Agenda item

To update the Committee on the actions taken to ensure patient safety within Blackpool Teaching Hospitals NHS Foundation Trust.

Mr Peter Murphy, Director of Quality Governance, Blackpool Teaching Hospitals NHS Foundation Trust (BTH) highlighted that there were national, ongoing reviews of clinical staffing and it had been recognised that there were not enough doctors and nurses for continuing demand. BTH currently had approximately 260 registered nurse vacancies.

With regards to the Standardised Hospital Mortality Index (SHMI), Mr Murphy reported that the current measure was 116, which was a small increase since the last reported quarter’s value of 115 in quarter 2 of 2018/2019. The Committee considered the SHMI in detail and was informed that the index was calculated using algorithms and being above the average of 100 did not necessarily mean that there was a specific issue, but that the hospital should investigate potential problems. Blackpool Teaching Hospitals NHS Foundation Trust sought to learn from all deaths and had commissioned two external reviews to gain assurance and develop appropriate action plans with a focus on pneumonia, Chronic Obstructive Pulmonary Disease (COPD) and sepsis. The intricacies of responding to subtle symptoms which did not necessarily indicate a serious condition and diagnosing patients correctly was also discussed in detail.

The Chairman highlighted that Blackpool Victoria Hospital had been an outlier for the SHMI since 2011 and queried why the hospital had been performing poorly with regard to the indicator for such an extended period. Mr Murphy advised that work had been ongoing to review deaths and understand the ways in which they had been documented. Once a diagnosis had been made, the patient would be given a code that reflected the diagnosis. Work was ongoing to determine the accuracy of the coding and its reliability. If a patient was coded incorrectly, the recording of any future death could also be recorded incorrectly.

Ms Maxine Power, Director of Quality, Innovation and Improvement, North West Ambulance Service (NWAS) advised the Committee that the SHMI was a complex indicator based on unexpected patient death up to 30 days following original diagnosis, whether the patient had died within the hospital setting or elsewhere. Therefore, a wide range of partners and systems outside of the hospital also contributed to the SHMI performance. It was queried whether data was available to demonstrate the number of patients that died unexpectedly within the hospital in comparison to the number who died after leaving hospital. Mr Murphy agreed to investigate the level of data held and supply the information to the Committee as appropriate.

The Committee went on to consider the Care Quality Commission (CQC) Inspection of the Emergency Department carried out in January 2019 and queried whether all the actions identified by the CQC had been implemented. It was noted that the actions had been implemented and that the Trust had been subject to a fully comprehensive CQC inspection of all services, the outcome of which was expected later this year. Mr Murphy highlighted that the Executive Team of the Trust’s primary focus continued to be the quality of care for patients.

The Committee agreed:

1.      To receive the CQC inspection report of Blackpool Teaching Hospitals NHS Foundation Trust when published.

2.      To request that the data held on the number of unexpected deaths (those that the SHMI was based upon) within the hospital and outside of the hospital following discharge be circulated to Members.