Agenda item

[To receive a presentation on Mortality and Learning from Deaths in Wolverhampton]. 

The Chief Executive of the Royal Wolverhampton NHS Trust presented a report on mortality and learning from deaths in Wolverhampton.  A phenomenal amount of work had taken place in conjunction with Public Health on the area of mortality and in part the situation was improving.  Deaths relating to alcohol were particularly high in Wolverhampton and this had been a persistent theme for many years.  Smoking related illness over time would decrease, which they were already starting to observe.  The Trust had not gamed the clinical coding system to drive their income.  Improvements had been made to the coding of co-mobilities, the Trust had been an outlier but were now coming into line. 

The Chief Executive of the Royal Wolverhampton NHS Trust remarked that he was particularly proud of the implementation of the Medical Examiners at the Trust.  Deaths were now investigated by someone who had not had any involvement with the patient.  A new Bereavement Centre had also been established at the Newcross Hospital.  He had received many thank you letters from bereaved families, complimenting the Trust for the way they had received information on the death of their loved one.  This had been one of the real benefits of the new method of working. 

The Chief Executive of the Royal Wolverhampton NHS Trust commented that there had only been three cases at the Trust where care had been less than satisfactory.  This was proportionately what would be expected when analysing the published literature on mortality at hospitals.  There was a city-wide work programme, with Sally Roberts at the CCG trying to replicate the work that she had completed at Walsall in the care homes.  Too high a proportion of people died in hospital in the Wolverhampton area, when it would have been more suitable for them to have died in a care home or at home.  In Shropshire the numbers were half that of the Wolverhampton area.    He wanted people to have dignity in death and it was important for suitably trained Trust staff to have the difficult conversations with family members about end of life care. 

The Chief Executive of the Royal Wolverhampton NHS Trust stated that they had identified with the GP practices that the Trust worked with, all the people that were assumed to be in the last twelve months of their life.  He was using his transplant co-ordinators to train staff in primary care about having difficult conversations.  Proper end of life care plans needed to be put in place for each person to ensure that they didn’t spend their last hours unnecessarily in hospital.  Families expectations needed to be appropriately managed.   A Member of the Panel asked if there were any timescales for the “dignity in death” proposals.  The Chief Executive of the Royal Wolverhampton NHS Trust responded that work was taking place but needed to progress faster.  He was acutely aware that care homes were also facing enormous pressures in relation to their workforce capacity.  They did not always have the rightly skilled people on shift when someone was close to death, which meant 999 was called unnecessarily.  There had been some excellent infection prevention control work that had taken place in the nursing homes in the past.    

The Director for Strategy and Transformation stated that there was a joint programme, which had been operating for the last few months, where primary and secondary care clinicians were working together to improve end of life care.  An Epack solution had been agreed, where if a person had been flagged at being end of life, there would be a medical record to state they need to be treated in a different way and not admitted to hospital unnecessarily.  It had also been agreed that £400,000 in collaboration with the Trust, for investment in end of life community response had been set aside.  A gold standard framework had been reinstituted, to ensure that patients recognised they were on a end of life care pathway and treated accordingly.   

The Chair of Healthwatch asked for some further information on how the end of life care messages were being managed from a communication perspective.  The good work taking place needed to be shared with the wider public. The Chief Executive of the Royal Wolverhampton NHS Trust offered to come back to her with further information in the future.  It was obviously a sensitive subject and there had been some issues in Liverpool with end of life care communications.  He wanted to ensure patients and families were fully informed before wider communications.   

The Chief Executive of the Royal Wolverhampton NHS Trust remarked that on the issue of Brexit he was not overly concerned, the situation reminded him of the Millennium Bug.  The most important part was to ensure the continuous supply of drugs.  He understood the Government had made contingency plans in this area. The Trust was fortunate in that they were in a consortium with the Hospital Corporation of America for purchasing.