East Lancashire Hospitals NHS Trust : Our improvement plan & our progress
Personal statement from the Chairman of East Lancashire Hospitals NHS Trust:“I am pleased to share with you the latest update on our plans to improve the quality of care the Trust provides to our local community.The Board welcomes the findings of the Keogh review,which was as a result of higherthan expected mortalityrates at the Trust. We, together with our staff, are wholeheartedly committed to continuing to improve the quality of our services. The Board believes we have made significant progress in addressing the findings of the Review, though we know there is still more to do.Once the actions identifiedwithin the Keogh action plan havebeen completed,we willset out a longer-term plan to maintainour progressand ensure that the actions lead to measurable improvements in the quality and safety of care for patients.These will address the findings from our forthcoming Chief Inspector of Hospitals visit at the end of April 2014. Therewill be regular updates on NHS Choices and subsequent longer term actions will be included as part of a continuous process of improvement.Our staff were rightly seen by the Keogh review as our biggest asset and we will work together, and support our staff, to ensure we provide compassionate care that places our patientsat the heart ofeverything we do.We are committed to improving as an organisation and our plan is fundamental to helping us on this journey.”Professor Eileen Fairhurst, Chairman
What are we doing?The Keogh review made 30 urgent recommendations on the 16thJuly 2013 which, if implemented, would improve the quality of our services. Specifically, Keogh said that we need to:-Improve the way in which the Board seeks to ensure high quality services are delivered every time, all of the time. This is important because the Board need to be aware of risks to the quality of our services , to promote patient safety and react swiftly to any emerging issues.In our response to the Keogh review we emphasisedthe need to putsustainable, safe and high quality care for our patients at the heart of everything we do. Wesimplifiedour visionto set out a clear ambition:‘ Tobe widely recognised for providingsafe,personalandeffective care’.This is supported by fiveimprovementpriorities.One of our key improvement priorities is toreduce mortality. Following theKeogh review we reviewed how we look at mortality in the hospital, particularly howwe learn from patient deaths.Now allpatient deaths are formally reviewed by a senior clinician and are discussed at weeklydepartmental meetings attended by all clinical staff. Wehave a mortality reductionplan,overseen by a steering group of senior clinical staff from a variety of professions. We monitor actual (crude) mortality on a week by week basis so that any unexpected peaks are identified and investigated immediately. We have introduced a number of clinical care bundles, which are best practice packages of care for specific conditions, for example pneumonia and acute kidney injury. There is now clear evidence that our actions have reduced mortality for our patients with specific conditions. Our Summary Hospital Mortality Indicator (SHMI) has been within the ‘expected’ range for the last two months. The SHMI at the weekend has also been within the ‘expected’ range during this period. We are also piloting the use of an electronic clinical Early Warning System on four wards.A group of senior clinicians have developed a set of professional internal standards to support improvements in our emergency pathway e.g. how quickly we initially assess patients, responsetimes for diagnostic procedures.Our performance against the 4 hour maximum wait time in Accident and Emergency services droppedfollowing theReview, whilst actions were being taken to address poor patient experience.Our performance is now improvingwith the 4 hour standard achieved in February at95.4%,although performance dipped inMarch, performancein April is muchimproved, we achieved over 97% in the week commencing 7thApril. We also now escalate into agreed non core clinical capacity on considerably fewer occasions.We have a dedicated email address for our local GPs to feedback any concerns. This information will help us to improve services and provides GPs with a central point to ask questions.-Improve the information that the Board receives about savings plans and their impact on the quality of our services. This is important because, although we have to make savings each year so that we don’t spend more money than we receive, we need to be better at checking that the savings we make will not have a detrimental effect on the care we give our patients.The process by which our savings plans are approved has been strengthened to ensure there is no detrimental impact on the quality of care we provide.Plans are now reviewed and signed off by both our Medical Director and Chief Nurse. We are also sharing our savings plans with our Clinical Commissioning Groups .- Improve the way we use our beds across all of our sites. We will also work more closely with other NHS organisations and the Local Authorities to ensure alternative services can be accessed by patients in a community setting. Both of these points are important because we need to ensure that we can continue to provide high quality care to the increasing number of patients who need to access emergency care.We have developed an ambulatory care service. This is a service where people coming in to hospital as emergency patients can have investigations, exploratory examinations and receive a treatment plan without the need for an overnight stay.We have also introduced an OutpatientParenteral AntibioticTherapy service(OPAT). This services allowspatients who are medically stable and whose only reason for hospital admission is the requirement forintravenous (IV)antibiotictherapy to go home and betreated in anoutpatient or communitysetting.OurnewUrgentCare Centre building on the Burnley General Hospital siteopened at the end of January2014.The building ispurposebuilt, offering much improved privacy for patients. There is alsoa separate waiting area for childrenand their parents.
East Lancashire Hospitals NHS Trust : Our improvement plan & our progress
East Lancashire Hospitals NHS Trust : Our improvement plan & our progress
What are we doing?- Improve our understanding of the reasons why we have a relatively high number of patients who are readmitted to hospital unnecessarily. This is important because we are now able to move some services into the local community so that they are closer to home which means patients don’t have to go into hospital. This improves the experience for our patients.We have undertaken a comprehensive audit of our readmissions to establish the reasons why they occurred. We are working with our partner organisations to address the issues highlighted. Wehave doubled the capacity in our virtual ward,whichsupports 300 patients, 7 days a week to be cared for in their own home rather than having to come into hospital. Wehave introduced paediatric hot clinics. Our readmission rate for adults is now within the expected range and the rate for paediatrics is 2% lower than this time last year.- Engagemore effectively with our patients and their carers and provide an increased opportunity for them to improve our services.We haveimplemented a more comprehensive walk round programmeby our Boardmembers, the focus of which ispatientsafety and quality. We have held listening events, where members of the public can ask questions or raise concerns directly with members of our Board. We are holding regular events with our members and shadow Governors, for example we held a member event on the 15 January 2014 to share our improvement plans.Governors have been allocated to divisions and are having introductory meetings with key staff and undertaking tours of the areas Anew initiative to encourage more feedback from users of our emergency department and urgent care centres through the use of text messaging has begun. There are already signs of significant improvements in responserates and positive feedback.We have launched an extensive public engagement campaign, ‘Tell Ellie’. Changes made as a result of feedback from the campaign will be fed back to the public using a ‘you said, we did’ approach.- We will listen to patients’ concerns and respond compassionately and quickly and we will listen to what our patients are telling us. It is important to learn from things which don’t go well so that they don’t happen again. We need to support our staff to continue to learn and develop in order to provide the best possible care for our patientsWe have extensively communicated withstaff in a variety of wayson theimportance of complaints and concerns raised by patients and relatives as a mechanismoflearning and improvingcare. We’ve introduced a neweducation and training programmeon how to respond toandlearnfromcomplaints. Anew complaints handlingprocessis in place thatchanges emphasis from investigation and formal response to understanding complaint/concern, offeringan earlymeeting, responding empathetically andlearningto improvecare. Executive directors review all new complaints and clinical teams are invited to discuss what lessons should be learned focussing on the issues from the patient’s perspective. Patientstories have become a feature of Trust Board. Wealso use patientstoriesat avariety ofmeetings asa learningtool. For example a patient’s relative attended our joint clinical leaders’ forum in early February to share their experience and describe the impact of staff behaviours. Our Chief Nurse and interim Director of HR and ODhave also been ‘back to the floor’wherethey are workingalongsidestaff across the organisation to learn and understand the issues our staff are facing on a day-to-day basis.A monthlyquality report produced by Medical Director / Chief Nurse incorporating ‘lessons learnt’ from engagementactivities and complaints is shared with the Board-Constantlyreview our workforce numbers and work hard to meet the changing needs of patients in our care. This is important to ensure all the needs of our patients are met and that the care that we give is safe and effective.We commissioned an external reviewof nurse and midwifery staffinglevels, which has resulted in range of actions taken including the introduction of adailystaffingtemplate, dailystaffingteleconference, rolloutof thepublication of daily staffingnumbers and the introduction of amonthly ward scorecard.We have significantly increased thenumber of nurses on duty at nights and are continuing to recruit additional trained nurses, health care assistants and midwives. We have improved our recruitment processes and initiated a major innovativerecruitmentcampaign. This has also included the recruitment of nurses from Portugal and Italy. Our sickness absence levels are improving and levels are significantly below the North West average and below the national average.We now employ 12 more consultants, 118 more qualified nurses, 172 more nurse support posts than we did on the 1 April 2013.
East Lancashire Hospitals NHS Trust : Our improvement plan & our progress
What are we doing?Strengthen the leadership and support to our nursing staff. This is important so that our nurses and midwives feel valued and ensures excellent and consistent nursing is provided throughout the Trust.We have reviewed our organisational development strategy and cascaded our leadership development programme to our matrons and specialist nurses. Our Nursing and Midwifery Strategy , which nurses and midwives from across the organisation contributed to, has been published and sets the direction for our nursesfocussing onthe 6Cs, the nationally recognised nursing values of Care, Compassion, Competence ,Communication, Courage and Commitment, withpatients firmly at the centre of all that wedo.The Customer Care Strategyhas alsobeen reviewed.A revisedcustomer care training programme, alignedto providingSafe, Personal, Effectivehas been developed. TheCustomer Care training approach includes face to face sessions , using interactive group discussions/use of case studies.In addition an on-lineCustomer Care programme is nowavailable to all staff.Staff can access the on-line training at any workstation. ‘Hotspot’ areas within Divisions have been identified using complaints information.We have also significantlyimproved levels ofstaff attending their required core and safeguarding trainingThis has been achieved through providing additional training sessions, evening sessions being particularly well attended, andon-linefacilitatede-learning sessions.This document shows our plan for making these changes and our progress. It builds on the ‘Key findings and action plan following risk summit’ document which we agreed immediately after the review was published. This can be found at:http://www.nhs.uk/nhsengland/bruce-keogh-review/pages/published-reports.aspxWhilst we make these changes to address the Keogh recommendations, the Trust is in ‘special measures’. More information about special measures can be found athttp://www.ntda.nhs.uk/blog/2013/07/16/nhs-tda-places-five-trusts-in-special-measures. The Trust Development Authority are working with us to ensure we have the right support in place to make these changes as quickly as possible.
East Lancashire Hospitals NHS Trust : Our improvement planandour progress
Howour progress is being monitored andsupportedWe will update this progress report on the first day of every month while we are in special measures.We will work with ourShadow Council of Governors, members andHealthwatchto ensure that the improvements we are putting in place are effective. We will also hold public meetings and attend listening events, where we will update, face to face, our local community on our progress. We will also produce monthly press briefings which describe how are delivering against our improvement plan. Further details will be announced in updates of this progress report.Marie-NoelleOrzelhas been appointed as the Trust’sImprovementDirector by the Trust Development Authority. Improvement Directors are appointed toprovide expertise to the Trust Board on how to improveservices and tocheck thatwe aremeeting our promises to deliver our improvement planWe will accesssupport from partnership working as appropriate with the Academic Health Science Network, NHS Improving Quality and the NHS Leadership Academy. (Timescale: By April 2014; Owner: NHS England).
Professor Eileen Fairhurst Chairman of the Trust (on behalf of the Board)
Who is responsible?Our actions to address the Keogh recommendations have been agreed by the Trust Board.With the Board ourInterim ChiefExecutive,JimBirrell,is ultimately responsible for implementing actions in this document. Other key staff are our Medical Director,Ian Stanleyand ourChiefNurse,Christine Pearson,who are tasked with implementing many of the key actionsdescribed, whichwill help improve the quality of care delivered by ourstaffand enhance patient experience.Nicky O’Connor from the Trust Development Authority is helping ustoimplement our actions by supporting and challenging the process by which we will ensure we deliver on our action plan.We will alsobe assessed by theChief Inspector of Hospitals,who isdueto re-inspect our Trustin April 2014.If you have any questions about how we’re doing, please ring Chris Hughes our Interim Director of Communications on01254732160,orif you wish to contact Nicky O’Connor, as an external expert, you can reach her on [email protected]
Our improvement planThis table shows the actions we’re taking to address the concerns about the quality of our services which were raised in the Keogh report. It also shows how we are progressing against our actions.
Our improvement planThis table shows the actions we’re taking to address the concerns about the quality of our services which were raised in the Keogh report. It also shows how we are progressing against our actions.
How we’re checking thatourimprovementplan is workingThis table shows how and when we are checking that the actions we’re taking are making a real difference on ourwards, in our operating theatresand in ourcommunity services. It also highlights how we will be communicating our progress to our local community.
How we’re checking that our improvement plan isworkingThistable shows how and when we are checking that the actions we’re taking are making a real difference on our wards, in our operating theatres and in our community services. It also highlights how we will be communicating our progress to our local community.
Key for progress reportsBlue -deliveredGreen– on track to deliverNarrative – disclose delays/risks/plan to recoverRed – not on track to deliver
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