Agenda item

Rose Hombo (Deputy Director of Quality & Clinical Standards Oxford Health NHS Foundation Trust) has been invited to present the draft Quality Account of Oxford Health NHS Foundation Trust, specifically, the quality objectives for this year and the next.

The Committee is recommended to: -

a)                      AGREE to provide comments on the account, in particular in relation to whether the account corresponds with HOSC member experience of the Trust over the last year, and whether they support the key areas of focus for the Trust over the forthcoming year.

b)                      DELEGATE to the Health Scrutiny Officer the task of compiling the Committee’s comments on the Quality Account in consultation with the Chair, and submit the feedback to Oxford Health prior to the publication date for the Quality Account on 30 June 2024.

PLEASE NOTE: The report for this item will be issued as an addenda.

Britta Klinck (Chief Nurse, Oxford Health NHS Foundation Trust) and Rose Hombo (Deputy Director of Quality & Clinical Standards Oxford Health NHS Foundation Trust) presented the draft Quality Account of Oxford Health NHS Foundation Trust. Dan Leveson, BOB ICB Oxfordshire Place Director was also in attendance.

Having introduced the Committee’s involvement in the Oxford Health quality account process, the Chair opened the floor to questions from the Committee.

Question on recruitment, levels of agency staff, and Oxford Weighting:

The Committee enquired whether there had been an increased reliance on agency staff, how successful the Trust had been with nursing recruitment, and what further steps the Trust would take to improve nursing recruitment. The Committee also asked about implementing an Oxford Weighting for salaries.

The Chief Nurse highlighted the Trust's efforts to reduce reliance on agency staff due to both financial constraints and the impact on care quality and patient relationships. She noted the importance of creating a positive work environment to attract and retain staff, mentioning partnerships with local universities and international recruitment efforts that had temporarily filled all vacancies in community hospitals. A notable success was the Trust's programme to train and retain local nursing associates, which had resulted in a substantial number of graduates from the local area, thereby mitigating some staffing issues.

The issue of an Oxford Weighting remained a national concern, but the boundary defining high-cost living areas would always be a point of contention. Oxford Health lacked the autonomy to address this matter themselves but were aware that the impact of this issue was significant, leading to staff attrition among those who wished to start families and own homes while working in the NHS. Any changes to salaries would need to be made in collaboration with other providers across BOB.

Question on support for staff wellbeing:

The Committee asked how the Trust had supported staff wellbeing overall and whether there was a means through which the Trust had measured the impact of support mechanisms for staff. The Chief Nurse outlined the various support mechanisms in place, such as supporting staff with cost-of-living pressures, clinical and managerial supervision and psychological support for traumatic events. They also focused on trauma-informed care for both staff and patients, along with initiatives like Swatch Rounds, which offered opportunities for reflection and processing. They assessed staff wellbeing through the annual NHS Staff Survey, and through participation in the People Polls survey (a monthly assessment administered by NHS England).

Question on patient feedback and experiences:

The Committee enquired how the Trust was utilising patient feedback and experiences to enhance the services it provided overall and whether there were any improvements in this area within the last year.

The Deputy Director of Quality & Clinical Standards explained the development of a more robust patient feedback system, including online portals and regular surveys. These tools were designed to gather comprehensive insights into patient experiences. Efforts were being made to ensure patient concerns were addressed promptly and effectively, including the introduction of patient liaison officers and regular town hall meetings with patients and their families. She also mentioned the creation of the 'Our Voices' pathway to ensure continuous feedback and response.

Question on patient safety:

The Committee asked whether the Trust had taken any steps to improve patient safety within the past year and whether there was there any room for improvement in this area.

Oxford Health NHS Foundation Trust joined the new Patient Safety Incident Response framework introduced by NHS England, which provided them with an alternative approach to investigating incidents. The framework allowed for a more thematic analysis, which enabled them to track changes over time and proactively identify emerging issues. Additionally, the Trust  had implemented a suicide prevention strategy and established a dedicated group to address this critical issue. The group had several work streams, including efforts to tackle health inequalities related to male suicide. They had worked on making services more accessible to men, particularly young men, and intervening early to address underlying societal factors. While they maintained a reporting culture and discussed incidents with moderate harm weekly, they recognised that complete safety remained elusive. Transparency and vigilance were essential components of their safety system, and they continually strived for improvement.

Question on learning from patient deaths:

The Committee asked how effective the process of learning from patient deaths was.

The Chief Nurse described the Trust's approach under the new patient safety incident response framework, which included family liaison services to facilitate engagement. This ensured that families' concerns and insights were integral to the investigation and learning process. She also highlighted the employment of patient safety partners and carer safety partners to embed the patient voice in safety initiatives.

Question on out-of-area placements for mental health patients:

The Committee asked how extensive the reliance on out of area placements was, and whether the Trust was taking any measures to reduce this reliance. The Chief Nurse acknowledged the challenges and high costs associated with these placements. In-area placements were operating at full capacity most of the time, making it at times impossible to provide beds locally. She explained the Trust’s strategies to reduce such placements by improving in-area capacity and support systems, including crisis teams and enhanced discharge planning.

Question on information sharing and recovery from cyber attacks:

The Committee enquired about what measures the Trust had taken to address and to improve information sharing, and the degree  to which the Trust had recovered from the previous cyber-attack which affected the Trust’s patient record system. The Chief Nurse reported that the recovery from the outage was successful, with full restoration. However, there remained a historical data gap in functionality, which complicated matters. Although they abandoned the compromised system and implemented new ones, time constraints meant ongoing fine-tuning to meet all service needs. Fortunately, the major components were now operational, allowing necessary reports to be pulled.

Oxford Health NHS Foundation Trust had implemented information sharing systems, and enhancing information sharing remained a goal. The Chief Nurse acknowledged the challenge of diverse and complex services with varying electronic requirements. Digital innovation would play a crucial role in meeting future demands. Serious incidents had fostered better understanding and collaboration among partners, even though seamless communication between systems remained an ongoing endeavour.

The Chief Nurse acknowledged that the impact of poor information sharing on a patient's experience of care was serious. Sometimes, in serious incidents, information got lost between agencies or was not transferred effectively, resulting in potential gaps in patient knowledge. Initiatives in place focused on recording essential information in the system, ensuring timely and accurate documentation without burdening clinicians unnecessarily. Additionally, efforts were directed toward building relationships between agencies and collaborative training and role changes facilitated smoother interactions within the system.

Question on complaints regarding staff attitude and behaviour:

The Committee asked about complaints regarding staff attitude, and the steps the Trust would take to improve staff attitude or conduct toward patients. The Chief Nurse acknowledged that incidents did occur, but instead of blaming or disciplining, she advocated for facilitating reflection on why such incidents happened. She recognised the intense pressure staff faced and their commitment to doing a good job. While they aimed to remove those few staff who did not meet expectations, she also highlighted the context of increased racial abuse and the ongoing challenges related to the COVID-19 recovery.

The Committee AGREED to issue the following recommendations to Oxford Health NHS Foundation Trust:

1.    For the Trust to take measures to tackle workforce shortages and to reduce reliance on agency staff, and for the Trust to seek support, alongside the wider system, for an Oxfordshire Weighting.

2.    To ensure that there is a clear process for learning from deaths, to include bereaved families, and to improve services accordingly.

3.    For the Trust to develop clear mechanisms for providing support to staff wellbeing.

4.    In light of this being a key area of complaints received, it is recommended that the Trust provides training and guidance to staff for the purposes of ensuring good staff attitude, conduct, empathy, and understanding toward patients.

5.    To work to reduce inappropriate and extensive reliance on out of area placements. It is recommended that a review of those in out of area placements is undertaken to determine if their needs could be better addressed through bringing them closer to their locality.