Agenda item

Michelle Johnson, Chief Nurse and Director of Patient Experience, and Jonathan Gardner, Director of Strategy and Commissioning, Whittington NHS Trust were present for discussion of this item.

Whittington NHS Trust made a presentation to the Committee, a copy of which is interleaved.

During discussion the following main points were made –

·         There were 108,651 visits to A&E in 2018/19, and 2,224 elective admissions. There has been a 10% increase in A&E attendance in the past year. Work is taking place with primary care and other partners to reduce this number. There were a number of reasons why people were attending A&E but this placed a strain on the Trusts resources

·         It was noted that new procedures had been introduced in ambulatory care which were proving beneficial

·         The maternity staff delivered 3,478 babies, and there were 793,423 contacts with patients in the community

·         The Trust had an annual turnover of £348m, and employs over 4,200 staff. The Trust also works with over 190 volunteers, who support the Trust

·         There have been positive maternity survey results

·         The Trust has the third highest uptake of flu vaccine by staff across London, and the proportion of staff taking part in the staff survey rose to 49.8%

·         The Trust held its first annual staff awards, and was placed 35 overall in the UK, and second in London from the National Cancer Experience Survey

·         The Trust has implemented the updated National Early Warning Score 2 system

·         The Trust participated in 100% of relevant national clinical audits, and 100% of national confidential enquiries

·         Trust staff have received a number of awards, and nominations, in 208/19

·         Financially, the Trust delivered against its year end control total of £22.7m. The financial performance made the Trust eligible for £6.2m in additional incentive and Provider Sustainability Fund funding from NHS Improvement

·         For 2018/19 the Trust reported an adjusted surplus of £28.2m, including £27.6m of PSF income

·         Whilst the Trust met its financial targets for 2018/19, it fell short of its Cost Improvement Target by c£5m, delivering £11.5m versus £16.5m. This creates an additional pressure for the 2019/20 financial year

·         In 2018/19 the Trust set itself 30 quality priorities covering 14 domains. These covered Patient Safety, Patient Experience, and Clinical Effectiveness. The priorities were identified following consultation with staff, managers and stakeholders. The Trust met 25 of its quality priorities, and moved forward significantly with the remainder

·         A number of achievements have been made in 2018/19 in the review of priorities performance including – Family and Friends test results for Podiatry has shown an increase of 150% over the year, due to the utilisation of SMS Friends and Family links sent to patients, and enhanced focus on collecting feedback amongst local teams. A Frailty pathway has been developed for urgent and emergency hospital care. A delirium rapid assessment test, and Delirium Care Plan have been introduced. In addition, an increased number of patients have been recruited to research studies, with 1,023 patients, compared to 751 in 2017/18. Falls - mandatory training has been developed, but more work is needed, and there has been significant improvement in the care of older people. The critical care outreach team reviewed over 90% of patients, with a grade 3 AKI, within 24 hours of detection. There has been a significant increase in the number of people with learning disabilities involved in Trust activities, including a Trust Volunteer team, involved in the Autism project, and offering three 10 week voluntary administrative placements to autistic service users

·         There have been no avoidable grade 4 pressure ulcers, and there has been a reduced number of 2 instances of attributable Trust Grade 4 pressure ulcers

·         The outpatient appointment Trust cancellations rate was reduced by 0.7%, and a number of these appointments that were cancelled were due to a change in time of appointment, rather than date. There is a Trust transformation programme, and this will continue to be part of improvement for 2019/20

·         The 2017 inpatient national patient experience survey presented a marginal improvement on the previous years’ feedback, in relation to food. The Trust has implemented a new patient dining service improvement group, and the contract for patient catering has been transferred back to the Trust management

·         Medicine safety reviews within 24 hours, for patients diagnosed with grade 3 Acute Kidney patients, was not consistently being met, and the achievement was just under the 75% target

·         The target of seeing 75% of patients with an autism spectrum condition, or a learning disability, in the Emergency Department in under 2 hours, is not consistently being met. The campaign for the right to stay with people with dementia, is also still not fully embedded across the Trust

·         Statement of Assurance – the independent Auditors’ limited assurance report stated that the Quality Account has been prepared, in line with the criteria laid down, and the sources specified in the guidance. Also the indicators in the Quality Account, subject to limited assurance, have not been reasonably stated in all material respects, in accordance with the Regulations, and the six dimensions of data quality, as set out in the guidance

·         Priorities for improvement 2019/20 – There are 28 quality priorities (within patient safety, patient experience, and clinical effectiveness domains), that reflect the needs of patients, and the community. In addition, there are 20 new priorities being introduced, and 8 priorities have been retained for reasons of being unmet, making significant improvement over the course of the year, or being of high importance to the Trust. The priorities have been co-developed with clinical staff, managers, patients and external stakeholders, and agreed by all relevant Committees

·         In response to a question it was stated that staff were seeing an increased level of violence from patients and work was taking place with psychiatric teams to help alleviate this

·         Reference was made to the changes being introduced in relation to patient transport and the fact that there had been problems and complaints with the service being introduced, when it had been in operation at Royal Free. It was stated that the changed contract had only been introduced that week in the Whittington and the Trust would be keeping a close watch on how the service is operating and if complaints increased

·         In response to a question it was stated that the Trust had to find savings of £16m and this included the £5m referred to earlier. This was proving very challenging to achieve this level of savings

·         A Member enquired whether the savings proposed compromised patient safety, however the Trust reassured the Committee that this was not the case and savings being looked at were employing more permanent/bank staff rather than employing agency staff

·         Reference was also made to the results of the staff survey on bullying and harassment and that these were not satisfactory. The Trust responded that they shared this concern, however these instances had mainly been confined to specific departments which were under the most pressure. There is a training programme in place for staff and a developmental approach adopted to enable teams to work better together

·         In response to a question on progress of the Estates Strategy, the Trust stated that they had submitted an outline case to NHS England/Improvement and the main priority is the redevelopment of the maternity unit

·         A Member enquired if the increase in A&E attendance was linked to an increase in the drugs trade around Finsbury Park and other areas of the borough. The Trust stated that alcohol was a big problem but she would supply the Committee of details of whether drug use had led to an increase on attendance at A&E. In addition, it was stated that the Trust would supply any details available on the numbers of frequent callers to A&E that did not require A&E attendance and caused disruption

·         It was stated that improvements in technology were being used to assist staff, and that staff on shifts needed to have working conditions improved, such as access to water and toilet breaks. In addition, electric cars are being introduced for community nurses, and also by provision of Oyster cards

·         In response to a question concerning the recent Healthwatch report on the maternity unit culture, and also enquired if there are any plans to downgrade midwives. The Trust responded that work is taking place on the culture issues highlighted in the maternity unit, and that targeted work is taking place. In relation to downgrading of midwives, it was stated that midwives were not being downgraded, however reorganisation is taking place to attract additional staff to support the service

·         Reference was made to the fact that the number of Friday discharges was resulting in difficulties in getting care plans in place in time for patients to be discharged. The Trust stated that it needed beds to be available over the weekend for admissions. The Committee expressed the view that more discussion and liaison needed to take place with providers on this issue

·         In response to a question it was stated that work takes place with mothers to identify any mental health problems, depression etc. and midwives were being given additional training to support them in this

RESOLVED:

That the Committee be provided with details on whether there had been an increase in drug related attendances at A&E, and to provide any available details on instances whereby frequent callers to A&E were impacting on the provision of services

The Chair thanked Michelle Johnson and Jonathan Gardener for attending