Patient Safety & Quality Improvement Report Governing Body Medicines Safeguarding Optimisation July 2020 Michelle Turner Patient Quality Improvement safety Research & Personalised development Commissioning
Content: Key Mandates impacting quality and safety: • Primary Care and Community Health Support to the Care Sector, NHS England/Improvement (NHSE/I) - 1/5/20 • Urgent further CCG assistance to local resilience forums in supporting care homes: “Training the Trainers” on Infection Prevention Control (IPC) NHSE/I 1/5/20 • Covid-19 Care Home Resilience Support Package HM Gov 15/5/20 • Nosocomial transmission and IPC Practice (14/5/20) and Test and Trace and the management of outbreaks in primary and secondary care settings (NHSE/I) 12/6/20 Equality Quality Impact Assessments for Service Changes : Key Themes & Trends Patient Safety and Quality Issues : Priority Issues Clinical Ethics Reference Group Impacts on Equalities and Population Health Priorities and Planning ahead
Primary Care and Community Health Support to the Care Sector, NHSE/I 1 May 2020 Draws on best practice in the Enhanced Health in Care Homes Directed Enhanced Service: • A consistent weekly check-in: Multidisciplinary team review of prioritised patients, consistent medical oversight, and more frequent contact where required; • Personalised care & support plans for care home residents: End of Life care plans • Provision of pharmacy & medication support to care homes • Practices organised & community services organised on Primary Care Network footprint • Ensure clear Out of Hours provision for each care home Locally, a robust range of interventions have been implemented via the Care@Home work stream supporting existing community services to work together to provide integrated community response to deliver care and support Care @Home, and new services including: nurse-led 24/7 telemedicine support to all care homes; Super-rota ( 0800-2400) providing MDT clinical support for complex decisions & prescribing and includes input from GPs, GP with a Specialist Interest in Older People, Care of Elderly consultants, pharmacists & Allied Health Professionals. Out of Hospital MDT (8am-8pm) comprising social care, therapies, personalised commissioning, & advanced practitioners, who quickly mobilise help for people with complex or escalating needs. Pharmacy support offering medication reviews for specific patients or general support to care homes with medication issues. End of Life (24/7) offers gold standard advice and Older People Mental Health Support (8am-8pm). Care Homes reporting good support & engagement from the system
Urgent further CCG assistance to local resilience forums (LRFs) in supporting care homes: “Training the Trainers” on Infection Prevention and Control NHSE/I 1 May 2020 Under mutual aid principles CCG Director of Nursing to work with LRFs to take immediate action to identify local trainers to be trained to ensure 100% care homes receive nationally approved training by 29 May 2020 resulted in: • Locally, 100% of all care homes in BdC were offered training • 118 homes trained locally, 5 confirmed compliance nationally (92%) • 10 care homes-booked to receive face to face training in June/July 2020 (8%) A Place-Based System Care Home IPC Sustainability Group meets weekly comprising nursing expertise and leadership from partner organisations, including local authorities, care trust, community nursing, primary care, and the CCG and with representation from Bradford Care Association to strengthen support and sustainability to the care home sector. The emerging programme is responsive and dynamic and being developed and shaped in collaboration with the Care Home sector. Proposals include coordination of activities and training across a network of Care Home IPC Link Workers, with support from community nurses and local authority IPC specialist nursing teams.
Covid-19 Care Home Support Package. HM Government 14 May 2020 A system support package. Led by Local Authorities and signed by the CCG. The CCG has worked collaboratively to support the North Yorkshire County Council and Bradford Metropolitan District Council Care Home Resilience Action Plans, which aim to: • Minimise infection and mortality levels across our care sector • Support the wellbeing of residents and the care workforce • Support the resilience of the care sector • Address inequitable outcomes within the care system Includes the broad range of interventions described in the Care@Home work stream and the IPC programme of work. Also includes: • Clear guidance on IPC responsibilities, supporting homes to access supplies of Personal Protective Equipment • Localised testing programme for staff and residents • Advice & guidance for staff & residents to support mental health & wellbeing • A capacity tracker to support daily monitoring and targeted action to address challenges and support Care Homes on infection rates; mortality; operational, processes, demand and capacity challenges • Support staffing resilience plans including the NHS Bring Back Staff scheme and mutual aid scheme
Nosocomial Transmission and ICP Practice; and Test and Trace and the management of outbreaks in primary and secondary care settings : Led by Public Health • To ensure that anyone who develops symptoms of COVID-19 can quickly be tested to find out if they have the virus • Help trace close recent contacts of anyone who tests positive for COVID-19 and, if necessary, notify them that they should self-isolate at home to help stop the spread of the virus • The approach to reducing the number of cases back to manageable numbers starts with widespread availability of testing for all with symptoms: new persistent cough, temperature above 37.8c or new anosmia • Appropriate PPE, in line with current guidance, is effective in preventing the spread of the virus. • Significant transmission has been seen in health care settings following contact where PPE is not used- this includes time in common areas. • Processes for NHS Trusts established • Processes for Primary Care under development
Equality Quality Impact Assessments: themes and trends • Focus on reducing risks to patients through provision / changes to services to reduce potential for infection transmission • Reduced face to face contact reduces the availability of detailed examination and similar reduced ability to identify safeguarding issues • Impacts on continuity of care where patients are not seeing their own GP or care is provided through different delivery models • Positive impacts through the reduced and different use of secondary care (Emergency Department, unnecessary non-elective admissions, and elective care). Noted impact on longer term health and delays to care provision for people with a long term condition (LTC) • Impact on safeguarding referrals and disclosures mitigated through updated / new protocols and staff training • Workforce issues identified including negative impacts on staff physical and mental wellbeing resulting from working hours, demands, redeployment, availability of PPE. • Positive impacts of the use of digital technology and accessing health care with a reduced risk, but highlighted potential for population groups to be excluded where they are unable or unwilling to access digital solutions and over reliance on digital technology (e.g., Voluntary sector) – highlights the importance of patient choice and the need to reflect this feedback in the way forward and restoration work. • Overall positive awareness of cultural and demographic needs of the Bradford and Craven population and differing demographics
Patient Safety, Experience and Quality Issues May & June 2020 Independent care sector multiple covid-19 related issues and themes: • Hospital patient discharge pathways to care homes (and reported Serious incidents) • Hospital infection prevention practices e.g., attending A&E, Dialysis • PPE availability • 4 red hubs across the district established and operationally supported by the CCG. An options appraisal and recommendations for alternative provision is being considered • Access to healthcare: primary care, management of LTCs and access to immunisations and vaccinations • End of Life/Palliative Care service provision responsiveness • Mental Health inpatient increased bed occupancy, new patients and acuity • System dashboard data: does this reflect increased complexity of cases in general practice and community services? • ANHSFT Ophthalmology follow up waiting list • Methadone prescribing and safe storage • Maternity and Better Births Programme
Patient Safety, Experience and Quality Issues May & June 2020 cont. Bradford potential outlier for infection outbreaks but rate reducing Increase in inadequate CQC rated care homes: Burger Court and Steeton Nursing Home – embargo to admissions Spike in harm to children although numbers remain low & impact on wellbeing flagged up Increase in domestic violence - National and local media campaigns & guidance provided Clinical Ethics Review Group (CERG) Established CCG Silver CERG and governance to Gold System CERG. Issues considered:- • PPE and reporting Covid-19 infections (workforce and care homes) • Do not attempt to resuscitate order objections by persons with a Power of Attorney over a care home resident • Death certification and cultural preference to be buried in 24 hours • Visiting end of life residents in care homes
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