Agenda item

The Committee received a report of the Director of Transformation and Partnerships and supporting information from County Durham and Darlington NHS Foundation Trust and Tees, Esk and Wear Valleys NHS Foundation Trust that set out progress made against their Quality Accounts priorities for 2017/18 (for copy see file of minutes).

County Durham and Darlington NHS Foundation Trust (CDDFT)

The Associate Director of Nursing, County Durham and Darlington NHS Foundation Trust highlighted the following information from her report:-

·         Patient Falls – biggest risk with an ageing population.  A post to lead this agenda had been created with would have a multi-disciplined approach.

·         Dementia – monitoring ongoing, training in place but will be enhanced.

·         Healthcare Associated Infection – 3 reported cases of MRSA against a target of 0 and 12 of clostridium difficile against a target of 19.

·         Venous Thromboembolism risk assessment – achievement is above the target of 95%.

·         Pressure Ulcers – 4 incidents last year and 2 this year so learning from assessments.

·         Discharge – 93.2% against a target of 95%.

·         Rate of patient Safety Incidents – 50% of reporters with a goal to reach 75%.

·         Sepsis – screening is a mandatory field on the Trust’s Nervecentre system.  A&E do not use this and fell short of the target.  Sepsis is now a mandatory field on their Symphony system.

·         Duty of Candour – compliance is at 96%.

·         LOCSSIPS – hit target.

·         Nutrition and Hydration – nerve centre under pilot.

·         Patient Surveys – ongoing.

·         Friends and Family Test – on track.

·         Mortality – work ongoing and recruitment of a central mortality review pool ongoing.

·         Reduction in 28 day readmissions – monitoring continues.

·         Patient Outcome Measures – on track with the exception of groin hernias being below the national average.

·         Maternity Standards – ongoing work to promote breastfeeding. CDDFT remain the exemplar Trust in relation to smoking in pregnancy and the implementation of the BabyClear initiative.

·         Paediatric Care – work ongoing and key part of clinical strategy.

The Chairman thanked the Associate Director of Nursing for her presentation.

The Chief Executive of CDDFT commended the information shared by Associate Director of Nursing and assured members that their board look at the priorities on a regular basis.  She advised of an unannounced CQC inspection and that she would bring the details back to committee after the draft report had been received.  With regards to falls she reported that University Hospital North Durham and Darlington Memorial Hospital were the 1^st and 2^nd best in the region and performed well against the country.  She said that an addendum to future reports could show the position across England and how the trust were performing. The Chairman welcomed this approach.

Councillor Temple asked for confirmation that the difficult targets were around pressure ulcers, MRSA and the inability to access “training for the trainer”.  The Associate Director of Nursing confirmed that training had been built in for dementia and that changes to create a dementia friendly environment had been identified such as large clocks, calendars showing the seasons, different coloured crockery, different coloured foods and door frames being painted in different colours.  With regards to MRSA she advised that the trust would always want to stay with zero tolerance and that policies and procedures were in place to tackle this.

Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV)

The Head of Planning and Business Development, Tees, Esk and Wear Valleys NHS Foundation Trust gave a detailed presentation that highlighted the following:-

·         Quality Priorities – Q2 Progress 5 quality priorities all on track

·         9 Quality Metrics

·         Red Quality Metrics –

o   Percentage of patients who feel safe on the ward – 74.5% for Durham and Darlington, against a target of 88%

o   Number of Incidents of Physical Intervention/Restraint – 23.07 against a target of 19.25

o   Average length of stay for patients in Mental Health Services for Older People Assessment & Treatment Wards – 52 days against a target of 59.38

o   Percentage of patients who reported overall experience as excellent or good – 90.5% against a target of 94%

o   Percentage of patients that report staff treated them with dignity and respect – 83.8% against a target of 94%

o   Percentage of patients who would recommend services to friends and family – 89.5% against a target of 94%

The Chairman thanked the Head of Planning and Business Development for his presentation.

The Chairman welcomed Denise Colmer to the meeting who was reducing Preventable Deaths lead, to discuss risks across the county for suicides.  Ms Colmer reported that nationally 75-76% of people who commit suicide were not previously known to services within the year of death.  She added that an all agency strategy led by Mental health teams was needed and that TEWV had been working on a multi-agency strategy.  There had been a number of recent changes to the Public Health team which may have delayed progress but a workshop was planned for 5 December to look at this.  She went on to report that a lot of work was ongoing around suicide prevention and core plans to ensure collaboration with service users and friends and family within a community were being developed.  She also reported that the North East had the highest rate of suicides than the national number.

Councillor Kay was aware of clusters of suicide in certain areas and that were predominantly male of a similar age group.  As these people were not known to services he asked what was being done to encourage people to speak to services.

With regards to the Crisis Service Councillor Crute suggested that it would be helpful to receive an update as through the review group into suicides it had been noted that access to crisis was a major problem.  With the roll out of universal credit he believed that this would increase problems for people.  The Chairman added that there had been concerns expressed about crisis intervention.

Ms Colmer responded that the Crisis Operations Policy had been re-written an overview of service users and a recovery strategy programme.  It was recognised across TEWV that it was a challenge to access services and she advised that there was a self referral route available if the person was already known to services. Alternatively referrals could be made through voluntary, statutory or GP services.  She added that the operational policy needed to be updated and refreshed.  Ms Colmer reported that often a dual diagnosis was given for people presenting with mental health issues but if intoxicated at the time of risk a thorough assessment could not be carried out.  An early alert process was carried out in County Durham and if a suicide was suspected a Police representative would attend.  Trends and clusters were looked at.

Referring to the transition for young people into adult services Councillor Grant asked is services tapered off if the person’s needs had not changed.  The Head of Planning and Business Development explained that the way the services were delivered and the culture of the way in which they were delivered may change as the young person reaches 18 but there needs would be addressed and supported.  He added that one of the main problems was that at 18 a young adult can cut their parents out of conversations.

Councillor Davinson referred to the data in metrics 1, 7 and 8 of the presentation slides and asked how only 62% of patients felt safe on the ward but that 91% of patients said that they had a good experience.  The Chairman added that he felt that the target for dignity and respect and for people feeling safe should be set as 100%.   The Head of Planning and Business Development reported that the information was survey based and the service would always aim for 100%.  The fact that people might not feel safe but still had a good experience could be down to their illness as they could feel uncomfortable but that the staff could have been helpful and the canteen and transport links were good and therefore the patient would still have had an overall positive experience.

The Chairman said that he would accept that the aspirational target but felt that the respect and dignity target should be mandatory and set at 100%.

Councillor Davinson was also advised that the medium length of stay for metric 6b was 52 days on average but was better in County Durham.  It had been recognised that the longer a patient was kept in hospital the more independence they lose.

In conclusion, the Principal Overview and Scrutiny Officer advised that Members would recall the presentation and report from the North East Ambulance Service at its meeting on 2 October 2017 on performance.  A new national mandated standard had been imposed and NEAS would come back with details on performance and the transition to the new standards in the New Year.

Resolved that:-

(i)           the reports be received and the information provided within the presentations noted;

(ii)          the CQC Inspection report for County Durham and Darlington NHS Foundation Trust’s recent unannounced inspection be brought to the Committee’s meeting scheduled for 5 March 2018.