PAPER
BOD 44/2014
(Agenda Item: 5)
Report to the Meeting of the
Oxford Health NHS Foundation Trust
Board of Directors
Board Meeting
30 April 2014
Chief Operating Officer’s Report
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For Information
This month’s report provides the Board with an update on:
Children and Young People’s Services – School Based Services
Adult Services Remodelling
Older People’s Services – Training developments
Recommendations
The Board is asked to note the report.
Lead Executive Director: Yvonne Taylor, Chief Operating Officer
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1.
Children and Young People’s Services
The Children and Young People’s Directorate deliver school based health
services across Oxfordshire. In May 2013, Oxfordshire County Council confirmed
its intention to re-procure a range of public health services including school
health nursing. Following our successful bid the Trust was awarded the contract
to deliver school health nursing in Oxfordshire. We were also successful in
winning bids to provide a healthy weight service for children and young people,
school based immunisations and the national child measurement programme.
We are working with colleagues in Oxford University Department of Psychiatry to
ensure that we can evaluate the school based metal health pilot into schools,
evaluating the service and improving the evidence base for interventions in
schools.
School services being delivered:
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School Health Nursing: there will be a school health nurse based in
every secondary school, available 9.00am-3.00pm every school day to
provide direct care and signpost to other services. The school nurses will
work in partnership with the head teachers and board of governors
developing a health plan for each school as well as delivering public
health interventions across the school. At the request of commissioners
we plan to trial nurses being in uniform in some schools and will get
feedback from pupils, school nurses and teaching staff. School nurses will
also work in primary schools and have an important role to play in early
intervention helping children and young people to remain in school,
managing illness as well as promoting good health, sexual health, the
wider public health agenda, such as smoking cessation and safeguarding.
School-Based Immunisations: Immunisation programmes for Human
Papilloma Virus (HPV), Tetanus, Diphtheria and Polio (Td/IPV), Menigisitis
C and Measles, Mumps and Rubella (MMR) will be delivered in each
geographical area, to ensure children are protected
College service: The college service will be fully integrated with the
school health nursing service, offering a seamless transition for young
people as they enter further education
National Child Measurement Programme: Children in reception and
year 6 are now having their height and weight measured, which number
exceeding national targets, allowing proactive follow-up to improve their
long-term health outcomes
Healthy Weight Management Service: The Trust was successful in
winning this contract against strong national competition, and is now
delivering a bespoke weight management programme for children and
families across the county
School-Based Mental Health Service: An innovative pilot study is being
launched to base 3 mental health workers in Oxford city schools, rising to
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10 county-wide from September, to improve school-based mental health
services and develop the evidence base for such interventions
We are very excited about the opportunities school based services have for
promoting good physical and mental health for children and young people and
particularly the opportunities to work with secondary school head teachers and
governors to impact on the lifelong health of the children and young people of
Oxfordshire.
2.
Adult Services
Following an 18 month build programme Adult Services have successfully moved
patients from the adult inpatient wards at the Tindal Centre into the new
Whiteleaf Centre, where we now have two 20 bedded wards; one male and one
female.
The new site provides a modern, purpose built environment for the provision of
inpatient mental health care and we have received a significant amount of very
positive feedback about the new facilities. Our patients have told us that the
environment has made a significant difference to their overall health and
wellbeing and they have told the inpatient staff how, in particular, they value the
en-suite accommodation and additional recreational space we have created
within the ward footprint.
All inpatient staff had an extensive period of training and induction, including
specific scenario training around emergency responses for the new environments
before they moved in. Staff have now been working there for approximately eight
weeks and have told us that they are delighted to be working in such a warm and
welcoming atmosphere and have reported that the environment has contributed
to developing supportive and therapeutic relationships with their patients.
Historically the recruitment of high quality staff has sometimes been a challenge
for the inpatient wards in Buckinghamshire and we had hoped that this move
would enable us to address some of these challenges with the new hospital
being seen as an incentive to people to come and work for the Trust. We were
therefore pleased that following formal interviews last month both Ruby and
Sapphire wards now have a full establishment of qualified nursing staff, some of
whom have come from other Trusts, and bring with them different and valuable
professional experience.
An extensive environmental improvement programme for the acute inpatient
wards in Oxfordshire has been taking place over the last six months, and is now
almost complete. This has included refurbishment of the bedrooms and
bathrooms as well as the purchasing of new equipment for the wards (such as
new televisions and games consoles) to support patients’ leisure time on the
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wards.
The wider remodelling of Adult Mental Health Services and the move into the
new Whiteleaf Centre provided the opportunity to review existing clinical models.
This piece of work, led by the Directorate Head of Nursing and Head of Service,
has now been implemented is built around the Accreditation for Inpatient Mental
Health Services (AIMS). This initiative from the Royal College of Psychiatrists is
a standards based programme which looks to improve the quality of care on
inpatient mental health wards. The accreditation assures staff, patients and
carers, commissioners and regulators of the quality of the service that is being
provided and the directorate are delighted that they have been able to use this
tool to benchmark their existing models of care against.
As part of remodeling services we committed to each inpatient ward having a
dedicated Modern Matron, who, along with the Ward Manager and the
Consultant Psychiatrist would form the clinical leadership team for each ward.
We have been successful in recruiting to all of these newly created posts, and
staff, some of whom have been recruited externally, will all be in post by the end
of May. The role of the Modern Matrons is to support and ensure the delivery of
high quality and safe patient care; they will also lead on patient and carer
experience, ensuring that the wards will be supported by a leadership team of
experienced senior staff.
3.
Older People’s Services – Training Programme Developments
The Sub acute skills programme was developed in response to the necessity to
prepare and support staff in the management of patients with increasing subacute medical and nursing needs in the community. Previous courses had
proven somewhat limited and were more theoretically based and lacked practical
clinical application. In addition staff in clinical areas focused upon integrated
approaches to health care delivery found that traditionally delivered training often
fostered a silo approach. The Trust applied for and was successful in securing
HETV funding to develop a sub-acute skills project. This has two main strands,
1. The development of an accredited (by University of West London at
Masters Level) sub acute skills course with the aims of increasing the
competence and confidence of staff to undertake comprehensive
assessment of patients.
2. Development of a purpose built ‘skills lab’. The lab, equipped with
manikins for wound care, suturing, blood pressure arms, manikin that can
produce breath sounds, catheter models etc has proved to be an
exceptionally useful resource to deliver the course to staff from across the
Trust.
Early feedback has been very positive with staff reporting excellent learning
experience and some reporting improvements in their ability and confidence in
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their management of clinical scenarios since the course in their workplaces.
Further work is being undertaken by course leads to gain further accreditation
with the University of West London for two further work based learning courses.
These will be offered externally and internally and aim to be in place from Late
summer 2014.
There are two aspects to the Sub acute Skills course. The first was the
development of the skills lab and the second the development of the accredited
sub-acute skills ‘work based learning’ course.
Skills Lab
1. We need skilled staff within the Trust to manage patients at home and
within the Urgent care services. These practitioners see, diagnose and
treat patients with minor injury and illnesses. It was becoming evident that
although practitioners were training to masters/degree level and
undertaking university courses that these staff were still not prepared
when they came into practice and still had to be trained in certain
competencies.
2. The increasing demand to manage acute patients at home in the
community means that staff require some consolidation of skills to
increase their competency and confidence as well as the development of
other skills.
The skills lab is nearly completed with just some outstanding equipment waiting
to arrive. It is well equipped with manikins for wound care, suturing, blood
pressure arms, manikin that can produce breath sounds, catheter models etc.
The sub-acute skills course has started and is in its third week this week. The
course was scoped within the community services and we are running three
courses:
1.
40 Credit Minor Illness: Developing competency through work based
learning course
2.
40 Credit Minor Injury: Developing competency through work based
learning course
3.
20 credit Student negotiated award – developing competency through
work based learning – to allow staff who need some skills but do not want to train
in autonomous assessment.
The first course has been accredited with the University of West London at
Masters Level and the two other courses are going through the examination
board of the University of West London on the 2nd May. We are offering the
courses internally and externally.
The course is running well thus far and we have had some very positive
feedback from staff on the wards regarding their confidence and ability to
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manage their patients in a more proactive way than previously. The course is
practical based with some theory teaching but interactive and followed up with
practical sessions where the students get to practice the examination techniques.
The Skills Lab officially goes live in June and we already have a few bookings.
We have run two acute deteriorating patient courses, one from the lab with the
aims of :
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Give an overview of the national and international developments to date
aimed at supporting the adult who has the potential to become acutely unwell.
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Understand that there are clinical signs of deterioration many hours
before most life threatening events
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Perform, analyse and interpret a rapid clinical assessment of a patient
who is at risk of deterioration/medical emergency
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Using Imperial MEWS/Local Trust tool to calculate risk, escalate care
and become familiar with interdisciplinary communication.
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Be confident in implementing initial interventions such as positioning
and oxygen therapy. Be aware of appropriate medical therapeutics.
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Be confident in accessing appropriate care pathways for a deteriorating
patient.
District Nursing Induction and Preceptorship
The District Nursing Induction and Preceptorship Programme has been set up to
address challenges around the long time frame that it has historically taken for
some nurses new to the service to access training and development that is
essential to their role and to help with both the role transition from being a
student to being a registered practitioner and with skills development for those
new to District Nursing.
In addition to clinical skills development in areas such as pressure damage
prevention and wound management and bowel and bladder care, participants on
the programme also receive input on practical aspects of using the electronic
patient record , ordering equipment and patient safety and incident reporting .
The programme is organised and delivered by the Clinical Development Leads
within District Nursing and subject matter experts from specialist teams. The five
day programme occurs in the week following Trust Induction and ongoing
support is provided through the initiation of a personal development plan and
membership of an ongoing action learning set. Current members of DN Teams
are also able to access sessions on an individual basis
A cohort of clinicians have received training that will enable them to act as
facilitators of action learning sets for nurses on the programme.
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Qualitative evaluation of the programme has been positive and quantitative
evaluation is planned following the completion of future cohorts as this will give
more robust figures for analysis.
Pressure ulcer prevention action Group
A Trust wide action group meets bi monthly to review the pressure ulcer
prevention action plan which has an overall aim of reducing avoidable pressure
ulcers. 5 work streams form the structure of the action plan, each with its own
lead who is responsible for coordinating the work plan. These are:
1.
2.
3.
4.
5.
Integrated working with the Oxford University Hospital Trust (OUH)
Education and competency frameworks
Documentation and audit
SSKIN bundles
Working with formal and informal carers.
This plan was and validated by the CCG Quality team at a meeting on 2nd April
2014.
Achievements to date include:
 Pilot sites across OUH and Oxford Health which aim to improve patient
information about pressure damage.
 Development of a national e learning programme which is now available
for staff
 A competency framework which has been launched across community
nursing teams
 Partnership working with local authority and the voluntary sector to help
raise awareness of pressure ulcers
 Introduction of SSKIN bundle across older adult mental health wards (pilot
sites).
These initiatives and the work of the Oxfordshire Wound Advisory Group and the
joint discharge action plan that has been developed in partnership with the OUH
through the Discharge Oversight Group have had a positive effect in reducing the
incidence of Grade III/IV pressure tissue damage.
A total of 15 SIRIs have been reported since 1st April 2013, 8 fewer than the
equivalent point last year. 13 of these relate to grade 3 or 4 pressure damage, 11
of which were reported by District Nursing teams and 2 by a Community Hospital.
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