Transcript

meeting of the Sheffield Health Scrutiny Subcommittee, our first meeting of this municipal year. The meeting today is open to the public, so a warm welcome to all of you in attendance in the room or virtually online. My name is Councillor Ruth Milsome, I'm the Chair of this Health Scrutiny Subcommittee, and before we go any further I'm going to ask our Support Officer from Democratic Services, Joanne, to read the housekeeping arrangements for us. Please can I request that mobile telephones and other such equipment switch to silent mode so as not to disturb the conduct of the meeting. There is no fire test planned for today. If there is an emergency evacuation, please take instruction from the Council staff present. The assembly point is Tudor Square. The meeting today is open to the public and will be streamed live and for subsequent broadcast via the Council's website. You should be aware that the Council is a data controller under the Data Protection Act. Data collected during this webcast will be retained in accordance with the Council's published policy. By entering the meeting room you are consented to be filmed and the possible use of those images and sound recordings for webcasting. Thank you. Thanks very much, Joanne. So I'm going to ask members to introduce themselves and then officers to introduce themselves. And I would like to say, so we have got new members on the committee, so a particular welcome to those new members. And we'll start with Sophie if you'd like to introduce yourself and we'll move round in this direction. Morning, thank you, Chair. Councillor Sophie Thornton for Beecher from Greenall. Good morning, Councillor Steeves, Deputy Chair of the Health and Health Committee. Good morning, Councillor Toby Mallinson, Councillor for Hillsborough and Green Party Spokesperson from this committee. Hello, I'm Councillor Rob Bannister and I represent Grays Park. Good morning, I'm Lauren McLean, I'm a Councillor for Waltham Ward. I join Cooper and I'm the Deputy Chair of the Health and Health Committee. I'm the Deputy Chair of the Health and Health Committee. I'm the Deputy Chair of the Health and Health Committee. I'm the Deputy Chair of the Health and Health Committee. I'm the Deputy Chair of the Health and Health Committee. I'm the Deputy Chair of the Health and Health Committee. I'm the Deputy Chair of the Health and Health Committee. I'm the Deputy Chair of the Health and Health Committee. I'm the Deputy Chair of the Health and Health Committee. I'm the Deputy Chair of the Health and Health Committee. I'm the Deputy Chair of the Health and Health Committee. In terms of reference for today's meeting, to read out so that we're all sure on what footing we are holding our discussions to fit within those pre-election period restrictions. So I would like to remind everyone attending and speaking today that we are in the pre-election restriction period. This means that the Council has to be especially aware of its legal duty not to publish any material that may be seen to favour a candidate or party in the election. There is also a requirement to ensure government policy is presented in a balanced and even handed manner. Publicity is given a wide meaning and includes matters said in Council hosted meetings. I therefore require everyone speaking today to confine their questions and comments to those strictly necessary to conduct the business on the agenda and not to stray into incidental or related matters that might breach the publicity restrictions. There are a number of reports on today's agenda relating to the quality of local NHS services as policy relating to the National Health Service is led by the government and is a matter of political debate in the general election. I would ask elected members to restrict their comments to the content of the reports themselves and not to stray into those wider issues of healthcare policy. And just to say that we have had a discussion amongst members before we've come into the room today to agree a broad basis for what we will and won't comment on today. So we also have Andrea with us as legal advice today to make sure that we don't cross any lines. Right. So exclusion of the public and press, I believe there are no items today that require the exclusion of public or press. I will mention at this point that we have removed during this pre-election period public questions are removed from the agenda because that doesn't fit with the pre-election rules. So apologies to members of the public but there will be future opportunities to bring questions to the committee. We've also removed members questions from this agenda because necessarily that is something that could imply to the public that this is a very important moment. Declarations of interest. I have to ask whether any members wish to declare an interest in any of the items of business on the agenda. Okay, thank you. And then we're on to the minutes of the previous meeting included in your agenda pack. We'll keep this brief as everyone's had a chance to read them beforehand. So I'm asking members to approve as a correct record the minutes of the last meeting held on the 14th of March. Are there any comments on the minutes? Are we happy with the minutes? I'm aware that there are a couple of action points that have fallen by the wayside because of multiple pre-election periods. So we held that meeting just before we went into the local election restricted period and then we've gone straight into the general election restricted period. So there are a couple of actions there. I'm looking at Deborah that we need to still pick up which involve writing to various bodies I think. So we'll pick those up as soon as we're able to after 4th of July. Right, on to our main items of business. So item 5 we have the quality account from Sheffield Children's Hospital Trust and we have Yvonne Millard and Craig Bradford with us today. Thank you for coming to take us through that report with a brief introduction and then we'll have questions and comments from members and we are asked to provide feedback to be published along with your report. So I'm going to start a stopwatch if that's okay. I don't mean to be mean with time but we probably need to keep it to half an hour. So take it away Yvonne and Craig, thank you. Good morning everyone, my name is Yvonne Millard and I'm the Chief Nurse at Sheffield Children's Hospital. Good morning everyone, I'm Craig Bradford the Chief Operating Officer at Sheffield Children's. Thank you for the invite. We're delighted to be able to share our quality accounts with you and we do welcome feedback. We know Healthwatch aren't here today but we have received their feedback that's in the pack and we will take their comments on board. So the plan will be briefly, I will touch on the two priorities that sit within my portfolio from last year and where we're at with those and then talk to this year's one. Craig will touch on his priority for last year and his for this year. So I will go into a little bit about us. So I don't think everyone realises that Sheffield Children's is not just the acute building of the road. We have 0-19 services which is health, visiting, school, nursing. We have tertiary care such as critical care, transport. We also have children and young people mental health services, that's community, inpatient and day case. So all of that counts as Sheffield Children's. Last year one of our first priorities was implementing patient safety instant response framework. It sounds very fancy but essentially it's a way of investigating incidents and the system changed to draw out much more learning which is really the point of an investigation. So we set out our priorities in last year's accounts. I'm pleased to say that we have achieved all of the aims in that domain. The key one for us as an organisation was that we took a compassionate approach. It was never about blame. It's always about learning. That's embedded really well in the organisation and what we really focused on was involving our children, young people and families right at the offset so their voice was central to any investigation. Their questions were embedded within that and then we share all of the learning with them during and at the conclusion of any investigation. So we achieved our PSURF objective. It's business as usual but we know that we will continue to build on that. I'm pleased to say the same for our second priority which was outstanding experience. We now have a strong voice in all of our governance structures from children, young people and families. We hear patient stories directly their lived experience at our board meetings. We have appointed two experience leads whose job is purely to focus on the experience, the lived experience engagement of our children, young people and families. We've also done quite a lot of work within that on health quality and we've grown our youth forum to increase their diversity. So again that's no business as usual but we will continue to build on those. All of the priorities from last year we now have a standing agenda item in our quality committee because we don't want them to drop off that radar so we continue to monitor through that. This year we developed our priorities through reviewing national targets, listening to our children, young people, families and colleagues, thematic reviews of complaints and we looked at our performance against other providers and benchmarked particularly with the Children's Hospital Alliance. So I'll talk you through the two priorities that sit within my portfolio. The first one is sepsis. Sepsis is a life threatening reaction to an infection that can be very hard to spot. We chose this priority, our own audits and investigation have shown us that there is more to do in raising awareness and early recognition of this. We know that patients aren't always treated as quickly as they should be and we know that there is national work being done but it hasn't improved as much as it could. We chose this in particular because we know from last year that by making it a priority with executive oversight there's a real focus on it and we make really good headway in it. So what we're doing in our sepsis priority is we have appointed a sepsis nurse whose sole role is raising awareness and education in this arena. To learn and improve we have listened to families, we've reviewed audits and case reviews, we are working directly with families who have been affected by sepsis and we're learning from them. They've been very generous with their time. We have improved our guidelines. I can go into detail of that when we get to questioning. We've improved our training that is now included in induction and particularly in our resuscitation induction. We have implemented standardised early warning systems which is a way of recognising when a child or young person becomes unwell. It's much easier now to identify that. We've introduced an escalation system for parents and carers if they feel that their child is clinically unwell and they are not being listened to they have an alternate route to take to get a second opinion for that child and I'm pleased to say that we are one of the early adopters of Martha's Rule which has been widely publicised but again happy to take questions on that. Our second priority will be to improve bereavement services. We know from recent bereavements, complex complaints and recommendations from inquests that our bereavement care isn't as good as it should be. We have only got one chance to get this right for a family and we need to do it the best we can. We have reviewed our entire bereavement programme. We are currently appointing a bereavement nurse and a bereavement co-ordinator. I now hold the central function for bereavement so all services within that including Rose Cottage which is our mortuary will sit with me. It's a whole family approach it's not just about the parents it's about the siblings and those that matter to that person. We have appointed a joint agency response nurse. We're reviewing our key worker training and that essentially means our core offer to all families will be the same. We know we are going to focus on communication with families. We have now sourced additional support for counselling through Bluebell Wood. All of this is being guided with those from lived experience. So I will pass over to Craig. Thank you. Thanks Yvonne. So I'm just going to touch on the two criteria for my areas. So last year we set one of the priorities regarding reducing waiting times which was in line with national targets but equally importantly about informing and keeping patients and families involved in their pathway of care and supporting them once they waited for that appointment or for that surgery. So the positive is that we did continue to reduce waiting times despite multiple rounds of industrial action and we are reducing the size of our physical health waiting times. As Yvonne alluded to as well we've done some really good work with trying to address health inequality so we actually publish in our public board papers health inequalities performance report where we look at our waiting times and our services being accessed by both ethnicity and deprivation and we try to amend our service offer for those families. An example I'll give you of that is we have a predictor tool around kind of predicting which people which families are unlikely to attend their appointments and we would ring those families up and try to give them access to either public transport or other mechanisms in order to support their attendance and that's a really positive impact. The other things I'd say is we've invested as a health system in our mental health services for community mental health services and that's having an impact on mental health and also we've expanded the provision of support into schools around mental health provision. So that was last year and then the priority of this year is a continuation of some of those supporting families whilst they wait for care with particular focus on our neurodevelopmental services where we do have extensive waiting times in those areas. So some of the things we are looking to take forward to address which is critical in terms of involving families and different community faith groups within that is kind of acknowledging people's referral from GPs or from other sources. We now publish all of our waiting times on our website and via kind of various different national platforms and what we've also started to do and we need to broaden this out and make it more specific is we have a very robust patient library with specific information of how families and patients can be supported whilst they wait for whichever condition they are referred into and then as I alluded to kind of going out and seeking patients and families engagement has been really key. So an example of that is we've translated some of our information into a video in Roma so that people from that background can understand what appointments and where the appointments are going to be and what we need to do is roll that out further across the organisations with our services. So linking a lot to what Yvonne's just said we're really kind of trying to build the services around the patients and make sure they're engaged while they wait. Thank you. Happy to take questions. Thank you very much indeed. So members questions or comments? We've got 20 minutes left for this so be fairly concise and remember that our comments are if you want your comments or questions to be considered to be included in the feedback that we're going to submit I think by tomorrow then please say that when you when you come in. Thank you and thank you for bringing that report today. Just a couple of questions about the waiting times part of the report which I think was on page 25 for our original PAC. It was good to hear the progress on reducing the waiting times to achieve the 65 weeks. I just wanted to ask about the hand surgery which is an area where you highlight there's still some patients waiting over 65 weeks and I just wondered if the only sort of time scales for sort of dealing with that and where the children with their hands you know it's developmentally it's important that they're able to to use them as well as they can and so that was my first question and then my second question which is relating to the mental health offer for crisis care and you've let us know that the commissioning for the crisis line was unsuccessful and because none of the bids met the criteria but no firm dates have been set for the work to be completed and I just wondered what the sort of plan was for moving ahead with that really because it sounds like quite a much needed service and from speaking to people in the ward I represent and you know I can I know that so yeah good to hear about that thank you so I'll call up both of them so the the hand surgery and the plastics care linked to that is very highly specialized so in terms of the organizations across the country that can provide what we provide is very specialized because of that there isn't a we don't have a massive team that can do all of that so there's only about three surgeons who can actually do the very delicate delicate surgery there was a number of things towards the end of march with regard to a kind of maternity leave or absence which kind of meant that we had those absences from that team pleased to report everyone is back in and here and we've managed to recruit a substantive consultant post in the past couple of months anyway so that situation actually has now resolved itself so that's positive and the patients who were waiting particularly at the end of the financial year have now actually been treated within april and may anyway so for that that's one of the areas where it's continually going to get better as we go through the year and so that was the first question the second bit regarding the crisis line which is a critical point as you as you made is what we were trying to do is kind of link it with the safe space element to it which is why it wasn't successful what we'd already had in place was a relationship as many organizations have with uh rethink which is an independent provider to kind of provide that crisis line so what we've done is extended that for another six months but we're having conversations both with our Sheffield partners but also South Yorkshire partners around how we can best provide that because it's important but then the volume of patients that use it both for adults and children is quite variable so and there was a national requirement to have that 24/7 crisis line in place so we will continue to have it as we have what we're trying to just make sure is that we're giving as the best off of patients and best value for money thank you hi thanks thanks for the report it's very interesting i was very pleased to hear about patients on the board about patient representatives on the board which i think is very very powerful um i think um i'm going to be asking uh there were trusts about uh uh patient records electronic records because i think there's some change going on in other providers but i'm just curious to know which patient record system you use is it system one or what we might do a double act on this one so because as advanced said in the introduction because we provide mental health community and acute services there isn't one single system that we use across the whole of the organization so system one is used for our mental health and system one is used for our mental health and community services but then our main epr our main electronic patient record for the acute services is careflow so and then what we've also done all we've been doing through here and it's mentioned in one of the sequence is we've rolled out electronic prescribing as well which is a separate system so most of these systems do link in so there is kind of one one central record but largely speaking the system one which does the community and mental health and then the acute physical health uses the careflow systems both of them are long standing within the organization i am aware of the trusts are in the process of upgrading their systems and going through a massive change process as part of that but ours have been embedded for a number of years now as part of the part of our digital kind of strategy and so they the systems do talk to each other effectively i think you alluded to that but there's no that's my my concern is when someone moves from one area to another there's access to the old records and all that yeah within the organization we have good mechanisms of kind of making sure that because obviously patients can present both with a physical health condition and a mental health condition so we would involve our respective team so they would bring all of that information to a multi-disciplinary team kind of conversation across south Yorkshire and the wider patch it would vary in terms of different organizations have got different systems and i think that is something going forward that collectively we would look at about how we can make that better thank you there's nobody else i'm chipping myself i wanted to ask about a couple of figures um vaccine delivery um so staff flu vaccination uh with a 62 uptake i just wondered what the factors are behind that relatively low uptake and have there been any consequences to that in terms of staff sick days would you want to see that improving thank you um so our um our target is to offer a hundred percent of our colleagues vaccine we did do that 62 of our colleagues took that offer up um we that's that's an improvement on um where we have been previously and actually we're one of the highest performing organizations in the region we have done some engagement with colleagues there is vaccine hesitancy there is a feeling that it wasn't a problem last year so perhaps i'll be okay not to be vaccinated we haven't seen any correlation between flu uptake and increased sickness what we have done is we have learned from last year on what we could do better and we did put some incentive schemes in that did help we did increase our offer so that colleagues could access vaccine from seven o'clock in the morning right through till ten o'clock at night across our community sites not just the acute site so everything we did last year again we will learn from we will adapt and adopt how we deliver it next year and hopefully we'll see an improvement going forward okay thank you um on the uh where you've got the uh the sequin so it's sequin is that how you say it yeah so the sequin targets and uh performance against those um so there was the flu vaccine uh numbers and then we've got routine outcome monitoring um of uh so this is about perinatal um mental health service access uh so there's a target to achieve 50 of children and young people uh and women in the perinatal period accessing mental health services having their outcomes measure having their outcomes measure recorded at least twice i think i've read that right so the 50 target but um am i reading this right that that you're hitting nine to nine point seven percent um which is marked red uh so i'm very very curious about that because that's an extremely low figure i'm i mean i'm ignorant of the context around it but what are the implications of that um and again what are the factors around that that very low figure yeah happy to take that question i think the it's quite a technical answer so in terms of the actual description of the sequin it's it's 50 of children and then it's and then women in the perinatal period so that's written nationally into how they've described it so we would be doing the children's element of it and other organizations would be doing the kind of perinatal period as part of that process what this is is about recording the outcomes of appointments about what the next step in the pathway is and recording it in a specific way that allows it to be data to be pulled via a data feed so it's quite a technical solution that involves some of the it software that we alluded to earlier so the outcomes in terms of are recorded here either in paper notes that are scanned or in our electronic systems but what it is is it's a data accuracy thing that gets fed into a national into a national system what this was and the reason why this was a secret is it's a precursor to the changing some of the national targets regarding cam services and how they are recorded and this was to kind of always prepare organizations for being able to do that what they've actually done in terms of in terms of this year what we're being asked to do is slightly different now to what that sequin was for last year so we're in a good place to be able to build on that i think the point i make here is there's no detriment to patient care as a result of not achieving that target because it's recorded it's just not recorded in a way that you can feed it into a national algorithm that pulls out that information so the key bit is patient care is not affected but it's been superseded to a degree by a change in the national system for this year um i just wanted to make a comment as well that so that sequin table is quite useful in that it uses red green amber uh to highlight certain numbers but um there's uh so my computer's really playing up and it keeps jumping through the report for some reason um i've lost my place now uh our progress against the 2023 24 objectives that section um i think i would comment that the narrative style of that is useful but the lack of a rag rating or tick tick and cross indicator as to so is it's left to the reader to interpret whether this is whether we're looking at a measure of success or more achievement still to come in the future so i found that section a bit difficult to interpret and i think a simple you know i'll be achieving red amber green on that would be quite useful maybe in on a future report um are there any areas in there that you would particularly flag up as not having achieved what you wanted to uh i don't think so um the point that you've just made is is a really good one because i've gone through it and gone tick tick tick to know what we have achieved um i think we have achieved what we set out to do but i think like most things you achieve something can realize that perhaps it wasn't a far enough stretch will you lift a stone and see there's more to do so we've done what we set out to do but we've discovered there is more that we can do hence we track through quality committee are there any other questions or comments i i have a question that i think we're probably going to ask each team that comes to present today um so we this this week we've had a very alarming news story about a major cyber attack that's obviously affected delivery of patient services and delayed inactive operations and so on in some of the london hospitals and i think in all the reports we're looking at today there's um what's probably quite a welcome um increase in the use of tech and it and ai to uh to improve patient pathways and the delivery you know speed up the delivery care and uh look at patient records across systems but how robust is the cyber security um on these systems and you know how precarious a position is is any nhs trust in in terms of cyber security and is there more that ought to be done to protect these systems especially with increasing reliance on them i'm just going to come in before craig gives you a really technical answer um so this year for chefield children's we have decided that our focus is a back to basics foundations approach and part of that is it's really great that we have all this equipment but you have eyes and a sense of um smell and actually the most important thing we do in looking after any of our children and young people and families is look and listen and feel so that that will always be if the systems go down that's what we will come back to which is the basics of care craig can give the technical answer yeah so a couple of things so each organization is required to have what's called an accountable emergency officer who kind of plans for any eventualities such as cyber attack or fire or those kind of things so i i hold that responsibility on behalf of the board um also on the board sits a chief information officer who kind of feeds in regularly around cyber security so there's there's a number of things i'd say on the question which is very pertinent based on what's happened in london this week um so first of all whenever we put a new system in such as the electronic prescribing one i alluded to everything we have a business continuity plan that goes with that so if this if this system is out what do we what do we do how would we revert back to paper where's that paper store do people know where to find it how do we do it how do we get that continuity of care so always whenever we put a new electronic system in there's always that document before we go live with it we also then have a responsibility to test that through the uh through the year so as part of the emergency planning resilience and response that we have as an organization we do run various different tests around if our a and e system went down if our main pass system went down how would we respond where would we get all of those uh informations from so obviously having all of this digital technology is brilliant it's it gives us so much more benefits but i do think as per the question we have to have those backups from that process so we we test them and then from a chief information officer perspective this is much more technical than i fully understand but we have lots of kind of um cyber security and firewalls and all of the appropriate systems and as nhs organizations we have to kind of submit like a security assessment around from a data perspective are we there and as an organization we've got everything in that we possibly could do but as we all know this is kind of like an arms race where people are always trying to get around the systems but touch wood at the minute that's not impacted on us as an organization and we've definitely done training on that in the past year to make sure systems are in place i'm going to battle with one final question if nobody else wants to come in i feel like i'm hogging the chair a bit but um on the sepsis priority um i just just comparing um what's in your quality account with uh shepherd teaching hospitals um i just wondered whether my my perception here uh is that you're um a little bit behind um in addressing that priority compared with sth but i just wondered whether that's because of different presentation of um of how the work's been undertaken um so are are you a step behind um the reason i ask is because sth perhaps uses a bit more statistical uh presentation of so the you know they've been quite exact about um the length of time for an assessment to take place having come come down dramatically uh and so on so i just wondered with whether you're there whether you're i mean is there knowledge sharing between the two trusts as well where do you sit in comparison um we don't have as much data as i think we should have um we did do an audit at the beginning of last year which showed that there were some gaps a practical example of that is there's something called the golden hour and from diagnosis of sepsis to administration of treatment it's an hour because we weren't clearly indicating when the diagnosis was made it's impossible to track if we delivered within that golden hour we've now updated our guidelines um so that's very specifically time stamped um so we aren't where we should be but i'm quite confident now that we have recognized that we've done all of the groundwork we've absolutely worked with families to make sure that it isn't it isn't completely data driven some of it is but some of it is about how our families experience us and feel that they are not being listened to um so that we are playing catch-up i would say slightly thanks that's that's it in a better context thank you right i think if we're at the end of our discussion just give me one so i'm going to ask deborah to summarize um before us some of the points that members have raised that we might want to put into our feedback um so if you could do that deborah and if if members can indicate if we've missed anything out um or if you feel there's anything that shouldn't be there thank you chair um okay so i've made a note of of the way the discussion has gone i would what i propose to do is put into the response from the committee a kind of bullet point of what those issues were that were raised and a statement excuse me a statement along the lines of these were the um points that members sought clarification on during the discussion um i'll go on i'll go through those points in a second just to make sure i've got them right um and um what i was also going to do was um flag up issues that um perhaps the committee might want to return to um at a future day as part of because we're because the the um this is the first meeting of this civic year so um they're in the process of developing the work program as we move along so it could then any issues that the committee wants to return to could feed into the development of the work program so um i have um the issue of the plans to deal with the waiting list for the specialist hand surgery um the um children's um mental health waiting list for um the crisis service have i got that right that was a bit that i missed a little bit yet um the electronic patients records and um clarity around the compala compatibility between the system one which is used for mental health and community care flow for the physical and acute setting i've got that right and also rolling out the electronic prescribing um system as well um vaccine delivery and the factors behind the low uptake um the monitoring of sequins um perinatal mental health access um and the apparent um clarity was sort over the fact that that seemed to be a load a low performance um and the fact that this has um no detrimental effect on the level of care and it's a recording issue which has been superseded by changes this year um progress against um i'm not sure i've written here just bear with me against 23 oh yeah the progress against uh the 20 20 20 23 24 section is which is a more narrative section but that a reg rating system would be useful to insist assist with interpretation um there wasn't anything in particular in that section that um hadn't been achieved um cyber security um how robust are the systems and um the the uh clarification around craig you're the accountable emergency officer for the board and the business continuity planning for all for all aspects of cyber security and the final one was sepsis and uh whether um the comparison with sheffield teaching hospital reflects that um you're a little bit behind them and do you knowledge share with each other um and i think i just go onto the next page yeah and you said that you didn't have as much data as you should have tracking the golden hour in particular and that you are a little bit playing slight catch upon that so hopefully um if i'm getting lots of nods so i'm hoping i've caught that right obviously i won't go into that much detail in the response like i said i'll do a bit a bullet point and um i don't haven't picked up anything in particular that needs to be carried forward into the work program unless you want to pull that out is that the case when there's nothing coming out of that that we particularly want to put on the work program nothing specific chair i think that you know in order to do this justice and i think they think this applies to all the policy reports on today's agenda that um you know i think we need to have a sit down about this was the work program separately from from this in order to pick out the issues that we'd like to yes but nothing immediately arising right now um good thank you debra so debra will uh is that uh is delegated to write up the feedback on our behalf so final chance to add or object all good are we happy thank you and thank you evan and craig for your time today and for being so willing to explain context and so on to us really appreciate that thank you a brief interlude while we change over uh officers so okay so our next agenda item is the quality account from sheffield teaching hospitals trust and we have sandy and angela with us uh thank you for coming um you've got a presentation i think how you always it verbal just verbal okay um so we're trying to keep to half an hour for each part so if you can confine your verbal introduction to say 10 minutes that would be helpful thank you so thank you chair and good morning everybody so we're delighted to be here again to share our quality report which is almost a retrospective review of the work that we've undertaken over the year i'm just going to do a little bit of an introduction and i'm going to hand over to angie to give you more of the detail so as you'll be aware sheffield and teaching hospitals primarily provides adult acute surgery and community services across the city from two main sites but we have a variety of other different services that provide care to patients across the country as well so just to pull out a few points from the report there's three key things i'd just like to share with you in terms of the developments that we've undertaken across the year the first is the the redevelopment of our sheffield elective orthopedic center we call that ceoc and we've almost have a state-of-the-art sort of theater complex to enable us to safely and effectively treat as many of our orthopedic patients as possible and you'll know that one of our key sort of aims over the year is to reduce the number of patients that we have waiting for care in our services the second point i'd like to mention relates to our sheffield maternity services so we obviously had a discussion about our maternity services last year and during the year we've continued all of our improvement work and worked really hard with both our staff and our regulators to improve the the care that we deliver to our women and children i'm pleased to say that the care quality commission have recognized that work and we've had all conditions on our license have been stepped down so it's a really significantly improved position for the organization but more importantly we're seeing that improvement come through in terms of the feedback we receive from our women and and families so we we can see that in the patient feedback that we we receive as well as in the surveys that are nationally undertaken so whilst we're never complacent and we're always really clear there's more work to do we're you know we're generally really pleased with the improvement work that's been undertaken over the year and then finally i just want to bring to your attention some of the work we do with our sheffield hospital charities so we work very closely with the charity and this year we've introduced a dragon's den type arrangement which means that any member of our staff can bring forward an idea that they they would like to try and trial in their area we do the traditional dragon's den they have to come and present that to to a panel of colleagues that included both our governors and external colleagues as well and a small number of individuals were then awarded 25 000 pounds to go away and pilot their idea and to to implement that innovation in practice and just to bring bring forward one of those we developed we call it an easy gown so you'll know that when you sometimes when you go into a hospital you're required to wear a gown that has traditionally a gap up the back that doesn't help to protect the dignity of of our patients so one of our members of staff has designed a different way of adapting that gown so that it does preserve the dignity of of our patients and enables a more comfortable journey for our patients as they receive our care so we're piloting that different style of gown and basically has ties in different places and doesn't have a big gap at the back so that's just one really small example of how we're helping to support our staff to innovate in practice there's a whole range of different items in the report you recognize the size report once angie's done her introduction and summary on our key priorities looking back last year and for next year we're really happy to take any questions on any aspect of the report so hand over to angie now to complete the next bit thank you thank you so last year we had three objectives for improvement in our quality the the first was around dementia being a two-year objective to improve the care they're developing training materials a new care plan and we were really pleased we had funding then for two admiral nurses which will help continue this work further forward that work is now considered complete although we do have a dementia steering group so obviously it doesn't stop it but it becomes business as usual the second one we had was around improving accessible information particularly in ensuring we knew how patients wanted to be communicated with and the aim of this was to kick start a program to look at methods of asking storing that information and assured assuring it was accessible to the staff so that was successful we got that up and running in the pilot areas it's being rolled out wider and part of that was ensuring that when we move to the new electronic patient record that will be included and the information we already have will transfer across so that's now sitting under the communications group and then the final one was around the management of medicines the safe and secure medicines focusing on the checklists that we do in areas on a monthly and quarterly basis there was huge progress made a lot of education and work with staff which really made us think about how we were asking and what we were asking and the assurance there so we did a lot of work really improved it there is still some work to do it was good progress not wholly complete we have a medicine safety group which will continue that work but also we've been looking at the new cqc quality standards that they've set and one of those obviously is the medicines and optimization we've looked at how we would potentially meet all of those and we have some priority areas and medicines will go into that and we will continue that work through that route so for next year we have set a further three objectives continuing in accessibility we wanted to and this was a suggestion that came from health watch about improving the experience for visually impaired patients particularly focusing on communication which we do feel is important we're also going to be working on the assessment and management of pressure ulcers we want to bring in a new risk assessment tool which has shown real promise elsewhere to improve care in that regard and the final one came from patient feedback both through our fft and through some complaints and concerns around the management of pain and we really do we have quite an ambitious project around education and working on trying to improve that for our patients so happy to answer any questions to indicate if you've got questions or comments to be yeah this is a similar question around you're moving to a new patient record system obviously i'm aware that nhs has got system one um uh can you give some reassurance about compatibility of the new system to that and whether a patient moving from one setting to another into it from outside to inside the trust will have a seamless experience in terms of their access to their medical records via their clinician thank you so i anticipated that question so we have we do have a very ambitious program with regards to the introduction of a new electronic patient record we're planning to do that at the moment in october this year so we call our connect 24 program we have a very robust and extensive program in terms of the pre-work that we need to do to get to that changeover point as well as then a huge amount of work embedding and ensuring we're getting the best out of our system and whilst we've got that date of implementation in october we really see that as the the first part of the journey because we all have a system and we then need to use that system wisely to help care for our patients in terms of the structure that we have supporting that we have a clinically led structure so we have a chief clinical information officer who's one of our anesthetists we have a chief nursing officer as well looking at that work led led by also supported and led by a chief innovation director who was a previous ops director so we have a really strong triumvirate of colleagues who are taking that work forward and clearly with any any of this type of program patient safety is really important and we're doing a lot of work now to make sure we're in the best position possible ready for that transition but then recognize it doesn't stop there there's a lot of work to do afterwards we do use system one now we use system one in our community services so that that will remain in the new in the new structure going forward i think that's probably does that answer your question sufficiently not quite sure so is there compatibility between within so obviously you're saying you've got system one within you're going to keep that we use that now and yeah clearly it's one of the most um used systems there's two key systems that are used in the community and with our gpe practices we um and we link in to system one that will remain as well as the access to the main spine so where individuals can draw down data from as well so so the consultant is working with the new system but they have to look at two systems so we have we have um a piece of software called aperture which means that an individual can look at one screen and can access the different systems from that one screen that was developed and that will remain with the new system so whilst um our epr program isn't to merge system one with our new epr but our clinicians have access to each of those different elements from one screen for one patient so you have a patient name and you have access to the system so for example we have the diagnostic test results on the ice system as well that will be that's available in one click for that for that patient view for our clinicians thank you thank you hi thank you and as you had a question about the quality performance information i was looking particularly the bit which talks about um waiting times and there's the data obviously if you're teaching hospitals the percentages and then underneath there's the line of national standards and i just wonder if the national standard is that data for national standard is it um hospitals are actually reaching that level or is just something that you should be aspiring to or is it based on um would it be possible just to show me the page because we could have both answers on that if you just um particularly looking at page 108 of the pack but it's 57 of your report so just bear with me one moment and i can answer your question i don't know if i articulated that very well either so it's so yeah that's a nationally um set standard in terms of a target across it's not an average of other colleagues so it is a national standard um and we know as as as with many organizations are a number of challenges in terms of um ensuring we're effectively and and safely delivering as much care as possible to our patients and and it is a huge area of focus for us as an organization thank you i think it's probably worth adding that in terms of our waiting list we had as you i'm sure you know we have been in tier one um we are now out of that um so we it has been recognized that we've made improvements it does take time it's still a massive focus for us to get that down for elective care yeah thank you i'm gonna chip in but please please indicate if i don't want to hold this um referring to the same section that um council mccain just did the uh so this is um around page 56 of your report uh so i'm looking at the cancer screening and urgent gp referral for suspected cancer this is an area that we know is um experiencing a lot of challenges and something we've scrutinized and are continuing to do so at south Yorkshire level um and particularly in terms of things like non-surgical oncology and the challenges in that field now here we've got what looks to me like a quite a dramatic drop off of performance since 2021 um with 60 percent going down to 39 percent for urgent gp referrals and i'm reading that the right way around a way that a lower figure is worse yeah um so i wondered if you could set that in context so even in 2021 that was quite a long way off the national target uh the national standard and now a really significant way off the national standard um so what lies behind that and what are the implications for patients um and similarly the cancer screening referral which had a quite a significant drop off and is a long way off the national standard yes thank you so um this is an area that does give us a lot of concern clearly it's um not the position we'd want to be in as an as an organization and it's not right for our patients and families so a lot of work needs to be undertaken i think there are two key areas that we we're focusing on the moment the first one is faster diagnosis standards so a number of patients are referred to us with suspected cancer um a reasonably high percentage of those patients don't have cancer so we need to be ensuring we're diagnosing those patients as quickly as possible so that we're not leaving um our patients in a worried state almost wondering whether they are do or don't have cancer or not so that's one of our key areas of focus at the moment and then we're also looking at our patients who've waited the longest so patients on our 62-day pathways as you've mentioned there and and looking to treat those patients um that that um have been waiting the longest and to to reduce that that long wait it is a key area of focus for us we have um a group working on this that is chaired by our chief executive um we know we've made significant improvements in elective care this is the next area of focus that we need we need to improve our performance on um so very valid comments and um i hope to come back next year with a better position it's probably not the time or the place to delve into the substance of that hope we i think we all hope as well but this isn't this isn't the time today but um no please know that we're we're with you in hoping for that um apologies i'm happy to give some a little bit of context of that because the the the reasons for for that performance are quite um um not not complex but but varied across the organization we know that some areas have workforce challenges we know that pathways can be improved our processes can be improved in some areas it links um to you know appropriate theater rate availability and and staff so in in all the different areas where we we deliver patient care we're looking to try and pull out what are what are the key areas that are helping the one that helped to improve the pathway but also to to um help us deliver faster more effective care but that's quite multifaceted across the organization and we need you know clearly it's an area of focus thank you apologies i didn't receive my question um i wanted to draw out a few positives that i think are really really stick out from the report um the working in partnership with hallam university's advanced well-being research center i think is really positive and i'm going to look for approval that that i think mentioning these positives is a good thing um to include in our feedback um i think as well the um proud values and the dragon's den was that was really exciting to read i think that continuous improvement culture and in making sure that everybody at every level is involved in that and has a chance to be involved in that i think is extremely positive and can only result in positive innovation and i think when i think last year you reported um that a nurse a a bed turnaround innovation had happened and won a national award for rapid rapid deep clean um and turnaround of beds um and so that kind of innovation that presumably comes from um from staff level um rather from from top management i think is extremely positive uh also the climate action which uh reading through the i'm sure that's just a summary of of all that you do um but i think that's again very positive going way above and beyond the really easy stuff like relaxed mowing regimes that's like the really easy to achieve stuff isn't it and actually cost saving anyway um but moving into plastic and waste reduction and in the food um food miles reduction all these kinds of things i think are all really positive as well looking forward to seeing what more you can do in that space with um that strong commitment to achieving more in that um i think as well in health inequalities there's some really positive stuff there as well for example the dental care for homeless people taking that you know to to where people are and providing it for free i think that's excellent there's there are other things in the report that are similarly excellent um in that area i'm really keen to see what more can be achieved with a greater partnership working um so health local authority and voluntary sector working together really keen in the future to explore much more of what could be done locally um to uh in terms of health creation and prevention work and reducing hospital admissions i think it would also be interesting to hear a bit more detail around what the work that you've done with yorkshire ambulance service as well that's um in the executive summary but there's i don't think there's a lot of detail around it um so it might be interesting at some point to hear uh what is being done to limit patient waiting times improve ambulance turnaround um and i think you refer to patient flow uh so that's that's all i think that sounds interesting but there's not a lot of detail in the report about it um so that would be something we might want to explore more okay so just to respond to those uh points thank you very much for um that feedback i think on um innovation and empowering our staff we we just this month launching a new proud improvement um initiative which builds on the work that we've done that brings together all of that um improvement work and and just say what that proud so proud okay so proud is patient first respect ownership unity and delivery so um that's we call it proud but that guides our values and also we have some really clear behaviors um established under underneath that so um it's almost what drives what we do it helps with our decision making in terms of you know whatever we do does that align to our proud values and then we've incorporated we've incorporated that into our improvement work so we've got proud improvement now and and which seeks to empower all of our staff to um if you've got a great idea or something we think we should be doing we need to be building on that and like you say i think it's absolutely it's where we get our best ideas from and then we hopefully support and enable our teams to deliver um sustainability yeah huge area of focus it's now one of our um six corporate objectives um so always more work to be done but um you know our catering team are really innovative in in what they're doing we have the um no mo may um elements and all sorts of um work like that so yeah really pleased with that and we do you know continue to work in partnership on a number of levels with Sheffield Place colleagues we work with um acute trust colleagues at South Yorkshire level as well as the um wider icb and then we're involved for example in um a shellford group of colleagues from across the country of of similar sized teaching organizations so we do a lot of um best practice sharing um and we have the shellford secretariat visit the trust only this week to come and visit a number of our different services and and to learn um from from what we do and again we we learn from what they do um moving on to our work with Yorkshire ambulance services clearly a huge area of focus we we know um many of the challenges we have it linked back to flow in our organization so making sure that our patients are treated in the right place as effectively you know as quickly and safely as possible so um whilst having a busy organization can create risk we know that not releasing our ambulances to go and pick up that patient at home creates more of a risk so we're working really hard with Yorkshire ambulance service to um more information to enable flow um through the organization and that's multifaceted at different parts of the organization both in a and e then ensuring our patients are safely transferred to base wards as well as discharged effectively to whether that's home or another place of care but i'm going to pause there because i'm going to let angie come in with hopefully some more information thank you so one of the we've we've been looking at a lot at how we make it easier for the ambulance service um so one of the things we've done in the discharge lounge is set it up so and it's in an easy location for the ambulances to get to and said that unless there is an absolute must reason the patients are picked up from there no so rather than the ambulance teams wasting sort of 10 minutes 15 minutes every time walking through corridors uplifts to get to various wards it's now pull up straight in pick up the patient so we've made that process much quicker um which i think is a real positive and we're monitoring the figures and the delivery of that on a weekly basis at a meeting on every monday and we've also looked at an action card and how how we react when we start to get several ambulances arriving because this can happen you suddenly get a wave in and you have a number of ambulances and obviously how do we speed that process up to get them through with the aim of making sure that none wait for more than 45 minutes outside now obviously we're not quite there yet but it's work we're continuing to look at can we um things like moving spaces and this is part of what we've been doing with estek as well about can we just get some of the patients who are okay to come off into another space and moving patients quicker uh towards um again particularly discharge line comes into that because if the patient isn't waiting on the ward that bed is available sooner and it's ready so we get that better flow so there's a whole raft of work that we're continuing to monitor in there just worth explaining what estek is it's same day same day emergency care so for some of our patients that come into accented emergency might not need admission to a ward but they might need some care and treatment and then could be safely discharged back either to their home or to their previous residence so we we have a what we call an estek unit that helps to provide that service thank you anything further from members okay debra i'm going to ask you to summarize very quickly if you can with ever so slightly over time so um if you can give us a brief summary uh this one's due on the 10th so um just the other side of the weekend so effectively a deadline of tomorrow thanks chair um again the electronic patient records uh was uh the first issue and in particular the compatibility with system one um and the connect 24 is your new system right thank you that's due to be implemented in october 24 and pre-planning to his work is taking place now to that implementation date and then obviously um we have made a note of the fact that you've got a strong staff team taking this forward with patient safety as an important element of that it's community can i just clarify the epr is connect 24 yes right it is the same yeah yeah it is the same thing sorry yeah i'll make sure that um and um system one is used for community services and that will continue and you talked about a program called aperture which allows access to information from all of the systems on one screen um performance information against national standards um we sought clarity on how that standard set and you uh confirm that it is set nationally that's not an average across um national settings um the issue of oncology and the um significant drop-off in performance since 21 um and we sought clarity around the context for that um that's an area of significant concern and the two areas of focus are around quick diagnosis for new patients and also tackling the patients that waiting that been waiting the longest and that you have a group focused on that which is chaired by the chief executive and um this is an area for kind of further investigation in the future um the um the committee wanted to um support a number of the positive initiatives such as the dragon's den um there was also the bed turnaround idea from last year which had won an award the climate action and the dental care for homeless people and were in particularly interested in greater partnership working around that initiative with the local authority and the voluntary voluntary community sector to potentially achieve more um you uh you also talked about the proud improvement um values and behaviors and incorporating that into your improvement work and the initiatives to share best best practice across the country and we asked for more detail around the work with Yorkshire Ambulance Service um you talked about um well it was around patient turnaround patient waiting and patient flow um which is a huge area focus um around the process of bringing patients into the hospital much quicker and reactions to um peak times when ambulances um are kind of coming in in a wave um the aim is to make maximum wait time 45 minutes you're not there yet but you're still working hard on this for example um looking at moving patients to different spaces where appropriate i think that's let me just check that i've not missed anything so are we content for deborah to summarize that into a feedback i understand there's a word limit so that will be condensed uh to represent okay thank you very much deborah and thank you to sandy and angela for your time today thank you very much see you again um before too long i'm sure thank you uh our next item is the quality account from sheffield health and social care nhs foundation trust uh so quick changeover of personnel again so so all right welcome to uh neil vanessa and tanya this morning uh please introduce yourselves and what your roles are because i i can't quite read your cards there actually uh and then i think you've got a presentation for us um which should appear on um the screens on the webcast for anyone watching to see at home um so uh if you can keep your presentation fairly concise to allow us time for questions after that would be appreciated thank you chair um i'm neil robertson i'm executive director of operations at sheffield health and social care hello i'm vanessa garrity i'm the deputy director of nursing and quality at sheffield health and social care trust and i'm tanya baxter head of clinical governance and risk at sheffield health and social care trust so just by way of a quick introduction sheffield health and social care mental health trust is a provider of community crisis and inpatient services across sheffield we also provide community services outside in the south yorkshire footprint and we also have national services specifically gender identity the other thing to note is that we have a small number or small cluster of services that provide physical health care so i'm going to hand you over to tanya who's going to reflect on our priorities previously then vanessa is going to talk about the priorities going forward thank you thank you so over the past three years from april 2021 to march 2024 we've had three quality objectives in place in the organization they are around demonstrating measurable and equitable reduction in the use of seclusion and restraint we collectively use the term restrictive practice within the organization which which includes things of people being secluded and people being restrained so people that are being held to possibly have take some medication or to receive personal care so when i talk about restrictive interventions and restrictive practice they're the they're the things that are included in that in that banner and so our objective has been to reduce the number of restrictive practices that have taken place in the organization and particularly looking at people from racialized communities our second objective was about demonstrating improvements in the number of people from diverse communities actually accessing community-based mental health services we found that we have a high proportion of people from racialized communities in within our inpatient areas so we were looking at barriers to ensure people are accessing community services so that we can treat more people in the community so they don't become an inpatient and our final objective was with regards to co-production with service users so making sure our service users and their carers and families are actually involved in the the care that we deliver and so how we've achieved what we've achieved this year and again as i've said this is the third year of our three-year objectives so we have achieved what we set out to do in this objective and there's never there was always more to do as an organization so just because this is no longer a quality priority for us does not mean to say the work underneath and behind that isn't continuing so going forward with this objective whilst it's not going to be a quality objective for this year and we obviously are continuing to work with racialized communities and to ensure that we we continue the work that we've started and making sure people can access services and that we're in a way we're not disproportionately restricting somebody's privileges and rights because of their of their ethnicity and their and their characteristics and this work will will continue forward as part of our reducing restrictive practice strategy and that work stream so as i said the work will continue as we go forwards and the next objective with with regards to ensuring we have equitable access again we've achieved the majority of this work there is an area where we have we continue to to really push and we know we've got improvements to make which is around the recording of ethnicity of our service users we know that we have a large proportion of service users where we on our system we have recorded as unknown that we we are unaware of their ethnicity and we need to make changes to that to to make those improvements so again whilst it isn't an objective going forwards that work continues we have created now a what we call the dashboard which goes out to services every couple of weeks to ensure that they're focusing on those unknown characteristics so we can ensure that we're providing person-centered care and for all our service users and that their needs are being met the third objective that we've just concluded is again around the co-production and as we move forwards into this not being a quality objective anymore the work that we need to to focus in on is around sort of enhanced communications with our service users we know communication is a massive area that i'm sure we're not alone as a as a national health trust and that sort of that needs to to make some improvements in this area but we've you know feedback from our our service users and our carers and relatives we know that this is an area that we must strive to continue to to improve and so we we have done a lot of work this year around implementing the triangle of care which is basically our our staff our service users and our care was working together to ensure that those messages are consistent and that we're communicating an effective way to those so as i said that work will also continue as we go forwards i'll hand over to Vanessa to talk about this year's okay thank you so our objectives going forward for this year as you can see around sexual safety neurodivergence dementia and patient level reporting so i'll start with sexual safety you may be aware that sexual safety safety is quite a high profile issue in terms of mental health services nationally and also reflects the wider societal movement around sexual safety so sexual safety for us is around um it's not just we're not talking just about um sexual assault incidents we're talking about anything that makes a person feel uncomfortable who comes into our services so it's thinking about everything from when somebody comes in whether they want a male or female worker whether they're on a mixed gender environment how they feel about that understanding people's trauma histories and might how that might impact on their experiences of care currently in terms of the sexual safety work that we're doing we've established a working group who are leading the sexual safety work and that's led by myself and also somebody who's got lived experience of mental health and of using Sheffield health and social care services we're focusing particularly on the inpatient areas and because that's clearly the highest risk area in terms of sexual safety incidents but we've established a sexual safety dashboard which monitors all our sexual safety incidents and enables our services to look at look at their incidents and actually provide some narrative around what's happening and for us to feel assured that we're supporting people appropriately and our sexual safety works linked really closely to our safeguarding work so we have um safeguarding huddles so any any sexual safety concern that's raised by the ward through their daily safety huddles or handovers um comes to a huddle that I attend and we take all sexual safety incidents at face value given that we know that you know many people in our services when they run well they will express concerns that when they're well they may not have the same concerns however given the vulnerability of our patients we take all those concerns at face value and we investigate everything thoroughly so that's just a whistle stop tour of that one in terms of neurodiversity this is around accepting that we have within the population neurotypical population and also a neurodivergent population as well this is around us providing person-centered care to everyone in our services so understanding how our environments for example meet people's social and communication needs because many people who may have a diagnosis already as being autistic or having ADHD but there are also many people who are undiagnosed in services so it's around making sure our environments consider sensory um needs and consider people's communication needs but also ensuring that our teams across all our services have a really good understanding of neurodiversity and can work with people in a person-centered care to where to understand how their neurodivergent needs might impact on them so as it says there we're doing lots of work around training and looking at assessing our staff competence in all our services we have a nurse consultant who's providing some training that's based on a national model and looking at our environment and working with people with lived experience we also have a staff network group with people who have neurodivergent needs so working with that group as well and also looking at how we support our staff who have neurodivergent needs as well next one so in terms of dementia again um you know more and more people are being diagnosed with dementia but equally more and more people are living well in the community with dementia so we decided that we'd give a focus to dementia this year and we're talking about you know um diagnosis and post-diagnostic support for dementia so what we're doing is we're um doing some discovery work to work with all our stakeholders and people in our communities to look at work plan um around dementia care and how we can respond organizationally to people with dementia and as we've talked about in our earlier objectives we've had a real focus on working with racialized communities and that's already starting to emerge within our dementia work looking at how people in some of our cultural communities might approach for example a faith leader around concerns rather than actually contacting services or how we work with wider communities around dementia care as well patient level reporting so we do already have patient level reporting but what we're trying to look at is a more diverse approach so that we've got a wider range of patient reporting measures that meet people's different needs and also look at our different services and I think the focus there is really very much again around people with lived experience so we have a really good engagement team and what we're talking about is formalizing the patient reporting element of the work so that once we've got these measures we bring the group together that's based on people with lived experience and we look at then what we do with that information and how that information informs our services I think it's really important to say that's a really trauma informed approach and it avoids people having to make complaints so really important that we kind of really proactive around people people's concerns but also that that work's led by other people with lived experience and just finally to add that as I've said with the sexual safety work as well we're developing a dashboard so we can bring all that together and look at all the different mechanisms and also make sure that the feedback mechanisms that we've got are really inclusive that we consider things like has our information translatable is it available in paper is it available digitally you know recognizing that some people might have health literacy needs in terms of their literacy levels so how do we make sure the information that we've got is as diverse and inclusive as possible and how do we reach more people and how do we change culture to ensure that feedback's really embedded in our services and with our clinicians thank you so I'll hand over to Neil I'm obviously conscious of time but we just wanted to obviously just conclude there with some of the main highlights that around quality improvement and I wasn't going to go into those into any detail but just wanted to note them so thank you thank you very much for all of that and any comments or questions members and Toby I'm aware you didn't comment on the last report actually I know you you had said beforehand that your your questions around compatibility of IT systems stands across really across all four reports today did you want to bring that forward again yes that's what I was indicating for yeah so also another patient recording system which I think is different from the other ones we've heard about today it all of his myriad of systems does cause me concern I appreciate you know you're just one provider but you know it is a weakness of the system if there's not a coherent way of recording patient data I mean I appreciate different areas might have different needs and everything and so there might be good reason for it but can you give them assurance that the new system is compatible with old systems and that the clinicians will be able to access previous records easily without any any problems so at the moment we are using three systems so we use system one which is part of the work we do with our primary care mental health we currently have an EPR or electronic patient record which is built in-house and we're actually transferring that to a new electronic patient record called Rio we've done the first tranche of that for older adults and we will be completing for the rest of the trust in the coming year the other thing as well is that we also use something for our from our Sheffield talking therapies we use something called iaptus which is a specific system that's been set up for those types of services what we're building in to the implementation of the Rio system throughout the trust is the interoperability so that notion actually that we can connect the systems which was quite similar to what Sheffield teaching hospital talked about earlier so that's one our priority work plan to make sure that we've got that connectivity it is the limitation at the moment but depending on the service people have access to all of those systems depending on what type of work that they're doing but as i said within the next year or so we'll have that connectivity can i just add something i think the difficulty is that there isn't one system into that meets our mental health population so some of the other systems and i've used a few of those systems and are not necessarily the best system for you know recording around mental health care so in terms of the system we've got it's built much better to work with supporting people who've got mental health difficulties than some of the systems that are more physical health focused but as Neil said that interoperability i think is the key aspect of of how we work with the different systems yeah i think um you know we people might not just have mental health issues they might have other physical issues or which are on different systems and there's a sort of risk there that occlusion might not pick up something which is important to sort of might have an influence on on the current sort of situation with that patient and uh um i just feel as if having lots of systems which the condition has to access to them get a full picture allows for mistakes to be made and i think that that's a really important point and um is something that we are thinking about from a risk mitigation perspective um the the um we're pleased with moving direction around we out because as i said it will give a much better connectivity um in terms of how we work with our partners going forward thank you thank you it was good to hear um about your quality objectives for the next three years i just wondered um it's actually well thought out what you're going to do but i just wondered if you could tell us a little bit about how you decide on those objectives what sort of makes the cut really and whether you involve service users and lived experience in making that decision um so we we do um we look at what the national priorities are so what what what's sort of happening um what's happening nationally um we then consult with uh some of our sort of stakeholder groups so we would we would you know contact our commissioners and understand from their perspective what their priority areas are we talk to our council of governors and find out from the uh the sort of our elected members uh their what their priorities are and then we've taken them to some stakeholder groups or some service user network groups internally and where to try to canvas as many views obviously we it's difficult to go in with a blank piece of paper because you can't you can't be everything to everybody and pick up everybody's uh sort of senses of needs and what their priority areas are but we took a range of priorities and then we whittled them down to sort of to pick up what the key priorities are there's always more that we could always add but obviously um you know we we try to focus them on a smaller number to give a better impact and a greater impact and outcome for the people that use our services so yeah it's we have consulted for probably about four months on them that's great thank you i think i'd like to comment about um co-production and involvement and how it does seem um it seems to come across quite strongly embedded in the improvement work that's happened over over the last recent years and then continuing to read through uh through the report into a new quality improvement priorities i just thought maybe it became less apparent how um how involvement and co-production might work in some of those areas i thought particularly the sexual safety and dementia priorities it was just less apparent i'm going to make the assumption that it's still there as it was set as a you know that whole area was set as a quality improvement previously and you've clearly done so much work on that and set up structures that allow um you know quite open involvement um and monitoring and co-production um but can you just comment on how that is likely to work in these new in these new objectives particularly in the sexual safety and dementia yeah um i'll just start a moment um it's um i think because we've only had limited time um and as you say our co-production approach is really embedded um we haven't focused on that particularly with the presentation however it is really embedded in the work that we do so for example with the sexual safety um work um i have um somebody with lived experience of using our services who's extremely passionate about sexual safety and she is involved in all aspects even down to the way that we word things and put things on ward and obviously has very kind of um at times slight differences in priority around what she sees and we take those into account but we also work really closely with our um co-production colleagues our peer support workers people in our community organizations we've got cultural advocates on the wards for example as well and and we um look at um information across all those different areas and how we involve people because obviously it's not a one-size-fits-all approach to sexual safety it's really important that we um have that sort of intersectional look based on different groups of people and it's the same with our dementia approach as well and and i suppose one thing that we didn't say particularly in terms of dementia is how we work with our carers and you see we've got the triangle of care accreditation which we're really pleased about and we work really closely with our carers group and we've got a really established engagement team as well who work with those communities and and feedback and so yeah it is very embedded and if i could just add from an organizational perspective we have an enabling strategy around engagement co-production um so that's about how we have the golden through threads through whatever we're changing um whether it's services whether it's particular improvements around quality or whether it's improvement around our estate and that's the golden thread of which we change and transform thank you i thought as well the honesty about restraint practices and restrictive practices was quite i thought it was quite refreshing to see that level of honesty especially around acknowledging where there's been deficiencies in relation to treatment of people from culturally and racially diverse backgrounds i thought it was really positive to see that um transparency in the report also around recording of race and ethnicity which you mentioned um in the presentation um so i think that that level of transparency is is really welcome and really helpful to members of the public as well so i'd really you know encourage more of that um as well i think um my other questions were around board visits and culture and quality visits so um on the board visits just really briefly um who do who do they meet when they visit um it's not quite clear how our staff and service users selected um so so with the board visits we will identify a service and then the service will um decide on who actually the best people to talk to because we it's about them um giving an opportunity to talk about what they're proud of but also as well what their challenges are um so um we we always try to include service users and carers as part of those visits as well so it's two um one non-exec director one executive director and one of us will split working with them at service users and carers and then the other person will will be engaging with the staff um so obviously it's not possible for them to speak to everybody across the board is it so there's some sort of selection process for who will be do you i mean do you feel there's any risk of valuable information not being heard on those visits by by the interview being a selected cohort of people that they speak to should it be more open do you think should there not be more of an open invite to people to have the chance to speak to them i mean it's certainly something that that we can explore and check around the fact that you know i mean people there is always a risk isn't that the people are going to put forward people that um have had a really positive experience um what we try to do though is is that when we're thinking about the services try to triangulate that with other bits of information so for example complaints serious incidents those sorts of things would also be the indicators that we'd be looking at so we wouldn't just be taking assurance from that visit we'll be looking at other information to make sure that we we are getting that view and i think that with the cultural and quality visits as well um that's quite quite quite an intensive assessment process um that people really do engage with and my experience of the workforce and one thing i'm particularly proud of is that they are very committed to articulating what needs to what needs to improve and what support they need lovely thank you any other comments or questions okay oh i did just want to ask um about the we're all aware that there's been a budget cut to the icb in the last year 30 um cut to their kind of operational budget um i just wanted to hear whether that's had any impact was likely to have any impact on for example the quality of co-production work that you're able to do and the development of that kind of work um i there isn't from my perspective i mean we're very fortunate that um that the icb and shafield do commission um rethink to to support to deliver or to provide experts by experience um so for example today we're having a peer review of mental health discharge in conjunction with the council and we are using experts by experience to contribute to that peer review who have come from rethink so so that there is that that that clear commitment um um i think from um a shafield place around um the importance of co-production thank you uh right over to you deb for a brief summary if you would thank you um i'm hoping i've got most of it um obviously the question um the first question was around the compatibility of the electronic patient records i've noted that you have three different systems that you use one is the system one around mental health services you've got an in-house electronic patient record system which is transferring across to a new one called rio and that you also use iaptis um which is used for talking therapies yep and that rio the aim is for rio to have interconnectivity across the systems um but the complexity around the fact that there isn't currently one system that meets all your needs um just determining objectives for the forthcoming year you work on national priorities and then a four-month consultation process which includes stakeholders commissioners governors elected members and it's based on co-production um oh no sorry i've got i've got the two questions are merged together so that was that was that one then there was another one on co-production um she talked about being well embedded um there was concern expressed that maybe that wasn't as apparent um as it had been in the past and you um reassured that it is still a priority and you use the example of the work around sexual safety to show how embedded that work is um and you also talked about and this is a bit i'm not sure enabling strategy is that right yeah um and the golden thread through all changes that you implement which focus on involvement and engagement and we noted that the transparency that you demonstrate in the report is really really important to members of the public and members are pleased to see this um board visits um always try you always try to include service users and carers as well as staff um there was concern expressed that the selection process might risk missing views out um you also but you reassured around um the triangulation of information with other performance information and the and the final one was the budget cut to the icb and whether this had an impact on the quality of co-production work um you used um the example of the commissioning of uh rethink via the icb um and you gave an example was it peer review of mental health discharge have i got that right yeah that's it are we happy members for deborah to take that away and summarize to some feedback um i think that's it yeah on that one okay thank you very much and thank you for attending uh and for explaining and answering questions much appreciated finally uh we have the st luke's hospice quality report sorry to make you wait till the end quick changeover of personnel again you you you you you right lovely welcome to uh two of you louise and joe if you'd like to introduce yourselves and the role that you have within the organization and then you've got a presentation for us haven't you thank you okay good morning i'm joe linton i'm chief nurse and director of care hi i'm louise bearder i'm the head of clinical governance and so yeah thank you for inviting us here today to talk through our st luke's quality account for 23 24. we just have a few short slides to run through and joe and myself will be sort of alternating as we go through um so um first couple of slides basically outline the structure of the quality account this year um so we have a statement from our chief executive on um on the quality and on the governance of the charity obviously sent loops is a primarily an organization that provides palliative and end-of-life care to the communities of people who live in sheffield so that's both within the hospice itself through some of our outreach work and into patients homes in the community um it's also a charitable organization so we have a number of retail outlets and shops we have a staff lottery not staff lottery a um a lottery a regional lottery so it's quite a sort of complex organization as well as providing health care then the quality account goes through what our special focuses are for 2024 around our strategy social prescribing and workforce and equality diversity inclusion reviews performance of last year so look at some of our services and activity um our relationship with cqc so we are currently still an outstanding organization and rated as outstanding by the cqc um talk about about some of our continuous improvements through research and audit and what our ongoing priorities will be so peter heartland in his key messages talks about the growth in service users and complexity of st luke's so we um as i said see people both in the hospice and in in the community and we are constantly trying to expand the offering that we have to those patients there are demands on us from from sort of the the conditions that those patients present with and we're noticing that as people have some more complex treatments for different conditions that the complexity of their conditions has an increased demand on some of the services that they require to support them to to live well with their disease there are some financial challenges and joe will go into those a little bit more some of the positives are around some of our income generation from project echo so that talks about um project echo if you've not heard of it is is a worldwide movement around learning and how we can share good practice and there's a community of practice around learning um an extension of community outcomes for that system one never talks a lot about systems today but that's our move to an electronic patient record that will help to communicate with other community services within sheffield including gps and district nurses and there's also some changes to our board and chief executive that are planned from last year and into next year just to touch on the point about the changes of the board we've had a new chair um who joined us in december and also our chief exec peter harland is due to leave the organization actually today is his last time and just to go through um some of the special focuses of our new strategy which we are due to implement later this year when we've got a new incoming chief executive and this new strategy has been developed in line with also local and also national priorities so this just really gives you a snapshot of what our priorities are so just to go through a couple to give you a bit of context when we're talking about improving our care we're looking at how we're going to address the needs of the growing demands in palliative and end-of-life care and that could be about making our services more accessible 24/7 looking at virtual award concepts and also addressing health inequalities reaching further is looking at how we can support people out in the community taking some of our social prescribing activities our unregulated activities out into the community looking at care of support and growing our research program to include national but also international programs and we've also been doing some work with hospice africa and global cancer care and valuing our people talks a lot about welfare of our staff and our workforce and making sure that we are actually preparing them to care for people at end of life and developing our learning and development strategy embracing new thinking is about innovation and that goes hand in hand with some of the research that we're doing and looking at ai and also looking at environmental developments champion our course is looking at our branding and marketing looking at ways that we can increase our awareness looking at ways that we can work in collaboration we work at the moment with compassionate cities and having more roadshow events sustaining growth is around looking at our financial aims and looking at how we can expand and look at looking at different ways we can diversify our income so social prescribing this is one of our unregulated activities that we have developed and grown since the pandemic this is based at our eckelsaw road site just above little common lane and it's a service that we offer to people and what we're trying to do is identify people a lot earlier within their diagnosis and come and join this service and this is a referral process to get into the service that people although people can self refer we deliver over 40 activities and that's things ranging from social work advice and support it advice and support it could be chair dancing it could be african drumming we do lots and lots of different things gardening lots and lots of different activities cooking last year the figures show all the attendances that we have and that is growing each month we're having a lot more new referrals it's mainly a volunteer-led service which adds enhances the volunteers as well we do offer some transport to and from the services we have a very established bereavement service at eckelsaw red south and we deliver one-to-one bereavement or we deliver group sessions or we also deliver volunteer at the moment that is also only for patients and families who come through air technique services one of our new initiatives this year is also addressing bereavement for children and young people because we identically recognize there's a gap in services we do a lot of collaborative working a perks or red south we work in partnership with the m&d society and also educate and delivering a dementia cafe so workforce well in and the top quality diversity and inclusion it's a really big focus for us this year so obviously recognizing the needs of the people who come to work at st luke's both as healthcare professionals but also in sort of the demanding kind of setting that end of life and palliative care brings so we do support staff with mental health first aiders staff have supervision which helps them to deal with some of the sort of difficult cases that they face and that just isn't our clinical staff it's some of our support staff as well so people such as porters and housekeepers who form quite close relationships with those patients we have an edi advisor who started with us in post last year and they're working very hard to sort of integrate some some sort of key theme weeks across st luke's so we do things like race equality week working with some groups around women's health menopause men's health week so we do have focused weeks of activities we conduct staff surveys and regular pulse checks with staff so these sometimes have a well-being element to them or look more at sort of spot checks on how staff are feeling and they've been you know to say they're quite new the uptake in those has been quite high we've had about a 90 percent of people think that you know st luke's is very fair and equitable place to work but they do believe that you know we could have a more diverse workforce and we are working hard at that and we have a comprehensive well-being program and as i say mental health first aiders help support with that so we do things like lunchtime walks and help staff with benefits service activity last year certainly it's received over 2324 referrals across all our three main services this is an increase from the previous year 33 percent of our patients now that we actually care for have a non-cancer diagnosis and we have a 20 bed inpatient unit and also we have quite a large community team where we are caring for over 400 patients out in the community at any one time last year we did manage to deliver 6 500 community visits a part of the community service we do have a rapid response service which is the same day next day visiting service and that was introduced and several years ago and that service has been invaluable to help avoid acute hospital admissions i think this rapid response service alone delivered 1600 visits last year the inpatient center we looked after just under 300 patients as inpatients last year our average length of stay at the moment for the inpatient center is up to 16 days but it can be a lot longer depend depending on the complexity and actually a third of our patients who do come into the inpatient center do actually go home and finances for hospice funding is quite a topical subject at the moment we receive only 25 of our funding from the icb which towards the end of this year next year we will be looking at discussing our new contract going forward and at this point we don't know how the funding will look going forward last year we made a loss of 400 000 it would have been greater if it wasn't for a one-off payment from the icb of half a million towards looking after more complex care this year was we have also set a deficit of half a million um on the flip side we are looking at different ways that we can income generate we are looking at opening new shops we've got a new one opening in kiln away retail part which is planned for later this year early next year so one of the areas that we have developed is research and audit we are actually delivering a research conference our first research conference around how to do introduce research into hospices and that will take place in sheffield in october the research team are attracting a lot of quality workforce from across all disciplines we don't only see the workforce as an opportunity to look at how we can improve our and develop our services but we're also looking at it from a workforce initiative about how we can attract different workforce into our services yeah so just around audit we obviously have audits set nationally from hospice uk and we do sort of emulate some of the audit work from the nhs but we have our own sort of delivery program as well on audit that then feeds into quality improvement projects and some of those are included in the in the quality account so i can just touch on the quality priorities so from last year it was a focus on system wasn't it system one as an integrated electronic patient record so we're on track for rolling that out in september this year and we will be carrying that through into our priorities for 24 and 25 because obviously for a small organization this is quite a big project and a lot of time and effort has gone into making sure that we get this right just to add we are currently we've got two systems we've got a paper-based system which we use on the inpatient center an electronic version that we use on the community the reason why we decided to build and deliver system one is the majority of our caseload is actually out in primary care so we'll have that integration with the primary care services we are part of a digital group working with a shuffle teaching hospital and the palliative end-of-life services about how we can share those patient records so i know they're introducing a different epr they will be looking at introducing system one solely into their palliative end-of-life care services so they can have access to our information and then the next priority is around the patient safety incident response framework so this will replace the previous nhs serious incident framework and this looks at how you respond to anything related to patient safety so it's mainly built around incident management but this could also be information from audits information wiggling from complaints and it looks at more of a systems-based approach into trying to find out what what are the sort of multi-factorial causes into why harm might occur or near misses might occur so it takes a systems-based approach and we look at learning improvement and how we communicate that meaningful change across the organization we try and engage families and patients as much as possible in that process so that talks again about meaningful engagement beyond just the statutory duty of candor and how we maintain oversight so we the icb have worked quite closely with us on this and agreed our p serve plans and priorities we've also worked with other hospices in the region to try and benchmark and make sure that we're all aligned and also our board of trustees help with the oversight process for this as well so other areas of quality look at around our incident management system and how we go on to develop that we haven't had any serious incidents in st louis office last year we employ an infection control lead nurse who oversees the assurance and management of all infection control activities both at the hospice and in the community and and he's actually lead for the yorkshire infection control so we try and reach out as much as we can so that we don't stand as a very much a standalone organization in that field we work on education of staff so like i said before through clinical supervision things like journal club mandatory training and involving them also in things like research in terms of complaints we only had three clinical complaints last year and that was compared to six in the prior year only one of those was partially upheld and we were able to respond to we had 446 compliments from our patients and that comes in through well and their families but that can come in through our website through cards or through some of the feedback activities that we carry out through patient experience we have a high level of patient satisfaction at st louis but we're always looking to try and improve either our services or our offering or our environments so we do collect feedback through various mechanisms and that's by using volunteers in person or it's using questionnaires codes on the internet or we do things such as the 15 steps where we invite service users and their families in to go around various areas within st louis so we can see what they see through their eyes and get that feedback and that helps us to co-design some of our services and then also in terms of developments we're looking at a family suite on the inpatient centre which i don't want to say something about the family suite we're recognised within the sent dukes that we needed a different space for families so we were combining one of one of the adjoining rooms so we can have an open door between the two so it's a space where we and it's a bit more self-contained i think the reason why we're doing this work is not only for to look after families at end of life we're going to use it for enablement work as well because it have what i call a normal bath in a kitchen area where patients can practice their home skills before they go home and also some of the work that we are involved in is a transition and around looking at how we can support young adults and families so this week because we're having track hoists in which we've not had before that will hopefully help address the transition piece of work that we're looking at so thank you thank you very much comments and questions from members toby you might be aware i've been asking about the patient record systems of different trusts it's interesting to note that all the other trusts are moving seem to be moving away from system one or not using it other than in small areas in their under their remits but you're moving towards it in the hope of being able to transfer records and presumably never have access more easily which is a bit in my mind if the others that aren't using it that's going to might be a problem is any work that's been done to try and i don't know do you have access to these other systems that are being used or because obviously it fits the objective if everyone's using a different system we because most of our caseloads the 400 patients around the community we made a conscious decision to move towards system one to give those they access where gps district nurses can have access to our information we are part of a digital working group within the trust about looking at how different systems can integrate so those discussions are still taking place at the moment i know from the working group the palliative n and w life services will have access to system one which will allow access to our records but i'm not sure if i'm being honest about the emergency care services whether they will have access or not thank you i mean maybe isn't a question for you but is it a role for the icb to try and ensure that there's some consistency across all of these providers in terms of patient records possibly okay did you want to speak just be brief because more time's getting on but just in both your report and your presentation you acknowledge that st luke's like many other hospices are sort of routinely budgeting for an annual deficits and you know the rest of your report tells us the amazing work that you're doing and that enlarges the people that are passing through your doors and your services and and they're clearly committed to sort of providing a high level of care in the face of that budget i just thought it's worth acknowledging that and commenting on that thank you thank you i think it's very much worth acknowledging that and that um there's um it seems sort of reading between the lines and your report this year and and last year when we saw your report um that there's just not a parity of this maybe that's something we'd really like to see um you know work better for you in the future uh but without going into too much you know detail around how that might work is i think parity of esteem for hospice care um is perhaps just not quite there um having said that you know you're innovating on a whole load of fronts um you know despite maybe despite that um i think it's uh brilliant to see the new emerging strategy for 24 to 28 um continuing to uphold everything you're already doing um i don't know if that felt like a risky decision or whether it would feel more risky to drop anything um from the range of services that you provide but um it must you know it must have taken a bit of courage to decide that that was the way to go forward when you're working on a deficit budget so i would applaud that um and and agree that there's nothing really that you could cut out the range of services that would not have an immediate detrimental effect um so i would commend that uh and i think the continued focus on social prescribing which of course we we highlighted last year is a you know a huge benefit um i think that's particularly welcome and for me that's an indicator of how you're um really enacting that compassionate uh compassionate care yeah um that looks after the whole person um and really you know prioritizing quality of life right to the end of life um i think that's really significant and a really key part of health care in the city um so thank you for that um i think as well as you're a founding partner in compassionate Sheffield um you know we have scrutinized the um emerging uh south Yorkshire end of life um palliative care strategy um that was uh you know members wanted to bring that into this scrutiny committee and look very carefully at how that strategy was emerging um and we we did highlight you know that compassionate Sheffield had an awful lot to offer um and that we would have liked to see more of that coming into that strategy and i think actually we haven't seen the final strategy report but um i think that end of life strategy does now include a whole lot more of that um compassionate Sheffield priorities so i think that's really excellent um i would also want to sort of commend the research activity and the commitment to keeping that um front and center which because it really enables all that knowledge transfer doesn't it and best practice transfer um and the fact that you're operating in that space nationally and internationally i think is it was really outstanding um so i think that's worth mention as well anything else from members okay uh deborah if you would summarize again for us please thanks chair um as with all the other three reports sorry just before you do apologies there was one really key thing just the readability of this um so printed for us on a fourth minuscule uh way way beyond my sight capacity at my age and reading on screen it was a lot of scrolling to and fro and very small text so just just a little point for uh future publications that this was really hard to read physically yeah i went back to our commerce department and it's when it's printed i've got one in my bag it's actually printed as sort of a4 to a4 so when it's on the website the accessibility tools will make it so that it's yeah appears like that whereas i think because you've printed it from a printer it comes out all squashed up and half that it's in our pdf and it's there as a page spread so it's really tiny just a little note for future thanks thank you but it is also really hard to you to read on screen because you have to start to see a copy of the slide yeah i think joanne's got them yeah thank you um as i was saying the um electronic patient records question it was asked to all for um of the presentations today um and you confirmed that you'd made a positive decision to move towards system one um and the issue of whether there was a role for the icb and ensuring consistency across eprs and their systems uh was raised um it was also raised that the recognition of of kind of funding issues and annual deficits making it harder um for the trust um and a desire for a Paris parity of esteem um for hospice care as something for the future um but wanted to point out um that despite this you've made obviously a brave decision to not cut anything and that you were innovating still despite this and continuing to hold up uphold progress and that the committee supports that that um the reference to social prescribing again um the committee is very pleased to see that and commenting commented that um they're looking forward to work um more on that with you in the future um they also recognize you as a founding partner in compassionate Sheffield um this scrutiny committee looked at the end of life strategy last year and as a result of that recommended more involvement of compassionate Sheffield and their priorities um and the committee also commends um your work around research activity and knowledge transfer and obviously there was a final comment about the layout of the of the document okay everyone happy with that summary thank you good uh just to say um Deborah when you write those up all those summaries just we're just double checking uh that the name of this subcommittee is correct on each of the uh four um reports there didn't notice one or two stuff i have it as healthier communities um etc committee that was his old name toby i'm just aware that we didn't pull out the positives from the children's reports one i raised was that there's a patient on the board or patient representatives on the board but um we'll just come back to that and check in the meantime thank you very much louise and joe for attending today and for your contribution and clear presentation thank you very much indeed we'll just quickly check that point toby before we finalize all what specific point was it the point that i i i raised was that i was very pleased to see a patient on the board or patient representative on the board sorry i can't see a reference to that in the summary that um i pulled together during the discussion so i can add that in yeah if the committee wants me to if there's any other positives that i'm sure there were but i can't somehow remember maybe it's too late to do that it doesn't matter great we'll just we'll slot that in thank you toby okay we have um our work program to consider uh just again being mindful that um discussion around this is also under our pre-election period restrictions so we're just being a little bit careful not to stray into political territory or anything that is subject to debate under the current general election deborah i just wanted to point out that um on the uh work program document that has circulated um with the uh report there is a slight mistake i didn't remove an item um for the december meeting i've still got an item from last year in there i don't know on sexual health i don't know i didn't quite manage to delete that properly so i apologize for that that needs to come out of the documents okay anything on the work program colleagues um i just wondered whether we should um add into the work program considering the long covid rehabilitation hub in clinic and because obviously that's a relatively new service in the last few years and whether and quite a crucial service at the moment and whether it'd be worth scrutinizing that other members opinions on that would we be happy to bring that into the work program so we would ask for a report on how that service is uh rolled out and what what the outcomes are so far yeah outcomes waiting times that kind of thing yeah they've got enough capacity to deal with the demand yeah okay deborah can you look into how we might pursue that please anything else there probably has already been discussion about this so maybe this might not be suitable but there's there's certainly quite a lot that i've picked up last year about waiting times for um not not autism ADHD assessments that helps and things is that is that covered oh is it in there all right i raised it at the um meeting in december oh fantastic and then it's there's been various difficulties with it but it's on the agenda for the september meeting on that item we're also uh planning to run a workshop in july prior to the report coming in september just coming out of the sheffield teaching hospital's quality account today i did wonder whether we might look a bit further at wait wait times particularly around um the 18-week target for um outpatient and admissions because those figures aren't particularly encouraging i thought in in the report and i wondered whether we might want to just look a bit further into that on the local footing and what plans there are in place to improve on that i don't know if that if that's worth us bringing in yes no yeah yeah i mean are we going to talk talk about the issues now or do i mean i thought was having a separate thing because i was thinking you know also is the possibility of looking at the yorkshire ambulance service and the wait wait time for the ambulance you know so maybe that's maybe that's something to look at in conjunction then as that's what is all around um patient patient pathways patient flows admission discharge wait times would we want to ask for a report from sheffield teaching hospitals in yorkshire ambulance side by side do you think i think so because obviously that it's not mutually exclusive the waiting times for ambulances are directly impacted by waiting times at a and e so i think that that would be prudent to have them side by side yeah i think it is important to having that because we haven't we haven't really had that as as to screw to me previously the whole issue about ambulance waiting times but part of that but yeah i'm happy with that okay so deborah i think that's around um um so urgent care wait times and admissions ambulance services in connection with that and then there's the um the slightly longer term 18-week waits for either admission to hospital for treatment or to begin outpatient treatment toby um just another idea for another one uh you you you did pick up okay just wondering whether we're out of time carry on very quickly uh you you did pick up uh about some other disturbing looking cancer percentages going down the long way uh you know cancer treatment uh at the hospital's trust um is it worth looking more deeply into that so that that is being looked at more broadly at south yorkshire level so there's the south yorkshire basset law scrutiny committee as well um which would is directly been um looking at some of the issues in cancer care uh system-wide in south yorkshire um so i think that probably sits under that uh under that more um footprint-wide scrutiny level but please um feed in any lines of inquiry uh or concerns that you have um please feed that in via email deborah myself um because that conversation is happening separately from this committee but it's it's not it's the south yorkshire committee isn't one that oversees the others it's it's just a separate entity um so the scrutiny committees from each place feeding into those discussions is really important um so by all means please please do contribute that way thanks okay i think we're just about out of time um digital clock doesn't align with the town hall clock are there any further comments about the work program at this stage okay and i think that brings us to the end of our business for today thank you very much for um remaining compliant it wasn't necessary for andrea to speak at all so i think that's a success so for managing the situation of holding um this this type of meeting in a restricted period so well done us thank you see you next time