Meeting documents

Purpose:

On behalf of the Committee, the Chairman and two Committee Members prepared a statement in response to the Buckinghamshire Healthcare NHS Trust’s (BHT) Quality Account for 2017/18.  The statement raised a number of concerns around the Trust’s quality priority targets although acknowledging that actions had been identified to improve the situation.  This item will review the areas mentioned and review the progress made to improve the situation.  The Committee will also hear about other improvement projects that the Trust is working on.

Attendees:

Carolyn Morrice, Chief Nurse, Buckinghamshire Healthcare NHS Trust

Tina Kenny, Medical Director, Buckinghamshire Healthcare NHS Trust

Papers:

Presentation from BHT attached

Intended outcome:

For the Committee to be reassured that the necessary improvements have been made in the areas highlighted in the Quality Account and that the targets will be met this year. 

The Chairman welcomed Ms C Morrice, Chief Nurse, Bucks Healthcare NHS Trust and Dr T Kenny, Medical Director, Bucks Healthcare NHS Trust.  He went on to explain that the Select Committee prepared a statement to the Trust’s Quality Account for 2017/18 and highlighted a few areas of concern.  This item would be an opportunity to hear from the Trust’s representatives about the improvements being made in these areas alongside other key improvement projects.

Ms Morrice confirmed that the Trust was committed to learning when things go well and replicating them and learning where things do not go well and making the necessary improvements.  2019/20 would focus on improving quality within the Hospital setting as well as looking at what quality in the home looks like.

During discussion, the following main points were made:

·         In response to a question around prevention, Dr Kenny explained that the CATS service (Community Assessment Treatment Service) was a standalone service within the hubs.  The purpose of the hubs was to keep people healthy and in their own homes for longer by providing care closer to home.  Part of this was about pro-actively going out to GP practices asking them to identify their most frail patients and putting preventative measures in place to avoid crisis situations. 

·         It was acknowledged that the use of the word "hub" can be confusing as it was being used across the system in slightly different ways.

·         In response to a question about the monitoring and reviewing of the services provided within the hub, Dr Kenny explained that there was a very active stakeholder group who were involved in developing the hubs and the technical steering group which looked at the key performance indicators and had general oversight of the piece of work.

·         In response to a question around how the five GP practices were identified, Dr Kenny explained that for the preventative piece of work, it was primarily around those nearest to the hubs but the services provided in the hubs were open to all practices across Bucks.

·         There was work currently underway to look at populations of around 30,000 and looking in more detail at the needs of each area.  It was acknowledged that the needs would be different, for example, in areas with more children there would be a focus on providing more services for children.

·         It was agreed that the development of the new models of care would come back to the Committee over the coming months.

Action: Committee & Governance Adviser

·         The Comprehensive Geriatric Assessment was a national tool used to identify frailty needs.  It was described as a well-developed "gold" star tool.

·         In response to a question about the vision for frailty cafes, Dr Kenny explained that people want to reduce duplication and have clear direction of where to go for services.  Discussions with patients and the voluntary sector had highlighted the need to be flexible and responsive to peoples’ needs.

·         On behalf of the Committee, the Chairman offered to review the draft frailty advice leaflet.  Dr Kenny and Ms Morrice agreed that this would be helpful and they would share an early draft at the appropriate time.

Action: Dr Kenny and Ms Morrice

·         Over the last nine months, the national definitions around Sepsis had changed and the new definition was "suspicion to needle time".  Sepsis still required national development and work was currently taking place to improve the reporting of this both locally and nationally.  Suspicion to needle time would be reported in the next quality account.

·         Dr Kenny confirmed that patients requiring emergency antibiotics could receive them in the ambulance or a Hospital setting.

·         The clinical team understand sepsis and the training referred to in the report was relevant to the whole team and focussed on keeping the patient safe.

·         There were key indicators around sepsis, for example, a patient would not be discharged if they still had a high temperature.

·         Re-admission rates were published and regularly scrutinised to see whether anything could have been done differently to avoid a readmission.

·         The NHS had introduced a standardised approach to quality improvement.  A training programme had been introduced to standardise the quality standards across the Trust. 

·         The ambition would be to have no healthcare acquired pressure ulcers but where there were cases, service leaders were held to account.

·         A number of factors affect MRSA including hygiene and a patient’s own health, in terms of the medicines they were taking.  Observing good hand hygiene was one of the key factors in minimising MRSA cases.

·         Automated, ultra-violet, cleansing methods had been introduced at the front door.

·         There was no national definition of what was meant by avoidable cases and it would be hard to define due to external factors.

·         There was always a challenge around undertaking a de-contamination programme as it required emptying the space.

·         A Member asked about the results from the Friends and Family test.  The A&E team had worked hard to improve the patient experience.  The results continued to be a priority and were used to drive service improvement.

·         Complaints were seen as a way to improve services and there was a drive towards more local resolution of complaints.  It was suggested that compliments as well as complaints should be published.

·         Ms Morrice confirmed that there would not be the same delay in getting the information relating to the quality accounts.

The Chairman thanked the presenters.