Issue - decisions

Jayne Hartley and Julie Smith presented the draft Quality Account from Mid Cheshire Hospitals NHS Foundation Trust. 

The Quality Account covered the period April 2011 – March 2012.  The Trust was now in the third year of its 10 out of Ten programme which set out 10 priorities under four headings:

Safety –

·        Mortality – reduce mortality rates by 10 percentage points in patients groups where death is not expected;

·        Patient Safety – monitor and reduce the number of unnecessary patient moves during a patient’s stay in hospital

·        Harm caused – monitor and reduce the number of patients who experience avoidable harm by 10% annually

Effectiveness –

·        Readmissions – reduce the number of patients who are readmitted to hospital within 7 days of discharge;

·        Finance – reduce the percentage of the Trust’s budget that is spent on management costs

Experience –

·        Patients and staff – ensure that the ratio of doctors and nurses to each inpatient bed is appropriate for delivering safe high quality patient care;

·        Environment – monitor and eliminate mixed sex accommodation for all patients admitted to the Trust (unless based on clinical need)

Outcomes –

·        Cardiovascular – reduce the 30 day mortality rate in patients following an Acute Myocardial Infarction (AMI)

·        Cancer – reduce acute admissions and length of stay in hospital following early complications of diagnosis and/or treatment of cancer

·        Infections – reduce the rates of Healthcare Associated Infections (HCAI).

Jayne explained that the Trust had achieved 5 of the 10 priorities – mortality, patient safety, finance, Cardiovascular and infections.  In relation to the targets that had not been achieved:

Priority 3: Harm caused – the Trust had made considerable improvements in this area especially in reducing harm in the severe, major and moderate harm categories with levels being below all other small acute Trusts according to the most recent data available. 

Priority 4: Readmissions – the Quality Account listed a number of actions the Trust had taken to reduce the number of patients who were readmitted to hospital within 7 days, with a plan to reduce readmissions to 2% by 2014.  This had resulted in a reduction in readmission rates during 2011/12 and better performance than peer Trusts; however the target of 3% had not been achieved for this year.

Priority 6: patients and staff – the Quality Account listed various actions taken to ensure nurse staffing levels were based on evidence, for example in July 2010 the maternity unit had begun using the Birth Rate Acuity.  This system provided “real time” information on the numbers of midwives needed to match the needs of the women in the labour ward.  It measured the intensity of need arising from the number and clinical status of women and infants during labour, delivery and other women being cared for in the delivery suite against the number of midwives available to provide care.  During this year, eleven out of the fifteen wards reviewed were within range of their required establishment which equated to 73% against the target of 75%.  Investment in clinical staff had been made including consultants for Accident and Emergency.  A request had also been made for middle grade Doctors from the Deanery.

Priority 7: environment – the Trust had the necessary facilities, resources and culture to ensure that patients admitted to its hospitals only shared the room where they slept with members of the same sex and same sex toilets and bathrooms were close to their bed area.  Sharing with members of the opposite sex only happened when clinically necessary.   A number of changes had been introduced to ensure compliance with this target including moving the Emergency Assessment Unit to a ward area with bays and side rooms to increase privacy and ensure same sex accommodation.  Any breaches would result in an apology to the patient and every effort made to address the situation.  All breaches that occurred happened in the Acute Stroke Bay and the Intensive Care/high dependency units.

Priority 9: Cancer – there had been some improvements in reducing the length of stay for patients admitted as an emergency who had a diagnosis of cancer, but the target had not been met.  Investment had been secured from the Greater Manchester and Cheshire Cancer Network to implement the Acute Oncology Service in 2012/13 – this would mean the appointment of two Acute Oncology Clinical Nurse Specialists and admin support for the team.  Funding had also been received for a rapid alert system. 

The Account also reported that the Trust had taken part in the annual National Inpatient Survey, which resulted in a questionnaire being sent to 850 patients in October 2011.  Results would be available shortly.  The Trust also had its on annual Patient and Public Involvement Programme which included patient involvement such as patient surveys; feedback would be assessed and action plans formulated.

The Account also listed involvement in clinical audits and any resultant action taken as well as participation in clinical research.

In discussing the Quality Account, Members made the following comments:

      The Trust was to be commended on achieving five of its 10 out of Ten targets in relation to

      - reducing mortality rates by 10 percentage points in patient groups                   where death is not expected;

      - monitoring and reducing the number of unnecessary patient moves

       during a patient’s stay in hospital;

      - reducing the percentage of the Trust’s budget that is spent on  

        management costs;

      - reducing the 30 day mortality rate in patients following Acute

        Myocardial Infarction:

      - reducing the rates of Healthcare Associated Infections.

      The Committee supports the action taken to address Priority 3, Harm Caused, and notes that the Trust scores much lower than 30 similar sized Acute Trusts in the severe harm categories ie moderate, major or catastrophic based on the most recent figures available (April – September 2011);

      The Committee suggests that in relation to Priority 4, Readmissions, base line figures are included to make the reference to reducing readmissions to 2%, more meaningful.  The Committee endorses work taken to reduce the number of patients readmitted to hospital within 7 days of discharge; including the introduction of an Integrated Discharge team; and notes that this has resulted in a reduction in readmission rates during 2011/12, although the target of 3% had not been achieved.  The Committee notes that Elmhurst, Extra Care Housing facility, has a valuable role to play in this respect.  The Committee would emphasise the need to ensure that a patient’s intended date of discharge was agreed at an early stage to ensure that families and carers could prepare and make necessary arrangements;

      The Committee is concerned about the failure to meet Priority 6 relating to staffing levels which appears to have been an issue since 2009.  The Committee notes that the target is not met in 4 out of 15 wards.  The Committee commends the action which is to be taken to try to increase staffing levels and ensure that staffing is matched to patient needs.  The Committee recognises that as the patient profile changes, through an increasingly ageing population etc, this will impact on the types of staff needed.  The Committee notes the action taken to address staffing levels at weekends.  The Committee is pleased to hear that the Trust does not have any recruitment issues in recruiting nurses including student nurses, or midwives;

      The Committee endorses action taken to eliminate mixed sex accommodation for all patients admitted to the Trust (unless based on clinical need) and notes that breaches only occur in the Acute Stroke Bay and the Intensive Care/high dependency units.  It notes that the Strategic Health Authority has advised the Trust that all possible action to ensure same sex accommodation has been carried out;

      In relation to Priority 9, Cancer – the Committee endorses the action to introduce an Acute Oncology Service and hopes that this will enable the Trust to meet its target next year;

      The Committee commends the Trust in its significant reduction in Infection Rates which it notes had been achieved by various improvements including better hand cleansing, quicker and more effective use of isolation, prompt removal of lines and work with GPs regarding the prescribing of antibiotics as some antibiotics were more likely to cause infections;

      The Committee notes with concern the results of the Patient Survey carried out at Victoria Infirmary Outpatient Department which identified that 50% of patients were not informed of clinic delays – providing up to date information can contribute to the patient experience and this type of information is straightforward and simple to provide;

      The Trust is commended in achieving 14 out of the 16 CQuin goals but the Committee suggests that Goal 2, Patient Experience – personal needs, contains more detail to explain what action has been taken and why.

RESOLVED:  that the comments made above be forwarded to the Mid Cheshire Hospital NHS foundation Trust for inclusion in their Quality Account.