To review the Quality Account for 2024 and provide feedback to the Trust.

(Note: presented by Liz Davenport, Chief Executive , Torbay and South Devon NHS Foundation Trust and Nicola McMinn, Chief Nurse, Torbay and South Devon NHS Foundation Trust).

The Chief Executive and Chief Nurse from Torbay and South Devon NHS Foundation Trust presented the Torbay and South Devon NHS Trust Quality Account for 2023/2024 as set out in the submitted papers.  A Quality Account was an annual report to inform the public of the quality of services and improvements offered by an NHS healthcare provider.  The report included progress against the priority areas identified in 2023/2024 as well as setting out the quality areas for 2024/2025.

The priorities for 2023/2024 were:

• zero avoidable deaths;
• continuously seek out and reduce harm:
• falls prevention;
• improved identification of the deteriorating patient; and
• improved experience on discharge.

Members noted that following feedback the goals and priorities for 2024/2025 were:

• reduce health inequalities (changed from zero avoidable deaths);
• continuously seek to reduce harm;
• deliver what matters most to our people; and
• excellence in clinical outcomes.

Members heard representations from Robert Loxton (member of the public) in respect of vaping.  It was agreed that a written response would be provided if pre-operation questions included asking if people vaped.

Members asked questions in relation to changes to monitoring of patients and if monitoring ceased when other priorities were introduced; what action was being taken to address bullying in the workplace; a lot of good work was being undertaken to support people with cancer with 119 extra referrals per month from GPs, what was classed as planned care and what should people do when they were waiting for diagnosis but needed to seek help sooner due to deterioration; how were goals set in 2023/2024 for the number of inpatient falls resulting in harm (moderate, severe and death) monitored in the future to ensure that they were being met; what action was taken to promote the successes of the Torbay and South Devon NHS Foundation Trust; was the statistics table for the Emergency Department etc. attendance analysis the time for someone waiting for an assessment; was the data about deaths in an ambulance all deaths; and what was the reason for missing data on pages 59 and 60 of the annual report.

In response to questions, Members were informed that reporting on vaping was currently not required under national monitoring, however midwives did talk to mothers about smoking and tobacco use and record if they are vaping at their first booking meeting.  Public Health also provided guidance and advice on smoking and vaping to expectant mothers.

Members were advised that monitoring activity was carried out in accordance with National Guidance and advice.  Changes had been made to early warning score trigger systems, using electronic scoring based on patient monitoring which then determined the actions to take.  The score would then dictate how long it would take for a doctor to respond and for them to remain on the ward, also taking into account if the patient became more unwell during that time.

Members noted the work being undertaken by the Trust to address bullying including the introduction of a Speak Up Guardian as well as two people within the Directorate to encourage people to speak up.  A recent Care Quality Commission (CQC) inspection referred to the kindness and caring they found through the organisation.  A compassionate leadership framework had been introduced and would be rolled out to all staff and people were encouraged to call out and report all poor behaviour and were given tools and techniques to have those conversations and to know that they would be listened to.  This was supported by the Francis Review to create a culture where people could speak up and know they would be listened to.  The Chief Executive of the Trust acknowledged that a recent CQC inspection had referenced issues with culture towards people from different backgrounds and gave assurance that the Trust was taking action and they had seen more people coming forward and speaking up as a result.  The impact of Covid-19 and how the Trust operated with distancing had impacted on relationships.

In response to questions around cancer, Members were informed that across the whole NHS there had been a significant increase in the number of people being diagnosed with cancer and it was being picked up earlier, with better outcomes for those diagnosed with Stage 1 or Stage 2 cancers.  There had been an increase in new technologies that detect cancer in earlier stages.  Around one in five people referred from their GP was diagnosed with cancer with GPs being encouraged to seek advice and guidance if they were not sure whether to refer a patient and were encouraged to refer rather than waiting and watching.  The Trust was small compared to others but was in the top quartile for their research especially around cancer with lots of innovation happening.  People were encouraged to visit their GP if they think they may have cancer so that they can been referred and seen quickly, diagnosed and treated where necessary.  Where someone’s symptoms got worse before having a referral they should go back to their GP so that the referral can be escalated.  This was part of the priority to reduce people coming to harm on waiting lists. 

The priority for reducing long wait times for planned care related to the response to the treatment time, looking at the disease pathway having regards to national targets but also how the patient was, as some diseases spread rapidly and it would not be appropriate for them to wait for the target timescale for that disease.  It was noted that the Trust would have no-one waiting more than 65 weeks by the end of September and no more than 52 weeks by the end of March 2025, however, the national standard was 18 weeks.  The 18 week deadline had not been met for a long time across the whole country and would require significant funding and intervention to meet that standard.  A lot of work had been carried out by the Trust to ensure that people get a diagnosis of cancer within 28 days by March 2025, which was one of the only Trusts in the Country to achieve.

In response to questions around falls, Members were informed of the Falls Project which was looking at different interventions such as offering caffeine free drinks which anecdotally had seen a reduction in falls in Hospital.  Future monitoring would be included in subsequent Quality Account reports and Members noted that if they wanted to carry out a deep dive on an area they could request this as part of their Work Programme review.

Members were advised that discussions had been carried out with a number of people and service users around the priority of zero unavoidable deaths and that some patients were concerned about the message this gave out and that it caused more concern and anxiety when visiting departments e.g. maternity as people did not want death to be highlighted when they use the service.  Each service had looked at actions that they could take to reduce health inequalities with them individually owning their projects which overall would help to meet the goals of that priority area.

It was noted that the Trust had a dedicated Communications Team who provide positive media stories and try to raise awareness of the positive work in different ways, recently this had included information around the trials for cancer treatment.

The analysis of people waiting for an assessment on 22 April 2024 was that it took ten hours for someone in the Emergency Department to receive an assessment.  It was noted that waiting times varied and it was not always clear on the reasons for this.  Sometimes there could be more complex patients who would take multiple staff members away and this was monitored four or five times throughout the day.  Staff ensure that those patients who were waiting were comfortable and provided with food and drink and regularly monitored.  When a patient arrived via ambulance, they were seen within 20 minutes of arrival by a senior nurse to assess their needs.  The data on deaths in ambulances only related to those who died on Hospital grounds, the other deaths were reported by the South Western Ambulance Trust as part of their monitoring.

Members were advised that the missing data related to audits that weren’t completed as they did not form part of the mandatory audits and resources had to be put to those that were mandatory.  A lot of work had been stood down during Covid-19 and it had taken a while to get up to standard for the required clinical audits.

The Sub-Board acknowledged that Liz Davenport, Chief Executive of Torbay and South Devon NHS Foundation Trust was retiring later in the year and thanked her for all her work.  Ms Davenport also thanked Members and the wider Council on helping her to do the right thing for Torbay’s residents over the past few years to improve adult social care and health.

Resolved (unanimously):

1.       that Members formally thank Liz Davenport, Chief Executive of Torbay and South Devon NHS Foundation Trust for all her work with the Integrated Care Organisation helping Torbay and South Devon to be a model of excellence and recognising the pivotal role she has played in providing integrated social care and health services for people in Torbay;

2.       that Members of the Board note the contents of the Quality Account Report for 2023/2024;

3.       that the Torbay and South Devon NHS Foundation Trust be requested to consider including questions, monitoring and reporting for vaping for all patients in the same way they do for smoking, and

4.       that the Torbay and South Devon NHS Foundation Trust be requested to provide more explanation in future Quality Accounts where data is missing.