St George’s University Hospital NHS Foundation Trust Clinical Quality Review Group (CQRG)
Posted on 13/09/2017
St George’s University Hospital NHS Foundation Trust Clinical Quality Review Group (CQRG) met to discuss two items:
The first of the presentations, Learning from Deaths, was given by the consultant Chair of the new Mortality Monitoring Group (MMG).
The hospital is making good progress using the new DATIX system as a platform for mortality reviews and,
The Mortality Monitoring Group is working closely with the leads for adult learning disabilities (LD) and safeguarding to ensure that the review process correctly identifies patients with LD and mental health diagnoses.
The second: the NHS Staff Survey 2016.
The overall indicator for staff engagement at the Trust was worse than average when compared to other similar trusts.
The Trust’s score was 3.70 compared with the average 3.80.
The Director of HR responded to the results, outlining plans to improve staff development opportunities and to address the five items with the worst scores. (Staff harassment, bullying, low staff satisfaction with resourcing and support, health and wellbeing.)
We will monitor, as important, progress with the Trust’s action plan to improve staff morale – and thereby help to improve recruitment and retention of staff.
St George’s Hospital Foundation Trust, Clinical Quality Review Meeting
Posted on 13/09/2017
Two key presentations were given at this review meeting by St George's consultant cardiologist and consultant orthopedic surgeon.
The Heart Failure Unit is a pilot approved by the Clinical Commissioning Group at present. This first half year has shown excellent outcomes although bed numbers have been reduced from 15 to 11, which is not enough to meet the unit's need.
The Orthopaedic Audit Report on fractured neck of femur mortality at St George’s Hospital suggested that the mortality rate post-operatively was greater than expected. Patients have been older and in frailer health than at comparable centres though.
Although standards of patient care have been high, overall performance is still below standard in some areas.
Commissioners and the Trust are working hard to make improvements before the Care Quality Commission’s next inspection in September 2017.
Please refer to our report below for further details.
South West London and St George’s Mental Health Trust Board Meeting - Part A
Posted on 21/08/2017
Both Executives and Non-executives met with the public to discuss the first part of the agenda at the South West London and St George’s Mental Health Trust Board Meeting.
Issues discussed: Fire safety, bed requirements, patient's belongings and experience, community service standards, recruitment and retention and finance.
Fire Safety - Following the recent tragic event at Grenfell Tower a report from the CEO (Chief Executive Officer) David Bradley showed that wooden cladding on the Wandsworth Recovery Centre was considered safe and the insulation used was non-combustible.
Bed spaces - The Trust was managing pressures better than most other mental health trusts in London and currently had no ‘out of area’ admissions.
A "zero tolerance" culture was agreed to be encouraged regarding failures of care concerning the loss of patients' clothing and other belongings.
- The Board have asked for a more comprehensive report on the various measures of patient experience including Real Time Feedback to be submitted in September.
For a full report please read the attached feedback form.
Visit to the Talk Wandsworth refurbished Hub at 56 Tooting High Street
Posted on 21/08/2017
The new Talk Wandsworth service is potentially of interest to all or any of Wandsworth's resident, although it is targeted at vulnerable people. Although setting up the new service has taken longer than expected it will be moving into its new Hub in July.
With 5 individual therapy rooms and 4 group rooms as well as a large training/workshop room it is spacious and fit for purpose.
It opens from 8a.m to 8p.m on weekdays and from 9a.m to 5p.m on Saturdays.
The new service model, as before, allows people to be referred by their GP or self-refer.
The new three step service model is staged at:
10% of referrals to one-off Wellbeing interventions.
80% to Cognitive Behavioural Therapy (CBT) Foundation groups or 1-1 services.
The remainder to Advanced CBT, evidenced based therapies, or counselling provided in GP practices.
We did not get time to discuss how this will happen and will therefore need to develop ongoing ways of keeping informed, and contributing to service development.
St George’s University Hospital NHS Foundation Trust Clinical Quality Review Group
Posted on 21/08/2017
Specialist Services Commissioners from Wandsworth Clinical Commissioning Group and NHS England Clinical Quality Review Group (CQG) met to hear a presentation by the consultant Chair of the new Mortality Monitoring Group and discuss the Trusts quality in end of life care practises, and staffing surverys.
Their report was on the Trust’s response to the national guidelines on learning from deaths with regards to:
Progress on staff training on the new DATIX database
The Mortality Monitoring Group who is working closely with the leads for adult learning disabilities and safeguarding
Failures to recognise end of life or failure to escalate to Intensive Care Unit earlier.
We will monitor progress regarding improvements to staff morale due to concerns after staff surveys reported an increase in the number of complaints involved in staff engagement and care.
Merton and Wandsworth Local Transformation Board meeting
Posted on 21/08/2017
Top NHS commissioners and providers from Wandsworth and Merton, together with our local Healthwatch, met for the first time in this forum to review progress towards the delivery of the Sustainability and Transformation Plan.
The two boroughs combined to addresse the next twelve months of planning. The key issues were:
- to agree on the areas of work to be monitored;
- and to agree how the Board would conduct business.
We aim to make sure that patient and public involvement is built in to these planning stages.
South West London & St George’s Mental Health Trust Board Meeting
Posted on 18/08/2017
In continuing to focus on raising standards the Mental Health Trust discussed various issues concerning: bed management, standards for Community Services, Triangle of Care pathways, the Child and Adolescent Mental Health Neurodevelopment Service, Equality & Diversity objectives and finance.
Bed closures have been postponed including the delay in closing Ellis Ward as demand remains high. The work focus though is aimed at successful alternatives to admission, and improved rehabilitation services and support in the community
The Wandsworth Single Point of Access continues to underperform due workload pressures in mental health services
Funding has been approved for a further 12 months for a young person's Autism service
And overall compliments were up significantly.
Healthwatch will continue to follow the work of the Board and will be asking about a number of these issues when we meet with them. The full report is below.
Stakeholder Group meeting for services provided or commissioned by the Multi Specialty Community Provider
Posted on 18/08/2017
This is a new meeting set up by the Multi Speciality Community Provider to discuss developments in the provision of health services working together in the community. St George's NHS Trust lost the contract so this is a key transition phase of information and communication of patient services.
The Multi Speciality Community Provider is an umbrella for the direct provision of some services, the commissioning of others on behalf of the Clinical Commissioning Group and the co-ordination of others provided by agencies such as the Council.
This contract will span seven years with joint care plans for mainly older people, bringing together input from GPs, community nursing and therapies, home care, community mental health interventions and voluntary sector support.
We will represent patient services by contacting the new provider to discuss their approach to gathering patient experiences and communicating findings.
Directors of the Merton Clinical Commissioning Group (CCG) Board met with lay members Clare Gummet for Personal and Public Involvement and Peter Derrick for Governance, following the conjoining of Wandsworth and Merton CCG.
These monthly meetings will now be used to discuss issues affecting both boroughs. Issues such as:
Treatment Restrictions due to Purdah
The public's questions and complaints.
Please see the attached Healthwatch report for details.
St George's University Hospital’s Foundation Trust Council of Governors Meeting
Posted on 09/08/2017
The new leadership team at St George's is starting a two-year process to deal with the underlying problems in processes and systems at St Georges. The first priority is to actively support staff in doing their work. The meeting looked in-depth at some of these issues with particular focus on:
Regaining Staff Trust from the senior team in order to show consistent values, consistency and commitment
The Relaunch of a patient experience committee
Particular targets to be reset around the resolution of staff compaints within certain time frames.
SWLStG (SouthWest London St George’s) Mental Health Trust Board meeting - Part A (the Board meets in public for the first part of its agenda)
Posted on 09/08/2017
The Trust met to disuss various issues for the year ahead including, bed pressure, Ellis Ward, the Lotus Suite, waiting times, eating disorders and general finance.
Waiting times were a key focus, particularly for the psychological therapies such as the IAPT services in Wandsworth and Sutton and the CAHMS Neuro-assessement for Autism and ADHD in young people.
IAPT have improved their services with the help of additional funding. Talk Wandsworth, however, will be working to make further improvements in this area in future. Healthwatch will also continue to keep an eye on this.
CAHMS Neuro-assessement for Autism and ADHD in young people are showing positive results with a backlog of referrals being cleared and waiting times also reduced.
"We commented on the Trust's more coherent and proactive communications profile and asked that they should consider making publicly accessible their new "map" of stakeholders and arrangements for engagement. This was agreed."
For financial results please refer to the full report below.
We met with the Clinical Commissioning Group (CCG) and Social Services to discuss various issues. Out of this meeting it was clear that key changes are happening in the CCG with seven new members all within the managment teams.
A good report was given on Child Services which showed an improvement in care of looked after children, with a figure of 200 attending local A&E.
About a dozen people representing local voluntary sector providers met with the Clinical Commissioning Group (CCG), the Mental Health Trust and the Council's mental health social work teams to look at how various services have been running over the past year.
A lively discussion followed a report given by MIND on how safer discharge was now being given to patients leaving hospital care. Better knowledge and communication however is needed on voluntary sector services.
Services at Springfield such as the new Lotus Suite were also giving positive results with statistics showing 71% of the 250 people in crisis assessed now referred back in to the community, rather than admitted to inpatient care.
The Recovery cafes set up both in Tooting at 966 Garrat lane by Hestia and the Sunshine cafe at Wimbledon Chase are building in numbers, and have a good show of volunteers to support each service user.
For a full summary of this meeting please refer to our attached report.
Around 90% of prisoners in England live with some form of mental health problem and mental ill health is much more prevalent within prisons than anywhere else. Inmates commonly suffer with depression or anxiety, psychotic illnesses or substance abuse disorders.
However, only 1 out of 5 prison inmates with a mental health problem is currently receiving treatment. This has lead to suicide in some cases as well as a whole host of other problems.
As Wandsworth Prison is one of the top three most overcrowded prisons in England, we felt that an investigation into conditions there, and a consultation on the mental health needs of the prison inmates, was long overdue. Our consultation was carried out in conjunction with the London Assembly Health Committee's efforts to improve access to mental health support for prison inmates.
We collected information from ex-offenders, service providers and other interested stakeholders to get a better idea of the main mental health challenges faced by prisoners and to try and assess what the Mayor and the London Assembly can do to support better mental health for this group.
One the main aims of our ‘Enter & View’ team’s current strategy is to find out more about patient experience at St. George’s Hospital. Early in 2017 we were invited to visit the renal services department. Following our visits to the hospital's renal services department, we visited Colliers Wood Dialysis Unit. The Unit has been open for six years and was designed to provide dialysis for people with chronic renal conditions but who do not require a stay in hospital.
Following major changes within St George's Trust, which had a negative impact on the delivery of its renal services, it was decided that community based satellite units would be needed to deal with the overflow of dialysis patients from St George’s. Colliers Wood is one of those additional units.
We interviewed a total of 25 patients, most of whom were between 60-79 years of age and had been attending Colliers Wood for between 4 - 6 years. Although they reported initial problems during the transition from St George's to Colliers Wood, things seemed to have largely settled down by the time of our visit.
Most patients expressed high levels of satisfaction with their care and treatment, and medical and nursing staff were praised for being respectful, helpful, and kind. Patients particularly valued the opportunities for socialising with each other at the Unit.
Our findings and recommendations, and the Unit's response to our report, are attached for information.
Enter & View Visit to Champney's Ward Dialysis Services Department, St George's
Posted on 02/08/2017
One the main aims of our ‘Enter & View’ team’s current strategy is to find out more about patient experience at St. George’s Hospital. Early in 2017 we were invited to visit the renal services department. We made a total of three visits to learn as much as we could about the renal services being provided at St George's.
Before we began our visits, we became aware that major changes had recently taken place in the organisation which affected delivery of the hospital’s renal services, including a reduction in the number of inpatient beds and dialysis stations.
We spoke to nineteen patients in all and on the whole received very positive feedback about the caring and responsive behaviour of staff. Most of the negative comments we received were about changes to appointments or the unreliability of the ambulance transport service.
We were very impressed with how well St George’s staff have responded to the challenge of maintaining the quality of patient care in the face of recent changes. Our report and recommendations, along with the Hospital's response to our findings, are attached below.
St George's University Hospital’s Foundation Trust Board
Posted on 12/07/2017
In the main part of the meeting the changes to the quality improvement programme were discussed first, highlighting the £60 million needed for change.
The Senior Staff of the Trust, Governors and members of the public spilt in to small groups to walk around the hospital assessing conditions and speaking to staff - a new initiative. They were asked to give their impressions and then discussed the following topics:
How to remedy the failings noted by the CQC (Care Quality Commission)
The redesign of the quality and performance report with more emphasis on reporting actions and progress rather than just presenting data
Emergency department weak performance
The reported final, financial deficit for last year at £73.9 million
The attached report contains more from this meeting