Agenda item

Tracey McErlain-Burns, Chief Nurse, to present

Tracey McErlain-Burns, Chief Nurse, and Hilary Fawcett, Quality Governance Lead, gave the following powerpoint presentation:-

 

Quality Account

-     The focus of the Quality Account is on how we take assurance that the services we provide are safe, effective and enabling our patients, their families and carers to have a positive experience of care

 

Care Quality Commission Registration

-          The Trust was required to register with the Care Quality Commission (CQC) – its current registration status was ‘fully compliant’ with no conditions on registration

-          The Trust was subject to a routine, announced inspection between 23^rd-27^th February, 2015 – draft report awaited

-          The Trust was currently on Band 4 of CQC Intelligent Monitoring Report (scale of 1-6 where Band 1 represents the highest level of risk, 6 the lowest)

 

Looking Back – our quality improvement for 2014/15

-          Priority 1 – Mortality – to achieve a 4 point reduction in HSMR

Confirmation of figures awaited

 

-          Priority 2 – SAFE – Harm Free Care (HFC)

Achieve minimum 96% HFC

Avoidable pressure ulcers grade 2-4

Zero avoidable falls with harm

 

-          Priority 3 – Achieve all national waiting times targets

Cancer    2 week waits

                 31 days

                 62 days

A&E

18 weeks

52 weeks target

 

-          Priority 4 – Achieve improvement in all Friends and Family Test scores

 

Looking Forward – TRFT Quality Objectives 2015/16

-          Clinical Effectiveness

·           Ensure maximum learning from unexpected deaths and reduction in mortality rates through review of all unexpected deaths in line with Trust Mortality Review process

·           Reduction in delayed discharge of patients – Safer patient care bundle

 

-          Patient Safety

·           SAFE – Harm Free Care- continue to aim for minimum 96% HFC

·           Sign up to Safety Campaign

Improve responsiveness to diagnostic test results to ensure avoidable harm caused by missed/delayed diagnosis

Improve processes designed to recognise and respond to signs of deterioration in condition of adult patients

 

-          Patient Experience

·           Achieve improvement in the outcome of the national in-patient survey specifically having a focus on reduction of noise at night

·           Achieve and maintain improvement relating to Friends and Family Test results both in terms of positive score rates and responsiveness

·           Improve care of patients with Dementia – ensure Trust colleagues undertake awareness training

·           Improve Trust responsiveness to complaints – 90% of responses with complainant by date agreed

·           Improve patient satisfaction with quality of complaints management process

 

Discussion ensued on the presentation with the following issues raised/clarified:-

 

-          This was the first draft of the document and, due to the timeframe, had not allowed year-end information to be included

 

-          SAFE Harm Free Care was a national programme involving monthly audits.  It looked at 4 very specific elements of care but focussed particularly on pressure ulcers and avoidable falls

 

-          The 96% target for Harm Free Care which, although not met, considerable progress had been made.  Nationally the figure was for acute trusts whilst Rotherham’s was for both the Trust and Community Services.  Rotherham had started to split the figure into “patients in hospital” (had achieved the 96% on 5 occasions over the year and a trend of improvement could be seen) and “patients in their own home”

 

-          There was no intention to separate Community and Acute Services.  The rationale was to enable comparison with the national picture.  Discussions with colleagues had revealed that they wanted to know what their level of performance was which separation of the figures allowed and demonstrated improvements in both.  At the start of the year Community was performing at 91% HFC but was now consistently reporting 93.9%; Acute was 92.31% and now 95.33%.  Separation of the figures allowed focus of the improvement implementation programme

 

-          There was now an experienced Head of Nursing working with the Community Nurses.  Tracey met regularly with School Nursing and the Health Visiting Service.  There was a Project Management Office which was working hard on the Integrated Service with a view to delivering a 7 day service

 

-          As previously reported, the 52 weeks waiting time target had not been achieved.  This was made up of 10 patients all of whom the Trust had been in contact with and 6 had now completed their treatment pathway

 

-          It was quite an ambitious Friends and Family Test and, whilst the national target had been achieved, the stretched target had not.  This would be carried forward to next year

 

-          2 measures of infection control, MSRA and Clostridium Difficile, were measured.  There had been no cases of MSRA and had not been for 3 consecutive years.  The target for Clostridium Difficile was no more than 24 cases throughout the course of the year; there had been 32 cases within the Trust.  All of the cases were reviewed by Public Health England and the Clinical Commissioning Group.  Only 1 of the cases was as a result of a lapse of care

 

-          Informal complaints typically were those made via contact with the Patient Experience Team regarding cancelled appointments asking when they would be rescheduled.  This information was previously not captured

 

-          Formal complaints would often arise from someone presenting themselves to the Patient Experience Team via telephone, email etc. with a list of concerns about the care received which required a thorough investigation and a formal written response.  The Trust had committed to personal contact and establishing more meetings and was partly why the timescale had not been met due to the inability to hold the number of meetings with families and clinicians within the 25 days’ target set

 

-          Claims for financial compensation were not managed through the complaint process.  There was the ability for small ex gratia payments but everything else was taken through the Legal Services route

 

-          The Trust was very clear that it would commit to what every level of commitment was required to the Multi-Agency Safeguarding Hub (MASH) based in Riverside House.  An experienced Health Visitor Team Leader had been seconded who would help share the Trust’s views on the level of input from the Trust

 

-          The Trust would be attending all meetings of the Improvement Board, the Local Safeguarding Children Board  and Health and Wellbeing Board and support the Commissioners in their objectives for Rotherham.  It was suggested that the Quality Account include more on the specific detail of the Trust’s involvement in CSE partnership working

 

-          It was noted that further scrutiny of the response to CSE was planned in the work programme following the work by Overview and Scrutiny Management Board in December

 

-          Members asked if due to patient confidentiality whether information such as a patient presenting at a hospital who was a CSE victim was shared with GPs?  It was verified after the meeting that this information was not shared with GPs unless it was the victim’s wish (this happened in all sexual related services)

 

-          The draft report from the CQC inspection of LAAC and Safeguarding had not been received yet but would reference Health’s contribution to the work.

 

-          Representatives of South Yorkshire Police had participated in the Trust’s education and training.  Discussions were also taking place regarding the level of enhanced training that may be required for School Nurses

 

-          The Trust was actively recruiting for a Medical Director

 

-          Throughout all the training that was now provided in the Trust “professional curiosity” obligations were built in.  Recruitment within the organisation was taking place for colleagues within each division to act as Speak Up Champions so people could have professional curiosity and start to enquire and would know how to raise concerns through the Champions

 

-          There would be future challenges including new services that would impact elsewhere and it was a case of capacity to deliver and still meet the standards. There was no doubt that the next year would be very challenging and the Quality Assurance Committee had set stretched targets in relation to quality and improvement.   Working with partners would remain important as was the help of RDaSH and continued working with GPs and PCT in relation to the front door service

 

-          Delayed discharges was still an area for improvement looking internally first at areas such as timely Section 2 and Section 5 referrals and continuing to workwith social care partners

 

It was noted that the Clinical Commissioning Group was in the process of renewing their 3 year strategic plan and had recognised the need to focus on children and child sexual exploitation.  The Health and Wellbeing Board was also reviewing its Strategy which would have a sharper focus on those issues.

 

Tracey and Hilary were thanked for their presentation.

 

Resolved:-  (1)  That the presentation be noted.

 

(2)  That any comments on the draft Quality Account be forwarded to the Chairman or Janet Spurling before 27^th April, 2015, for collation into the response to the Foundation Trust.