Agenda item

To consider a report of the Chief Nurse & Director of Quality Governance, Stockport NHS Foundation Trust.

The report will be a draft of the 2017/18 Quality Report for the Stockport NHS Foundation Trust, which sets out the performance of the Trust against a range of priorities.

The report is being submitted late in draft form to enable the most up-to-date information to be presented to the Scrutiny Committee. Due to the timing of the meeting certain data will be missing from the report.

The Scrutiny Committee will be invited to consider the report and provide feedback.

Officer contact: Gareth Longstaff, 0161 419 4872, gareth.longstaff@stockport.nhs.uk

Alison Lynch, Chief Nurse and Director of Quality Governance and Helen Howard, Deputy Chief Nurse at Stockport NHS Foundation Trust, attended the meeting to present the draft of the Trust’s 2017/18 Quality Account (copies of which were circulated) as required by the Regulator, NHS Improvement. The report gave an overview of performance in the past year in relation to quality achievements and improvements in patient care and experience. Due to the timing of this meeting it had not been possible to include all relevant data within the documentation.

The following comments were made/ issues raised:-

·      Concerns were expressed about levels of staff satisfaction and the potential negative effects of the manager’s discussion guidance in relation to sickness absence by making staff fearful of taking time off when unwell. In response its was stated that the Trust was not aware of any concerns expressed about the new approach that had been introduced in order to regularise practice when reporting sickness by ensuring that notice was given to an employee’s line manager rather than a third party. It was also reported that the Trust experienced good attendance in particular work areas, but the Trust was engaged with NHS Improvement to address challenges around recruitment, retention and attendance.

·      The Trust’s focus on healthy eating was welcomed but assurance was sought that staff were able to take appropriate breaks and have access to healthy food during those times. In response it was stated that the Hospital had a fantastic canteen facility for staff, patients and families, although this was only available during the daytime. The Trust was committed to ensuring staff took appropriate breaks and senior management were working o make sure this policy was consistently applied. The beneficial effects of breaks on staff wellbeing and productivity were stressed.

·      Assurance was sought on whether work to improve discharge was leading to improvement. In response it was stated that a range of partners were engaged in activity to improve this multifaceted problem, and actions included measures such as planning discharge on admission.

·      Concerns were expressed about the spike in the number of patients waiting 12 hour for admission, and it was queried why there was no reference to ambulance turnaround times within the report. In response the poor performance in respect of breaches of the 12 hour wait was acknowledged as was the extremely poor experience this would be for patients and family members. Assurance was given that each breach was investigated and no medical harm was found to be caused to the patients as a result, although the harm caused by the poor experience was recognised and taken seriously by the Trust. Additional staff resources had been deployed in response and the Trust was endeavouring to avoid similar breaches in the future.

·      It was commented that there was no reference in the report on measures to address the high number of attendances to the hospital. In response it was stated that there was no specific target the Trust was able to use, but that narrative information would be provided.

·      In relation to efforts to reduce falls in hospital it was stated that the Trust was working to better implement the NICE guidance.

·      Clarification was sought on whether a 2% target of reducing use of anti-biotics was sufficient given the threat of anti-biotic resistance. In response it was stated that this was a target imposed on the Trust but that a 2% reduction would have statistically significant effect.

·      Concerns were expressed about performance in relation to microbial infections and sepsis, and clarification was sought on what measures were being put in place to address these issues. In response it was stated that a review of procedures and clinical governance had been undertaken, working with colleagues including those from Public Health. Improved measures included specialists undertaking rounds on wards.

·      The low rates of CDiff/ MRSA infections were welcomed.

·      Further information was sought on improving the assessment of chronic wounds. In response it was stated that this was an NHS wide issue and failure to assess and respond correctly could be very costly and distressing. Improvement measures was being led by nurses both in the hospital and in the community.

·      Experience of patients discharging themselves from hospital because of disruption to sleep on the wards caused by other patients was highlighted. In response regret was expressed that any patient felt the need to discharge themselves in these circumstances.  Assurance was given that the Trust had developed a dementia strategy to address some of these issues, but also to work with patients become isolated and withdrawn. The Trust was also committed John’s Campaign to help improve how those with dementia and their carers were cared for while in hospital.

·      Assurance was sought that the Trust was addressing pressure ulcers. In response it was stated that there was lot of good work taking place with partners to address this and that there had been a reduction in the previous 12 months, although one ulcer was one too many because of the harm being caused by them. Nevertheless there was a lot of positive work and energy and the plans in place were robust.

·      Further information was sought on the role of advance nurse practioners and similarly trained staff being used to relieve pressure in ED. In response it was reported that there were several such nurses in the Trust undertaking these roles and that the experience of their contribution had been positive. Nevertheless it was acknowledged that there was a need to ensure the right balance of staff within any department, and further work was underway to involve more mental health nurses to augment this approach.

·      Concern was expressed that the CQUIN target regime had changed from locally driven improvement to nationally imposed with financial incentives that might not necessarily match local need and was using more resource to achieve than was received back from meeting the target. In response it was stated that even without the requirements to achieve the CQUIN targets the Trust would likely be spending resources to seek to make improvements in the same areas. Of the nine CQUIN areas in the report, it was likely that the Trust would have chosen these if there were still locally determined targets.

·      Efforts to improve prevention, even if this meant putting oneself ‘out of business’ were welcomed.

·      The good work of the Trust in relation to bowel cancer care were highlighted and welcomed.

·      It was queried whether flu vaccination could be made a condition of service to improve take-up and protect patients. In response it was reported that the Trust had reached its CQUIN target of 71%, but the Trust was no complacent and asked staff to explain why they had not had a vaccination. Imposing the vaccination by making it a condition of service could only be done nationally. It was confirmed that the Trust was already planning for next year’s vaccination programme.

·      It was commented that personal experience of care at the Hospital had been fantastic, and the Stroke Unit in particular was singled out for praise.

RESOLVED – (1) That Alison Lynch and Helen Howard be thanked for their attendance and presentation.

(2) That the draft Stockport NHS Foundation Trust Quality Report for 2017-18 be noted and that the Chair be authorised to agree to an accompanying statement to the report.