it addition to the meeting held on 4 November to discussed two items of business.

2. DIVISIONAL REPORT – MEDICINE

Mr Wilson welcomed Dr Bodmer to the meeting who had been invited to present the Medicine divisional report. The following points were discussed:

There were three outlying areas within the quarter 2 Friends & Family results. Actions were being taken to address these areas by the division. Peldon Ward had developed a robust system which was being shared with the other wards.

The Meridian Tracker scores were discussed and the varying response rates between the wards noted. Ms Barnett asked that the issues of the broken trackers on Nayland and Layer Marney wards be escalated to the Acting Director of Nursing for action.

Professor Temple had taken part in the CAAP visit to Nayland Ward and had received the draft report which had not included an action plan. Dr Bodmer confirmed that there was an action plan in place and agreed to check progress against the actions. The issue of timeliness of medication that Professor Temple had raised during the visit had not been mentioned in the report. It was agreed that this should be bought to the attention of the Acting Director of Nursing.

Complaint response rates had been discussed at the Executive Team meeting and would be addressed via divisional governance meetings however there had been delays in the division receiving complaint response data. It was agreed that the Acting Director of Nursing would be asked to ensure that data was provided in a timely manner to enable meaningful discussion at divisional governance meetings.

The top five complaint issues for the division were discussed. Dr Bodmer explained that issues relating to staff attitude were addressed immediately and disciplinary action taken where appropriate.

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Mortality rates for the division were noted. Dr Bodmer explained that there were very few elective deaths within the division so one death could skew the figure. It was agreed that exceptions like this would be annotated in future reports.

The divisional quality dashboard highlighted the following outlying areas:

o Overdue incidents of which a large number related to inadequate specimen labelling. The division needed to address the root cause of incorrect labelling and how this could be address in the interim prior to the Order Comms system being implement.

o VTE assessments – the introduction of a post-take ward round checklist would address this.

o Fluid balance charts were now being completed properly since the provision of calculators to the ward staff.

The high level actions from the Keogh Action plan were being addressed by the division. Progress had been made with the patient escort policy and staffing levels on EAU at peak patient transfer times were being reviewed.

An external JAG visit would take place in December. A pre-assessment had taken place which had gone well. Dr Bodmer agreed to follow-up any outstanding actions required prior to the visit.

Ms Barnett had taken part in the recent CAAP visit to Tiptree Ward. Verbal feedback from the visit had been positive however the draft report had not yet been circulated. It had been difficult to assess levels of patient experience from many of the dementia patients and ideas on how this could be covered in future visits were being considered. There had been an issue with the patient alarm bells on the ward and it was agreed that this would be escalated to the Acting Director of Nursing for investigation.

Dr Bodmer remarked on the high standard of competency of the recently employed nurses from Spain who were settling in very well and providing excellent levels of care on the wards;

Mandatory training compliance was being addressed via the new core skills set of training. The divisions would be identifying additional training required for each role.

Reasons for the number of missed antibiotic doses were discussed and it was agreed that the data would be provided in a different format within the next divisional report;

The various clinical audits taking place within the division were discussed. It was suggested that future reports include findings from the audits and actions taken to address these. Areas for future audit were considered including reasons for delayed discharges and accuracy of anticipated discharge dates.

The committee discussed the priorities from the Quality Strategy which provided the key issues for focus by the divisions in the coming year and that reports should outline progress against these objectives

The committee acknowledged that the original reporting template circulated to the divisions may not be completely accurate for all the information that needed to be reported to the committee. It was agreed that the template should be amended to suit individual divisional reporting requirements but must provide the committee with a full understanding of what was going well, where there were problems or issues (and what was being done to address them) and what were the divisions future concerns and the mitigating actions being taken.

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RESOLVED i. That the issue of the broken meridian trackers be addressed.

ACTION: ACTING DIRECTOR OF NURSING

ii. That the Nayland CAAP report be reviewed and reference to issues of timeliness of medication included within the report.

ACTION: ACTING DIRECTOR OF NURSING

iii. That divisions receive timely data regarding complaints response rates. ACTION: ACTING DIRECTOR OF NURSING

iv. That the root cause of the incorrect labelling of specimens be investigated and action taken to address this.

ACTION: DIVISIONAL CLINICAL DIRECTORS

v. Future reports to include explanation of areas of exception and actions being taken to address these, key risks /concerns for the division, clinical audit findings/actions, key achievements and progress against the quality strategy priorities.

ACTION: DIVISIONAL CLINICAL DIRECTOR

vi. That the JAG pre-assessment be reviewed for outstanding action. ACTION: DIVISIONAL CLINICAL DIRECTOR

vii. That the issues with the Patient Alarm bell on Tiptree ward be investigated and resolved;

ACTION: ACTING DIRECTOR OF NURSING

3. CANCER SERVICE STANDARDS & PERFORMANCE – MONTH 6

Ms Barnett presented the report and highlighted the following issues to the committee:

The report provided performance against cancer standards using the same methodology as in previous reports. No changes had been made to the way in which the Trust reported performance against these targets. From mid-October there were no changes to patient pathways without the permission of a clinician.

The committee discussed key issues and actions for each tumour site as outlined within the report. Ms Barnett explained:

An external team had undertaken a review of the Trust’s Upper GI Cancer Pathway and confirmed that it was safe. Commencing on 15 November, a further external review of the pathways for all tumour sites would commence. The committee acknowledged that these reviews would include detailed conversations with the clinicians and it was possible that clinical time may be needed to undertake these thus impacting on performance.

The Trust had informed Monitor that it did not expect to be compliant with all cancer standards until quarter 4.

Additional resource had been bought in to manage the current cancer service and review the way in which the Trust provided cancer services. These two members of staff would commence this week.

A plan for the provision of anal cancer was required – there was not a designated surgical centre for this specialty. A joint MDT with Southend was being discussed;

The Trust was awaiting feedback from Basildon regarding access to EBUS for respiratory cases;

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Demand and cost analysis for 2nd day PET scan was outstanding. Ms Barnett agreed to follow this up.

Issues around accommodation for Trusts Dermatology service had been raised and the division would be presenting a case at the next Executive Team meeting.

Ms Barnett agreed to confirm whether or not the meeting on 25 October had resulted in any dental work being repatriated to CGH.

Radiology support had now been identified for Breast service;

Mrs Barnett explained the impact of recent events on staff confidence and how it was anticipated that this would affect other areas of Trust performance. Regulatory interest was being paid to A&E as the winter period approached. The Trust had experienced heavy patient numbers during the last two weeks and delays to patient discharges which had resulted in the opening of the contingency ward. Staff required support to build confidence which would in turn improve clinical quality standards. RESOLVED: i. That the committee noted the content of the report and the verbal update.

ii. That Ms Barnett follow up the analysis for a 2nd day PET scan on site and check whether dental work had been repatriated.

ACTION: DIRECTOR OF OPERATIONS

4. DATE OF NEXT MEETING Tuesday 26th November 2013, 1pm, Trust Offices New Date - Friday 20th December 2013, 9am, Trust Offices