Agenda item

·         Appendix 1a – Minute extract, QA, Royal Free London (RFL) NHS Foundation Trust

·         Appendix 1b - mid-year QA, Royal Free London (RFL) NHS Foundation Trust

·         Appendix 1c – RFL NHS Foundation Trust Draft QA 2021/22

 

·         Appendix 2a – Minute extract, QS Central London Community Healthcare (CLCH) NHS Trust

·         Appendix 2b mid-year QA, CLCH

·         Appendix 2c – CLCH Draft QA 2021/22

 

·         Appendix 3a – Minute extract, QA North London Hospice

·         Appendix 3b, mid-year QA, North London Hospice

·         Appendix 3c – North London Hospice Draft QA 2021/22

 

 

Royal Free Hospital NHS Foundation Trust

 

·         Professor Derralynn Hughes, Director Clinical practice groups and Clinical director research and development 

 

Further to a presentation by Professor Hughes, the Committee discussed the Quality Account. They then put on record the following comments:

 

·         The Committee congratulated the Trust on its continued recovery from the Covid-19 pandemic, including its successful research and development and Covid-19 vaccination programme, and for its continued support to the community during a very difficult time.

·         The Committee was pleased to see the improvements in patient records meaning that records could easily be shared across all three sites in the Trust.

·         The Patient Experience Strategy as part of priorities for improvement, 2020-21, was welcomed by the Committee, in particular additional tools in relation to dementia practice and the cross-Borough Carer Steering Group. The Committee was pleased that support was being provided for patients in understanding their care. The Committee would be interested to receive information on outcomes for patients.

·         The Committee welcomed the advanced care planning as part of End-of-Life Care.

·         The improvements in clinical effectiveness were noted

·         The Committee welcomed the improvements in patient safety, with the reduction of never events down from five to one.

·         It was noted by the Committee that the action taken to improve data quality was a positive step.

·         The Committee complimented the Trust on reducing the 18-week waiting times.

·         The Committee welcomed the progress on improving maternity services.

·         The restart of kidney transplantation at the Royal Free Hospital was welcomed.

·         The Committee congratulated the Trust on reducing its cancer waiting times and referrals backlog caused by the pandemic. The speed of  treatment being offered to patients is impressive.

·         The Committee was pleased to see that there was an improvement in the number of C.Diff cases since the report in 2019-20 rates.

·         It was noted that the Trust was given no ‘must do’s but has ‘should do’s’ which is an improvement. 

However:

·         It was noted that the avoidable harm targets had not been met and that the Trust had achieved less than it had hoped and was well below the score. The Committee would be interested to know whether the approach to this would be reviewed.

·         The target to reduce inpatient falls had not been met and the Committee enquired what action could be taken to improve this as it is important for elderly, patients with dementia and with learning difficulties.

·         The Committee wondered what could be done to meet national cancer waiting times targets in relation to GP referrals.

·         The Committee had been informed that patients still reported having difficulties contacting a hospital doctor even whilst on the wards. They reported leaving their contact details and then not being contacted and having to wait around to try to speak to a doctor. The Committee requested that this be fed back to the Trust.

·         The Committee was concerned that mental health support in maternity services, antenatal check-ups and midwife and health visitor check-ups did not receive good feedback in the questionnaire and wondered what would be done to improve this.

·         The Committee was concerned that there had been three avoidable deaths over the past year.

·         The Committee hoped that the Trust could improve its scoring on ‘recommendations to friends and family’ as this reflected the earlier comment on communication with doctors and information on patient care.

·         The Committee was disappointed that the Trust had only achieved the 62-day target for first definitive treatment for 69.3% of patients, and this had been decreasing since April 2021.

In addition to the above comments being submitted for publication in the Quality Account, the following comments were made:

A Member commented that the Trust had only moved from ‘inadequate’ in maternity services to ‘requires improvement’, with 14 ‘should do’s’ remaining (page 71). Professor Hughes responded that work was ongoing within the maternity teams who were reporting back regularly and are subject to regular overview and scrutiny. Dr Greenberg could revisit HOSC with specific details in the future.

Action: RFL

The Member enquired about the timescale for improvements and when would the CQC revisit the Trust. Professor Hughes noted that Dr Greenberg could provide more information, but the requirements were being actioned urgently.

Action: RFL

A Member enquired whether the Trust is noticing an increase in comorbidities and worsening of existing conditions due to the longer waiting times (page 50) and whether this resulted in additional treatments being needed. Professor Hughes noted that patients waiting longer than 62 days receive reviews to look into additional harm as a result. The Trust is seeing more comorbidity than usual in patients who have waited longer to be seen. Professor Hughes added that data on this may be available if required.

Action: RFL

A Member asked what criteria was used to find out which areas were ineligible for research and development (R&D) in the post Covid era (page 112). Also what efforts had been made to step up the research and development not yet begun. Professor Hughes responded that cancer studies had continued but many others had been paused. The requisite governance process had been followed and  all studies had now been reviewed and most restarted. New guidance from the National Institute for Health and Care Research (NIHR) stated that studies that are not meeting recruitment targets should be closed as they waste R&D resources.

The Chair thanked Professor Hughes for attending and requested that any follow up data could be provided following the meeting.

 

Central London Community Healthcare NHS Trust

• Kathleen Isaac, Director of Operations, NC Division, CLCH
• Noyola McNicolls-Washington, Divisional Director of Nursing and Therapies, NC Division, CLCH

 

Further to a presentation by Ms Isaac and Ms McNicolls-Washington, the Committee discussed the Quality Account. They then put on record the following comments:

 

·         The Committee congratulated the Trust on its strong performance against the key performance indicators.

·         The Trust’s work with volunteers is impressive including the implementation of a new Volunteer Communications and Engagement Plan, and the increase in the number of volunteers that had been recruited.

·         The Trust was congratulated on its success in meeting its targets, in Covid-19 vaccine delivery and in managing the deployment of staff to the Nightingale Hospital at the start of the pandemic.

·         The Committee complimented the Trust on its diverse representation of patients in patient feedback questionnaires, which would help to enhance patient experience further.

·         The Committee was pleased that an annual volunteer survey had been introduced, to help to understand the benefit of volunteers on patient experience.

·         The Committee welcomed the new CLCH Research Strategy and the commitment to reducing health inequalities and that it had become a member of the North West London Clinical Research Trials Alliance. 

·         The Committee congratulated the Trust on the provision of mobile phones for homeless people during the pandemic. 

·         The Committee was impressed with the ‘Outstanding’ rating from the CQC for its community health services for adults and suggested this be displayed more clearly in the report as the chart was difficult to read.

·         The Committee welcomed the team’s initiative to improve equity of access to CLCH services.

·         The Committee was pleased to see that Long Covid training packages had been developed by the Trust.

·         The Committee complimented the Trust on the introduction  of the School Engagement workstream, which provided presentations in schools about employment opportunities in the Trust.

However:

·         The Committee noted that the Trust had received a CQC rating of ‘requires improvement for the ‘safe’ domain for children and young people. However there was no information in the report on action that would be taken to improve this.

·         The Committee commented that the Trust has some challenges outstanding. The audit results showed that some patients were not given the correct fluids and had not seen their families either in-person or virtually during the pandemic.

·         The Committee noted that 13 patient safety incidents had occurred resulting in severe harm.

·         The Committee was pleased that the CLCH had introduced the Freedom to Speak Up (FTSU) project for staff including a FTSU Guardian but requested some anonymised data to show how well this programme was being followed.

In addition to the above comments being submitted for publication in the Quality Account, the following comments were made:

A Member asked whether outcomes from the Freedom to Speak Up project were available (page 21). Ms McNicolls-Washington noted that a Guardian had been appointed to support staff in speaking up and there was evidence that this was effective, with staff being willing to speak to the Guardian. This had helped to improve quality of care, and staff morale. Ms McNicolls-Washington would ask for some data on this. Ms Isaac reported that a recent staff survey showed a 10% increase in staff being willing to share their concerns.

Action: MsNicolls-Washington

 

Ms Isaac noted that she could provide details on the reimagined health visiting model that the Trust is developing, if helpful. The CQC inspection had predominantly been related to health visiting services and the number of children on caseloads due to recruitment issues. She would also find out the vacancy rate.

Action: Ms Isaac

 

A Member asked what the biggest challenge is in mitigating the risks of families not being seen either physically or virtually resulting in patient safety incidents. Ms McNicolls-Washington responded that the step down of services due to the pandemic had been a challenge as also the acuity of those patients increased in those circumstances. There had however been a definite improvement in performance and monitoring using Commissioning for Quality and Innovation (CQUIN) and learning had been shared across the division.

 

A Member noted that it was good to see the support for homeless people in providing three months’ connectivity and mobile phones. Ms Isaac offered to share further information on this pilot scheme which included community dental services for homeless people.

Action: Ms Isaac

 

A Member noted that the ‘outstanding’ rating by the CQC is excellent but requested that the charts (page 22) be bigger in the report as they were difficult to read.

 

A Member asked what actions had been taken on the ‘requires improvement’ rating for the ‘safe domain’ for children and young people.

Action: Ms Isaac/Ms McNicolls-Washington

 

The Chair thanked Ms Isaac and Ms McNicolls-Washington for attending the meeting. Ms McNicolls-Washington noted that  HOSC Members are welcome to attend the CLCH Quality Forums.

 

 

North London Hospice

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

 

Further to a presentation by Ms Deane and Ms Schiavone, the Committee discussed the Quality Account. They then put on record the following comments:

 

 

·         The Committee thanked the NLH for the hard work that had gone into providing services during the Covid-19 pandemic and recovery from the pandemic.

·         The Committee appreciated the NLH taking account of all patients and relatives when undertaking its ‘digital first’ approach

·         The Committee was impressed by the recruitment and work of the NLH’s volunteers and by the Walk&Talk Group which provided support due to the pandemic.

·         The Committee looked forward to the development of a formal community engagement and user involvement strategy.

·         The Committee commended the NLH for receiving 207 written compliments from friends and relatives of patients which showed the high quality of care provided, including for the kindness of staff and for support during difficult times.

·         The Committee congratulated the NLH that 368 clinical and non-clinical incidents and near misses, and reports on organisational learning, had been reported in 2020-21 which showed a continuous improvement over the past three years.

·         The Committee was pleased to see that the number of patient falls had reduced from 37 the previous year to 24.

·         There had been no patients who had contracted Clostridium Difficile, MRSA or norovirus cases. The Committee congratulated the NLH on this.

·         The Committee commended the NLH for its ongoing work on recruitment, including internal promotion opportunities and the recruitment of two new members of staff.

 

However:

·         The Committee was disappointed to see an increase in new pressure ulcers being reported.

·         The Committee noted that medication incidents had increased from 67 to 81 though it was noted that only quarters 1 and 2 were reflected in the figures. 

·         The Committee noted that recruitment was still a problem, but ten fewer members of staff had left compared to the previous year, and it was noted that the pandemic had had an impact on recruitment and retention.

In addition to the above comments being submitted for publication in the Quality Account, the following comments were made:

A Member asked whether the transition to digital working during the pandemic had been more difficult due to the age range of patients. Ms Deane responded that the Hospice had been surprised at the relative ease of this transition but that a hybrid model is in operation so that those who need it could be seen face-to-face. The Hospice had never stopped home visits or closed its inpatient unit and had never been closed to visitors and has a 24-hour service. The Hospice is aware of the population it is serving and has the support through compassionate neighbours. Often digital assessments are preferred by some patients. She added that feedback showed that families are satisfied with communication from the Hospice.

A Member enquired about the increase in the number of patients presenting with pressure ulcers. Ms Deane responded that the Hospice had seen patients arriving with increased frailty who had waited much longer during the pandemic for end-of-life support, and patients not having received the usual level of pressure care. She added that pressure ulcers can develop on the unit which can be due to the skin dying at this stage of life. The Hospice is always concerned about pressure ulcers and is starting a more in-depth review of pressure ulcers that develop on the unit.

The Chair thanked Ms Deane and Ms Schiavone for attending the meeting.

 

RESOLVED that all three Quality Accounts were noted, and that the Committee would submit their comments within the time frame agreed for them to be published within the Quality Accounts.