Agenda item

·       Appendix 1 - Royal Free Hospital (RFH) Quality Account 2019/20

·       Appendix 2 - Central London Community Healthcare (CLCH) Quality Account 2019/20

·       Appendix 3 - Minute Extract (RFH and CLCH Quality Accounts Item) HOSC May 2019

·       Appendix 4 - Mid-year Quality Accounts 2019/20, RFH

·       Appendix 5 – Mid-year Quality Accounts 2019/20, CLCH

 

Royal Free London NHS Foundation Trust Quality Account 2019-20

The Chairman invited to the meeting:

 

·       Dr Streather – Group Chief Medical Officer, Royal Free London NHS Foundation Trust

 

The Committee scrutinised the Draft Royal Free London NHS Foundation Trust Quality Account 2019/20 and wished to put on record the following comments:

 

• The Committee was pleased to see positive outcomes and a lower mortality rate in Chronic Obstructive Pulmonary Disease in the Royal Free Hospital.
• The Committee commended the Trust on its specialist training courses on understanding the needs of patients with dementia and learning difficulties who have no mental capacity. The CQC has found improvements in urgent and emergency care for these patients across all three hospital sites. Understanding the needs of someone with no mental capacity, for example advanced dementia, is very difficult and challenging. Whilst it is pleasing that the Trust has Dementia-friendly Wards, it is important to ensure that staff are fully trained to understand how to care for patients with advanced dementia regardless of which Ward the patients are in, especially as it can also be difficult with staff changing shifts.
• The Committee was impressed that the Trust held an interactive workshop with the Chickenshed Theatre Company and over 100 members of staff had completed an innovative Study Day.
• The Committee was pleased to see the use of tele dermatology and high quality photographic work at the Trust, reducing the need to travel to larger hospitals and helping with capacity.
• The Committee congratulated the Liver Transplant Team at the Royal Free Hospital, which has one OrganOx machine, for their quick-thinking decision to ‘borrow’ a second machine from the University Hospitals Birmingham NHS Foundation Trust so that they could keep two livers ‘alive’ while performing two liver transplants in quick succession.
• The Committee thanked the Trust for the reduction in gaps in the data and the improved accessibility of the report. There are helpful explanations of the charts and the ‘lollipop’ chart presentation is much more accessible for people who are not used to viewing detailed data, making benchmarking much easier than in previous reports. 
• The Committee noted the stabilisation in the C.Diff infection rate although there is some variability since April 2019. However, this is lower than benchmarked organisations. The Committee also noted the explanation that more C.Diff was being detected due to robust measures taken and a more sensitive test being used. The new ways of working in general are clearly demonstrated in this report and the Committee hoped the Trust will continue to develop the report in this way in future. It is helpful to understand the depth beneath some of the stories.

 

• The Committee congratulated the Patient and Risk and Resuscitation Team for winning a National Patient Safety Award for developing and pioneering a kidney care ‘Streams’ app in conjunction with Google Health.

 

• It was noted that ‘Joy in Work’ was launched in June 2019. This showed positive

outcomes from 4 out of 15 teams showing a 50% increase in the ‘good day’ measure. The link between staff satisfaction is directly linked to staff retention, less sickness/absence and improved patient experience.

 

• The Committee applauded the aim to have zero ‘never events’, zero trust-attributed MRSA cases and to remain below the mandated threshold for C.Diff as three of the priorities for improvement in 2020/21, as the Trust acknowledged that there is a continuing problem in this area.

 

• Members were pleased that the number of patients’ valid NHS Numbers recorded in A&E were up from 95.7% in 2018/19 to 97.1% in 2019/20.
• The Committee noted that between Oct 2018 and Sept 2019, the risk of mortality was lower than expected for the case mix of the Royal Free and they were ranked 8^th out of 129 non- specialist acute Trusts.

However:

• Concern was expressed that the Trust failed to achieve their aim of zero ‘Never Events’ by the end of March 2020 but unfortunately had had six.

 

• The Committee noted that the report mentions a Review into the importance of quality date but there is no indication as to how that Review is progressing or a completion date.

 

• The Committee noted that the number of Reviews of ‘Learning from Deaths’ was down considerably from the previous year.

 

• The Committee was disappointed to note that SMART targets were discussed last year but these still haven’t been taken up in relation to quality of data. The quality of data is most important, particularly in relation to research projects, and it is frustrating that this still hasn’t been included despite it being requested. The Committee would like to know when Electronic Patient Records (EPR) would be available throughout the Trust as many patients are transferred between hospitals.
• With regard to Chronic Obstructive Pulmonary Disease, it was noted that the length of stay and re-admissions are higher than national figures.
• The Committee noted the reduction in the use of Agency staff and the continuing use of Bank staff whilst recognising that permanent recruitment is an ongoing national issue.  
• The Committee requested that data be presented in a way that is easier to digest for the lay person. The Performance Indicator data was found to be illuminating and the graphics interesting but clarity was required relating to whether ‘high’ or ‘low’ was a positive indicator or not. The direction of historical trends needs to be clear and exactly what the target is for. 
• The Committee enquired why so many clinical pathways had been designed and yet still awaited digitisation.
• The Committee requested reassurance regarding infection control, especially given the current pandemic, but noted that all staff are adhering to the Trust’s Infection Control policies.
• The Committee was disappointed to see there were 54 cases of C Diff in 2018/19 when the National average is 12 and that there are 87 (57 + Quarter 4) cases this year, which is an increase again on the previous year.

 

• The national waiting time standard required Trusts to treat, admit or discharge 95% of patients within four hours. The Committee was disappointed that the Trust had substantially missed this target by only achieving an average of 83.2%, which was also worse than the 87.4% achieved the previous year.
• The Committee requested that all acronyms must be in the glossary and should be written in full the first time they are used in the report. The Quality Account is still not always written in easily accessible language.
• The Committee was disappointed that in 2019 the ‘Friends and Family Test’, as to whether staff would recommend the Trust as a provider of care for their family or friends, was down from 73% to 71% which continued the downward trend of the past three years.
• National targets require 93% of GP cancer referrals to be seen within two weeks. The Committee was disappointed that the Trust only achieved 90.9% of its targets for all cancers and 89% for breast cancer. The Trust also did not meet the first definitive treatment within 62 days of an urgent GP referral, achieving only 80.7%.
• It was noted that the CQC had some criticism of written policies relating to care for patients with dementia which were not easy for staff to access.
• The Committee expressed great concern that out of the 11 ‘Must Do’ Actions, which were part of the 93 recommendations in the CQC Report, only six had been done with five due to be achieved by mid 2020-2021 and that out of the remaining 82 recommendations, which were ‘Should Do’ Actions, only 44 had been done leaving 38 which the Trust anticipated would only be completed in full by the 3^rd quarter of 2021.

 

The chairman thanked Dr Streather for joining the meeting.

 

RESOLVED that the Committee would forward their comments for inclusion in the final Quality Account by 13 May.

 

Central London Community Healthcare NHS Trust Quality Account 2019-20

 

The Chairman invited to the meeting:

 

·       Kate Wilkins – Assistant Lead for Quality, Central London Community Healthcare (CLCH) NHS Trust

 

Ms Wilkins reported that the CQC would be publishing their report for 2019/20 in the next few weeks so it would be too late to be included in the Quality Account. The CQC report had been delayed due to Covid-19. She would share the CQC Report with the Committee when she received it. 

 

The Committee scrutinised the Draft Central London Community Healthcare NHS Trust Quality Account 2019-20 and wish to put on record the following comments:

 

·       The Committee thanked CLCH for producing an interesting, clearly laid out report   which was easy to read.

 

·       The Committee praised the ‘Freedom to Speak Up’ initiative and was impressed with the number of new contacts that had been received and hoped that this had shown positive outcomes in terms of staff satisfaction.

 

·       The Committee congratulated the Trust for launching their Academy where staff can learn together gaining skills, knowledge, academic accreditation and professional support enabling them to grow and develop their career.

 

·       The Committee was impressed that the Trust, during its inspection by the CQC, also managed to set up one of the first Covid-19 testing centres in the country at the Parsons Green Health Centre.

 

·       The Committee noted that the Trust’s Community End of Life Care grading had improved from ‘Requires Improvement’ to ‘Good’.

 

·       The Committee commended the Trust for the positive strategy ‘Learning From Deaths’ that it had put in place and noted that this had been put on hold due to the Covid-19 pandemic, but looked forward to seeing this important work being restarted as soon as possible.

 

·       The Committee was pleased that CLCH had taken over responsibility for providing adult community services in Hertfordshire, and that the transition had been smooth, which was a credit to the staff of the Trust.

 

·       The Committee was delighted that since the introduction of Quality Development Unit (QDU) accreditation two years ago, eight teams have been awarded QDU status with nine more teams in the process of completing the QDU Excellence Standards.

 

• The aims of the four ‘Campaigns’ were noted and the Committee is looking forward to seeing further positive outcomes.
• Regarding the Falls assessment in the Parkinson’s Unit at Edgware Community Hospital, the Committee was pleased to see that the findings identified ‘no areas for improvement’ and only recommended that the ‘current standard of care’ be continued.

 

·       The Committee was pleased to hear that the number of shared governance quality councils had doubled and particularly the initiative that looked at improving pressure ulcer care in Care Homes in Barnet by developing a resource pack which has led to increased staff confidence in recognising ulcers.

 

• The Committee was impressed that category 3 & 4 pressure ulcers were down from five last year to one in 2019-2020 and that category 2 were down from 57 to 44, although the target is zero. The table showing the results was well set out and easy to read.

 

However:

·       The Committee was disappointed that most patients had rated the quality of the food and presentation as ‘poor’ but understand that there will be more information on improving food for patients next year and look forward to hearing about these developments.

  

·       The Committee noted that the percentage of patients’ valid NHS number was only 93.9% at the Trust’s Walk In Centres and asked that the Trust work to improve on this figure.

 

• The Committee was disappointed that the outcome of the Sentinel Stroke National Audit Programme had commented that ‘many patients are still left without specialist psychological support’ and that ‘a focus is required on assessments and outcomes six months after a stroke to highlight the needs of patients, their families and carers over the longer term’.

 

• Under the UNICEF Baby Friendly Initiative Staff Audit, the action recommended that all staff be trained on a mandatory two-day Breastfeeding Management course and that ‘greater awareness was required on breastfeeding positioning, attachment and hand expressing and the importance of not advertising formula milk’.

 

• The Committee expressed great concern that under the Commissioning for Quality and Innovation (CQUIN) and Local Incentive Scheme Payment Frameworks, CLCH failed in the CQUIN ‘Staff Flu Vaccinations’ to achieve 80% uptake of flu vaccinations by CLCH frontline clinical staff working in Barnet and also failed in the CQUIN ‘Local Wound Care’ to increase improvement in the number of ‘assessed’ wounds which have failed to heal after four weeks. These two failures resulted in a loss of income of £204,873.04 from Barnet CCG.

 

•  The Committee noted that between April 2019 and February 2020 two deaths of patients were subjected to both a case record review and an investigation.

 

·       The Committee commented that CLCH’s remit was over a wide geographical area and it was unclear which parts of the report were relevant to Barnet.

·       The Committee commented that not all the targets were Specific, Measurable, Achievable, Relevant and Time-bound (SMART) targets.

 

·       The Committee was concerned that the target of 8% for Staff Vacancy and Turnover rates was not achieved again this year and that the Sickness/Absence rate was even higher than the previous year.

 

The chairman thanked Ms Wilkins for joining the meeting.

 

RESOLVED that the Committee would forward their comments for inclusion in the final Quality Account by 11 June 2020.