Manchester South

Noted (AI summary) The Trust has policies to protect meal times and regularly screens patients for malnutrition. They have completed a mini-accreditation for nutrition and hydration compliance on all inpatient wards and have shared a 'seven minutes briefing' session focused on nutrition. They have also made available an intranet microsite for Nutrition and Hydration. Greater Manchester has developed principles to prevent patients being redirected to A&E due to lack of ward capacity, requiring specialities to accept direct referrals unless patients are clinically unstable. They have also implemented guidance to reduce delays in discharging patients to community beds, including a single referral form, triage within 30 minutes, and 2 weeks of medication on discharge. Stockport Trust has also implemented an Integrated Transfer Team and a Discharge to Assess hub. The Department of Health and Social Care acknowledges the concerns raised and notes regulatory action taken by the CQC. It highlights existing NHS guidance and funding aimed at improving discharge processes and community care.

Noted (AI summary) NHS England notes the Trust's response and states it is promoting the free online Just and Learning Culture training to NHS employers. The Trust acknowledges failings in care and communication and has implemented several changes, including red flag identification, a revised Serious Incident Panel process for 12 months, and a local Serious Incident Panel to review serious incidents requiring further response, and implementation of Patient Safety Incident Response Framework (PSIRF). A mortality review process is also embedded at Trafford General Hospital. The CQC acknowledges the concerns and explains the statutory notification process. While stating that current reporting processes are adequate, it will review existing notifications guidance to determine if it could be clearer about reporting requirements relating to the circumstances of a person’s death. The Trust has updated its falls investigation template to include more detailed guidance around immediate action, including checking and documenting the environment of a fall. The CQC will review its existing notifications guidance in light of the findings from the death.

Noted (AI summary) NICE acknowledges the concerns and notes that existing guidance (CG95) flags points where healthcare professionals should consider aortic dissection. They note that topic experts decided against including more detailed guidance, but that they will engage with professional bodies to improve use of their guidelines.

Noted (AI summary) The Department acknowledges the concerns, notes the role of the AACE in disseminating learning, and highlights the Quality Standards Framework for telecare providers. It has asked officials to bring the concerns to the attention of ADASS.

Noted (AI summary) An Electronic Patient Record (EPR) has been introduced. Mental Capacity Act (MCA) training is being provided and MCA forms are available on the EPR. A competency framework has been developed for the Home First team, and transfers will be reviewed daily; wards have been advised that the decision to reduce the level of enhanced care should not be undertaken by ward staff without a full multi-disciplinary meeting. Learning from the inquest was shared with senior management and leadership teams, with an action plan to ensure staff are up to date with Best Interest & Capacity Training and CPA training. Staff have been informed of care coordinator expectations when patients are in alternative care settings. Bolton Council and BNFT have advised all wards that the decision to reduce enhanced care levels should not be undertaken by ward staff without a full multi-disciplinary meeting, instructed Ward Managers that any patient with complex needs should be escalated to the integrated discharge team, and are developing a skills and competency framework. The Department of Health and Social Care acknowledges the concerns and points to existing guidance and rights regarding mental capacity assessments and care planning.

Noted (AI summary) The CQC acknowledges the report and details its role as a regulator. It notes actions taken by the care home and Tameside Local Authority, including new handover sheets and risk assessments, and states the CQC is satisfied appropriate steps have been taken. The response acknowledges the concerns and refers to the CQC's review and satisfaction that sufficient action has been taken. It then discusses national guidance on PPE disposal, waste management, care plan reviews, and dementia training.

Noted (AI summary) NICE notes that its guideline CG179 provides relevant guidance on pressure sore prevention in emergency departments and no further action is required, but mentions a multi-year programme to improve how NICE produces and presents guidance and advice. The Department for Health and Social Care notes the existence of NICE guidelines on pressure sore prevention and that Stockport NHS Foundation Trust has adopted a Patient Safety Checklist and improved access to dynamic mattresses.

Noted (AI summary) NICE's guideline on epilepsies (CG137) is being updated, with a draft consultation expected in November 2020 and publication planned for June 2021. The update will consider the effectiveness of new technologies for detecting seizures and interventions for reducing seizure-related mortality. The Department of Health and Social Care acknowledges concerns regarding annual reviews and highlights the Social Care Act 2014. They note that a LeDeR review is being conducted and that the CQC has inspected Cheddle Lodge, finding it compliant with regulations in October 2019. Stockport Council is creating a dedicated review team of six social workers and a team manager to address the backlog of annual reviews in the Learning Disabilities Service, with an option to increase staff numbers as required.

Noted (AI summary) Stockport NHS Foundation Trust has achieved a 90% delivery rate for discharge summaries within 48 hours, and aims to reach 95%. Learning from the case will be presented to the Greater Manchester Quality Board and shared with commissioners. The Department of Health and Social Care acknowledges the failings and concerns identified in the report and refers to the response from the Greater Manchester Health and Social Care Partnership. It notes the JCVI's consideration of varicella infection risk in children with Down's syndrome.