Report of the NHS Trust.
The Sub-Committee received the Quality Account 2018-19 of the London North West University Healthcare NHS Trust, which had similarities with those of the reports considered at Minutes 43 and 44 in terms of the improvements made in the provision of care.
The representative of the Trust introduced the report and summarised the progress made. He stated that the Trust was placed 10th in the country in terms of mortality rates. Northwick Park Hospital was the second busiest in London but considered to be the most improved hospital in terms of its performance.
The representative added that the Trust’s Transformation Programme focused on its staff and provided development opportunities. Staff retention was also key. The Trust was working towards becoming a digital exemplar and praised the work carried out by Imperial College NHS Trust in this area. Work on a new electronic patient record was underway and he outlined the progress made in the various priorities of the Trust. He reported that it was important to ensure improvements were sustainable.
Members of the Sub-Committee asked the following questions which were responded to:
Q -In relation to the development of the workforce, had this been sustainable?
A - The Transformation Programme had helped to ensure the development of staff. Data was being used to compare services. Retaining staff was an issue but the situation was improving. Various measures such as health and wellbeing initiatives, effective communication, training and a zero tolerance approach to bullying had helped. New initiatives such as the introduction of ‘speak up’ guardians had helped to establish trust with staff and to show that they were being listened to. The Trust continued to use agency/bank staff. Staffing numbers were reported on a monthly basis. Safe rostering arrangements had also been put in place.
The Trust was undergoing a journey of continuous improvement and supporting staff to embed a ‘can do’ culture. Individual Wards were visited to monitor and resolve behavioural issues.
The Trust was experiencing problems when patients remained in the hospital(s) longer than required thereby creating blockages.
Q -Maternity services were flagged by CQC as needing attention. The Quality Account states that the physical environment in maternity services has improved – what are these changes and what does this mean for women using the service?
A - Another representative of the Trust reported on the provision of maternity services. She explained that a greater focus on staff working in this area, including their training needs, had to helped deliver improvements in the care provided and there had been an alignment with national standards.
Members were also reminded that the majority of the recommendations in the CQC Inspection Report had related to security, operation of the bleep system and tailgating. These issues had been addressed and audits were undertaken to ensure that the measures put in place were working. Compliments and complaints were shared with staff, particularly in relation to ‘after care’. All complaints were taken seriously and addressed. The intention was to ensure that staff in maternity services provided a consistent service and the Trust was looking at a revised model of care.
Additionally, the Trust was building a library of patient stories which would be used to educate and develop staff. Patient stories had proved to be a powerful tool in improving care.
Q -Emergency Department performance was the third most improved in the country since January 2017 and there had also been an increase in the number of attendances at A&E. How did this translate into an improved experience for patients?
A - A representative of the Trust outlined the following:
- patient and ambulance waiting times had been reduced;
- improved processing and pathways had helped to move patients out of A&E into Wards, where required. A better flow within the hospital system had been introduced;
- length of stay in hospitals had been reduced by working with clinicians and partners, such as the CCG and care homes. Earlier doctor visits to Wards (Ward rounds), improved working with hospital pharmacies, better management of prescription charts and improved transport facilities had also helped reduce waiting times and improve patient experience.
In relation to the question on warning notices issued by the CQC, some related to the critical care provided by the Trust. The notice focused on the number of beds provided and their location to perform emergency life saving care and treatment. Additionally, there were insufficient hand washing facilities to mitigate the risk of cross contamination. These matters including other warning notices were being addressed.
The staffing levels in A&E had been improved. The team had developed a ‘WOW’ campaign and awards to team members had been introduced for those who went the ‘extra mile’.
Q -What measures had been put in place to improve communication?
A - The adviser on the Sub-Committee, Healthwatch Harrow, stated that his organisation had met with the Trust regarding this matter and he cited the examples of the poor telephone system and appointment letters. Discussion were continuing in this regard.
Generally, the care provided at Northwick Park Hospital was good but poor communication methods resulted in adverse comments from patients. A representative from the Trust acknowledged that the response rates of switchboard operators needed improving.
RESOLVED: That the London North West University Healthcare NHS Trust’s Quality Account 2018 - 2019 be noted.