Dr Hilary Lloyd, Chief Nurse and
Dr Mithilesh Lal, Associate Medical Director will be
in attendance to present South Tees NHS Foundation Trust’s draft Quality
Account for 2022/2023.
The Health Scrutiny Panel welcomed the
opportunity to consider the South Tees NHS Foundation Trust’s draft Quality
Account for 2022/2023.
written response, detailing the scrutiny panel’s comments and feedback, needed
to be submitted to the Trust by Monday, 26 June 2023.
meeting, the Trust’s Chief Nurse and Associate Medical Director were in
attendance to provide
an outline of the priorities for
improvement and the quality of services at the Trust.
The Associate Medical Director advised that, in
2019, an inspection had been conducted by the Care Quality Commission (CQC) to
review whether the services provided by the Trust were safe, caring, effective
and responsive to people’s needs. Following the 2019 inspection, the CQC had
rated the Trust as ‘Requires Improvement’. However, the scrutiny panel was
advised that a more recent inspection had been undertaken in November 2022,
whereby the CQC had upgraded the Trust’s rating to ‘Good’. The scrutiny panel
congratulated the Trust on that significant achievement and commended the hard
work, commitment and dedication of its staff.
In terms of the 2019 inspection, the Chief
Nurse explained that three areas had been rated as ‘Requires Improvement’, i.e. ensuring services were ‘Safe’, ‘Effective’ and ‘Well
Led’. The scrutiny panel heard that a significant amount of improvement work had
been undertaken to ensure those areas were now judged as ‘Good’. Members heard
that a new distribution leadership model had been implemented, which aimed to
empower staff members and involve them in decision-making in respect of the
management of resources and the delivery of care in the hospitals and
communities. The scrutiny panel welcomed those practices that had been adopted
to promote a positive culture that supported and valued staff.
The Associate Medical Director advised that
more doctors, nurses and midwives had joined the Trust
and recruitment remained a key focus. It was also commented that the Trust had
experienced the largest national increase in the number of staff members who
would recommend the organisation as a place to work.
The scrutiny panel was advised that there was a
continued commitment of staff members in ensuring access to services and care.
Members heard that, since 2019:
2 million outpatient appointments had taken place;
a million diagnostic scans had been undertaken;
surgical procedures had been performed;
had been delivered closer to home for more than 3 million patients;
than 0.5 million had accessed accident and emergency care facilities.
The Chief Nurse advised that the Trust’s staff
teams had worked incredibly hard to improve the quality of care for all
patients and the Trust was delighted that it had been upgraded to ‘Good’. It was highlighted that the Trust had become one
of the first acute hospital trusts in England, since the start of the COVID-19
pandemic in 2020, to achieve a rating improvement to ‘Good’ from the CQC for
the care delivered to patients and service users. It was commented that the
staff at the Trust should feel immensely proud of that achievement.
Members heard that the Trust continued to focus
on promoting the safety and wellbeing of staff members, patients, and service
users. It was acknowledged that improvement work would continue, to enable the
Trust to recover from the detrimental impact of the pandemic. The Trust’s
Quality Priorities for 2023/24 were outlined to the scrutiny panel:
In terms of Safety:
Trust would continue to develop a positive safety culture, in which openness,
fairness and accountability was the norm.
Trust would continue to optimise its ability to learn from incidents, claims
and inquests to improve outcomes for its patients.
Trust would increase medication safety and optimise the benefits of Electronic
Prescribing and Medicines Administration (ePMA).
In terms of Clinical Effectiveness:
The Trust would ensure continuous learning
and improved patient care from Getting It Right First Time (GIRFT), a national
programme that undertook clinically-led reviews, and clinical audits.
The Trust would strengthen the mortality
review processes, ensuring learning from deaths was triangulated and shared.
In terms of Patient Experience:
Trust would implement the Patient Experience Strategy that had been developed
in collaboration with its patients, carers and HealthWatch.
Trust would develop and implement a Mental Health Strategy to improve care and
share learning for its patients who had mental ill health.
Trust would develop and implement shared decision making and goals of care.
The Associate Medical Director advised that the
Trust’s Digital Safety and Quality First Programme 2022-24 planned to introduce
digital systems, including:
Patient Records - A digital based notes record system, which would replace a
paper-based recording system and allow easier storage, retrieval
and modifications to patient records.
Prescribing and Medicines Administration (EPMA) - a system, which would allow
prescriptions to be transmitted and populated electronically, replacing paper
and faxed prescriptions.
Members heard that the implementation of a
record system planned to allow access to a single on-line patient record, which
would integrate with other electronic systems, such as GP records. It was
commented that the introduction of the system would undoubtedly improve the
coordination and delivery of care. In addition, the implementation of the EPMA
planned to reduce the number of prescribing errors.
In response to a Member’s
query regarding challenges faced by the Trust, the Associate Medical Director
explained that the COVID-19 pandemic had been an extremely challenging time and
there had been capacity issues, particularly in respect of intensive care
services. To cope with increased demand, many non-urgent appointments had been
put on hold and many services reduced, which had resulted in a major backlog
for the Trust. In addition, workforce issues had been encountered by the Trust,
with high staff sickness levels being reported, which were often due to
COVID-19 related sickness.
In response to a Member’s
query regarding the amalgamation of the trusts, the Chief Nurse advised that a
decision had been made for South Tees NHS Foundation Trust to come together
with North Tees and Hartlepool NHS Foundation Trust to form a hospital group.
It was commented that the move planned to support shared goals by formalising
the way in which the Trusts worked together in the interests of the people and
communities across the Tees Valley. By forming one hospital group, the Trusts
could learn rapidly from one another and the
professional knowledge of senior clinicians (across both organisations) could
be accessed to facilitate effective learning, secure improvements and support
change. It was highlighted that effective planning of the merger would be of
critical importance, to ensure that high-quality patient-centred services
across the Trusts were developed and maintained. The Director of the North East and North Cumbria ICB advised that the Trusts had
previously worked well together to determine new concepts and models in respect
of the delivery of urgent care, which focussed on learning opportunities
identified at the Urgent Treatment Centre based at North Tees. It was envisaged
that joint working would enable the Trusts to share best practice and resources
and enable the development of new improved models and pathways for delivering
care across the Tees Valley. The importance of joint working in relation to
health outcomes, to promote good health and prevent ill health, was also
highlighted. The Director of the ICB advised that the Health Inequalities
Board, a partnership group (involving public health colleagues, the ICB and the
Trust), regularly discussed the factors that influenced and impacted on health
outcomes for people across South Tees to ensure timely access to targeted
support, care and treatment.
A Member raised a query regarding the pressures
faced by urgent and emergency services. In response, the Director of the ICB
advised that discussions were being held regarding the potential future
development of an Urgent Treatment Centre (UTC) on the site of James Cook
University Hospital, which planned to manage and mitigate the current demand.
Furthermore, the Chief Nurse advised that work was being undertaken to reduce
avoidable emergency admissions. That work included signposting to the right
In response to a
Member’s query regarding patient experiences, the
Chief Nurse advised that a Mental Health
Strategy and a Patient Experience Strategy were being implemented. It was
commented that those strategies demonstrated a positive commitment, from the
Trust, to ensure:
staff members were able to recognise and
respond to patients with mental health needs; and
patients felt respected, supported
and were able to raise concerns
A Member raised a query in respect of Clostridioides difficile (C. difficile). In response, the Chief Nurse advised that the
rates of incidence associated with Clostridioides
difficile (C. difficile) infections had increased nationally, however,
infection control remained a key priority and an ongoing focus for the Trust.
It was highlighted that high standards of infection control practice were
promoted to minimise the risk of occurrence. It was also advised that the
pandemic had resulted in an increase in health care associated infections.
A Member queried the reasons for the Trust not
completing some of the national audits, such as the National Obesity
Audit. In response, the Chief Nurse
explained that difficulties had been encountered in responding to some audits,
as patient records were currently paper-based. It was
commented, however, that once the digital system was implemented, patient
records and associated data would become more easily accessible.
A Member expressed concern in respect of the
Trust’s performance against national priorities. The Chief Nurse advised that
the Trust had faced many challenges since the pandemic
and it was working hard to address those areas and improve performance
A discussion ensued and the scrutiny panel was
supportive of the 2023/24 priorities and looked forward to continuing to
receive updates on progress during the year ahead. The scrutiny panel wished to
place on record its gratitude for the significant and widespread improvements
that had taken place over the last year by staff across the Trust. It was commented
that the Trust was truly committed to ensuring that its specialist, acute and
community services provided people with safe, effective, compassionate
and high-quality care. That had been evidenced, not only by the recent results
of CQC inspection, but also by the Trust’s future priorities and its continued
commitment to improvement, promoting best practice standards and developing
responsive and receptive patient centred services.
That the South Tees Hospitals NHS Foundation Trust’s
2022/2023 Quality Account document be noted.
That a letter containing the comments made by the Health
Scrutiny Panel, in respect of the 2022/23 Quality Account, be sent to the Trust
by 26 June 2023.