Agenda item

Representatives of Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV) will be in attendance in order to outline performance against the Trust’s quality priorities for 2023-2024 and inform the Committee of the emerging priorities for the next year.

Representatives of Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV) were in attendance to provide their annual presentation to the Committee in relation to the organisation’s Quality Account, a document which NHS Trusts had a duty to produce each year.  The TEWV Chief Nurse, supported by the TEWV Care Group Director MHSOP / AMH and the TEWV Lived Experience Director for Durham, Tees Valley and Forensics, covered the following elements:

·       Quality Account Quality Priorities 2023/24

·       Priority 1: Care Planning

·       Priority 2: Feeling Safe

·       Priority 3: Embed the New Patient Safety Incident Response Framework (PSIRF)

·       Setting the 2024/25 Quality Priorities

·       Timeline

Agreed by the TEWV Quality Assurance Committee in May 2023, the Trust’s quality priorities for 2023-2024 were developed following discussion and review of quality data, risks and future innovations in collaboration with colleagues, patients, families and carers.  Delivering on these priorities supported the ongoing mission to ensure that safe, quality care was at the heart of all TEWV did in line with its Our Journey to Change initiative and Quality Strategy.

·       Priority 1: Care Planning: The Trust had identified several aims for completion by 31 March 2024 involving new system developments, measurable goals within care plans, the publication of new policies and procedures, and data collection / monitoring mechanisms to assess the effectiveness of clinical interventions.  Whilst it was stated that performance impact was not yet where the Trust would want it, progress during the year was then outlined, a key element of which was the delayed implementation of (and associated training on) the new CITO patient record system which went live on 5 February 2024.  Other areas noted included the continuation of region-wide work with relevant stakeholders to move away from the Care Programme Approach (CPA) (the five principles signalling how systems should start to do this were subsequently listed), the now fortnightly meeting of the Personalising Care Planning Oversight Group to provide oversight and assurance to other workstreams / groups, and the continuation of the Care Planning Co-production Group which informed TEWV from a lived experience perspective.

In related matters, six priorities for personalised care were highlighted – workforce (job descriptions), workforce (what is our offer?), data (e.g. waiting time metrics), interoperability (ICBs), managing risk and accountability, and working with partner organisations.  Regarding the latter, it was noted that TEWV was often one of a number of entities involved in an individual’s care, therefore effective links with partners (including schools) was important.  Understanding data around inequalities and how this may help identify different needs (and therefore service requirements) across various geographical areas was also emphasised.  From a wider perspective, the seven NENC ICB priorities around care planning were also outlined.

·       Priority 2: Feeling Safe: To ascertain a better understanding of why some patients did not feel safe on TEWVs wards, as well as what would help foster a greater sense of safety, the Trust engaged with individuals using its inpatient services.  Feedback on both these elements was relayed, with common themes being a lack of / need for appropriate staffing levels, involvement in their own care, opportunities for meaningful activity, access to quiet areas, and support when unwell or when incidents had occurred within their environment.  Crucially, reassurance from staff and staff support was a key protective factor in ensuring that patients felt safe on the ward, with patients stating that they valued their relationships with staff.

It was explained that ‘feeling safe’ was not a mandated measure nationally and that all Trusts had different ways of determining and presenting this (hence benchmarking was not viable).  Also emphasised was the possibility that not feeling safe could be an inherent feature of an individual’s condition.  To aid its aim of creating a positive relationship in which patients felt safe, TEWV had three key elements to achieve by the fourth quarter of 2023-2024 (January to March 2024), namely the implementation of the range of actions identified from the Feeling Safe Focus Groups with patients and staff, the continuation of the body-worn camera pilot work (and evaluation of impact), and the continued implementation of the Safewards initiative (an evidence-based model to support and enable patients to feel safe).

Progress against these three areas of focus was documented, with dedicated Action Plans being produced and monitored for services where particular concerns had been identified by the Feeling Safe Focus Groups, and a process put in place to develop an overarching rationalised strategic workplan and reporting framework in relation to ‘feeling safe’ (specific work undertaken within Durham, Tees Valley and Forensics in response to the care group being given a performance improvement notice was also noted).  Benefits and challenges associated with the body-worn camera pilot were highlighted (it was also acknowledged that this was a controversial topic, with some (including patients) liking this and others not), with an in-depth review of the pilot now a component of the Trust’s Positive and Safe Plan (approved by the Quality Assurance Committee in August 2023).  In terms of Safewards, the need to refocus the corporate approach to the implementation, monitoring, reporting and assessment of outcomes for these standards had been agreed.

Developments in relation to TEWVs use of the question, ‘During your stay, did you feel safe?’ were outlined.  Following review by the Trust’s Lived Experience Directors (with support from members of the Involvement Team), it had been agreed that analysis would now reflect a two-answer configuration and include ‘yes, always’ and ‘most of the time’.  This change was made following the gathering of significant intelligence through focus groups which indicated that there were genuine reasons why people may not feel safe on an acute admissions ward.

Responding to a question on why Trusts were not mandated to track if people felt safe, the Committee was informed that, whilst this was a matter for NHS England, regulators would want to know if TEWV had mechanisms in place to ascertain how safe its service-users felt.

Linked to the first priority around care plan personalisation, the Committee asked if there was a way of establishing an agreed baseline measure with an individual where they can agree to feeling safe.  A recent TEWV Board of Directors meeting involving a contribution from a care-experienced person who reflected on positive changes whilst using the Trust’s services was referenced, and it was also noted that the new CITO patient record system should help support the co-production (between patients and clinicians) of safety plans.

Returning to the lack of a standardised national ‘feeling safe’ metric, the Committee expressed unease that TEWVs decision to change the way it presents feedback on its existing question could be interpreted as a means to merely achieve better-looking outcomes.  Hartlepool Borough Council’s health scrutiny function was writing to the NENC ICB with the aim of getting clarity around this situation and possibly establishing a baseline measure which could enable benchmarking, an endeavour the Committee agreed to support by sending its own correspondence.

The sensitive issue of body-worn camera use was probed, with Members asking if there had been any concerns raised around privacy.  TEWV officers stated that employing such technology required careful consideration as there was the potential for misuse.  The Trust drafted a policy for this some time ago (something the Lived Experience group had since examined), and, like the principles behind Oxehealth / OxeVision, its use had to be considered on an individual basis.  If someone was not comfortable, both patient and staff needed to understand why.

The Committee drew attention to the ‘How will we know we are making things better?’ table (included alongside the aims for completion by the fourth quarter of 2023-2024), and felt that the lack of change in the percentage of inpatients feeling safe / supported by staff to feel safe throughout 2023-2024 suggested the measures being used to address this quality priority (e.g. body-worn cameras) were not working.  TEWV officers reiterated that the wrong question was being asked of people who may not feel safe under any circumstance, and that the Trust had perhaps not helped itself in using / publishing such a measure when other Trusts asked / reported on this in different ways.  It was also highlighted that the previous year (2022-2023) had seen reduced occupancy within TEWV services (possibly as a result of the ongoing impact of the COVID-19 pandemic) which meant staff had more time for patients compared to the 2023-2024 period.  Like most Trusts, TEWV was experiencing challenges around demand for its services – this was linked to wider system pressures that were being caused by a number of factors (e.g. cost-of-living).

·       Priority 3: Embed the New Patient Safety Incident Response Framework (PSIRF): By the fourth quarter of 2023-2024 (January – March 2024), TEWV aimed to achieve five elements within this priority, including compliance with the national PSIRF requirements, increasing staff completion of national Patient Safety Syllabus training (level 1 and 2), introducing an annual patient safety summit and the role of patient safety partners, and completing focused work on Duty of Candour through the delivery of an improvement plan.

A summary of the implementation of PSIRF noted significant preparatory work undertaken over the past two years which ultimately led to the process going ‘live’ on 29 January 2024.  A multi-disciplinary team (MDT) thematic review of serious incidents was undertaken in early-November 2023 and future quarterly reviews would be scheduled in collaboration with key specialty / directorate colleagues to review quarterly themes and to ensure learning was identified and embedded in workstreams and / or monitored.

Other achievements were relayed in relation to Patient Safety Syllabus training (89% staff compliance for level 1; 66% for level 2), secured monies to fund two part-time Patient Safety Partner (PSP) posts (though a recent development meant this was now in doubt), and the ongoing delivery of the Duty of Candour improvement plan which would include a forthcoming independent audit to check progress.  Once PSIRF was embedded, the annual Patient Safety Summit would be held.

The Committee asked if the Trust was meeting its deadlines with regards PSIRF.  Assurance was given that these were being met and that this ensured that immediate learning was established.

The presentation concluded with details on the process for setting the TEWV quality priorities for 2024-2025 (the importance of these being co-created with service-users and carers was emphasised), and the remaining timeline for the consultation period and publication of the Trust’s Quality Account 2023-2024 document.

Members probed the recruitment of Lived Experience staff, with TEWV highlighting the benefits of peer support and the important role of Lived Experience Forums within the community which allowed wider engagement and a potential pathway for future use of care-experienced individuals to help shape service delivery.

Whilst pleased that the Lived Experience work had become more established, the Committee commented that TEWV had been on its ‘journey to change’ for some time now and queried how far along it felt it was.  In response, the anticipated benefits of the new CITO system were reiterated, the routine checking of whether carers were being identified and engaged / involved was highlighted, as was the mandated monthly Quality Board where TEWV had an agenda set for them.  From a regulatory perspective, the last CQC inspection saw the Trust’s three ‘inadequate’ domains improve, though it was acknowledged that the focus needed to be on patient safety (the historical backlog of serious incidents to report on were noted).  Some staffing issues had also been identified, but these had since been addressed – Members felt it would have been helpful to have more detail on this latter statement, and also drew attention to the very limited statistics / data within the presentation, something which made it very difficult to determine performance / progress.

Continuing the workforce theme, the Committee asked about the results of the recent staff survey.  TEWV officers stated that this was a mandated survey, and that feedback was reflecting positive strides over the last year (data would be published nationally in the near future).

Reflecting on the content of the presentation, Members felt there was little mention of 18-25-year-old provision and the challenges around transitioning from children’s to adult services – assurance was given that development work was ongoing in relation to this demographic.  In other matters, it was acknowledged that neurodiverse individuals had been poorly served for years, and that TEWV was trying to understand how it might work differently for this particular cohort.

AGREED that:

1)    the Quality Account-related update on Tees, Esk and Wear Valleys NHS Foundation Trust performance in 2023-2024, and the process for setting the 2024-2025 quality priorities, be noted.

2)    a statement of assurance be prepared and submitted to the Trust, with final approval delegated to the Chair and Vice-Chair.

3)    a letter be sent to the North East and North Cumbria Integrated Care Board (NENC ICB) supporting Hartlepool Borough Council’s health scrutiny function in requesting clarity around how mental health Trusts ascertain patients sense of ‘feeling safe’ and the potential establishment of a baseline measure.