Agenda item

Report of the Head of Legal and Governance

Tracy Tyrell, Director of Nursing and Allied Health Professionals at Nottingham CityCare Partnership, presented a report on the draft CityCare Quality Accounts. The following points were discussed:

(a)  the Quality Accounts are an important way for local NHS service providers to report on quality and show improvements in the services that they deliver to local communities and stakeholders. The quality of services is measured by looking at patient safety, the effectiveness of treatments and feedback about the care provided. Quality Accounts assess where CityCare is performing well and where improvements are needed, the progress against the priorities set previously, the new priorities for the following year, and how the public, patients, carers and staff were involved in decisions on these priorities;

(b)  there were four main priorities for 2018/19 and the following was achieved:

  (i)  in Promoting Prevention, there has been continued working with wider partners, promotion of social prescribing internally and externally, over 200 self-care prescriptions received from GP practices and CityCare staff since May 2018, updated information to promote the agenda of self-care across clinical services, and successful partnership with the Greater Nottingham Partnership Delivery Group. The Maternal Mental Health pathway has been developed with mental health support threaded through all of the core contacts in the Healthy Child Programmes, in addition to training in mental health first aid skills and the upskilling of the whole children’s services workforce;

  (ii)  in Reducing Avoidable Harm, there has been continued learning from incidents and complaints, focused work on leg ulcers, new leaflets developed for care and understanding of venous leg ulcers, arterial ulcers and use of compression hosiery, and booklets and online videos on caring for feet as part of the ‘React to’ series for staff, patients and carers. Changes have been made to how internal quality visits are undertaken, with training provided, checklists to follow the Care Quality Commission’s Key Lines of Enquiry, all-staff induction, Patient Safety Walkabouts and improvements to the clinical governance structure. There has been continued focus on pressure ulcer prevention, including investigation and reporting of all pressure ulcers to a weekly incident review panel, focused training and education in teams, the review of tools used to support investigation, and training and education for all;

  (iii)  in Supporting Our Staff there is a ‘You Said, We Did’ approach, with non-clinical forums launched in addition to the current Allied Health Professionals and Nursing forums, enhanced sharing of training and development opportunities with targeted Black and Minority Ethnic (BME) leadership programmes, and continued work and training on the appraisal process and supervision reviews. A Health and Wellbeing calendar is in place with dedicated support for sickness management and focused work on stress, an NHS Improvement retention programme is underway with ‘thinking of leaving’ focus groups, and there was an equality and diversity engagement week in May 2018;

  (iv)  in Safe and Effective Discharge, the data collected has shown an improvement with system-wide planning for winter, CityCare is now a member of hospital Accident and Emergency delivery board and supporting structure, the Integrated Discharge Team leads on supported discharges from the Nottingham University Hospitals, a triage hub is in place, improved information for patients is available, community capacity has been increased and there is an Urgent Care Centre. Regarding the transitions from children’s to adults’ services, joint pathways focused on streamlining appropriate support for young people moving into adulthood, and CityCare is working with them to establish what information and resources they need to support them in transitioning into adult services, with further engagement to develop new approaches;

(c)  the themes for future priorities are the recruitment and retention of staff, improving the quality of care to ensure that the right staff with the right skills are available at the right time and in the right place, and improving mental health support for patients and staff. To help shape these priorities, CityCare has engaged with staff and stakeholders and reviewed the feedback from a diverse range of patients and service users over the last year. Complaints are listened to carefully and effective communication is vital;

(d)  recruitment and retention is challenging and there is a shortfall in nursing staff nationally. Experienced practitioners are not often available to recruit so it is important to attract, train and retain newly qualified nurses. This is done through the ‘Novice to Expert’ programme, which is designed to provide the right training for a person and provide them with a good career structure. Recruitment to community nursing posts has been positive when compared to national trends and there is a strong focus on seeking support workers, in addition to registered nurses. Places are found for apprentices where they can discover and be supported in developing their abilities. More targeted recruitment will be done through recruitment fairs in the city and ways of encouraging school-aged children to be interested in future nursing careers are being explored;

(e)  the ‘Health and Wellbeing Calendar’ displays initiatives and engagement sessions to discover how staff are feeling and when, and it gives links to events run by a range of providers. It helps to establish in a holistic way what staff need to improve their working lives and reduce stress, and it encourages staff to take their breaks and holidays, stay hydrated and care for their patients by caring for themselves. It also aims to improve staff equality and diversity;

(f)  feedback from staff has been important in selecting new contracts and changing the nature of the workforce. The executive and non-executive directors are engaging with staff, who are invited to Board meetings, which include presentations on patient and staff stories. Working groups give feedback to monthly Human Resources and development meetings to assist planning to increase staff morale and retention;

(g)  equality standards are under review and improvements have been seen in most areas. There is a current emphasis on recruiting BME staff into senior roles and to develop leadership training for people moving up through the organisation, where more effective means of tracking circumstances and progress are being introduced. Steps have been taken to ensure that staff with disabilities have exactly the same opportunities as other colleagues and, following the establishment of a BME staff support network, similar networks will be established for people with other protected characteristics. Bespoke training for teams, including training in unconscious bias, is in place;

(h)  a great deal of work has been done in the last 12 months through development and training to address and combat issues relating to sepsis, though it is not a priority theme of itself;

(i)  CityCare’s primary focus is on the wellbeing of children in its area, but transition plans are in place to help children eventually move to adult care effectively, especially in cases of mental health. The case managers for the child and adult services work together to ensure continuity of health services across the transitional period, which is carried out within the requirements of the national framework. Patients with complex care needs have a clinical assessment to develop the right care package, which is reviewed regularly with the patient and their family. Strong communication with the patient is vital and feedback to date suggests that the process is working well;

(j)  CityCare is signing up to ‘Time to Change’ to seek to reduce the stigma and discrimination sometimes experienced by people when accessing mental health services. Consideration is being given to what new measures should be introduced and there is a focus on ensuring that managers are equipped with the right skills.

RESOLVED to:

(1)  thank the representatives of the Nottingham CityCare Partnership for the report on the draft Quality Accounts;

(2)  submit a comment for inclusion in the Quality Account based on the evidence available to the Committee.