Agenda item

To receive and comment on the draft report of the Croydon Health Service and NHS Trust

The draft annual quality account was presented to the Sub-Committee for comment.

Members were informed of some of the highlights of 2017/18 which included the following:

•Infection Control- There were a number of areas where the trajectory around infection control such as MRSA and C Deficile came under recommended level; and performance was very good.

•Winter Pressure - There was a huge demand for service which was managed very well. The local outbreaks of norovirus was well contained.

•Cancer performance and reaction to treatment had seen some improvements.

•CQC Inspection – The Trust was rated good in all core services, there was however further work to be done to improve across services.

The priorities for 2018/19 included the following:

•Improvement of patient experience though on going work identified through the friends and family feedback and annual survey response.

•Appointment of a senior practitioner from SLaM to collaborate on issues identified in the care pathway.

•Mental health identified as a national priority and in particular Croydon will look at its acute pathway.

In response to a Member query on what was meant by ‘enhancement to the critical care unit’, officers stated that it was recognised that the environment in terms of capacity, size and facilities were in need of expansion. The CQC highlighted issues with the physical environment and a business case had been logged to expand the unit.

Members raised concerns on care pathways for patients that presented with mental health issues or crisis and the facilities and provision in place.

Officers responded that this remained a priority. They were aware that there was currently limited facilities in the department for their care and treatment at present due to the constraints of the temporary emergency department, when the new facility opens this will improve. They were currently working with partners on a review of pathways and were working with SLaM to ensure the appropriate level of staff were available to respond to demand.

Members requested clarification of the CQC rating which showed that critical care was rated as ‘required improvement’ and three other services rated as good. The overall rating was ‘required improvement’.

Officers responded that the CQC had made changes to the assessment criteria, they had not reviewed core services and this would happen later in the year, the rating would then be amended to reflect that review.

In response to a Member question on the challenges of recruitment, officers stated that recruitment remained a challenge, in particular in retaining senior level staff and specialists. Flexible working also had an impact on staffing levels during core hours. The Members praised John Goulston, Chief Executive, Croydon Health Services NHS Trust on the work done in transformation of recruitment and noted the progress made in this area to date.

In response to a Member question on the process of determination of priorities for each year, officers responded that whilst national guidance was received and considered there was local flexibility on the priorities selected. A list of priorities were drawn each year from which a selection was made following a thorough process of consultation with external stakeholders.

A Member requested further data on the Department of Health (DoH) mandatory indicators. Officers stated that data was still being collected and this could be reported to the Sub-Committee at a future meeting. Officers were able to inform the Sub-Committee that incident reporting figures had improved, data on mortality instances were lower than expected. Patient safety incident reporting had increased but these were no harm incidences which was encouraging.

A Member raised concerns that staff uptake of the Flu vaccine remained moderate for an acute hospital and queried how this would be managed in the next year. Officers responded that uptake of vaccine by staff remained a personal choice and the evidence gathered by the Trust each year was used to change tactics on encouragement. Staff had varying reasons for lack of uptake including cultural reasons and management had spent time with staff to address myths associated with vaccines.

The Director of Public Health stated that immunisation was very complex and although the uptake was moderate it was better that in some boroughs. There was still extensive work to be done and staff in all services would be worked with closely to encourage increase in take up of vaccines.

The chair thanked all officers for attending, the openness to working with Scrutiny over the years and wished all officers moving on all the best for the future.

The Sub-Committee response to the Quality Accounts

Members of the Health and Social Care Scrutiny Sub-Committee welcomed the opportunity to provide comment on the draft quality account.

The Sub-Committee agreed in the first instance that the information presented in the draft quality account did not include sufficient information to enable robust comments to be made, in particular in relation to data which was still being collected. This was an issue that occurs every election year due to the variance in timetables for the National Health Service and that of Local Government.

The Sub-Committee Members did however acknowledge that there had been notable improvement in services over the years and welcomed the hard work that the retiring Chief Executive John Goulston had done on the transformation of the service. Many of the priorities set were improving well with many fully achieved already.

The Sub-Committee welcomed the actions that were being undertaken to improve quality and standards across the whole service and recognised that there was still more to be done to improve and sustain customer satisfaction whilst improving standards of care.

The Sub-Committee was encouraged to hear of the successes of 2017/2018 which saw good performance trajectories around infection control. They were also pleased with the amount of work that had been carried out on engagement with staff, specifically the ‘Listening into Action’ programme to promote inclusion, address staff morale and areas requiring quality improvement.

Whilst the Sub-Committee remained encouraged with achievements of the Trust to date, there were still areas of significant concern. In particular, the care pathway of patients presenting with Mental Health needs.  The Sub-Committee felt that senior management were lacking in the ability to provide detailed information on this important area when questioned or data on the experience of individuals. The Sub-Committee was however reassured to learn that this was one of the priorities for 2018/19, with the physical environment for patients upon initial attendance to the emergency department identified as one of the fundamental areas that required immediate attention. Further evidence of the impacts of the measures that will be put in place and the patient experience would be required as part of the scrutiny of Croydon Health Services over the next year. It was of paramount importance that stakeholders and partners continue to be proactive in working together to ensure investment, improve quality and influence improved outcomes in this area.

It was also highlighted that the staff take up of the Flu vaccination was moderate for an acute hospital and whilst it was recognised that the uptake of vaccinations was sometimes controversial and that the reasons for lack of uptake  in general is complex, more work was required in this area.

The Sub-Committee was encouraged to learn that changes had been made to contracts of employment that now included a mandatory requirement for staff to be immunised. Further robust work was needed to encourage and influence all staff, practitioners, and partners to take up vaccines to protect themselves and the members of the public that they serve.

The Sub-Committee thanked CHS for all the work that had been completed to date, and looked forward to continually building on the working relationship.