Agenda item

·       Director of Clinical Services, North London Hospice

The Chairman invited the following to the meeting:

• Fran Deane, Director of Clinical Services, North London Hospice
• Assistant Director of Quality, North London Hospice

Ms Deane thanked the Committee for their patience in allowing the NLH to bring the Quality Account 2019-20 later in the year to the Committee due to the Covid-19 pandemic.

She added that the Carers Strategy, the new clinical database and the work on non-medical prescribing had been carried forward to next year due to the pandemic. Also, the upgrading of the Inpatient Unit bathroom had had to be placed on hold but instead the NLH is proposing to review the delivery of some of its health and wellbeing services. A

6-month post had been created to review the NLH’s virtual response to health and wellbeing and to work on setting up groups to support patients in the community.

Ms Deane reported that Covid-19 had accelerated some of the NLH’s learning and development opportunities with nearly 2000 learners having attended online courses.

There was a delay in presenting full data due to the introduction of the new clinical database, Egton Medical Information Systems (EMIS) going live in January. Full data would be available in 2021.

Ms Deane noted that a Director of People has been recruited and this post has been beneficial with the introduction of a People Strategy and clear direction to develop the workforce. 

The Committee scrutinised the draft North London Hospice Quality Account 2019-20 and wished to put on record the following comments:

• The Quality Account was well presented and easy to navigate with an interesting mixture of information and including a ‘Patient Story’ demonstrated the ethos of the Hospice.
• The Committee was delighted to see that three of last year’s ‘Priorities for Improvements’ will continue again this year, as Members felt that they were of great importance: the Carer’s Strategy, training on Non-Medical Prescribing and ongoing development of Egton Medical Information Systems (EMIS). EMIS was considered of vital importance providing the Hospice with access to patients’ records and information sharing as 96% of GP Practices in Barnet, Enfield and Haringey are on the same system. (P.6-9)
• The Committee praised the progress made on the’ Productive Ward in the Impatient Unit’ to improve and initiate new ways of working thereby enabling nurses to spend more time with patients. (P.10)
• The Committee noted that a Priority for 2021 ‘IPU Bathroom Spa Experience’ aimed to improve the current facility by adding new blinds, a privacy curtain as well as creating a small changing area and expressed disappointment that the facility was currently closed due to Coronavirus social distancing recommendations. (P.13)
• The Committee was glad that the Audit of the Dementia-Friendly Environment had been rated ‘Good’ and looks forward to hearing how work progresses on the few potential improvements which were identified. (P.16)
• The Committee was pleased that there were positive results in the Audit of Five Priorities of Care following the introduction of electronic documentation in January 2020 as part of the EMIS project. (P.17)
• The Committee noted that the Resuscitation Council had recommended the purchase of two additional pieces of equipment, although the review of the resuscitation trolley equipment met the standards. (P. 17)
• The Committee was pleased that the Hospice had trained another 50 people as ‘Compassionate Neighbours’ to add to the 96 who underwent training last year and that students continued to be welcomed as well as 40 young adults considering a career in healthcare who had attended two successful Summer Schools. (P.21 and P24)

• The Committee congratulated the ‘Catching the Light’ Photography Group on holding its first exhibition with over 100 people attending who had had the opportunity not only to view but also to purchase some of the exhibits. (P.21)
• The Committee was impressed that all sections of Key Performance Indicator 1 regarding patients’ and relatives’ views on how staff treat patients were even higher than last year. (P. 29)
• The Committee was delighted to hear that the number of patient related falls was down from 62 to 45 this year, showing a positive trend since the introduction of patient alarms and the purchase of low beds in IPU last year. (P. 36)
• The Committee congratulated the Hospice on developing an Action Plan to learn from near misses and recognising these as an opportunity to prevent further incidents. (P.36)
• The Hospice was complimented on achieving zero cases of Clostridium Difficile (C.Diff) again this year. (P.37)

However:

• The Committee was most concerned at the low levels of compliance recorded during the Hand Hygiene Audits completed for IPU, the Health and Wellbeing Centre and George Marsh Premises at 84%, 83% and 69% respectively, especially at the time of a Coronavirus pandemic. (P.15)
• The Committee was disappointed that under the heading Audit of Fall Paperwork in IPU, 20% of falls risk assessment reviews occurred late or were overdue. (P16)
• Great concern was expressed that the Audit of Waste Management found several areas of non-compliance: the external clinical /infectious waste stores are not always locked and the sharps bins were not always correctly labelled or closed when full. (P.17)
• The Committee was saddened to learn that the number of volunteers had decreased from 950 last year to 830 this year as they play such a vital role in augmenting the staff. (P.20)
• The Committee noted that there had been a huge increase in ‘closed bed days’ this year, 160 compared to 12 in 2018/19, which was due to extensive fire and safety work being carried out in the bedrooms. The Hospice confirmed that the work was now complete and the number of ‘closed bed days’ was back down to the normal level. (P.26)
• In the graph for Key Performance Indicator 2, the Committee was concerned to see a decline in whether patients and relatives feel involved as much as they want to be in decisions about care and treatment and a decline in Key Performance Indicator 3 whether patients and relatives would recommend the service to family or friends. The decline in satisfaction in both Key Performance Indicators 2 and 3 was particularly noticeable in the Health and Wellbeing and Palliative Care Support Services, with the Community Team having slightly mixed results. (P.30 and 32)
• The Committee was disappointed that the number of complaints had increased from 12 last year to 19 this year with 16 being upheld. (P.33)
• The Committee was alarmed at the upward trend in’ Patient Safety’ reported incidents from 352 in 2017/18 to 367 in 2018/19 and to 489 in 2019/20. (P.35)
• The number of pressure ulcers reported had increased from 63 in 2018/19 to 124 this year. The Committee was concerned that this upward trend should not continue, despite the frailty of many of the patients, and suggested that it would be helpful if the Hospice divided the total of 124 into the various categories of pressure ulcers so that it could be clearly seen how many of the ulcers were either Category 3 or 4 or if some fell into the lower categories. (P.36)
• The Committee noted that there had been an increase in medication errors but was relieved that the Hospice was taking this matter seriously and had already put several measures in place and had also developed an action plan for future improvement in 2020/21. (P.36)

A Member asked whether there were any communication problems with carers such as language barriers. Ms Deane responded that the NLH uses an interpreter service which is currently by video or telephone.

A Member noted that as a Trustee of Barnet Carers Centre she is keen for organisations in the Borough to liaise with each other to avoid duplication of work. Ms Deane reported that she would bring back details of organisations that the NLH had held a working party with around the Carers Strategy. Also, if there has not been a conversation with the Barnet Carers Centre she would arrange for this to be facilitated.

Action: Ms Deane

The Chairman reported that Pam Clinton, Chief Executive of the NLH, has announced her retirement. She asked Ms Deane to pass on to Pam the Committee’s thanks for her hard work during her time at the Hospice. She noted that Declan Carol would be taking over from August 2020.

RESOLVED that the Committee noted the Quality Account 2019/20 and will provide comments on it in writing to the Governance Officer by 22 July.