Agenda item

(i)       Tees, Esk and Wear Valleys NHS Foundation Trust – presentation by Leanne McCrindle, Associate Director of Quality Governance, Compliance and Quality Data and Dominic Gardner, Care Group Director AMH/ALD

(ii)      County Durham and Darlington NHS Foundation Trust – presentation by Warren Edge, Senior Associate Director of Assurance and Compliance; Lisa Ward, Associate Director of Nursing and Patient Safety and Claire Skull, Infection Control Matron

The Committee received two presentations on the NHS Foundation Trust Quality Accounts 2023/24 priorities updates (for copy of presentations, see file on minutes).

Tees, Esk and Wear Valleys NHS foundation Trust

Leanne McCrindle, Associate Director of Quality Governance, Compliance and Quality Data, Dominic Gardner, Care Group Director AMH/A and Elspeth Devanney, Director of Nursing and Quality were in attendance to deliver the first presentation that provided Members with details of quality account quality priorities for 2023/24.

Following the presentation, Members were invited to ask questions.

Councillor Jopling indicated that there was a problem with staff and patients when it came to feeling safe. She stated that she was always worried when she sees 50% of people not feeling safe and stated some degree of context was needed to measure this against in terms of the total number of patients responding. She stated that more data would be helpful and that she was worried that staff were not feeling safe and it would appear that the figures do not seem to be improving. She indicated that the framework seemed to increase bureaucracy and more for staff to take on board that would reduce their work directly in caring for patients. She also queried whether staff had expressed concerns at being overloaded and if there had been a previous issue identified where staff were not fully compliant with previously agreed procedures and practices.

The Director of Nursing and Quality responded that the number of people not feeling safe was concerning and was why they had carried out some work nationally. She indicated that what they asked was ‘do you feel safe all the time’ and were one of ten trusts nationally who asked this question, other trusts asked, ‘do you feel safe’ and they asked the question that was beyond what they were expected to deliver nationally. What they found was most patients coming into their ward were probably not feeling safe and if they were feeling safe would not be admitted to a mental health ward. They had carried out some research on how they compared to other trusts and they compared very well and nationally were around the average in terms of that percentage. Ultimately what was important was the basics and those questions could be interpreted in a number of differently ways by a number of people and data was only relevant at a single point of time. They had tried to focus on the key elements they could do to change things and get it right like the safe wards and the introduction of body worn cameras and the change in patient review process. She understood Members concerns and hoped that people had the opportunity to look at their recent CQC report that does begin to see the change in direction of travel and now have no more regulatory action requirements and any inadequate ratings across their service. They knew that they needed to carry out some work around governance processes but they were beginning to see that change and shared the views of Members that they needed to get back to basics.

The Care Group Director indicated that they were not creating new processes they were trying to understand the problems and revisit what should be the Trust’s core services and delivery mechanisms.

Councillor Jopling indicated that if it was done right the first time it prevents the necessity of repeat admissions to inpatient wards.

Councillor Howey indicated that even before the survey everyone knew it was a difficult service that was not working properly. She had heard that a number of people did not have faith in the service with the deaths that had happened in some wards. More people than ever were now requiring the service but were accessing private care as they did not have confidence in the Trust’s service anymore. She indicated that the treatment she had a number of years ago made her feel worse and she was worried as they kept hearing it was going to improve but asked if it was ever going to be actioned.

The Director of Nursing and Quality responded that unfortunately they did hear some sad stories and sometimes people make mistakes, they work with people who aren’t able or in a position to tell them what they are really thinking or feeling. They were not working in an exact science and it was difficult to interpret but she acknowledged members’ comments in terms of that improvement and indicated that they were beginning to show signs of improving and turning the corner but this would take time. What they did not want was people not asking for help being fearful of what care they might receive. She stated that she would welcome the opportunity to come to a future committee to talk about some of the positives they had been doing as they did have a lot of success stories. They work with thousands of people on a daily basis and know that they have had some challenges with the crisis services and have heard from local MPs that they are hearing reduced concerns from constituents. They work closely with GP services and they were telling them that they were seeing improved access to services and they know from data when they are carrying out patient safety review that they are seeing embedment of that change. She knew it was going to take time to build that trust but was encouraged that they were turning the corner and was reflected in their recent CQC report.

Councillor Howey indicated that if it were one or two people, she would understand but it was a lot more. She asked the Officer if she heard of Bridge Creative who work with people with learning difficulties who were fantastic and this would be good to tap into to help people.

The Associate Director of Quality Governance, Compliance and Quality Data wanted to give some assurance to Councillor Howey and indicated that they were happy to come back and present their recent CQC report to Members and had three further services now that were rated as good again. She continued that they were seeing the improvements that reflects people’s experience of the services. Patient and carer feedback received by the CQC was that positive improvements were right across the service. She also stressed that whilst they do not get it right all the time, they are very much seeing that change and the positives from the CQC report in respect of organisational culture.

The Care Group Director highlighted that priority one they had changed the approach and the crisis services over the last year were working closely with the voluntary and community sector and the Waddington Street Centre.

In response to a question from Mrs Gott on co-production, the Director of Nursing and Quality responded that the presentation was an update on where they were with the Quality Account but they could bring a report back to committee on the work that the Trust had embarked upon as part of community transformation.

Councillor Haney referred to 50% of patients not feeling safe that was worrying. He stated that this could be perceived as we do not like the answer so we are going to change the question and thanked the officers for a bit more context on how it does not align with what was asked nationally. He asked what ‘does safe mean’, does it mean safe from harm from themselves, other patients or potentially staff and asked how this information was asked and if the question was explained.

The Director of Nursing and Quality responded that the question was asked in a number of different ways that included surveys on paper or a member of staff sitting down with the patient or it could go out via a text message or on an IT system to complete online. She continued that often there was no opportunity to describe the context of the question, she knew that when someone experiences mental illness the core part of how they felt was not to feel safe and were anxious and not able to go outside. The introduction to a new person can be difficult for patients and can make them not feel safe and was why this work was so important to understand that narrative fully so that they could fully help people move forward.

The Care Group Director indicated that going out and having conversations was key as part of the variance in the way the question could be asked. The key thing that they needed to do was to support staff and to notice what was going on in every conversation and not just relying on metrics.

Councillor Hovvels indicated that the Mental Health Trust were the poor relations when it came to services and the finances being given out. She continued that throughout COVID as a Councillor she had experience where people had falling through the system. She stated that anything that could be done to improve the service was welcomed and would like the Committee to take up the offer to come back so that they could understand a lot more of the work taking place.

The Chair indicated that she had read the CQC report, and some of the items identified about safety was for staff as well as patients. She indicated that staff often relied heavily on appropriate training and development to improve professional competencies. The use of body worn cameras was an interesting development and would welcome further information around whether this practice made people feel safer, including staff and patients and if incident numbers reflected this.

The Director of Nursing and Quality responded that they were expanding that programme. They were using the cameras more to inform practice and help people understand how they are perceived or how it can feel from a patient’s point of view and were using the cameras more in a proactive way. Historically they used CCTV following a serious incident and went back and looked at the footage respectively but now it was used to inform practices and was incredibly helpful.

The Principal Overview and Scrutiny Officer suggested that the Committee invite Tees, Esk and Wear Valley NHS Foundation Trust to a future meeting to bring back a report on its recent CQC Inspection and a presentation on the Community Transformation work.

Resolved: (i) That the contents of the presentation be noted.

(ii) That Tees, Esk and Wear Valley NHS Foundation Trust bring back a report to a future Committee on its recent CQC Inspection and a further presentation on the Community Transformation work.

County Durham and Darlington NHS Foundation Trust

The second presentation was presented by Warren Edge, Senior Associate Director of Assurance and Compliance, Lisa Ward, Associate Director of Nursing, Patient Safety and Claire Skull, Infection Control Matron which provided Members with details of positive performance; review of progress on quality objectives; key challenges and actions and an update on matters raised by the Committee on the 2022/23 Quality Account.

Following the presentation Members were invited to ask questions.

Councillor Howey asked if they could produce a report which set out data and performance for both UHND and Darlington Memorial Hospital as in her experience people were happy with Durham but not Darlington. She then referred to dementia patients on wards and asked if they had trained dementia staff on each ward and thanked the team for their work on sepsis.

The Senior Associate Director of Assurance and Compliance responded that the report could be broken down between the two hospitals. With reference to dementia the aspiration was to have a dementia champion in each ward and would confirm if they were now fully recruited.

Councillor Haney indicated that the work on sepsis was not good enough and asked how many people were treated within the one-hour target and what was the average delay and how many patients were going to die because this had not being acted upon. He commented that there must be hospitals in the country that were doing this effectively and space should not be the overriding factor, they just needed to administer the antibiotics.

The Infection Control Matron responded that they needed to get the antibiotics right and they had the go ahead to explore Patient Group Directions for chest sepsis and urinary sepsis. They had a large data set now and she could tell how many people were screened for sepsis and the time treated. She stated that nobody had cracked sepsis nationally as it was really hard to spot and they would learn from other people’s best practice and commented that you needed to treat people with dignity. She stated that they were putting a lot of attention on trying to crack sepsis and was high on their agenda.

The Chair asked if the Committee could obtain a copy of the sepsis data. The Infection Control Matron responded that she would arrange for the data to be put into a readable format for Members.

The Associate Director of Nursing indicated that they had a dedicated nurse who looked into blood stream infections.

Councillor Early referred to his taxi journey this morning and commented that the driver was full of praise of the maternity service, his only fault was the number of people who asked if everything was all right.

Councillor Quinn asked about pressure ulcers and commented that the report stated that there were currently no pressure ulcers and asked if this was due to people not presenting or if pressure ulcers were on the decline.

The Infection Control Matron responded that she would obtain the numbers and advise Members accordingly.

Resolved: That the contents of the presentation be noted.