Agenda item

North London Hospice

The Chairman invited the following to the table:

•         Fran Deane, Director of Clinical Services, North London Hospice.

•         Nada Schiavone, Assistant Director Quality, North London Hospice

The Chairman thanked the North London Hospice for the mid-year Quality Accounts submission.

Ms Deane advised that the North London Hospice currently had 10 new volunteers for front of house roles, who had replaced those that had not returned due to age or ill health reasons. Ms Deane said there had been some issues around staff recruitment in other roles but that this was common across the sector.

She also advised that, in relation to medication incidents, research was being done to investigate how Care Homes administer their drugs in order to share best practice. However, more controlled drugs were used at the Hospice compared with Care Homes, so liaison with other Hospices would also be taking place. Ms Deane also raised the point that there was a positive attitude within the organisation in terms of staff wanting to report near misses and incidences of error, to be open and transparent and to create a culture of improvement. She said that approximately over 250 medicines are administered each day, so when looking at the overall number of incidents, the numbers were very small and most medication errors caused no harm to patients. However, the Hospice is dedicated to continually reducing the numbers of errors.

A Member asked if the need for reporting incidents was included in training and upskilling sessions for staff so that they understood the importance of doing this. Ms Schiavone confirmed that competency was a significant focus within all training and that the education team worked closely with any members of staff requiring additional support. She also said that staff were counselled in relation to any near misses in order to avoid similar incidences reoccurring.

A Member raised concerns regarding the number of medication errors as they felt that even a small error was still a major incident. The Member asked what measures or processes were being put in place to ensure these errors were avoided at all costs and whether the staff were medically trained. Ms Schiavone said there is primarily a focus on staff competence and that individual performance was regularly reviewed. She said there was an on-site education team available for support as well as senior nurses on duty on every shift to provide medical advice. Ms Schiavone stressed that all incidents were investigated as soon as they occurred and were taken very seriously, and that staff regularly attended Hospice webinars to learn from others. Ms Schiavone clarified that the incidents were not always in relation to providing the wrong drug or dosage, often they were minor errors.

A Member asked if the Clinical strategy would be included within the Quality Accounts. Ms Deane said she was happy to forward a copy for circulation to Committee Members. A Member also requested more information in relation to the projects being undertaken. Ms Deane agreed to include an update on projects within the end of year Quality Account reports.

RESOLVED that the Committee noted the North London Hospice verbal updates.

Community London Central Healthcare NHS Trust

The Chairman invited the following to the table:

•         John McLinden, Divisional Director of Nursing and Therapies, North Central Division, Central London Community Healthcare Trust (CLCH).

•         Denis Enright, Director of Operations at Central London Community Health Care NHS Trust (CLCH)

Mr McLinden provided a verbal response to the public question that had been submitted. He said that the NHS nationally through NHS Digital have either procured Microsoft products on behalf of the NHS, in the case of Windows10, or negotiated improved procurement at scale in the case of Office 365. These are the de facto systems in use within the NHS and are familiar to staff and allow a commonality of communication between providers working in an integrated and collaborative manner. CLCH as a provider have taken advantage of these opportunities provided nationally and have maintained a Microsoft environment that is familiar to our staff and in line with the systems that partners utilise.

Mr McLinden informed the Committee that the Trust had reviewed how health visits were being done and had identified what improvements needed to be put in place, as well as what parts of a health visit could be performed by Community Staff Nurses and Nursery Nurses. He advised that the programme was in its final stages and that recruitment was taking place internationally, with the completion due to end in early 2022.

A Member questioned the rise in patient safety incidents resulting in ‘severe harm’ over the past year compared to the previous year and asked whether this was as a consequence of training staff on the importance of reporting. Mr McLinden said that this was partly due to more patients being taken on last year which had skewed the numbers. However, he advised that there had been a decrease in Category 2 pressure ulcers and that a review of the data needed to take place. He explained that the increased figures in relation to point 9 of the report was also related to a greater number of beds and therefore more patients being cared for. Mr Enright said that the 30-40% growth in beds correlated to the increase in incidents as well as the increased complexity of patients on the Ward during Covid who required more one to one care.

In relation to point 7 of the Report, relating to CLCH needing to check records and improve communication with acute providers, a member asked why information on vaccines was not updated. Mr McLinden explained that the system used by the NHS and GPs was different and that CLCH did not have access to update GP records through E-miss themselves. However, CLCH was planning to move over to the E-miss system next year.

The Chairman noted the responses that had been provided by the Royal Free Trust. The Chairman requested that the Governance Officer asked the Royal Free to provide answers to all the outstanding questions and that these be circulated and published.

Action: Governance Officer

RESOLVED that the Committee noted the verbal updates.