Quality of Patient Experience Working Group

Agenda item 7(i)

THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST

COUNCIL OF GOVERNORS

QUALITY OF PATIENT EXPERIENCE WORKING GROUP

The group has met twice since the last Council meeting in September 2015. We have had presentations at each of these meetings.

OCTOBER - Presentation by James Callaghan, Head of Paediatric Dietetitics on “Nutrition & Dietetic Services within NUHT ”

Mr Callaghan began his talk by outlining the difference between a nutritionist and a dietician. Whilst anyone can claim to be a 'nutritionist' dieticians are the only qualified health professional that can assess, diagnose and treat diet and nutrition problems at an individual and wider public health level. Dieticians use the most- up-to-date and scientific research on food, health and disease enabling them to translate this into practical guidance to enable people to make appropriate lifestyle and food choices.

They work as part of a team, caring for people in hospital or in the community and supporting patients whose quality of life is linked closely with their diet, e.g. difficulty swallowing following a stroke or surgery. A dietician may also work in the community, developing training for individuals with diabetes or working in a school supporting the implementation of healthy school meals.

Dieticians also work to promote good health and prevent disease by informing and teaching the public, health professionals and others about diet and nutrition. Many dieticians work in the food industry, public health, education, sports nutrition, research or the media and many others decide to work in a freelance capacity.

In Newcastle the dieticians work in three main teams with 8 support staff:- Acute Adult Care – This team includes 16-17 dieticians, mostly hospital based, working with Inpatients and Outpatients. A growing aspect of their work involves the supply of suitable fluid diets for patients unable to swallow or with nasogastric tubes or PEG gastrostomies. Another part of their work involves the supply and formulation of parenteral nutrition. Paediatrics – this also comprises 16-17 dieticians who are mainly hospital based working with Inpatients, Outpatients and in Community Outreach clinics. As with the adult service there is a growing requirement for fluid feeding and parenteral support for children. Community – currently there are 8 dieticians providing support to Diabetes clinics / groups, home visits, cooking skill training, Nutrition and Health Promotion in Schools and Specialist Weight management services.

Jim Price asked what had happened to the Dieticians attached to individual GP practices. James explained that this was no longer possible but hoped to introduce a new system where a group of practices were supported by a Dietician.

James then went on to define what is meant by effective nutritional care. This

1 involves a co-ordinated approach to the delivery of food and fluid by different healthcare professionals recognising the individual needs, preferences and cultural needs of patients and their physical requirements. It follows a person's progress through an illness, responding to their changing requirements. I t involves monitoring and re-assessment at regular intervals with referral to specialist care when appropriate, with good communication between all the professionals looking after the patient. Providing this good nutritional care necessitates the training of all staff, carers and patients and providing them with access to all necessary information.

Evaluation of the dietetic service is done through User Feedback Surveys. These include the Friends and Family Test; CARE questionnaires in Outpatients; multidisciplinary clinic satisfaction surveys; evaluation of group interventions; and Compliments and Complaints.

How is the service organised? This is through a Nutritional Steering Group with membership from the Heads of Nursing and Dietetics; a Consultant lead; Matron; Catering Manager; Nutrition Nurse Specialist; and Public Governor. It reports to the Trust Board and has sub-groups that include Food Tasting Panels, Clinical Nutrition Teams and Link Nurses and Catering and Action Plan groups.

What has been achieved over the past year?

Menu developments in partnership with Catering including a Children's a la carte menu; disease-specific menus e.g. renal; cystic fibrosis; allergy; texture modified; group specific; multicultural, Elderly Care and dementia patients. An audit of nutritional intakes of elderly patients at Freeman Hospital. Nutritional screening within Paediatrics using the STAMP tool. Developing a framework for collecting dietetic information on specific patient outcomes. Development of specific Dietetic led services. Establishing new services including at the Marie Curie centre; oral nutritional support; specialist weight management; low FODMAP diet for Irritable Bowel Syndrome; and a Dietetic service for drug resistant Epilepsy.

What are the Challenges to the service?

These include: maintaining the high standards; addressing resource gaps within the services and re-assessing priorities; the recruitment and retention of staff with the necessary skills required – this is a problem when there is only one current dietician with the specialised skills in a particular area; and the most effective use of resources by reviewing administrative processes and systems and embedding the Dietetic Outcomes framework into routine practice.

NOVEMBER – Presentation by Karen Wall (Nursing Sister RVI Ward 3) on the Bubble Unit

Ms Wall explained that the unit was first established in 1987 and became a National Centre for 6-8 patients in 1991 as one of the only two units within the UK (the other being at Great Ormond Street Hospital). They had moved to the Great North Children's Hospital with 10 beds in 2000 and take all children requiring Haematopoietic Stem Cell transplants. The unit has been accredited as one of the 2 best Transplant Units in Europe and has an outstanding International reputation.

The unit accepts children from birth to young adulthood. They are drawn from a wide geographical area extending from the Midlands up to and including Scotland and Ireland and from overseas when referred for the specialist care available. Their length of stay can vary from 8 weeks up to one year in a few instances.

There are a number of conditions where stem cell transplant is now used and these include:- Severe Combined Immune Deficiency (SCID) Chronic Granulomatous Disease (CGD) Juvenile Idiopathic Arthritis (JIA) Wiskott Aldridge Syndrome Leukaemia Severe Aplastic Anaemia

In addition, there is an ongoing active research program looking into ways of using Genetic Modification as a form of treatment for certain inherited conditions.

When first set up at the Newcastle Genera Hospital the unit used 'Bubble Tents' in which the child was completely isolated from the surrounding environment. However, since moving into the new unit at the Great North Children's Hospital, the children have been accommodated in beds within a High Air Pressure Curtain which isolates them from the surrounding area. This has many advantages as it enables direct access to the child without the risk of infection, is more child friendly and is very effective in preventing infections, provided all staff/relatives etc. are meticulous in their hand washing technique.

When a patient is accepted into the program they first undergo a complete destruction of their own bone marrow by cytotoxic chemotherapy treatment (this has now mainly replaced Irradiation treatment) before undergoing the bone marrow stem cell transplant. The marrow stem cells are obtained from the National Bone Marrow Bank and matched to the patient prior to them starting treatment. As a result the survival success rate is now verging on 90% for all of the conditions treated.

The unit has an active programme to involve all of the children's relatives in their care. It uses a variety of methods for finding out what they think of the care provided and the facilities for their accommodation. These involve the use of graffiti boards and cards, a parents room communication board, post-it notes, a monthly questionnaire and involving the Rainbow Trust group with International liaison. By this means they have been able to respond quickly to any problems encountered by the parents.

Future plans include the appointments of Assessment and International coordinators; increasing the accommodation available; rotating staff to support pre- and post- care on other wards; and a re-launch of the Bubble Foundation.

CQC PREPARATIONS

A few of our members had enquired about what the CQC might need from them when a visit took place. We sought advice from the Director of Quality & 3 Effectiveness (Angela O’Brien) on this and she suggested that we might be asked about the following:

How does your Council of Governors organise its work on quality and safety? Is there a dedicated group or committee that CQC can link with?

What information does the Council of Governors gather or review about patients’ experiences of their care? Is there an agreed process for sharing this information with the Trust Board?

How does your Council of Governors organise its work on quality and safety? Is there a dedicated group or committee that CQC can link with?

What information do governors gather or review about complaints, concerns or comments from patients and carers using the Trust’s services? Is there an agreed process for reviewing the common issues arising from this information with the Trust Board?

Are all the governors familiar with the national standards of quality and safety that CQC monitors?

What information does the Trust share with governors to show how it monitors its performance against CQC’s national standards of quality and safety?

How do governors assure themselves that the Trust is monitoring the standards in all locations across its services?

Do governors visit the Trust’s wards and departments themselves? If so, does this include visits across the whole trust, not just the main site?

Do governors know what to do if they are concerned about someone’s care at the Trust? Is there an agreed process for individual governors, and the Council of Governors as a whole, to raise concerns with the Trust, and with the Local Authority or CQC if necessary?

Mrs O’Brien informed us that she was to give a presentation on this topic at the Council of Governors meeting in November.

WARD & DEPARTMENT VISITS

There have been two visits during the past two months.

Derek Thompson visited Ward 50 at the RVI – the Coronary Care Unit – which he found to be a mixed ward with 6 beds. It works in concert with Ward 49 (currently temporarily at FH while it is refurbished) as a 'step-down' unit. He was impressed by all of the staff and the cleanliness of the ward. His only concern, which was not reported by the staff, was the shortage of Storage Space for the Monitoring and Diagnostic Equipment on the Ward. These, often large, items, when not in use were placed in the corridor giving rise to concern about access etc.

4 Helen Lucraft and Jacqui Springthorpe had visited Ward 43 at the RVI – the Neurology ward. They noted that patients in this ward came from a wide geographical area including West Cumbria and the Scottish Borders. All of the patients they spoke to were very happy with the ward environment, facilities, staff and food. Their only complaint was the cost of the Patient line TV when they were in hospital for a prolonged period. They had a few concerns about what they observed:  Poor signage to the ward from the Leazes entrance and reception area  Delays in discharging patients to either their parent hospital or Walkergate for rehabilitation  Cost of the Patient line TV for long-stay patients who were often restricted to their beds.

RECOMMENDATION

To receive and note the report.

Chris. Venables Chairman – QPE Working Group 11th November 2015