Agenda item

Report of the Chairman of Joint City and County Health Scrutiny Committee.

Dr Stephen Fowlie, Medical Director and Deputy Chief Executive at Nottingham University Hospitals (NUH) presented an Environment, Waste and Cleanliness update, highlighting the following points:

(a)  between 15-18 September, there was a planned Care Quality Commission (CQC) visit to NUH, following a previous inspection that took place 18 months before.  Following the planned inspection, there was an unannounced visit on 28^th September, which garnered complimentary feedback.  The CQC rating was expected in December, but no major issues of concern had been raised;

(b)  Patient-led Assessments of Care Environment (PLACE) scores relating to the environment including cleanliness, food, privacy, dignity and wellbeing were slightly better in 2015 than in 2014.  At Queen’s Medical Centre (QMC), the dementia PLACE score is currently below the national average, due to the facility not being well suited to patients living with dementia.  Work is progressing to improve the environment for patients living with dementia;

(c)  there is now a dedicated decant ward at QMC. Between ten and twelve wards will be deep cleaned and decontaminated by Christmas 2015.  There was no increase in CDiff cases over the summer when cleanliness issues were raised over the summer; 

(d)  where possible NUH signposts both patients and staff to Smoking Cessation Services and there is focussed targeting of parents of children in hospital. Visitors are encouraged not to smoke at entrances and an enhanced cleaning programme is underway but there is still a way to go to resolve this matter;

Disciplinary measures have been taken against some NUH staff;

The existing smoking policy is being reviewed, including the use of e-cigarettes (hospital policy currently does not include e-cigarettes). Work is also underway with Nottingham City Council to explore the issuing of fines;

  A patient led social media campaign has been highly effective in asking visitors not to smoke;

(e)  behavioural disturbance at night can feature as part of some patient’s condition and is unavoidable.  However, staff are trying to reduce the number of call bells and buzzers on the wards, and have asked families, carers and other staff to refrain from using electronic devices at night.

  There has been a reduction in noise levels generated by bin collection, but there is still further work to do in this area.

Following questions from Councillors and attendees, the following points were discussed:

(f)  the number of staff employed within the cleaning service has increased since  Carillion took over the contract.  A significant improvement plan has been undertaken including specific cleaning training within the team and cleaning supervisors spending more time on wards;

(g)  CQC’s ‘unannounced inspection’ is part of the CQC methodology, so organisations are  prepared and gear up for this. NUH was notified ten working days prior to the visit and were informed that inspectors could potentially visit out of hours services, including weekends and/or during the night. Peter Homa confirmed that CQC inspectors speak to 1000’s of patients during their visits;

(h)  PLACE scores do not include external quality assurance so it is very difficult to compare performance;

(i)  a new meal ordering system is resulting in less food waste.  Previously, 24-25% of food taken to wards was wasted due to over-ordering.  Now, the smart system takes the meal order from the patient 2 hours in advance of food delivery.

  This service has been implemented across both campuses in Nottingham.  Food waste is now down to 5%;

(j)  there is a close relationship between NUH food assistants and patients and there has been positive feedback on the new ordering system.  A Gold Standard Award has been achieved for food produced at the City Campus;

(k)  work on Biofuel from waste food is ongoing, and should be completed by the end of the year;

(l)  cleaning arrangements and services  are now more demanding than the previous in-house system;

(m)  there are currently twelve different service lines to the Carillion contract so negotiations are very complex. It was acknowledged there have been some issues to address in the first year of the Carillion contract but work is underway to resolve these; 

(n)  response time for cleaning up spills, and dealing with areas exposed when furniture is moved, as well as other reactive circumstances is monitored and addressed through auditing;

(o)  NUH is very aware that responsive cleaning needs to be robust. Coffee spillage is problematic at the QMC site. There is a 24 hour helpdesk for all NUH Estates located on the City Campus;

(p)  staff suspected to be under the influence of alcohol  can be tested  in association with Trade Unions. Carillion has a Drugs and Alcohol Policy in place;

(q)  there has been an increased robustness of how staff are challenged about smoking.  However, many staff work 12 hour shifts, which can be a long time for a smoker to be without a cigarette;

(r)  although there is a certain satisfaction that decontamination can control cdiff, it is still vitally important to track each case very carefully.  There are weekly meetings held, but by and large, cdiff cases are relatively low and were under trajectory in the last quarter at NUH;

(s)  there is a consistent approach to sharps waste across QMC and City campuses. Recycle bins are now replaced more effectively, and where a new arrangement is piloted it generally operates on one site prior to being rolled out across the Trust;

(t)  NUH encourages and facilitates where possible for carers/family members of dementia patients to stay overnight.

RESOLVED to:

(1)  note the update;

(2)  ask NUH to return in August 2016 for a further update.

(3)   request that NUH provide the Committee of numbers of children in hospital known to have parents that smoke;