Agenda and supporting papers - Plymouth Hospitals NHS Trust

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Item 15, Annex 1 RB noted that whilst 7 day working for consultants is currently being considered other changes can be made to improve the mortality rate at the weekends. For example, if phlebotomy services coincided with ward rounds there would not be a 24 hour delay in obtaining results, during which time patients can deteriorate rapidly. The Chair asked the Committee to consider what changes to drive improvements can be made within the next 6-12 months. Although this issue cannot be resolved in its entirety within this timeframe particular elements can be focused on. These can then be included within the Trust’s safety improvement plan. AM 6. Effective Care Report The Committee noted the content of the report which focuses on the follow-up backlogs and compliance with NICE Guidance. Capacity for clinical audit within the Trust was highlighted as being particularly small for an organisation of this size. As a result AM and GD are discussing how this can be incorporated within the governance quality team. Follow-up Backlogs The Chair informed the Committee the Non-Executive Directors were particularly disappointed with lack of progress in reducing the outpatient follow-up backlog. It would appear that significant time is being spent trying to complete risk assessments within each directorate and there is not enough focus on resolving the backlog. RB explained there are significant capacity problems as additional funds to clear the backlog of patients are not available within the commissioning contract. This is trying to be done in addition to delivering a normal service. Changes to pathways need to be made to prevent this from being an ongoing issue in the future. We must ensure the correct patients are being added to the follow-up waiting lists for the right reason. The Chair explained risk assessments, as completed within Ophthalmology, need to be in place within all directorates and a review of which patients are being added to the waiting lists needs to be completed. AJ added that a specific plan for each specialty needs to be put in place as each backlog will need to be addressed in different ways. Issues within one area may not be relevant for another. The Chair noted that Ophthalmology remains the biggest concern particularly given the risk for some of these patients. RB assured the Committee that patients who have been identified as high risk are being dealt with as a priority and this has been incorporated within the capacity planning for this specialty. LB highlighted it was still not clear within the report where the high risk areas lie in other specialties within the report. AM explained that Paul McArdle is working with directorates to ensure a breakdown of the risk, as included within appendix 2 for Ophthalmology, is available for all directorates. Report on progress to be brought to the next meeting The Chair summarised that there appear to be continual issues in reducing the follow-up backlog due to the lack of capacity however; high risk patients within all directorates will be identified so that these can be treated as a priority. In addition, service line leads will need to develop local action plans to demonstrate how the overall backlog can be reduced and how pathways for adding patients to follow-up waiting lists will be reviewed. PMc KB 7. Personal Care Report GD presented the Personal Care Report to the Committee and highlighted the following key points – • Publication of results for key performance measures will be reviewed so that the trend analysis for each measure can be reviewed and provide additional assurance • PALS and complaint rates have remained relatively stable during the past five months except for the spike in the number of complaints received in April 2013 GD/JG S&Q Draft Minutes June 13 Page 3 of 7
Item 15, Annex 1 • Top three issues raised through PALS remain as communication, inpatient delays and outpatient delays. Although communication remains a top theme there are no particular areas of concern that could be addressed which would show an improvement in the overall figures of these issues • A particular piece of work in relation to communication is being completed with those who are visually and hearing impaired so that feedback can be used to drive improvements for these care pathways. AJ suggested doing the same with patients who suffer with learning difficulties • The FFT response continues to improve and run charts will be included within the report from next month. The Trust is currently achieving a response rate of 13.5%. Some wards have achieved a 40-50% response rate whilst others have only achieved 4%. Implementation of FFT within good performing areas will be shared to ensure the response rates are increased. The Chair noted that a significant number of the PALS and complaints received within the Trust relate to the Gastroenterology, Surgery and Renal directorate. JG explained the key issues within this area relate to patient access to treatment for example, a number of patients are informed they will be reviewed within 4-6 weeks but the waiting list within the directorate is 12 weeks at that stage. RB noted that there is a strong correlation to the follow-up backlog as this directorate account for half of the admitted follow-up backlog. The Committee took assurance from the content of the report and asked that actions were taken to reduce the PALS and complaint levels in Surgery. JG 8. Safe Care Report AM presented the Safe Care Report to the Committee and highlighted the following key points – • The HSMR and SHMI data demonstrates the Trust is maintaining good rates • In February 2013 VTE cases were identified and each patient had received the appropriate treatment, although 93% of these cases received the appropriate risk assessment • The four yearly GTT report shows there has been a continual reduction in harm caused to patients. Areas identified consistently with top three areas of harm are wound infections, pressure ulcers and hospital acquired pneumonia. All of these are currently being addressed through ongoing work programmes The Chair asked whether specific improvement areas from the Regional Patient Safety Initiative will be incorporate within the overarching quality improvement action plan. AM explained that service line leads will be expected to lead on particular improvements however, Trust wide issues will be monitored at sub-committee or committee level. GTT is an indicated of where the efforts of the Trist must be focused. The Chair highlighted inpatient falls as a particular issue and explained that a particular piece of work regarding intentional rounding was completed at RD&E Hospital and this appeared to have a significant impact on the number of falls. GD added that the implementation of intentional rounding was re-launched at Taunton hospital as it became a tick box exercise. Within two years of this re-launch there was a 30% reduction in the number of inpatient falls. The Chair emphasised the importance of ensuring this is implemented properly within the Trust and that there is culture change. For this to happen within the hospital there needs to be clear leadership. GD and DH are working on getting intentional rounding used within the Trust which will reduce falls and improve nursing care. GD/DH 9. Assurance Framework LB presented a new Quality Assurance Framework to the Committee and asked for their comments and whether any risks were felt to be missing. The Committee asked that the following comments and risks were incorporated within the framework – S&Q Draft Minutes June 13 Page 4 of 7 LB
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Trust Board Friday 5 July 2013, 9.0
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Members of Plymouth Hospitals NHS T
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Item 3 observer. The Chairman requi
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Item 3 Board oversight of contribut
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Item 3 the Board next month. • Th
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Item 3 been involved and there was
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Item 3 continuing to build. Mr Babe
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Item 3 to Norovirus, Professor Lewi
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Item 3 • Careful communication of
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Item 3 • Approved the writing off
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Updated: prior to July Board Item 4
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Updated: prior to July Board Item 4
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Item 8 Quality Impact Assessment Pa
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Item 8 3.2 Quarterly Summary Hospit
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Item 8 4.4 Monthly Proportion of Pa
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Item 8 Inpatient falls are currentl
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Item 8 REI signage PALS were contac
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Item 8 Complaints received listed b
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Item 8 The graphs below illustrate
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Item 8 5.5 Friends and Family Test
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Item 8 1. Pressure Ulcers (EoC) 2.
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Item 8 Observations The essence of
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Item 8a SUMMARY REPORT Trust Board
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Annex 2 Item 8a Summary of Serious
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Item 9 Key Recommendations The Trus
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Item 9 Effective Care (Section B2 o
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Item 9 Description 31 days from 'de
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Item 9 4.6 Non Elective Activity is
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Item 9 Summary of performance excep
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Item 9 Ensure that all patients adm
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Item 9 Forecast Significant progres
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Item 9 Update on previous actions C
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Contents EXECUTIVE SUMMARY D FINANC
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B1 Safe care Description Hospital S
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Response Rate Recommender Score B3
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B5 Other safety & quality metrics D
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C2 Non-Elective Activity Descriptio
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C4 Referral To Treatment (RTT) Desc
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C6 Other access & activity metrics
Page 79 and 80: D2 Cost improvement programme (CIP)
Page 81 and 82: D4 Cash Management Description Revi
Page 83 and 84: E1 Staffing numbers Description Est
Page 85 and 86: E3 Sickness absence PERFORMANCE IND
Page 87 and 88: Risk Rating F2 Monitor's Financial
Page 89 and 90: Item 10 DETAILED REPORT Trust Board
Page 91 and 92: Item 10 4. Key Issues for the Board
Page 93 and 94: Item 11 SUMMARY REPORT Trust Board
Page 95 and 96: Item 11 DETAILED REPORT Trust Board
Page 97 and 98: Item 11 • Challenge in respect of
Page 99 and 100: Item 11 Over the past two years, me
Page 101 and 102: Item 11 Getting it Right Charter An
Page 103 and 104: Item 11 Outcome of review with exte
Page 105 and 106: Item 11 Learning Disabilities Natio
Page 107 and 108: Item 11 Peer Review 2.5 Peer Review
Page 109 and 110: Item 12 Next Steps 1. Conversation
Page 111 and 112: Item 12 2. Board Inclusion Developm
Page 113 and 114: Item 12 EDS Grades and E & D Object
Page 115 and 116: Item 12 Plymouth Hospitals Trust -
Page 117 and 118: Item 12 3.6 The workforce is suppor
Page 119 and 120: Item 13 Key Recommendations The Tru
Page 121 and 122: Item 13 Telephone conversations.
Page 123 and 124: Item 13 19. The Medical Director ha
Page 127 and 128: Item 15 incident investigations to
Page 129: Item 15, Annex 1 3. Review of Actio
Page 133 and 134: Item 15, Annex 1 The Chair asked SS
Page 135 and 136: Item 16 COMMITTEE MINUTES Finance,
Page 137 and 138: Item 16 pay and staffing, highlight
Page 139 and 140: Item 16 • PACS contract - likely
Page 141 and 142: Item 17 Terms and Conditions of Emp
Page 143 and 144: Item 17, Annex 1 29/2013 Minutes an
Page 145 and 146: Item 17, Annex 1 31/2013 Francis Re
Page 149 and 150: Item 18 Next Steps The Audit Commit
Page 151 and 152: Item 18, Annex 1 Matters arising 4/
Page 153 and 154: Item 18, Annex 1 time to embed and
Page 155 and 156: Item 18, Annex 1 Payroll & Expenses
Page 157 and 158: Item 18, Annex 1 The Committee note
Page 159 and 160: Item 18, Annex 1 Going Concern Revi
Page 161: Item 18, Annex 1 if Internal Audit
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Agenda and supporting papers - Plymouth Hospitals NHS Trust

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