Agenda item

The Sub-Committee are presented with a copy of the Quality Accounts for the Croydon Health Service NHS Trust for noting.

An update on will also be provided on their priorities for the forthcoming year.

The Sub-Committee was presented with the Quality Accounts for Croydon Health Service NHS Trust (CHS) for their information and comments. In attendance at the meeting on behalf of CHS was:-

·         Matthew Kershaw – Interim Chief Executive

·         Dr Nnenna Osuji – Medical Director

·         Elaine Clancy – Joint Chief Nurse

A presentation was delivered to the Sub-Committee on the Quality Accounts and the plans for CHS over the forthcoming twelve months. During the presentation the following points were noted:-

·         The vision for CHS was to deliver integrated care at every stage of a patient’s life, including at home, in the community and at the local hospitals. It was recognised that the changing needs of the population would increasingly be met through working with partners to deliver services.

·         CHS had approximately 500,000 annual contacts with patients in the community, which was many more than through either emergency or in-patient care. In the past year 3,500 babies had been delivered in the borough including through the award winning home delivery service.

·         More than a third of CHS staff worked in the community. This included the Community Nursing Teams, senior consultants and speciality doctors.

·         Work had commenced on delivering closer alignment between the Croydon Clinical Commissioning Group (CCG) and CHS services which should lead to service improvements for residents and was seen as the next step on the journey to Total Place service delivery.

·         CHS had performed better than the national average in three out of four national indicators, namely in cancer treatment being delivered within 62 days, carrying out planned surgery within 18 weeks and mental health therapy being provided within 6 weeks. The fourth indicator was treatment in Accident & Emergency (A&E) being within 4 hours which was at 84%.

·         Previous inpatient survey results had shown improvement, but the results from last summer’s survey had reported a slight deterioration. To address this the Executive Management team were meeting with staff to communicate expectations and were in the process of delivering an action plan targeted towards the areas highlighted in the survey.

·         Areas identified for improvement included embedding patient safety and shared learning, continued improvement in the reporting of incidents and lessons learnt, continued improvement in listening to patients, improving patient flow through and discharge from hospital. There was also a need to improve the support and care provided for patients with mental health issues such as dementia and alzheimers.

Following the presentation the Sub-Committee was given the opportunity to ask questions with the first asking the representatives from CHS what they thought were the key areas of weakness within their service. In response it was advised that it was proving challenging to achieve the target for emergency care pathways of treating patients within four hours, however this was a common weakness experienced by health services across the country.  Also within emergency care it was recognised that communication between staff, patients and other partners needed to be improved, particularly relating to general care and patient discharge. Although the patient outcomes for CHS were strong, there was a need to improve the overall quality of service provided as the patient experience during their treatment did not necessarily reflect the level of outcome. Finally there was an ongoing concern regarding staffing levels, with recruitment and retention proving to be an ongoing challenge.

Although it was welcomed that CHS was meeting three out of the four national indicators, concern was raised that service improvement might not necessarily reflect the experience of patients on the wards. It was advised that while it was important that services were delivered safely, patient experience was also priority. Both staff and patient engagement was used as an indicator of the quality of service provided and would lead to further improvement going forward.

As it was noted that 14% of patients attending A&E were admitted, it was questioned whether this should be considered to be a normal level. In response it was confirmed that it was important to be able to turn people away safely. CHS worked hard to keep people out of hospital and it was a good indicator that people were being turned away safely, which was benchmarked by monitoring re-admittance rates. It was highlighted that the level of admission through A&E was at a similar level to other health care providers.

In response to a question about the areas to improve following a Care Quality Commission (CQC) inspection, it was advised that there were a number of actions concerned with increasing the level of audit within community services. There were also a number of actions for critical care related to the infrastructure and the need for investment. Another area highlighted for improvement was staffing for services such as speech and language therapy, with a number of steps being taken to deliver the required improvement.

The length of time taken to respond to complaints was highlighted as an issue. It was confirmed that the Interim Chief Executive both received and reviewed complaints received by CHS. The timeliness of responses could be effected by a number of factors including the availability of the correct person to respond to a complaint, as they were often involved in running services. Complaints could also often be complex and require a considerable amount of time to resolve.

An update was requested on the outcomes arising from the recent survey on the priorities for CHS. It was advised that a long list of priorities had been prepared based on discussions within CHS. A short list from this had subsequently been prepared based on patient feedback. It was agreed that further information on the survey and the resultant priorities would be circulated.

Members raised concern that anecdotal feedback from residents seemed to indicate that some patients found the process surrounding their stay in hospital confusing and as such it was questioned whether this was being addressed. It was advised that it was important to strike a balance as many patients went through the system smoothly. However part of this would be addressed through ensuring that staff were both supported and listened to as the environment could be challenging. Notwithstanding the often challenging environment within hospitals, it was important to ensure that staff did not lose sight of the need for effective communication with patients.

In response to a question about the staffing levels in A&E, it was acknowledged that there were challenges in this area. Although there was funding available to fully staff the department, there was at present staff vacancies which were in the process of being recruited to.

It was noted that statistics provided from the Friends and Family feedback highlighted that the number of patients who would recommend the A&E service had dropped from 93% to 76% over the past two year and as such the reasons for this were questioned. It was advised that this could in part be attributed to the temporary A&E facility that was in use before the new facility was opened late last year. There had also been changes made to how feedback was gathered from friends and family which meant that it was now more accurate and comprehensive.

It was advised that a number of new staff initiatives had been launched as a result of CHS being ranked fifteenth out of sixteen Trusts in 2018. The next staff survey was due to be undertaken in the autumn and would be an opportunity to find out whether these initiatives were achieving the desired outcomes.  

It was noted that the staff uptake of the influenza vaccine was 72%, which was a similar rate to peer organisations. However there was an ambition to increase the level of uptake of the vaccination amongst staff with work planned for this area.

It was agreed that a comment would be added to the quality accounts before being published to reflect that the Health & Social Care Sub-Committee had reviewed the document and looked forward to working with CHS in the forthcoming year on their priorities.

The Chair thanked the representatives from CHS for their attendance at the meeting and their openness in responding to the Sub-Committee’s questions. It was also highlighted that it may be useful for the Sub-Committee to arrange a visit to the hospital in the forthcoming year as part of their work programme.

Conclusions

Following discussion of the report, the Sub-Committee reached the following conclusions:-

1.    The Trust meeting three of the four national priorities was to be welcomed.

2.    There was concern raised about the results from the patient and staff surveys which would need to investigated in greater detail in the forthcoming year.