Agenda item

11:30 – 12:00

Marie Crofts (Chief Nurse), Britta Klinck (Deputy Chief Nurse) and Rose Hombo (Deputy Director of Quality) have 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 Scrutiny Manager the task of compiling the Committee’s comments on the Quality Accounts in consultation with the Chair, and submit the feedback to Oxford Health by 14 June 2023.

NB There will be slides used to support the presentation of the report; hard copies of which will be available on the day of the meeting.

The Chair welcomed Britta Klinck (Deputy Chief Nurse) and Rose Hombo (Deputy Director of Quality) of Oxford Health NHS Foundation Trust; and on behalf of the Committee, thanked the invitees for their comprehensive report as well as for the glossary. The Chair handed the floor to the invitees to provide a brief overview of the report.

The invitees summarised the following points:

1.     The Annual Quality Account had been drafted in the context of a difficult time. The challenges being experienced are not unique to the Trust but analogous challenges were being experienced by counterparts Nationwide. It was highlighted that there has been a higher level of demand in various services delivered by the Trust, and that pressures within the healthcare system had reached heightened levels. This Quality Account had been published on the back of a staffing crisis which is affecting Oxfordshire but also other areas nationwide. It was also emphasised that the Trust, much in the same way as many other providers, are in the process of recovery from the Covid-19 Pandemic.

2.     It was also reiterated that there was a significant critical incident within Oxford Health last year, which was elicited by the outage of the Trust’s entire Electronic Patient Record System. The Provider of the Trust’s electronic patient record system was subjected to a cyber attack which rendered the system unusable. The Trust was required to operate in the absence of their Patient Record Systems from August through to December last year. For instance, district nursing teams were significantly reliant on these systems for appointments with patients.

3.     It was highlighted that there are fourteen objectives in the Trust’s Quality Account, and that five of these have been achieved. It was emphasised that that was not as high a number as the Trust would have liked, although there has been a significant amount of progress on the five objectives that have been achieved. It was acknowledged that there still was further work to do further into the current year by the Trust to help meet its objectives, and it was expressed that there is a strong commitment to do so.

4.     The Trust had been working on improving mental health services, by focusing on further prevention work. This is being undertaken through closer collaboration with Primary Care and GPs in order to achieve early intervention for patients with mental health issues. The Trust also has teams in over 200 schools to help with prevention and early intervention work for mental health and have been expanding this programme.

The Chair thanked the invitees for summarising Trust’s Quality Account, and expressed that the Committee had a keen interest in the wellbeing of all frontline practitioners during these challenging and unprecedented times.

The Committee acknowledged that the challenges from the Covid-19 Pandemic still remained and that this would continue to have challenging impacts on the Trust; including on workforce.

The Committee also felt that it was good to see a reduction in seventy percent of admissions for eating disorders, and that this was a positive development, particularly in light of an increase in eating disorder tendencies and statistics at the national level.

The committee asked about the extent to which Keystones mental health and wellbeing hub had elicited improvements across the population. The Trust responded that one of the consequences of the cyber attack on patient record systems was the lack of quantitative data, although there is a plethora of qualitative data relating to the experiences of patients who utilised that centre. Patients are able to access services much closer to home at the local level. It has also been a useful centre in incorporating contributions and collective work with Mind and other voluntary workers. It was also mentioned that the Trust is committed to help overcome some of the challenges with access to mental health services and for patients to not have to be bounced around services and to have to repeat their story multiple times.

The Committee asked for clarification as to whether there was a formal partnership between Oxford Health and the Frank Bruno Centre. The Trust responded that there was no partnership of any kind. The benefit here is that patients also face the prospect of self-referral, which avoids some of the challenges of having to go through avenues of accessing a GP initially and to then hope to be referred.

The Committee also queried some of the snowball effects that the outage of the patient record system has had, not only on the effectiveness of service delivery to patients, but also on staff health and wellbeing and staff retention as a result of increased pressures. The Trust responded that the migration of the historical data on patients has not yet completed; and that another consequence of the outage relates to challenges with reporting around waiting times and appointments being carried out. It was emphasised that the Trust would develop that functionality by July-August this year, and that this could/would? help staff to deliver care on the ground more effectively. However, staff would also require some time to get accustomed to new systems.

The Committee asked what the consequences of the aforementioned challenges are on the general health and wellbeing of the people of Oxfordshire, particularly given that there are many residents who make use of District Health services as part of people’s everyday access to healthcare for instance. The Trust responded that clinical harm reviews were undertaken throughout the course of the critical incident, but that not every harm can be easily ascertained or identified but that the Trust does its utmost to nonetheless review the impact of any challenges on the health and wellbeing of patients and wider residents.

The Chair enquired as to whether there were any lessons learned by the Trust, which could then be shared with other actors within the healthcare system so as to improve services overall. The Trust responded that there are always lessons learned and that these lessons are routinely shared with the Integrated Care Board. It was also highlighted that another useful source of collective learning was that it was approximately 15 other providers who were also affected by the outage of the patient record systems.

The Committee raised a point about the imperative to support staff wellbeing, and for the Trust to closely monitor the percentage of staff leaving relative to the numbers of staff being recruited, as this will help to ensure prompt and adequate staff recruitment and retention measures.

ACTION: For Oxford Health NHS Foundation Trust to share information with the Committee on the percentage/ratio of staff leaving the Trust relative to the numbers of staff being recruited.

The Committee was 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 Scrutiny Manager the task of compiling the Committee’s comments on the Quality Accounts in consultation with the Chair, and submit the feedback to Oxford Health by 14 June 2023.