Agenda item

The draft Hospital Quality Accounts will be considered alongside the following information:

A. Hospital Trusts complaints, with some sample detail

b. Hospital mortality statistics

c. Comment on hospital ward staff turnover and levels of ward staffing

The Guy’s & St Thomas’ (GST)  papers are attached . GST presenters will be Elizabeth Palmer, Deputy Director, Assurance & Compliance and Katrina Cooney, Deputy Chief Nurse .

• Presentation on Quality accounts; mortality & complaints; (GST1)
• Complaints report Jan- Dec 2013 (GST2)
• Briefing paper on how Guy’s and St Thomas’ NHS Foundation Trust determines its nurses, midwifery and health visitor staffing levels (GST3)
• January Board report on nurse staffing (GST4)
• April Board report on nurse staffing (GST5)
• April workforce report (GST6)

The King’s College Hospital (KCH) information on this item is  has been combined with the paper circulated with previous agenda item; number 5.

6.1  The chair invited the Trust representatives to present their reports briefly. Guy’s & St Thomas’ (GST) Foundation Trust representative Katrina Cooney; Deputy Chief Nurse, presented the draft Quality Account report and supplementary information.  Elizabeth Palmer, Deputy Director, Assurance & Compliance (GST) gave her apologies. The Deputy Chief Nurse explained that next year’s draft priorities continue to focus on improving care to older people, particularly patients with dementia, in conjunction with Barbara’s Trust. The Trust will also continue to focus on Complaints and PALs. There will also be various initiatives promoting Integration, better use of IT and a consolidation of progress on patient safety.  She then spoke about progress on achieving last years priorities and reported that  everything was mostly achieved however a review and consultation recommended the merger of PALs and complaints, but this has been put on hold pending national guidance following the Clwyd-Hart report. This means work will continue on this priority this year.

6.2  King’s College Hospital NHS Foundation Trust (KCH) representatives: Mike Marrinan, Medical Director and Briony Sloper, Emergency Department Head of Department explained that the draft Quality Accounts priorities for the year are close to being completed. 

6.3  South London and Maudsley NHS Foundation Trust’s (SLaM) representative Cliff Bean, Associate Director, Quality and Assurance, referred to the draft priorities circulated in the report. He noted that SlaM is not bound to report on mortality rates however they do consider suicide rates and the Trust is aware that mortality rates are higher for people with poor mental health – this is one of the reasons that there is a draft quality priority to continue toimprove the quality of patients physical health by screening patientsfor cardio-vascular and metabolic disease.

6.4  The chair invited questions and a member referred to a constituent who made a complaint about the removal of a canualar at GST; it took him a year to get this resolved. The member noted that the complaints timescale indicates that a response will be given in 3 days but he would like to know how long GST takes to resolve a complaint. The Deputy Chief Nurse responded that this is normally 35 days, however that depends on if it is a major incident. She said that GST do carefully investigate but she agreed that a year is concerning. She explained that while the GST plans to merge PALs and the complaints service had to be shelved, the Trust has an agreement to secure more funds for investment in the service.

6.5  SlaM was then asked about the high level of complaints in the Psychosis CAG. The Associate Director for Quality and Assurance explained that Psychosis is about half of SlaMs activity. He said that the Trust is undertaking a programme with staff to impact on attitude, treatment and care.  He reported that workshops held on complaints have been really helpful in finding more informal resolution. A member responded that he was pleased to see this investment in staff skills and attitude, but he asked if complaints were really an outcome of overwork. The Associate Director said there is a broader issue about staffing levels and drew members’ attention to the report which detailed that how levels vary from service to service; there is no magic number. He added that SLaM have been surprised by the variation in levels of staffing. The member asked if SLaM need more staff and if there is sufficent funding made available. The Associate Director responded that commisioners allocate the funding and so can better address this. The member asked if the Psychosis service had enough funding & staff and the Associate Director said that it is not as simple as increasing staff as sometimes the services required a complex mix of the right socially appropriate interventions and ethnically diverse staffing.  He added that some services are good on fewer resources.

6.6  GST was then also asked about staffing levels and the Deputy Chief Nurse referred to the papers submitted that explain the process, which include detailed impatient analysis and monthly reports to board.  She emphasized that there is good governance in place and they are looking at workforce plans. They actively manage nurse placements and there is a recruitment nurse.

6.7  KCH Medical Director explained that PRUH is understaffed and KCH have been recruiting to improve this, whereas the issue at Demark Hill is too many bank and agency staff. He explained that the hospital do meet and usually exceed the staffing ratio target of nurse to patients of 8:1. Ratios are reported to the board and there is a red system in place to act urgently. He explained the problem is recruiting full time staff paid at the proper level.

6.8  A member asked the Trusts if money pressures would lead to a cut in staffing. KCH and GST said that while there are saving targets nursing and medical directors can veto proposals and on the grounds of patient safety and the views of medical consultants trump money.

RESOLVED

The final quality accounts will be put in front of the next committee.