Agenda item

The Committee received a joint presentation of the ADN Patient Safety and Chief Nursing Information Officer and Senior Associate Director of Assurance and Compliance, County Durham and Darlington Foundation Trust (for copy see file of minutes).

W Edge, Assistant Director of Assurance and Compliance advised that the drafted report had been through both internal and external consultation.

He referred to issues in relation to health acquired infections and four cases of MRSA despite the zero tolerance.  There had been one Category 3 pressure ulcer reported and second that had not been suffered in the Trusts premises, however there were lessons to be learned by nurses in terms of picking up symptoms earlier. 

There had been staffing issues which had prevented patients with sepsis from receiving antibiotics within the first hour and a Lead Sepsis Nurse had been appointed alongside a screening tool for all patients that were triaged in A&E.

The Trust had developed a palliative care strategy but due to COVID-19 there had not been sufficient opportunity to engage with stakeholders and there was a shortage of side rooms which was challenging for people on end of life.

Maternity services had faced some staffing pressures, and to ensure the models were right, the Trust had requested an external review from birthrate plus and it was hopeful that this would be completed in 2022 in order to provide validation or issue recommendations to make further improvements.

NEAS had an ambition to replace the existing UHND A&E facility with a new emergency care centre and the Chief Executive was committed to ensure this happened whether or not national funding was received.

Councillor Haney referred to the data with regards to sepsis and noted that no data had been presented on the average number of minutes that it took for people to receive treatment.  He asked whether figures could be provided on the average time it was taking and people treated within one hour.

Councillor Bell referred to palliative care and after experiencing this personally, she advised that improvements could be made to make the room more comfortable for patients that were coherent.  Patients that were unable to walk, should have a television to keep them occupied.  L Ward, Associate Director of Nursing (Patient Safety) advised that she would pass the comments back to the palliative care team.

Councillor Howey queried the response to an emergency with regards to patients with dementia following an incident where she was unable to contact anyone and was being advised by the crisis team to contact 111.   The Senior Associate Director of Assurance and Compliance advised that he would provide a written response after the meeting.

M Laing, Director of Integrated Community Services County Durham Care Partnership added that the CCG had funded provision for an urgent community response centre and was set up to cover admissions to hospital, however there were plans to extend the service to cover GP, community and voluntary sector.

Councillor Howey referred to her own personal experience of the misdiagnosis of sepsis which had resulted in a fatality and the Associate Director of Nursing (Patient Safety) advised that there was a sepsis team who would be contacted if there were any symptoms that could be attributed to sepsis and when a patient triggers certain criteria during observations or parameters reached 45 or more the system would automatically prompt the nurse to check for sepsis.  The main priority would be to issue fluids and antibiotics and sepsis within the allocated time frame however it was challenging to diagnose, and teaching staff to recognise the signs remained a high priority.

Councillor Howey referred to the pressures on wards for beds and asked whether consideration would be given to opening up Bishop Auckland General Hospital.  The Assistant Director of Assurance and Compliance confirmed that the Trust was considering how to utilise it to the best effect, and part of it was used for orthopaedics and elected care so they were increasing the level of elective cases after recognising that.

To take pressure off A&E in Durham and Darlington a frailty pathway had been established to provide sub-acute care for elderly patients and if they did not require complex acute care, they would be transferred to Bishop Auckland and one ward had been opened for this purpose with the Trust still considering whether a second was needed.  This also ensured that elderly patients were not kept longer at other sites when they could be cared for in Bishop Auckland or moved there for rehabilitation, so they did not remain on a busy acute ward for longer than necessary.

The Trust were unable to recruit acute care physicians in the numbers that would be required to open up all facilities for the provision of another A&E so it was being utilised best to provide sub-acute care.

Councillor Howey advised that Bishop Auckland had a really good urgent care centre which was now by appointment only and she queried the number of patients who were travelling from rural areas to Durham or Darlington.

Councillor Kay advised that despite living less than a mile away from Bishop Auckland Hospital, he had to travel to Darlington for some urgent care.  After being triaged he was not seen for four hours, and he expressed concern that there were certain individuals for which this would be unacceptable.  He considered that Bishop Auckland should have been considered as part of the plans to extend A&E services.

The Assistant Director of Assurance and Compliance advised that it was difficult to comment on individual case without knowing what was happening in that hospital at that time but clinical indicators on triage or emergency situations could lead to patients being re-categorised and subjected to longer wait times.

In response to a query from Councillor Andrews, the Associate Director of Nursing (Patient Safety) advised that Nurse Practitioners, were able to give drugs for sepsis but in certain circumstances, such as where sepsis was of a known origin, but there may be an issue with resistance to antibiotics or administering the incorrect type if the origin of the infection was unknown. 

In response to a further comment from Councillor Andrews regarding palliative care beds in community hospitals the Associate Director of Nursing (Patient Safety) advised that palliative care was much better in a community hospital environment and patients had the choice as to whether they went there.

Councillor Quinn advised that whilst working in a care home unit she had seen various degrees of pressure ulcers and although rare to see redness appearing there were some really bad cases and in many cases due to people hesitating to contact medical services.  During the pandemic people did not want to go to hospital and rises in energy costs and other projected difficulties would impact on nutrition and whilst people were unable to look after themselves, there could be a rise in cases, especially in rural areas where vulnerable people tended to self care.

The Assistant Director of Assurance and Compliance advised that when a patient was admitted in to care an incident report was produced to capture every moisture region and ensure that themes were identified or concerns would be raised.

Councillor Earley queried the priority funding for a new regional body and what other steps would be taken to ensure it came to fruition, should funding be unsuccessful.

With regards to quality, Councillor Earley asked whether any proactive learning data was collated to trigger a warning if it started to fall out of line, especially in relation to, but not limited to maternity.

The Assistant Director of Assurance and Compliance advised that there was a maternity dashboard to report through and a quality insights system for incidents such as falls which would hopefully alert when

leading to worse outcomes and would also ensure that policies were being met.

Councillor Earley referred to the electronic patient record and queried the data sharing between the ambulance service, primary care and 111, and whether it was accessible at Consultant level.  The Assistant Director of Assurance and Compliance confirmed that it had not yet been fully developed, but there was some ongoing cross team work on data sharing and understanding the quality of each service to get to emerging trend and national audits, to ensure data was reported.

The Associate Director of Nursing (Patient Safety) advised that the Great North Care Record would ensure that electronic systems were able to provide data across the whole of the North East.  With regards to Do Not Attempt Cardio Pulmonary Resuscitate, a copy was sent to NEAS and the aspiration was to ensure patient information was available to all.

In response to a question from Councillor Sutton-Lloyd regarding public consultation, the Assistant Director of Assurance and Compliance advised that he would seek a response from the Head of Communications however regular information such as waiting times, was shared with the public through the website.

Mrs R Gott referred queried the facilities for people with mental health issues that were not comfortable with sharing a ward with other people and the impact that this could have.   The Associate Director of Nursing (Patient Safety) confirmed that an identified priority was to upskill staff regarding the needs for patients with physical disabilities or mental health issues, and how to manage the pressures of side rooms, whilst understanding severe impact hospitalisation could have on mental health.

Councillor Higgins had not had an unpleasant experience after a hospital stay, but he was concerned about the dangers of sepsis and suggested that more information should be shared in surgeries to warn of the symptoms and seriousness.  The Associate Director of Nursing (Patient Safety) confirmed that there had been a national campaign on sepsis a few years prior and she would ensure that communications were sent to GP’s to continue to inform the community.

With regards to capacity and pressures on A&E wait times, Councillor Higgins queried the decision to close a walk-in centre in his ward which had been open 24 hours and suggested decisions such as this should be reconsidered to reduce pressure on A&E.

Councillor Robson queried whether there was any additional capacity within the hospital for beds or nursing staff that would improve turnaround times for ambulances.

The Associate Director of Nursing (Patient Safety) advised that there was never a great deal of capacity, whether it was beds or staff in order to expand safely.  There were plans to open up additional beds on new wards in Durham in the Autumn and the reason it would take so long as the issues with recruitment.  There were protocols to escalate patients and allow additional beds if it was safe to do so.  The Associate Director of Nursing (Patient Safety) confirmed that it took three years to qualify as a nurse, followed by 6-12 months of training.

The Director Integrated Community Services advised that managing patients in hospitals was an hourly process in which consideration was given to pressures and risks.  There were regular meetings throughout the day and at night in order to ensure the safe discharge of patients, however consideration also had to be given to staff availability.

With regards to community hospitals, there were an increased number of beds that nurses could attend to safely, with one qualified member of staff per eight beds however the ward could not open any additional beds if there was not a 1:8 staff ratio as it would be unsafe to do so. 

To reduce beds, would require reducing admissions by utilising GP’s and social care and in extreme circumstances other hospitals were asked to take patients, an example was a recent bank holiday when NEAS were diverting patients to the QE at Gateshead or North Tees to divert patients and equally Durham assisted other hospitals when needed.

In response to a question from Councillor Robson as to whether there was any way the Council could assist and the Director Integrated Community Services confirmed that working together in crisis, supporting care homes with initiatives such as sharing nursing capacity, and the use of consistent methods of communication.

Resolved

That the content of the report and presentation be noted and member comments be incorporated into the Committee’s response to the CDDFT’s Draft Quality Account for 2021/22.