Cllr Carole Bonner nominated Gary Hickey as the Sub-Committee's Non-voting Co-opted HealthWatch Croydon Member. The nomination was seconded by Cllr Andy Stranack. Gary Hickey was duly appointed as HealthWatch Co-optee on this sub-committee.

Both sets of minutes were approved by the sub-committee.

There were none.

There was none.

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The following officers were in attendance for this item:
- Neil Robertson, Service Director and Croydon Lead
- Amanda Pithouse, Director of Patient Experience and Quality and Deputy Director of Nursing
- Rachel Flowers, Director of Public Health

The Sub-Committee was given a presentation on the Trust's Quality Accounts. It included the following:
- The Trust's ten aims for their five year Quality Strategy (2014-2019)
- Quality priorities for 2016-2017
- Improvements achieved in 2016-2017 including reductions in restrictive interventions and improvements in risks assessments and care plans, physical healthcare screening and in carers' assessments
- Priorities for 2017-2018 in patient safety, clinical effectiveness, patient experience, as well as staff experience, a new priority for the Trust

SLaM representatives acknowledged that the quality account provided to the Sub-Committee was a very early draft and stated that the final version would be published in June.

Members expressed concerns regarding the high levels of staff illness (46%) reported in the quality account. They were advised that
"return to work" interviews were being used to assess staff stress levels and provide appropriate support.

Members noted the 11 new priorities for 2017/2018 and asked whether SLaM had the resources to meet them as they had only achieved four out of their 9 objectives for 2016-2017. They were informed that SLaM had worked with the Institute for Health Improvement to set appropriate targets and that quality improvement methodology had been improved.

SLaM representatives were questioned on community mental health services. They stated that at least 80% of their service users were outpatients although inpatients were the main focus of CQC inspections. Members enquired whether the Trust would prioritise differently if there were a lighter inspection regime. Officers acknowledged that outpatients were not the main CQC focus but that the engagement of CQC was now becoming more positive and meaningful.

Members asked to what extent patients had a stake in managing their treatment. They were advised that in a community environment, there was significant engagement with patients on their type of treatment. In the case of psychological therapies, the first two appointments involve discussions on patients' priorities.

The Sub-Committee discussed the Trust's approach to absconders and male suicide. In both cases, representatives of SLaM stressed the need for partnership work with key stakeholders such as the police and railway staff.

The Sub-Committee sought assurances about the level of partnership with the public and were advised that there was patient and public involvement at Trust level and departmental level, looking at the quality of services and also taking part in some interviews. The Trust also has an involvement strategy for carers of mental health patients and meets regularly with representatives of the mental health charity MIND to discuss ongoing issues.

Members noted with concern that the 2015 CQC inspection had revealed that elderly patients' wards did not receive as good a service as other wards. Trust representatives stated that CQC had carried out a reinspection two months before this meeting with positive results in this respect.

Members turned their attention to the 40% target for reducing the number of transfers of adult patients to private "overspill" beds due to local shortages, and noted that this target had not been met. In answer to a member question, Trust representatives explained that patients had to be admitted to hospitals in Surrey, Sussex, or as far away as Hertfordshire.

The Sub-Committee commented on the high levels of bullying of staff by other staff. Trust representatives stated that this was also very much a concern for them although they were also making efforts to foster a culture in which staff would feel free to report such incidents. To this end, the Trust had implemented the recommendation previously made in respect of Mid-Staffordshire Hospital to develop a team of "Freedom to speak out" ambassadors to ensure that such practice could not be perpetrated.

Members expressed concerns over the percentage of staff working extra hours. Trust representatives explained that it offers very good flexibility around staff hours to help balance the Trust's with those of its employees.

Members heard that a lot of work had been carried out on staff appraisals, with a focus on meaningful discussions and staff wellbeing.

Members asked whether there were any alternatives to inpatient care. They were advised that wherever possible, the Trust evaluated whether individuals referred to it could be treated as outpatient, with support from daily multiple visits if necessary. If the individual is alone or isolated, however, inpatient care is often the preferred option. The Trust is working on intervening quickly to deal with acute episodes and on improving crisis management.

In answer to a Member question, Trust representatives gave assurances that its information technology had been fully protected and operational over the previous weekend, unlike that of many other health trusts in the country. The Trust uses Microsoft Cloud and has full "patch" protection against the ransom ware which had brought many organisations to a halt in the past few days.

Members noted that statistics were not available in the report for the following, and asked officers to provide these after the meeting:
- First Episode Psychosis waiting time
- Readmissions to hospital within 28 days of discharge

The Chair thanked officers for their presentation and answers to Members' questions.

The Sub-Committee unanimously agreed to send the following comments to South London and Maudsley NHS Foundation Trust,  to be included in the final version of the Trust's Quality Account:

1. Members expressed their appreciation of the Trust's commitment to engagement from patients, carers and staff
2. Members also acknowledged the challenges faced by the Trust in tackling absconding and male suicide, and in reducing the use of prone restraint to control patient behaviour
3. The Trust's services are commissioned by four boroughs, LB Croydon, Lambeth, Lewisham and Southwark. Members asked for its quality account to include a section on the Croydon context as it is known that the borough has seen a particularly significant growth in demand for mental health services, as shown by the significant rise in individuals presenting at A&E in Croydon with mental health issues but with no previous history of these conditions - a trend unique to this borough
4. Members asked for the Trust to identify the causes of the significant recent growth in need for mental health services in Croydon which was discussed at the meeting and wished to receive more information on unmet need and gaps in provision in the borough
5. Members were disappointed that there were statistics missing from this year's draft quality account (see pages 24, 25 and 27) and asked for future quality accounts to contain complete sets of statistics to inform their assessments and statements on the quality account
6. Members asked for the quality account to provide more information on mental health services in the community as at least 80% of the Trust's service users are outpatients
7. Members expressed their disappointment at the fact that the Trust had not met their target for Priority Seven - Patient Experience; Reducing the number of Acute out of area treatments. They asked for the following year's quality account to provide more detailed information on the out of borough areas where adult inpatients are given acute treatments
8. Members expressed their concerns about the high level of harassment, bullying and abuse including physical violence experienced by staff at work. They look forward to receiving an update in the next quality account showing an improvement arising from measures put in place by the Trust to tackle these issues

 

The following officers were in attendance for this item:
- John Goulston, Chief Executive
- Michael Fanning, Director of Nursing, Midwifery and AHPs
- Janet Coninx, Head of Patient Safety and Risk
- Rachel Flowers, Director of Public Health

Members were given a presentation which included the following information:
- an overview of the Trust and its work
- progress made in 2016-17 against quality priorities
- statistics on complaints
- quality priorities for 2017-18

Officers highlighted the health messages being disseminated on a weekly basis to all staff to help foster good health and prevent illness. The challenge for the Trust will be to evaluate how effective these communications are.

Officers stated that the Trust had a very proactive pharmacy team, which was working on improved information sharing with ward sisters. However, they acknowledged that the Trust still needed to improve on medication safety e.g. storage and administration and stated that a lot of work was being carried out to bring this about.

Members asked whether patient engagement had increased or improved over recent years. Officers stated that the Trust used "Friends and Family" feedback proactively, and shared it with wards and services to bring about improvements to treatment and care. They also pointed to the work carried out through the "Listening in Action" initiative, where "big conversations" had been carried out with the public over the previous 18 months, as well as consultation with a range of service user groups. This includes a mental health liaison service to support patients with mental health issues.

Officers highlighted the fact that Croydon was the only borough with a large increase in patients attending A&E with mental health problems which were previously unknown to SLaM NHS Foundation Trust. In view of this trend, the Trust is considering the possibility of allocating a 24 hour mental health liaison officer in A&E. Officers added that the Trust had a mental health subgroup in the A&E Delivery Board. They surmised that this trend was partly due to evolving demographics and that it might merit closer investigation.

Members questioned officers on the rise in complaints to Patient Liaison and Advice Service (PALS), which had grown from 499 to 617. Officers explained that a great deal of work had been done to make this service more visible, and that the Trust was a victim of its own success as more patients had taken to using this service. In answer to a question on the type of complaint received, officers stated that they were mainly about communication issues and satisfaction regarding care. They added that lessons learnt from the complaints were being shared with directorates and service teams to bring about improvements in care.

Members asked how satisfied patient felt after receiving a reply to their complaints, and requested data on responses given and on the number of ombudsman referrals and their responses.

Members felt that improvement was still required in A&E services. Officers stated that satisfaction with services stood at 89%, broadly in line with the national average, although performance had actually declined over the previous year, having been above average last year. Officers pointed to difficulties in filling vacancies in A&E, particularly for twilight and night-time work, and to issues with staff resilience in this very demanding service.

Officers highlighted the need to speed up social care assessments to free up hospital beds for new arrivals and pointed to a national drive in 2017 to assess all relevant patients for social care services while they are being discharged. It is hoped that this will bring significant improvements in bed availability for next winter.

This Trust was also questioned in IT resilience in view of the previous weekend's ransom ware attack on health trusts. Officers confirmed that this Trust had not been directly affected and that it was "business as usual". Microsoft patches for NHS systems had previously been installed and a lot of work had been done to improve IT resilience. Indirectly, however, the Trust was affected by the need to divert some patients from other hospitals which had been affected by the attack, leading to a rise in the number of cases during the previous weekend.

Members questioned officers regarding pressure ulcers and training to help home carers take appropriate steps to prevent these from developing and thus necessitating a hospital admission. Officers stated that pressure ulcers were not a common cause of attendance at A&E but monitored skin integrity carefully for any patient admitted to hospital. Members observed that good prevention work had previously been carried out with nursing homes and stressed the need for further work in the community to prevent the incidence of pressure sores.

Members discussed the new A&E facilities. Officers announced that the resuscitation unit was due to open by end May, with 6 adult beds and 2 children's beds, up from 4 adult beds and 1 child's bed. The new A&E department would be much larger, with an increase in the number of stations, providing patients with greater dignity and privacy. Officers also pointed out that this brand new unit should increase staff working conditions and satisfaction.

Members commented that they were pleased with the improvements brought about across a number of areas and with officers' positive responses to members' questions.

The Chair thanked officers for their presentation and answers to Members' questions.

The Sub-Committee unanimously agreed the following comments, to be included in the final version of the Trust's Quality Account:

1. Members welcomed the progress made by the Trust in making significant improvements to the quality of their services
2. Members also expressed their appreciation of the Trust's commitment to engagement from patients, carers and staff
3. Members expressed concerns, however, regarding the level of detail regarding complaints statistics: in future, they would value additional figures measuring customer satisfaction at the Trust's responses, and the number of complaints which have been escalated due to complainants' dissatisfaction at the Trust's responses
4. Members welcomed the openness of officers in disclosing that there had been a significant rise in individuals presenting at A&E in Croydon with mental health issues but with no
5. previous history of these conditions. They requested that the Trust conduct further work to identify the causes of this trend and work with South London and Maudsley NHS Foundation Trust to find sustainable ways of addressing these patients' needs. Members welcomed the fact that the A&E delivery board included a mental health subgroup and supported the Trust's aim to employ a 24 hour mental health liaison officer in A&E.
6. Members were disappointed that the very good work previously carried out in the borough and particularly with nursing homes to reduce pressure ulcers had been discontinued, leading to a 12.5% increase in avoidable hospital admissions from 2015-16 to 2016-17. They urged the Trust to resume this work with relevant partners e.g. nursing homes and home carers to raise awareness of the risks, help prevent this condition and thus reduce avoidable pressures on hospital beds.