Agenda item

The Committee scrutinised the Central London Community Healthcare NHS Trust’s Quality Account 2015-16 and wish to put on record the following comments:

·         The Committee were pleased to note that CLCH had appointed Angela Greatley OBE as their new Board Chair and that they were currently recruiting a new Chief Executive. 

·         The Committee congratulated the Trust on being ranked ‘Outstanding’ in the first annual ‘Learning from Mistakes’ league which was published in March 2016 and noted that the Trust is one of only eighteen providers in the country that has achieved this ranking in one of the latest quality initiatives launched by NHS Improvement.

·         The Committee noted that when scrutinising a previous Quality Account, they had requested a response to the patient stories.  The Committee were pleased to note that this had been done in this year’s Quality Account under the heading of “Learning from the Story”.

·         The Committee congratulated the Trust on their “good” rating from the CQC.

·         The Committee welcomed Quality Priority 1 – Positive Patient Experience, Preventing Harm – Developing a Quality Alert Process for Stakeholders.  The Committee were pleased to note that the Trust would develop a mechanism by which clinicians in other organisations will be able to quickly alert CLCH to issues within their service.  The Committee noted that a secure e-mail system would be established to assist with this.  

However:

·         The Committee had expressed their concerns about pressure ulcers to the Trust during the consideration of last year’s Quality Account.  The Committee noted that CLCH was a large Trust, with patients being treated across many areas, both at home and on wards.  The Committee welcomed the new initiative on pressure ulcers which would involve input from nurses and healthcare providers. 

·         The Committee also expressed concern that there were several areas in which CLCH was failing to hit its KPIs in relation to pressure ulcers and that that there was a lack of a specific section on pressure ulcers within the Quality Account.  The Committee noted that the issue of pressure ulcers was an area of concern for the Trust and welcomed the re-launch of another pressure ulcer working group and making pressure ulcers part of staff appraisals.

·         The Committee commented that Graph 17, which showed the proportion of patients who did not have pressure ulcers could be clearer and that it did not match the Key Performance Indicator.

·         The Committee noted that there had been complaints about staff communication which the Trust felt could be down to waiting times at Walk in Centres. 

·         The Committee noted that in October and November 2015, the number of complaints the Trust received had spiked.  The Committee noted that the Trust believed this was down to the onset of the winter season and requested to be provided with further information on this. 

·         The Committee expressed concern at the staff survey results showing the percentage of staff experiencing harassment, bullying or abuse from staff in the last 12 months.  The Committee noted that the score for 2015 was 24%, down from 28% in 2014.  Whilst the Committee appreciate that this is an improvement of 4% within one year, the Committee noted that this figure is above the national average for community Trusts which is 21%. 

·         The Committee noted that in relation to “End of Life Care”, CLCH had received “requires improvement” markers in the respect of the care being: Safe, Effective, Well Led, and Overall.  The Committee welcomed however, that the overall rating  was “Good”.  The Committee were pleased to note the recent recruitment to an End of Life care post

·         The Committee noted that a percentage for the number of complaints upheld was not included in the Quality Account and suggested that it would be a useful statistic. 

·         The Committee commented that not many members of the public would know what the term “cold chain incidents” meant and suggested that an explanation be included in the final version of the Account. 

·         The Committee expressed their concern that there were 58 incidents reported (5.0%) resulting in severe harm, which was higher than the cluster rate of 0.7%. The Committee were very concerned to note that there was one incident which resulted in the death of a patient whilst in the Trust’s care.

·         The Committee requested that the Trust define the acronyms “MUST” and “AGULP” within the Account because they would not be clear for members of the public who might be reading the document. 

·         The Committee noted the achievements of the Trust against the Commissioning for Quality and Innovation (CQUIN) payment framework goals for 2015/16, and expressed concern at the forecast drop in income for dementia, value based commissioning and children’s safe transition into adult services.  The Committee noted that the figures within the draft Quality Account were not the final figures.    

The Committee scrutinised the Royal Free London NHS Foundation Trust Quality Account 2015-16 and wish to put on record the following comments:

·         The Committee welcomed the new £2 million endoscopy unit which opened in December 2015 at Chase Farm Hospital.

·         The Committee were pleased to note that in December 2015, the Dementia Implementation Group launched a new 12 month strategy for dementia care.  The Committee noted that it comprised three work streams each focussed on one of the main stakeholders in world class dementia care: the patients and their carers, the staff and the organisation.

·         The Committee welcomed the following continuing actions being taken in relation to making the Trust more dementia friendly: introducing Dementia boxes; introducing tiptree tables, involvement in “John’s Campaign”, providing parking discounts, the “Forget-me-not” scheme being built into electronic records, and welcoming carers 24/7.

·         The Committee were pleased to note that Dementia awareness is now part of the routine induction for all staff with over 850 staff having been trained. 

·         The Committee were pleased to note that the Trust would be looking into increasing the ability of Dementia advocates or “anchors” to care. 

·         The Committee were pleased to note that the Trust’s goal is to reduce severe sepsis-related serious incidents by 50% across all sites (A&E and Maternity) by 31 March 2018 and welcomed the delivery of the following milestones: Staff training in sepsis recognition in Maternity and Barnet ED;  Testing of improvement tools: sepsis trolley, sepsis safety cross, sepsis grab bag, sepsis checklist sticker; Introduction of sepsis improvement tools: Severe sepsis 6 protocol; Monitoring of data and PDSA cycle improvements; Review of improvement to attain 95% compliance

·         The Committee welcomed the work that the Trust was doing to recruit more A&E Consultants and staff.

However:

·         The Committee noted that the winter had seen unprecedented pressure on accident and emergency departments and urgent care pathways and acknowledged that the 4 hours A&E target was challenging. 

·         The Committee expressed concern that the Trust has reported 10 “Never Events” during 2015/16, 8 of which related to surgery. The Committee noted the Trust’s new goal to improve compliance with the “5 steps to safer surgery” to 95% and to reduce the number of surgical never events by 31 March 2018.  The Committee were informed that when a “never” event has taken place, often, junior Members of staff have felt something was wrong but felt unable to speak up.  The Committee requested the Trust to put measures in place to encourage staff to feel able to voice concerns.

·         The Committee noted that regarding falls the Royal Free acknowledged that they were “worse than the average, so there is room for improvement” 

·         The Committee were concerned to note that the rate per 100,000 bed days of cases of C.diff infection that have occurred within the Trust amongst patients aged 2 or over had increased from 17.5 in 2014/15 to 20.4 in 2015/16. 

·         The Committee noted that the Trust would look to improve their performance in relation to Delayed Transfers of Care and welcomed closer working with colleagues in care homes and in the community.

·         The Committee were concerned about the lack of data in relation to re-admissions to the Trust within 28 days of discharge. 

·         The Committee were alarmed that the issue of staff/colleagues reporting being bullied, harassed or abused was raised in the Quality Account again this year.  The Committee wished to put on record their concern that 34% of colleagues had reported recent experience of harassment, bullying or abuse.  The Committee noted the five suggestions to improve the staff experience: a strong campaign on bullying and harassment; working closely with leadership teams in the units with worst outcomes from the staff survey; setting clear expectations of managers in relation to appraisal, staff engagement and team communication activity; rapid improvement of the intranet with clear and easy ways to find policy, procedures and forms; delivering leadership training to support managers. 

·         The Committee wished to put on record their concern regarding the insufficient amount of patient parking at Barnet Hospital and disappointment that a quarter of the visitor/patient parking had been changed to staff parking.

·         The Committee wished to put on record their shock at statistics provided by the Trust which show that a deficit of approximately £2 million as a result of unpaid invoices from overseas visitors not entitled to free NHS services. The point was made that the Committee were referring to invoices that the Trust had issued and did not take into account people accessing the hospital who had not been invoiced therefore the £2 million deficit could be much greater. 

The Committee scrutinised the Draft Quality Account from the North London Hospice for the year 2015-16 and wish to put on record the following comments:

·         The Committee welcomed the fact that the North London Hospice would be trying to reduce the length of their Quality Account which would make the document more public friendly.

·         The Committee welcomed the “easy read” literature produced by the Hospice and noted the pertinence of having “easy read” literature for people with learning disabilities.  The Committee were pleased to note that a number of staff employed at the Hospice had previously worked with people with learning disabilities and were able to bring those skills into providing palliative care.  The Committee were also pleased to note that people with learning disabilities are invited to visit the Hospice before they stay in order to make them more comfortable with the environment. 

·         The Committee welcomed the significant reduction in closed bed days from 116 in 2013-14 to 30 in 2015-16.

·         The Committee welcomed the use of “Hello, my name is…” badges.

·         The Committee welcomed the actions taken to improve the personal safety of patients, which included the access code number being changed more frequently, printing of paper being undertaken in secure areas, and confidential waste being stored in secure bins before collection for destruction.

·         The Committee welcomed the “Come and Connect” scheme which was available for registered patients as well as those who had been discharged from Outpatients and Therapy, which provides a means of meeting socially which can be compromised by illness. 

·         The Committee were pleased to note that Key Performance Indicator 1, “Did you feel / the patient was referred to the hospice at the right time” would be changed to “Do you feel staff treat you with compassion; understanding; courtesy; respect; dignity?”

·         The Committee noted that there had been an increase in “minor” category clinical incidents from 68 in 2014-15 to 153 in 2015-16.  However the Committee acknowledged that the Hospice had introduced a new risk management database and that this increase could likely be down to an increase in reporting.   

·         The Committee were pleased to note that patients did not contract any of the following infections whilst in the care of the North London Hospice Inpatient Unit: C.Diff, Pseudomonas, Salmonella, ESBL or Klebsiella pneumonia; MRSA. 

·         The Committee welcomed the fact that “Oyster” training to volunteers to help develop emotional competence and resilience was taking place and would be continuing. 

·         The Committee welcomed the inclusion of user feedback and noted that the feedback was very moving. 

However:

·         Whilst the Committee applauded the efforts of staff working at the Hospice, the Committee expressed concern about staff working with patients being required to “tick boxes” and suggested that project outcomes were clearly defined.

·         The Committee noted that the Hospice was continuing offer free “Sage and Thyme” training but thought it would be helpful to define the term more clearly so that members of the public reading the document would understand.

·         The Committee expressed concern at the fact that the Handwashing Audit at the Winchmore Hill Site had seen a significant decrease in compliance since the first audit. The Committee expressed their disappointment in noting that 2015-16 compliance was 61% compared with 77% for the first audit.  The Committee noted that the developments at Winchmore Hill had also seen an increase in the number of staff and volunteers within the service and that despite the completion of induction training, the theory of infection control and hand hygiene is not being put into practice as much as it should be.  The Committee welcomed the fact that further training has been, and will continue to be provided for staff and volunteers. The Committee were pleased to note that the audit will be completed again in 6 months to continue to monitor compliance and requested to be provided with the results.

·         The Committee noted that 14 of the 15 patients who developed Grade 3 or 4 pressure sores were admitted with pressure sores which progressed under North London Hospice care but acknowledged that the Hospice client group is prone to increased incidence and vulnerability to pressure ulcers. 

·         The Committee expressed surprise and concern that GPs and clinicians were unaware of the extent of the Hospice’s services and the support available for those with a Long Term Condition and sought assurance that the Hospice was developing a marketing plan to get the message out. 

 RESOLVED that:

1.    The Committee requests that the above comments be included in the final version of the respective Trust’s Quality Accounts.

2.    The Committee requests to be provided with the results of the next handwashing audit at the Winchmore Hill site from the North London Hospice.

3.    The Committee requests to be provided with the percentage of patients at the Hospice who had Alzheimer’s or Dementia from the North London Hospice. 

4.    The Committee requests to be provided with information on the “Gold Standard” for Hospice care.