Agenda item

Following consideration of the 2018 Quality Accounts at the Health Select Committee meeting on 25 June 2019 to receive an update from Salisbury NHS Foundation Trust.

The Salisbury NHS Foundation Trust Quality Accounts 2018-19 can be accessed here. The comments from the Health Select Committee are included on pages 178 and 179 and the specific points highlighted by the committee for an update are listed below for ease of referral: 

1. progress achieved to date for the five quality priorities identified by the trust for 2019/20, with particular interest in:

a)    Improving patient flow through the hospital, including measurements of the impact of the SAFER care bundle (Priority 3) and measurements of emergency re-admissions within 28 days of discharge as this has been slightly increasing for patients aged 16 and over since 2016;

b)    Increasing the number of patients who are able to de discharged to their preferred place of care at the end of their life, including working collaboratively with the community and social care partners to develop an older persons’ pathway (Priority 3);

c)    Organisational development strategy with regards to improving staff health and wellbeing;

2. Progress on expanding parking provision for both staff and visitors.

3. An update on the following areas from the priorities identified for 2018/19:

a)    Continued efforts to reduce the number of patients who fall and injure themselves;

b)    Identify patients with delirium;

c)    Ensure a rapid discharge for patients at the end of their life who wish to die at home;

d)    Outcome of the audit of the delirium care bundle;

e)    Performance of the frailty pathway against the discharged within 72 hours measure;

f)     Maintaining 90% standard of patients receiving hip fracture surgery within 36 hours;

g)    Monitoring of improvements (education and training) in understanding whether a patient meets the eligibility criteria for fast track Continuing Health Care funding (NB - Please note this is of particular interest);

h)    Navigator performance with regards to patients being seen within 15 minutes of arrival in the emergency department, as well as any additional development of skills offered to navigators;

i)     Trusted assessors, development of the concept and impact on speeding up discharges.

Lorna Wilkinson, Director of Nursing, and Claire Gorzanski, Head of Clinical Effectiveness for the Salisbury NHS Foundation Trust gave a presentation on Salisbury NHS Foundation Trust - quality priorities 2019/20. The key points of the presentation were:

·         Work with partners to prevent avoidable ill health and reduce health inequalities had improved. A Treat Me Well campaign was launched in 2019 and more work was being done to embed learning disability standards.

·         Exceeded c-diff infection targets – 18 infections were picked up, 8 within the hospital and 10 outside of the hospital. The hospital had the lowest gram negative blood stream infections in the region.

·         Sepsis screening and escalation to doctors had improved. Sepsis treatment - administering antibiotics within one hour had decreased which would be monitored.

·         Patients over 65 now received three fall prevention measures: mobility and medication assessments and lying / standing blood pressure checks.

·         Achieved 79% of hip fracture best practice (target was 80%), there was sometimes a struggle with carrying out operations within 36 hours and work was being done to look at lessons learnt.

·         Work with partners to improve patient flow through the hospital was being worked on. The target of 90% of consultant review within 14 hrs of admission was being met, although only 18% of patients were being discharged before midday where the target was 33%.

·         The OPAL had increased to a 7 day service.

·         Readmissions had increased. There was no clear reason for the increase and it was being looked into.

·         Targets for delayed discharge had all been missed, this was due to how the hospital worked with partners and internal patient flow. The Local Delivery Board held a workshop looking at figures and priorities. Also an

internal expert panel was held each week which was multi agency to look at patients stays over 7 days and specifically look at complex discharges to identify lessons to learn. 

Issues such as not having medicines ready and transport were areas being explored.

If a patient was being discharged after noon, the patients circumstances were taken into account on whether they would be kept for another day or discharged.

·         Attend Anywhere was a new technology “digital” appointment via phone, tablet, etc. The system had been trialled with speech and language therapist at school which enabled the child to stay in school and not miss class time and the therapist was able to demonstrate techniques for the teachers. Feedback so far had been positive.

Consultant Connect was currently being used at Bath hospital, which enabled consultants to receive specialist advice very quickly and reduced the amount of further appointments required. The next stage was to get clinicians on board with the programme and conversations were taking place.

·         Work was ongoing to Improve the health and wellbeing of staff.

RESOLVED

To thank officers attending and for the quality of their presentation.

To note the Salisbury NHS Foundation Trust quality priorities for 2019/20.

To welcome a similar update from the Salisbury NHS Foundation Trust on its quality priorities for 2020/21, with segmenting figures by age where possible.

Cllr Howard Greenman left the meeting at 12.07.