1. the panel had been provided with documents which outlined the key actions being undertaken to implement the dementia strategies locally. Local and National actions were referenced within the dementia self assessment paper which had been validated by the South West Strategic Health Authority;

2. the panel was also provided with a spreadsheet detailing NHS Plymouth spend and Adult Social Care Spend with regard to dementia services;

3. although there were areas marked green in the action plan these areas were being taken further;

4. the spreadsheets did not reflect total spend on dementia services, there were additional costs such as pharmaceutical and primary care the figures provided needed to be considered in the context of the wider spend.

5. it was noted that the membership of the partnership board was weighted toward clinicians and there was little permanent local authority membership. However the panel was assured that local authority officers were brought onto the panel when required. The approach ensured a free flow of information throughout the department;

6. the focus on early diagnosis and end of life provision was reflected in the panel membership.

(1)   the membership of the partnership board should be reviewed;

(2)   service user feedback is provided by PIPs and the LINks to the partnership board to review the development of the strategy.

1. the documents included with the agenda highlighted the work completed since NHS Plymouth last provided the quality accounts to the panel in June 2010;

2. the 2010-11 quality accounts were extended to include all services provided by NHS Plymouth provider services;

3. NHS Plymouth were currently consulting various stakeholders over the priorities included within their quality accounts; these priorities had been based on robust evidence and a number of organisations had already been consulted. The consultation period would end on the 1 April 2011;

4. following the end of the consultation period NHS Plymouth would refine the quality accounts and provide them to the Health and Adult Social Care Overview and Scrutiny Panel in May 2011 for final comment.

5. there had been a number of newsletters and an online survey which had helped patients be included within the quality accounts process. As it was only the second year of quality accounts this would be the benchmarking year in terms of quantifying success;

6. NHS Plymouth had not compared the results of similar sized trusts. NHS Plymouth would use their networks to compare the consultation results;

7. LINks were helping with the development of NHS Plymouth quality accounts.

(1)   the final quality accounts are presented to the panel in the new municipal year with detailed analysis of consultation responses;

(2)   the quality accounts would be Plymouth focused and would reflect the four city priorities throughout;

(3)   the quality accounts should illustrate where NHS Plymouth aligns its priorities with other service providers in the city;

(4)   the quality accounts should be written in plain English to ensure they are accessible for the public.

a.      a strong focus on infection control had resulted in falling rates of Methicillin-Resistant Staphylococcus Aureus (MRSA) andClostridium Difficile (C.diff);

2. stroke services were viewed as amongst the best in the country and Dr Foster Healthcare Intelligence rated Derriford Hospital among the best hospitals in the country for patient outcomes;

3. the PHNT standardised mortality ratio continued to fall;

4. a national inpatient survey showed that almost 80 per cent of PHNT patients rated their treatment as excellent or good;

5. maternity care in Plymouth was rated as good and in parts amongst the best in the country according to the patients who used the service.

6. a reduction in the number of cardiac arrests and the number of grade 3 pressure ulcers, surgical site infections and the incidence of Venous Thromboembolism (VTE);

7. a reduction in the number of patient falls, the average length of  patient stay and the number of delayed discharges;

8. improved compliance rates for National Institute for Clinical Excellence guidance, an overall percentage improvement in the National Inpatient Survey, improved provision of single sex accommodation and an increase in the number of rapid response calls.

9. there had been an increase in the number of complaints, this was in some part due to an improved reporting process. Staff had been provided with a new complaints handling process which had improved the PHNT response rate;

10. on site security was a constant presence at the hospital, it ensured that all staff and patients were safe;

11. many modern operating procedures required a shorter stay in hospital. It was highlighted that the longer a patient remained in hospital increased significantly the chances of infection and many patient’s recovery was aided by being at home;

12. there was a well developed work stream on dealing with paper records, PHNT’s performance record in this regard could be reported to the panel and be included within future quality accounts;

13. the main reason for delayed discharges was due to a delay in providing medication for patients leaving hospital or identifying a suitable location for them to be discharged to.

(1)   PHNT’s performance in relation to the management of patient records is added to the quality accounts 2011/12;

(2)   the final quality accounts are presented to the panel in the new municipal year with detailed analysis of consultation responses;

(3)   the quality accounts would be Plymouth focused and would reflect the four city priorities throughout;

(4)   the quality accounts should illustrate where PHNT aligns its priorities with other service providers in the city;

(5)   the quality accounts should be written in plain English to ensure they are accessible for the public.

1. never events were serious preventable incidents which should not occur when preventable measures had been implemented. Six never events had occurred at the hospital over a ten month period;

2. never events were reported to the PHNT public board meeting on the 28 January 2011 where the board agreed to engage proactively with the CQC;

3. the CQC made an unannounced visit to the Hospital on the 16 February 2011 and found that there was not full and proper compliance with World Health Organisation checklists;

4. since the CQC visit PHNT had published clear guidance on how to complete the checklist. This guidance was displayed in all theatres and anesthetic rooms;

5. before making mitigating changes theatres were reporting compliance rates of between 18 per cent and 80 per cent of patients receiving a complete checklist. Since the guidance had been published weekly compliance rates increased consistently above 95 per cent;

6. further work was being carried out in order to prevent further incidents which included:

·        a review processes related to swabs and a standard operating procedure was developed for use in all theatres;

·        a swab ‘bag it’ system was introduced in all theatres to ensure accuracy of swab counts;

·        the throat pack process had been reviewed and a standard operating procedure was developed for use in all theatres;

·        team brief and debrief processes were being reviewed to ensure standard approach across theatre teams;

·        theatre lists scheduling and compilations were being reviewed;

·        all staff were receiving written and verbal communication updates on changes to practice and plans for improvement;

7. theCQC visited again on the 22 March 2011 to check for compliance. Although the CQC had not yet published a report on this visit PHNT did not expect to have to carry out further work.

8. PHNT had carried out route cause analysis into each never event and had implemented processes and procedures which were easy to adhere to;

9. it was possible that junior staff felt unable to challenge senior staff members, if there was a case for disciplinary procedures further action would be taken;

10. theatre teams were based around specialities, if there were staff shortages people could be moved around teams. PHNT had started a review around the scheduling of surgery;

11. PHNT had a higher instance of never events than other hospitals in the UK;

12. each ‘never event’ had been subject to a root cause analysis. It was felt that adequate mitigating processes had been put in place. However when a further event occurred in November the problem was found to be rooted in the culture of the work place;

13. no long term harm had been caused to any patient. Patients and their families were offered meetings with the trust following the events and engagement with patients  ...  view the full minutes text for item 108.