The North Central London Joint Health Overview and Scrutiny Committee meeting was scheduled to receive quality accounts for three local NHS trusts: Royal Free London NHS Foundation Trust, Whittington Health NHS Trust and North Middlesex University Hospital NHS Trust.

Scrutiny of NHS Quality Accounts

The committee was scheduled to scrutinise the quality accounts of these three NHS trusts. The quality account for North Middlesex University Hospital NHS Trust was not included in the meeting pack.

Royal Free London NHS Foundation Trust

The report pack included the Royal Free London NHS Foundation Trust Quality Account 2023/24. The Royal Free London NHS Foundation Trust provides NHS services to 1.6 million people at over 70 sites across north London and Hertfordshire.

The trust's quality account explains that it has a quality strategy to underpin its Excellent Health Outcomes governing objective . This sets out to improve the health of its local communities through service transformation.

The account also sets out the trust's priorities for 2024/25.

Patient experience

The trust's first stated priority is Improving patient experience – delivering excellent experiences . In 2023/24, the trust launched an involvement register to help standardise how patients and carers can contribute to designing and improving services.

The quality account states:

Key highlights and successes achieved for patients and cares in the last 12 months include:

• In April 2023, the Royal Free London NHS Foundation Trust (RFL) launched the involvement register, which provides a standardised process for recruiting and supporting patients and carers in ad-hoc and regular involvement activity across the group, as well as documenting evidence of involvement.

The account gives an example of patient involvement in the deteriorating and resuscitation committee . It also describes the introduction of a reasonable adjustments field on the trust's Electronic Patient Records (EPR) system.

The trust is also prioritising Fundamentals of care: nutrition . The report pack states that the trust intends to make sure patients are receiving appropriate nutrition and hydration where necessary. It plans to establish a trust-wide nutrition group including patients, speech and language therapist, dieticians and estates and facilities .

The account also describes how the trust will improve communication with patients regarding cancelled appointments. This builds on progress in 2023/24, which saw the trust implement an SMS system to notify patients of cancellations.

The trust also plans to increase compassion and kindness among its staff. The report pack describes how the trust intends to deliver a civility and kindness project .

It also intends to increase the number of linked actions arising from digital patient experience feedback.

Clinical effectiveness

The trust's second priority is Improving clinical effectiveness: delivering excellent outcomes . It plans to standardise the format for reporting on mortality and morbidity across its hospitals.

It also aims to achieve 75% recruitment into open research studies.

Patient safety

The trust's third priority is Improving Patient Safety: delivering safe care . The account describes the trust's ambition to achieve zero trust-attributed Methicillin-resistant Staphylococcus aureus (MRSA) cases. It also describes its plan to reduce the incidence of Gram-negative bacteraemia in line with the NHS Long Term Plan objective of a 50% reduction by 2024/25.

The account states:

From April 2023 to March 2024, the trust recorded 7 [ Final data to be confirmed] attributable cases of MRSA bacteraemia, a reduction of two infection in comparison to the previous financial year.

The trust has set out to reduce the incidence of trust-attributed Clostridium difficile (C. diff) infections that are caused by lapses in care to zero.

The account describes the trust's patient safety plans in the context of the recently implemented Patient Safety Incident Review Framework (PSIRF). It aims to reduce the number of patient safety reports where deteriorating conditions are given as a contributing factor by 30% by the end of 2024/25.

Finally, the trust states its aim for all wards and divisions to establish a regular practice of reviewing shared learnings from safety incidents and to develop their own improvement plans.

The account contains statements of assurance from the board on areas like CQUIN, Information Governance and participation in clinical audits. It also contains performance information on indicators like Summary Hospital-level Mortality Indicator (SHMI), emergency readmission rates and performance against the four-hour A&E waiting time standard.

Whittington Health NHS Trust

The report pack also included the Whittington Health NHS Trust draft quality account for 2023/24. The draft account sets out Whittington Health NHS Trust's priorities for 2024/25, which are based on a combination of NHS England priorities and feedback from the trust's engagement activities.

Ensuring patients are seen by the right person, in the right place at the right time

This priority is aligned with the trust's commitment to the NHS Long Term Plan, which pledges radical change to planned care. The trust sets out its aim to reduce waiting times for first appointments for a range of services by at least 20% by the end of March 2025. This includes assessments for Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD), Child and Adolescent Mental Health Services (CAMHS), Occupational Therapy (OT) and Speech and Language Therapy (SLT).

It also aims to reduce harm from pressure ulcers¹. It aims to reduce the number of Category 4 pressure ulcers² in the community by 50% based on 2023/24 figures. It also aims to achieve a 25% reduction in all other full thickness pressure ulcer incidents across the trust, in line with new national reporting requirements.

The trust also aims to prevent unnecessary hospital admissions by supporting patients to stay well in their home environment. It aims to utilise up to 48 virtual ward beds, 28 in acute settings and 20 in the community.

The trust intends to improve performance on the two, four and 24-hour virtual ward and urgent response targets, aiming to meet these targets for at least six months of the year.

It also aims to direct 75% of patients in the Emergency Department to an appropriate care pathway by March 2025. It also aims for a 20% reduction in moderate and severe harm from falls across the trust.

Reducing health inequalities in the local population

This priority reflects the NHS Long Term Plan's focus on preventing and managing ill health in groups that experience health inequalities.

The trust plans to deliver a new community Red Cell (sickle cell) service for patients with sickle cell disease. This will be delivered in partnership with patients and North Middlesex University Hospital (NMUH) and University College London Hospitals NHS Foundation Trust (UCLH). It aims to deliver NHS targets, reduce length of stay (LOS) and reduce admissions.

The trust also intends to implement the NHS's Sickle Cell Card for at least 75% of Sickle Cell patients attending the emergency department by March 2025.

It plans to build on the success of its prostate cancer awareness events by holding 40 events by March 2025. It will focus on events relevant to patients experiencing health inequalities.

The trust also plans to implement the Attend Anywhere system in maternity services by March 2025. It also aims to implement the Birmingham Symptom Specific Obstetric Triage System (BSOTS) in Maternity Triage by the end of March 2025.

The trust also states its plan to further develop its intranet page for patients with autism and learning disabilities and to improve access to a range of accessible information for this group. It also plans to deliver Oliver McGowan mandatory training on learning disability and autism to 80% of its staff by March 2025.

Improving access and attendance for appointments

This priority is based on feedback received from patient representatives about how confusing information around appointments can be.

The trust plans to improve the clarity of patient letters and on-site signposting. The trust will ensure outpatient letters are reviewed to make sure they correctly match hospital signage. It will also implement a wayfinding strategy for patients and carers.

The trust will ensure accessible information is provided for patients with learning disabilities for several aspects of the patient journey. These include: attending outpatients appointments; checking in at outpatients; going to the emergency department; going to theatre; having an operation; having an anaesthetic; and going home from hospital.

It also plans to reduce the number of complaints received from patients about communication by 10% across all of its integrated clinical service units (ICSUs) by the end of March 2025.

The trust will offer patients more options to attend local sites for appointments, including by offering paediatric blood tests at the Wood Green Children's Development Centre.

Improving the Trust Environment to Improve Patient Experience

This priority is based on feedback from patient representatives, the Patient-led assessment of the care environment (PLACE) report, the Care Quality Commission (CQC), and other stakeholders.

The trust plans to work with its estates team to Transform ED Front of House . It aims to improve the waiting area, triage cubicles, rapid assessment area and space available for patients with mental health needs.

It also aims to improve cleanliness, condition, appearance and maintenance scores in the 2024 PLACE report to over 90%.

The draft account also includes statements of assurance from the board, along with performance information and updates on local initiatives. It includes information on indicators like Summary Hospital-level Mortality Indicator (SHMI), emergency readmission rates, performance against the four-hour A&E waiting time standard, staff survey results, patient Friends and Family Test (FFT) results, and infection control.