Agenda item

Representatives from ST NHS FT will be in attendance to discuss the key performance outcomes for 2019/20, as detailed in the Quality Account document.

In terms of background context the Medical Director at South Tees Hospitals NHS Foundation Trust (STH NHS FT) advised that in July 2019 the Trust had received its CQC inspection report, which had seen the Trust downgraded from a rating of good to required improvement. In September 2019 the Trust had given a presentation to the South Tees Health Scrutiny Panel outlining the areas for improvement and undertaken by the Trust to immediately address the concerns highlighted by the CQC. The Trust had again attended the South Tees Health Scrutiny Panel in November 2019 to update specifically on the changes that had been made to Critical Care Services since the CQC inspection.

 

The Medical Director explained that since the CQC inspection the Trust had been working to 'get back to our best' and a clinical policy group had been established. STH NHS FT was now a clinically led, as opposed to a managerial or operationally led, Trust and clinical priorities directed decision-making.

 

In response to COVID-19 the panel heard that an escalation process was put in place, which ensured that as much high level quality care could continue to be delivered across services, with the James Cook University Hospital (JCUH) site separated into COVID and NON-COVID areas. The same approach was adopted at the Friarage Hospital site to ensure that any mixing was minimised. Testing was also key in this approach. At the start of the pandemic the Trust built up capacity very quickly, from a position of conducting 30 tests per day the Trust now had capacity to conduct 1500 tests per day and those tests could be carried out 24 hours per day.

 

It was advised that throughout the pandemic the Trust had exceeded national emergency guidance requirements. On 12 March 2020 the Trust introduced COVID-19 testing for all admitted patients who met the national case definition (list of symptoms) and on 6 April that was extended to include all inpatients upon their arrival at hospital (irrespective of the case definition). On 16 April 2020 national COVID-19 guidance was published setting out requirements to test patients being discharged from NHS hospitals to a care home. On 21 August national guidance was published setting out the requirements for Hospital Discharge Service: Policy and Operating Model effective from 1 September 2020.

 

In terms of PPE availability and staff testing it was explained that PPE Marshalls had been introduced, as it was relatively easy for cross contamination to take place. Psychological support had been introduced and was available to staff and the Trust had seen lower staff sickness rates when compared to similar Trusts. At the height of the pandemic JCUH had 150 positive COVID-19 patients but the Trust’s resources team had ensured staff never ran out of PPE. A comprehensive risk-assessment process for all BAME colleagues had also been introduced, which was subsequently extended to all staff.

 

In respect of supporting patients and communities it was explained that staff had undertaken kindness calls and used ipads / technology to communicate with patients’ family members. The support received from the local community had also been fantastic and had kept the staff going into recovery. Following the surge a de-escalation process had been undertaken. In respect of recovery it was advised that the four pillars of recovery were; staff safety, patient safety, sufficient resources and clinical prioritisation.

Reference was made to the support provided by the Trust to the wider health and social care system and it was advised that the following support had been provided:-

 

- 600,000 pieces of PPE distributed to neighbouring health trusts and local care providers

- 5,201 COVID-19 test results provided by pathology labs to neighbouring health trusts

- Care home support service led by community matrons delivering full training, advice and guidance package to local care homes

- Online COVID-19 education and training films produced and provided to primary care and social care partners

 

Following the surge the CQC had undertaken a COVID-19 Infection Prevention and Control Assessment and concluded that the Trust had effective prevention and control measures in place. In respect of the number of COVID positive patients on site at JCUH at present it was advised that the number was 25, with 5 of those patients in critical care. The Trust was currently considering reintroducing the escalation process and separating the site, as the figures were starting to increase. It was acknowledged that this time there would be the added complexity of winter pressures but the Trust was confident it could deal with a second surge.

 

The Head of Patient Safety and Quality advised that in terms of the Trust’s Quality Priorities for 2020/21 the following priorities had been agreed:-

 

Safety

 

- Increase incident reporting by 10 per cent per year. This will also mean an increase in incidents reported to the NRLS.

- Reduce the occurrence of Never Events and ensure there is a focus on safe surgical practice including improving the safety culture within theatres and continue the LoCSSIPs work.

- Improve the quality of incident investigations at all levels including those for Serious Incidents and those reported on Datix.

 

Clinical Effectiveness

 

- To identify, develop and implement a Quality Strategy for the trust and embed an agreed approach to quality improvement methodology

- To implement and embed the South Tees Accreditation of Quality Care (STAQC) accreditation process for the trust and the Quality Assurance framework

- Ensure patients have a safe, effective and timely discharge

 

Patient Experience

 

- Continuing work to further develop the patient experience programme using Meridian, specifically focusing on implementation of the new FFT guidance and 'hard to reach' groups.

- Embed the revised complaints management process within the trust in line with the revised Patient and Carers Feedback Policy

- Improve the Outpatients Department (OPD) experience through 'task and finish' groups to review and continue the work that has taken place during 2019/20.

 

Members of the panel expressed their gratitude on behalf of residents across Middlesbrough for the tremendous work that had been undertaken by the Trust in responding to the COVID-19 pandemic.

 

In respect of the Trust’s performance in respect of the 2019/20 Quality Priorities Members raised a number of issues. It was agreed that the points made would be included a letter from the Panel for inclusion in the Trust’s 2019/20 Quality Accounts document.

 

AGREED that a letter be drafted from the Health Scrutiny Panel for inclusion in the STH NHS FT Quality Account document 2019/20. A copy of the letter would be circulated for Members’ approval prior to submission to the Trust by 23 September 2020.