Agenda item

The Committee considered a report from Leicestershire Partnership NHS Trust (LPT) which provided an update on the Quality Improvement Programme.  A copy of the report marked ‘Agenda Item 9’ is filed with these minutes.

 

The Chairman welcomed the following people to the meeting for this item:-

 

Dr Peter Miller, Chief Executive of LPT

Dr Satheesh Kumar, Medical Director at LPT;

Dr Dave Briggs, Managing Director of East Leicestershire and Rutland Clinical Commissioning Group (ELRCCG), the lead commissioners for LPT.

 

Dr Briggs emphasised that the Quality Improvement Plan was ambitious and was intended to improve quality at LPT to a position that was significantly above the minimum standards.  It was intended that, once a certain standard was achieved, there would be a reduction in the scrutiny of delivery, currently carried out by a newly established Quality Oversight Group.   The timescales for delivery were challenging and it was intended that LPT would focus on delivering improvement in priority areas.  However, timescales might slip in other areas.

 

Written comments had been received from Healthwatch Leicestershire and a copy is filed with these minutes.  At the invitation of the Chairman, Geoff Smith OBE, the Healthwatch representative, commented that Healthwatch would welcome a shortening of the timescales for delivery of the Quality Improvement Programme.  However, the timescales, which had been developed with staff and the Quality Oversight Group, were ambitious and unlikely to be shortened.  Dr Peter Miller confirmed that Healthwatch would be invited to future meetings of the Quality Oversight Group.

 

Arising from discussion the following points were raised:-

 

(i)        The Quality Oversight Group would ensure that LPT and its commissioners were monitoring performance in the right areas and could demonstrate that people were receiving the care that they deserved.  The Quality Improvement Plan had been rigorously tested during development to ensure that it was satisfactory.  Work had already started on the key priority measures.

 

(ii)       In order to achieve the necessary improvements in quality, LPT would need a sustainable change in culture.  Strong leadership would be required to deliver this, for example every clinician would need to demonstrate leadership potential and not walk past poor practice.  A cultural audit of several hundred members of staff had already been undertaken and would be repeated in order to measure whether the change had been implemented.

 

(iii)      A variety of mechanisms were being put in place to improve the experience of patients and carers.  These included strengthening the complaints process, undertaking surveys when patients were being discharged and collating patient feedback by ward to enable performance to be considered at ward level.  In order to collect relevant data from staff as well, LPT wanted to create a culture which encouraged openness and the raising of concerns about poor performance.  Policies to support this were in place.  Senior managers were also visible on wards and would speak with staff and patients.  The Committee commented that it was important to have the right balance to ensure that data collection was not overly bureaucratic and that key messages were not overlooked.

 

(iv)      The model for providing psychological therapies on wards would be informed by NICE guidance but would also build on existing services available to inpatients such as self-help groups.  Base level training in Cognitive Behavioural Therapies was also being planned for ward staff. 

 

(v)       The Supporting Leicestershire Families programme used an assessment tool called ‘Family Star’ to support and measure change.  It used a scale of one to ten to outline key steps in a transition from dependence to independence.  It was suggested that this model could be adapted by LPT to measure performance of therapies.

 

(vi)      The Committee was pleased to note the number and range of activities available for in-patients.  Most activities were undertaken in the Involvement Centre, within the safety of the Bradgate Unit but away from the wards.  Those patients preparing for discharge were given support to go out into the community.  The need to ensure that sufficient Occupational Therapists were available to provide these services was acknowledged by LPT.

 

(vii)     The average length of stay on the Bradgate Unit was 44 days, with more than half of the patients detained by the Mental Health Act.  The wards always had nearly 100% occupancy, which put the service under pressure.  The Committee was pleased to note that, in order to reduce pressure on in-patient services, LPT also planned to improve the discharge process and how the Community Mental Health teams supported patients in the community.  LPT was currently working to address capacity issues in this area.  Evidence showed that engaging with patients while they were in the community helped to prevent readmissions.  To this end, LPT had also established a Recovery College which provided evidence based education in self-management.  Less than 5% of LPT’s patients were readmitted within one month of discharge, although this number had increased recently.

 

(viii)    One of the actions in the Quality Improvement Programme was to set a standard time between agreeing to admit a patient and actually admitting them.  The performance measure for this target was still being developed.  However, it was noted that a police triage car was in operation and had reduced the number of patients who ended up being put on Section 136 by the police.  This contained both a mental health clinician and a police officer and would ensure that the patient was kept safe until admitted.

 

(ix)      Although 15% of police time was taken up with mental health issues, it was noted that most actions undertaken by the police to ensure that people with mental health problems were dealt with appropriately and sensitively were within the police’s remit.  It was important that the response to requests for support from the police was efficient.

 

(x)       The length of time a One to One session lasted was a matter for professional judgement.  One to One meetings had already been introduced as part of the Quality Improvement Programme.  Patient feedback would be used to check if the One to One sessions were meaningful.

 

(xi)      LPT did not offer a specific service to assist patients where their mental illness had caused a family breakdown.  However, it had signed up to the Leicester, Leicestershire and Rutland Carers’ Strategy which worked with families to prevent breakdown.  Bereavement services were also available.

 

RESOLVED:

 

(a)       That the development of the Quality Improvement Programme be noted;

 

(b)       That a report on the outcomes of the work of the Quality Oversight Group be submitted to the Health Overview and Scrutiny Committee meeting in March 2014;

 

(c)       That officers be requested to organise a visit to the Bradgate Unit for members of the Committee.