Agenda item

Representatives of NTHFT will be in attendance in order to outline performance against the Trust’s quality priorities for 2024-2025 and inform the Committee of the emerging priorities for the next year.

Representatives of North Tees and Hartlepool NHS Foundation Trust (NTHFT), supported by University Hospitals Tees personnel, were in attendance to provide their annual presentation to the Committee on the organisation’s Quality Account, a document which NHS Trusts had a duty to produce each year.  The draft NTHFT Quality Account document had also been shared prior to this meeting and was included within the papers.

The initial section of the presentation focused on the formation and development of the ‘Group’ model (a formalised partnership approach between NTHFT and neighbouring South Tees Hospitals NHS Foundation Trust (STHFT) which had culminated in the establishment of the ‘University Hospitals Tees’ framework).  Group ambitions for patients and staff were outlined, as were nine Group quality priorities for 2024-2025 which covered the three key headings of ‘Patient Safety’, ‘Clinical Effectiveness’, and ‘Patient Experience’.

NTHFT performance during the 2024-2025 period was then reflected upon, features of which included:

·       Infection Rates: Hospital-onset healthcare-associated cases for MSSA (36), Klebsiella species (22), MRSA (3), and C Difficile (60) had all increased compared to the previous year (2023-2024).  Community-onset healthcare-associated cases and community-onset community-associated cases had all decreased for these same four infections (aside from community-onset healthcare-association cases of MRSA which had remained the same (2)).  Like all Trusts across the country, NTHFT was focusing on infection control measures to reduce these rates.

·       Summary of Improvements: A range of improvements in relation to events (safety-associated; cardiac arrest reviews), patient experience (complaints; compliments; claims), Medical Examiner feedback (an area which had significantly expanded since 2021), and surveys (national inpatient, cancer and Friends and Family Test results) were highlighted.  It was noted that the Trust had a responsibility to respond / react to the feedback it received (both good and bad).

·       Urgent and Emergency Care: A chart illustrating A&E flow demonstrated a very positive picture across each stage of the urgent and emergency care pathway.  NTHFT had performed better than regional and national averages for several measures including lower conveyance rates, shorter handover times, lower mean waiting times, front-door streaming (reducing crowding), fewer 12-hour waits, and lower ‘no criteria to reside’ rates and shorter 1+ non-elective lengths of stay (increasing bed availability).  The Trust recognised that all its departments (not just A&E) played a significant role in these achievements, with performance against the 4-hour standard wait target ranking NTHFT as the third best Trust in the UK.

Despite these successes, the Trust had identified a number of action points to further enhance patient flow – these included the recruitment of GP registrar trainees, a review of staff-to-patient ratios across urgent treatment centre sites, and a focus on streaming (ensuring the patient was in the right place first time).  The issue of security was also noted, with the Trust experiencing a further increase in the number of cases of abuse towards its staff, something it had a zero-tolerance to.

·       Summary Hospital-level Mortality Indicator (SHMI): NTHFT continued to perform well on this indicator, with the Trust remaining in a better place than other Trusts across the region and nationally.

·       Staff Friends and Family Test: Responses to three questions (25a. Care of patients / service users is my organisation’s top priority; 25c. I would recommend my organisation as a place to work; 25d. If a friend or relative needed treatment I would be happy with the standard of care provided by this organisation) placed NTHFT above the national average for each.  The Trust was proud of this, and work was ongoing in relation to engagement with staff so further improvements could be made moving forward.

In other staffing matters, NTHFT was doing well in terms of recruitment, though whilst the Trust was in a good position regarding doctors and nurses, it was anticipated that levels of the latter would dip due to funding limitations.  Work was underway with local universities to ensure a pipeline of health professionals, and it was noted that the Trust’s turnover of nursing staff was around 6% compared to the national average of around 10% (demonstrating a loyal workforce).

·       Completed Quality Improvement Initiatives: Several achievements were relayed including new operating theatres (robotic and maternity), a new Emergency Department ‘majors’ and control room, an integrated single point of access (ISPA) in Billingham, new endoscopic ultrasound equipment, navigational broncoscopy and CT for early cancer siting and biopsy, and delivery room improvements.  Whilst clinicians had access to state-of-the-art equipment, the Trust acknowledged that its estate continued to present challenges.

·       Developing Innovative Technology for Patients: NTHFT had received awards following digital innovations – one being for the successful implementation of paper-free patient records (saving a significant number of care hours), and two others recognising the state-of-the-art monitoring of patients with heart failure in their own home and in revolutionising the patient record process.

·       Maternity CQC Position: All maternity-related ‘must do’ requirements identified by the Care Quality Commission (CQC) had been completed by NTHFT – the Trust was awaiting confirmation from NHS England that it could now come off the improvement plan it was placed on following its last CQC inspection.  The Trust emphasised that there had been a real culture change within this service.

The Maternity and Neonatal Voices Partnership plan of work for 2024-2025 was also included for information – this infographic outlined various engagement mechanisms to hear from those who had experienced services, holding in-person sessions, running local events, and specific focus on bereavement, labour induction, consent, mental health, pelvic health, and infant feeding.

·       Summary of National Inpatient Survey (2023 results): It was stated that the true measure of any quality initiatives was what patients were telling the Trust – to this end, national inpatient survey 2023 outcomes were highlighted which showed where NTHFT could do better and where scores remained high.  In terms of the former, scores were significantly worse than in 2022 for ‘Did hospital staff discuss with you whether you would need any additional equipment in your home, or any changes to your home, after leaving the hospital?’ (7.8) and ‘Before you left hospital, were you given any written information about what you should or should not do after leaving hospital?’ (7.3).  For the latter, the Trust was most proud of maintaining positive feedback in the question, ‘Overall, did you feel you were treated with kindness and compassion while you were in hospital?’ (9.0).

Reference was also made to CQC Maternity Survey 2024 (published November 2024) feedback (the link to which was included in the covering report for this agenda item) – the survey window coincided with the Trust’s progression of its maternity improvement plan, so it was hoped that there would be more positive feedback reflected in the results of the next survey which would be undertaken in 2025.

·       In-House Data Collection and Reporting System: Friends and Family Test (FFT) results remained very positive with over 93% of respondents rating NTHFT provision as ‘very good’ or ‘good’.  FFT feedback could be broken down into Trust departments so positive performance could be acknowledged and areas for improvement identified (e.g. a follow-up call was introduced by the Assessment Service).

Nine Group quality priorities for 2025-2026 were highlighted earlier in the presentation – these comprised eight elements which had been carried over from 2024-2025 (to allow for embedding of the progress made as NTHFT and STHFT continued working together as part of University Hospitals Tees), and one new priority focusing on Infection, Prevention and Control (introduced following concerns around increased healthcare-associated infections).

Thanking officers for the presentation, the Committee commended the work undertaken on the Trust’s maternity improvement plan and the achievements resulting from digital investment.  In response to a Member query, it was confirmed that NTHFT patient records were available across all Trust sites, though this was not the case for community services and GPs who operated different systems.

The Committee asked if the CQC had given any indication to the Trust about when it would likely be re-inspected.  NTHFT officers stated that engagement with the CQC took place every two months which enabled feedback on any areas of concern and developments within the Trust to be highlighted to the regulator (the importance of being open and transparent was recognised).  NTHFT was not aware of any timeframe for its re-inspection and noted the ongoing period of change that the CQC was undergoing.

With reference to the A&E flow infographic, the Committee noted that the Trust’s 4-hour wait performance dipped slightly during the course of 2024-2025, and welcomed the efforts to bring this back up.  Members heard that NTHFT was a net ‘importer’ of patients which could sometimes impact wait times, and were also informed of the temporary closure of 8-12 beds to facilitate improvements to the emergency assessment area, a development which would put the Trust in a better place for winter 2025-2026.

Regarding the bedding-in of the new discharge hub, officers were asked about the communications between NTHFT, partners and patients, with emphasis put on the latter element.  Trust representatives invited Members to visit the hub to see it in operation and noted that discharge facilities were part of the community team (an unusual arrangement for an NHS Trust).  Assurance was given that clear plans on how to further strengthen discharge processes were in place.

Concluding Committee comments included praise for involvement in diagnostic developments.  NTHFT officers noted the ongoing work with local partners around smoking cessation and also highlighted ‘Group’ activity regarding early imaging.

AGREED that:

1)    The update on performance and development of the North Tees and Hartlepool NHS Foundation Trust Quality Account be noted.

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