Buckinghamshire Healthcare NHS Trust
Review into the Quality of Care & Treatment provided by
14 Hospital Trusts in England
Key Findings and Action Plan following Risk Summit
July 2013
Contents
1.
Overview
3
2.
Summary of Review Findings and Trust response
6
3.
Risk Summit Action Plan
Appendices
Appendix I:
13
17
Risk Summit Attendees
18
2
1. Overview
A risk summit was held on 11 July 2013 to discuss the findings and actions of the Rapid Responsive Review (RRR) of Buckinghamshire Healthcare NHS Trust (“the Trust”).
This report provides a summary of the risk summit including the Trust response to the findings and an action plan for the urgent priority actions. The action plan includes any
agreed support required from health organisations, including the regulatory bodies.
Overview of review process
On 6 February 2013 the Prime Minister asked Professor Sir Bruce Keogh, NHS England Medical Director, to review the quality of the care and treatment being provided by
those hospital trusts in England that have been persistent outliers on mortality statistics. The 14 NHS trusts which fall within the scope of this review were selected on the
basis that they have been outliers for the last two consecutive years on either the Summary Hospital-level Mortality Indicator (SHMI) or the Hospital Standardised Mortality
1
Ratio (HSMR) .
These two measures are intended to be used in the context of this review as a ‘smoke alarm’ for identifying potential problems affecting the quality of patient care and
treatment at the trusts which warrant further review. It was intended that these measures should not be reviewed in isolation and no judgements were made at the start of the
review about the actual quality of care being provided to patients at the trusts.
Key principles of the review
The review process applied to all 14 NHS trusts was designed to embed the following principles:
1)
Patient and public participation – these individuals have a key role and worked in partnership with clinicians on the reviewing panel. The panel sought the views of the
patients in each of the hospitals, and this is reflected in the reports. The Panel also considered independent feedback from stakeholders related to the Trust, received
through the Keogh review website. These themes have been reflected in the reports.
2) Listening to the views of staff – staff were supported to provide frank and honest opinions about the quality of care provided to hospital patients.
3) Openness and transparency – all possible information and intelligence relating to the review and individual investigations will be publicly available.
4) Cooperation between organisations – each review was built around strong cooperation between different organisations that make up the health system, placing the
interest of patients first at all times.
Terms of reference of the review
The review process was designed by a team of clinicians and other key stakeholders identified by NHS England, based on the NHS National Quality Board guidance on rapid
responsive reviews and risk summits. The process was designed to:
1
Definitions of SHMI and HSMR are included at Appendix I of the full Rapid Responsive Review report published here http://www.nhs.uk/NHSEngland/bruce-keogh-review/Pages/published-reports.aspx
3


Determine whether there are any sustained failings in the quality of care and treatment being provided to patients at these Trusts.
Identify:
i.
ii.
iii.
Whether existing action by these Trusts to improve quality is adequate and whether any additional steps should be taken.
Any additional external support that should be made available to these Trusts to help them improve.
Any areas that may require regulatory action in order to protect patients.
The review followed a three stage process:

Stage 1 – Information gathering and analysis
This stage used information and data held across the NHS and other public bodies to prepare analysis in relation to clinical quality and outcomes as well as patient and staff
views and feedback. The indicators for each trust were compared to appropriate benchmarks to identify any outliers for further investigation in the rapid responsive review
stage as Key Lines of Enquiry (KLoEs). The data pack for the Trust is published at http://www.nhs.uk/NHSEngland/bruce-keogh-review/Pages/published-reports.aspx

Stage 2 – Rapid Responsive Review (RRR)
A team of experienced clinicians, patients, managers and regulators, following training, visited each of the 14 hospitals and observed the hospital in action. This involved
walking the wards and interviewing patients, trainees, staff and the senior executive team. This report contains a summary of the findings from this stage of the review in
section 2.
The three-day announced RRR visit took place, on Monday 10th to Wednesday 12th June 2013. The Stoke Mandeville, Amersham and Wycombe sites were visited during
this period. The unannounced visits took place over four sites and were held on the evenings of Sunday 16 June 2013 and Tuesday 18 June 2013, and the morning of
Wednesday 19 June 2013. A variety of methods were used to investigate the Key Lines of Enquiry (KLOEs) and enable the panel to analyse evidence from multiple sources
and follow up any trends identified in the Trust’s data pack. The KLOEs and methods of investigation are documented in the RRR report for the Trust. A full copy of the report
was published on 16 July 2013 and is available online: http://www.nhs.uk/NHSEngland/bruce-keogh-review/Pages/published-reports.aspx

Stage 3 – Risk summit.
This stage brought together a separate group of experts from across health organisations, including the regulatory bodies (Please see Appendix I for a list of attendees). The
risk summit considered the report from the RRR, alongside other hard and soft intelligence, in order to make judgements about the quality of care being provided and agree
any necessary actions, including offers of support to the hospitals concerned.
The Risk Summit was held on 11 July 2013. The meeting was Chaired by Andrea Young, NHS England Regional Director (South), and focussed on supporting the Trust in
addressing the urgent actions identified to improve the quality of care and treatment. The opening remarks of the Risk Summit Chair and presentation of the RRR key
findings were recorded and are available online: http://www.nhs.uk/NHSEngland/bruce-keogh-review/Pages/published-reports.aspx
4
Conclusions and priority actions
The RRR Panel was welcomed to the Trust by all staff and patients and met some outstanding and dedicated individuals at all levels within the Trust. The Trust has recently
undergone significant change, most notably the consolidation of the A&E department from Wycombe to the Stoke Mandeville site and the creation of three large divisions from
the original six. The Trust is also an integrated provider with community services. In response to the Trust’s higher than expected HSMR a Mortality Task Force was set up in
2010.
The Trust and ward areas were observed to be clean and tidy, with patients generally seen to be well cared for during the visit. Many examples of good practice were found
and are included in the body of the RRR report, but there were six broad areas where more focus from the Trust will lead to significantly improved quality of care:

Governance (including risk management and reporting);

Urgent care (pathways);

Patient safety;

Organisation-wide monitoring of clinical and operational effectiveness;

Patient and public engagement (including communication and complaints); and

Workforce (including recruitment, training and leadership).
The Executive team recognise the review’s conclusions and recommendations and accept the highlighted areas for development. The panel indentified that there was a lot to
do and for which there needed to be an explicit plan (with timelines) to ensure all staff are aware of what is important and the pace of change required.
The RRR also identified a number of areas of outstanding concern across all eight KLoEs. The Trust responded positively to the RRR process and welcomed the issues
raised in the RRR. Six areas were identified for discussion at the risk summit. These are summarised in the following sections and are detailed within the RRR report. An
action plan was agreed at the risk summit addressing all the urgent priority actions discussed.
Next steps
The risk summit focused on urgent priority actions. The Trust is expected to also provide a detailed action plan to all outstanding concerns and recommended actions included
in the RRR report.
Follow up of the RRR and risk summit action plan will be undertaken by other organisations within the system, including the Trust Development Agency (“TDA”). A formal
follow up will consist of a desktop review and targeted site visits to the Trust in October / November 2013, which will include speaking to staff and patients and reviewing key
areas to understand the improvements that have taken place. A report of the follow up findings will be issued to the risk summit attendees and will consider, if there are
significant remaining concerns, if there is a need to convene a further risk summit.
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2. Summary of Review Findings and Trust response
Introduction
The following section provides a summary of the RRR panel’s findings and the Trust’s response presented at the risk summit. The detailed findings are contained in the
Trust’s RRR Report. The Trust response was presented by Anne Eden, Chief Executive. She was supported in the questions and clarification session by Kathy Cann, Interim
Medical Director, Lynne Swiatczak, Chief Nurse & Director of Patient Care Standards and Neil Dardis, Chief Operating Officer (COO). The agreed action plan in response to
the urgent priorities is included in the following section.
Overview of Trust response
The Trust welcomed the review and its findings and recognised the issues identified. The Trust accepted the report as a fair account and accepted that that although
improvement actions have been in place and/or planned in relation to patient safety and mortality, further improvement is needed and it plans to continue in a sense of
openness, transparency and urgency.
The Trust stated that the review confirmed the areas of concern that it was already working on. The Board is determined to continue to ensure quality and patient safety are
their overarching principles. They stated that although much work has already been done, there is a need to ensure this is consolidated, that variation across clinical services
is reduced and that the connection between the Board and wards is enhanced. They look forward to working with external parties in implementing the recommendations, in
particular in:

Developing the Board capability and capacity;

Improving urgent care pathways (particularly management of deteriorating patients) and out of hours medical cover;

Enhancing the Board reports to show more metrics related to clinical and operational effectiveness and patient feedback;

Improving the system of reviewing and responding to patients’ views;

Performing a safety culture review; and

Increasing staffing levels and mix throughout the organisation.
Furthermore, the Trust will work with parties such as patient and carer groups, the NHS 111 provider and CCGs to improve functionality of NHS 111 for this healthcare
system.
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Summary of Review Findings
1. Governance
The Trust needs a more robust method to provide assurance on the quality impact of major service change with regard to clinical effectiveness, patient experience and
safety especially in regard to the consolidation of A&E at the Stoke Mandeville site. Leadership at Board level appears “reactive” to issues and there seems to have
been limited challenge and examination of the data presented to the Board for reassurance, not assurance. The current approach is over reliant on incident reporting
and needs strengthening to be sufficient to detect and address unforeseen quality concerns. Patient information and signage needs to improve especially for the benefit
of out of hours patients.
Recommendation


At this time of significant change within the Trust, there is an urgent need for the Board to develop both its capability and capacity to work in a proactive way and its
ability to scrutinise and challenge effectively.
The Board should urgently develop its approach to risk management. In order for the Board to proactively plan, monitor and manage risks to patient safety, there is
a need to ensure the key risks are identified at all levels of the organisation and appropriately fed through to the corporate risk register.
Trust response
The Trust agreed to procure a consultant to undertake a rapid Board development review, which will baseline capacity and capability (including the Board’s grasp of
safety tools) and implement a development programme to focus on all six key issues outlined in the Action Plan. The Trust was concerned about the speed with which
it could procure an external consultant to support its development, but was advised by the risk summit that the process could be expedited by using the procurement
framework. It will also contribute to the enhancement of Board reports, to ensure metrics such as mortality and Friends & Family data are presented, and improve
granularity to Divisional level.
The Board Development review will include assessment of the Board’s approach to risk management, in order to proactively plan, monitor and manage risks to patient
safety, and ensure key risks are identified at all levels of the organisation and appropriately fed through to the corporate risk register.
The Trust is also standardising governance processes, to remove variation across the organisation.
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2. Urgent care (pathways)
There has been a recent period of significant structural and organisational change in the Trust including the consolidation of A&E on the Stoke Mandeville site.
Emergency activity remains on the Wycombe site for acute stroke patients and “in hours” cardiac patients. Prospective evaluation of patient transfers between hospital
sites for those presenting as emergencies should be urgently undertaken to assess patient safety and experience. This evaluation should cover all patients transferred
following presentation as an emergency to ensure that high quality care is provided for those who remain with Buckinghamshire Healthcare Trust as well as those who
are transferred to other hospitals such as Oxford or Harefield. This issue has been a significant reputational risk to the Trust. During the review visit the team observed
patients who required transfer between the two sites and considered that urgent evaluation of this service change must be undertaken to assess the quality of care.
Investigation of high mortality rates shows pneumonia and acute renal failure as likely contributing conditions. There is a lack of clear and formally agreed pathways for
the recognition and management of acutely ill and deteriorating patient.
The TDA recommended the introduction of more metrics in Board reports. It was agreed that capacity for care on specialty wards and the monitoring of patient
placement in specialty could be measured. This work will be carried out with support from the TDA, CCGs and the Local Authority.
Recommendation




The Trust should review patient pathways between hospital sites to ensure high quality of care and ensure clinical effectiveness, patient experience and safety.
The identification and appropriate management of deterioration of medical patients admitted as emergencies is an area that the Trust should focus on urgently.
The Trust must review medical staffing for out of hours/weekend medical cover.
The Trust should increase capacity for care on specialty wards. This should include the establishment of a respiratory unit with increased capacity.
Trust response
As discussed at the risk summit, and picked up in more detail between the Panel Chair, Chief Executive and the Interim Medical Director in subsequent conversations,
the Trust is aware that urgent improvements are required in the recognition and management of deteriorating medical patients. The Trust has agreed with the Panel
Chair that an audit of medical patients admitted to ITU within 72 hours of admission should be performed. This will allow an assessment of timely identification and
management of acutely ill patients, including the response to deterioration. The Terms of Reference for such an audit should be finalised within one week.
Following receipt of CQC mortality outlier notices relating to pneumonia and acute renal failure, the Trust has developed an audit for these groups together with the
TDA. The report of this audit should be presented by September 2013.
The Trust has agreed to review medical cover for out of hours/weekend care with immediate effect and carry out a Trust wide review which will report by December
2013.
The risk summit recommended that patient pathways between hospital sites should be reviewed. The Trust responded that work had begun in this area and that an
assessment would be complete by the end of September 2013. It was noted that the panel did not have reservations about the new structure of the Trust, following
reconfiguration, but that pathways and the overall patient experience could be improved. The Trust agreed that as part of the work to improve Board reports, metrics
will be included which show patient transfers within the Trust.
The Trust has agreed to review care of specialty patients across the whole pathway including in patient bed capacity.
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3. Patient Experience
The panel considered that a more systematic approach is needed to gathering and reviewing patients’ views about their experiences of care in the Trust. Although some
good work was being done by some wards, there should be better methods of sharing information from the feedback that is gathered. The Trust needs to be more
robust in using patient feedback and complaints as a means to informing and improving service delivery, and to help it plan for the future and share learning across the
organisation.
Recommendation



The panel saw evidence of ward level collection and review of patient experience data and recommend that this is urgently implemented across the Trust. This
should be linked to a single route of accountability within the division structure and combine all patient related contact services (PALS, complaints, patient
engagement, claims)
Put in place consistently high standards for addressing patient complaints across all divisions with clear Board level accountability.
Establish an effective process for capturing and reviewing the experience of patients presenting acutely to the Trust.
Trust response
The Trust stated that it had recently appointed a Patient Experience Manager with responsibility and accountability for complaints, PALS, litigation and patient
experience. It will be their remit to ensure a more systematic and consistent approach, overseen by the Chief Nurse at Board level, which will feed into the quality and
safety strategy covered in Key Issue 1.
The Trust is currently appointing a clinical governance manager post to all divisions to ensure a single route of accountability within the Divisions. The Trust agreed that
as part of the work to enhance Board reports, metrics should be included which show more Friends & Family and patient experience data.
A panel member suggested at the risk summit that in future, the Trust should be able to demonstrate where patient feedback has informed their approach. The Trust
agreed and stated this would include complaints, which they admitted had not been responded to in a timely way in the recent past.
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4. Clinical and operational effectiveness
The Trust needs more robust, organisation-wide monitoring of clinical effectiveness and operational performance data. Quality scorecards should be in place on every
ward, and the Board needs to have more clarity in how it gains robust assurance about quality and safety risks across the sites. The Trust needs to move its focus on
mortality away from trying to explain the figures at the Mortality Task Force. It must concentrate more on the identification of trends in the data and the development of
action plans and improvement projects to address issues such as pneumonia and acute renal failure mortality rates – the approach seems to have been reactive in
response to information from Dr Foster (and recently confirmed by the CQC mortality outlier alert notices for these categories). While there are a number of recent
developments which focus on safety (e.g. National Early Warning Scores), the Trust needs to adopt national initiatives in developing a mature “safety culture” and use
incident reporting positively and constructively alongside more proactive tools.
Recommendation



The Trust should bring together all improvement projects as part of a Trust-wide safety strategy to address the causal factors associated with high mortality. These
should be incorporated as part of a recognised improvement methodology and their progress reviewed.
The Trust need to commission an external safety culture review.
Training to be provided to all staff and Board members on the definition of incidents and the importance of reporting them in a way that promotes the development of
a no-blame culture.
Trust response
The Trust has undertaken improvement projects, but recognised they need to be combined into a Trust wide safety strategy.
The Panel Chair recommended that the Manchester Patient Safety Framework (MaPSaF) should be adopted which will promote a commitment to the real time
collection of data. This data should be used to ensure that performance is everyone’s responsibility throughout the trust. The Trust should also undertake a safety
review based on this framework, as detailed knowledge of the current position will support the development of the whole organisation, rather than building on previous
work, there should be a single external safety culture review which uses the Manchester Patient Safety Framework (“MaPSaF”). The NHS England regional team
offered to assist in arranging this and the Trust agreed to begin as soon as possible.
It was agreed that an integrated quality and patient safety strategy should be produced and its development be informed by the outcome of this safety culture review.
The Trusts stated this will help ensure a systematic implementation of the strategy and decreased some of the variation which exists across the organisation.
The Trust’s quality and patient safety strategy will address the causal factors associated with high mortality. These should be incorporated as part of a recognised
improvement methodology and their progress reviewed. The Trust has said that they have used the INTERMOUNTAIN programme for their staff, some Board members
and partners in the healthcare economy, for an improvement project. The Trust will review to assess if this is the optimal approach, which should include greater
numbers of Board members and staff.
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5. Patient safety
The panel stated that there is an ineffective Out of Hours telephone cover service for the Community Hospitals. They spoke with staff who relied upon informal
agreements with GPs and consultants to provide support when the telephone cover was not effective. There is an opportunity for the Trust to work to enhance the 111
service as an aid to the public in signposting the appropriate point of entry to the Trust.
Recommendation

The Trust works with patient and carer group/NHS 111 provider and CCGs to improve functionality of NHS 111 for this healthcare system.
Trust response
The Trust is urgently working with Buckinghamshire Urgent Care (“BUC” - current out-of-hours GP provider) and commissioners to reinstate the healthcare
professionals direct line for all community hospital staff out-of-hours. In addition, the panel recommends that the Board development programme and safety culture
review should ensure issues such as staff use of NHS 111 are picked up by the Board sooner.
6. Staffing levels and skill mix
The Trust recognises the difficult issues raised by the panel such as recruitment, high levels of staff sickness and poor staff survey results, but needs a clear, more
visible strategy to overcome these challenges. There is good evidence of both ward level initiatives to increase staff engagement, and others such as the staff
newsletter, and the CEO coffee mornings – increasing the diversity of two way communication between Board and ward; developing this would provide a good
opportunity for the Board to listen to staff. There was a concern over staffing levels of senior grades, in particular out of hours. The Nursing staffing levels and skills mix
was also found to be suboptimal in places.
Recommendation



The Trust should consider urgently the staffing levels and mix throughout the organisation, particularly at the senior grades, to address concerns about
weekends and out of hours.
The Trust should undertake a review of the provision of services at its community hospitals and whether clinical staffing levels are appropriate and provision of
care continues to be sustainable at the current level of service use.
A variety of two-way communications are in place and these must be developed in order to encourage effective and diverse staff engagement, in order to close
the gap currently described by members of staff between the Board and the ward.
Trust response
The Trust outlined the Business case (under development) to deliver comprehensive consultant-delivered 7 day working and agreed that in the short-term urgent
consideration will be given to additional junior doctor support, in particular to the medical wards with appropriate clinical supervision. In addition, the panel advised the
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6. Staffing levels and skill mix
Trust to review the staffing levels and mix throughout the organisation (including senior support for junior doctors).
A smaller, more urgent piece of this work will be undertaken, to review capacity across acute and community teams to ascertain specialty requirements along the urgent
care pathway e.g. respiratory.
It was agreed at the Risk Summit that support will be provided to the Trust, and the CCGs and the Deanery agreed to provide support in these areas. The Trust was
already actively engaging with the Thames Valley Local Education and Training Board, and plan to make changes in training and development, e.g. staff administering
of IV antibiotics or fluids, and to develop a recruitment and retention plan.
It was agreed that the workstreams to review safety culture and develop the quality and patient safety strategy will include assessing the effectiveness of the two-way
communication initiatives.
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3. Risk Summit Action Plan
Introduction
The risk summit developed an outline plan focused on the urgent priority actions from the RRR report.
Action plan
Key issue
1. Governance
Weak methods to provide assurance on the quality
impact of major service change with regard to clinical
effectiveness, patient experience and safety. Board
appears too reactive, rather than proactive, and is not
effective in challenging information presented to it.
Reliance on reassurance over assurance.
Agreed actions
Procure rapid Board Development review and programme, which will
baseline Board capacity and capability, including the Board grasp of safety
tools and will focus on all six key elements of the Rapid Responsiveness
Review Report.
This should ensure that Board reports are revised, to include metrics such
as mortality, Friends & Family data, and allow improved granularity to
Divisional level.
Owners
Trust (Chief
Executive)
Timescales
1 to 2 weeks to
procure.
Complete
assessment during
Sep 2013, report to
Board in Oct 2013.
The Board Development review will assess the Board’s approach to risk
management, in order for the Board to proactively plan, monitor and manage
risks to patient safety, and ensure key risks are identified at all levels of the
organisation and appropriately fed through to the corporate risk register.
2. Urgent care (pathways)
The consolidation of A&E on the Stoke Mandeville site
has resulted in the need to transfer patients between
To review patient pathways between hospital sites to deliver high quality of
care and ensure clinical effectiveness, positive patient experience and
patient safety at all times.
Trust (Medical Complete
Director)
assessment by end
Sep 2013, report to
Board in Oct 2013.
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Key issue
Agreed actions
sites within the Trust and to other hospitals.
Investigation of high mortality rates shows pneumonia
and acute renal failure as likely contributing
conditions. There is a lack of clear and formally
agreed pathways for the recognition and management
of acutely ill and deteriorating patient.
The identification and appropriate management of deterioration of medical
patients admitted as emergencies is an area that the Trust should urgently
focus on. An audit of medical patients admitted to ITU within 72 hours of
admission should be performed. This will allow an assessment of timely
identification and management of acutely ill patients, including the response
to deterioration.
Owners
Timescales
Trust (Medical Audit Terms of
Director /Chief Reference to be
Nurse)
finalised within one
week.
Audit to be concluded
by end Sep 2013.
Audits of patients whose death was recorded as pneumonia or acute renal
failure are being performed following receipt of CQC mortality outlier alert
notices.
Audit report to be
made available by
September 2013
The Trust must review medical staffing for out of hours/weekend medical
cover for medical patients and put in place additional cover at these times as
soon as possible if required.
Trust (Medical Within one week.
Director)
The Trust should introduce metrics, presented in Board reports, to measure
capacity for care on specialty wards and the monitoring of patient placement
in specialty.
Trust (Chief
Operating
Officer)
New metrics to be
introduced to the
Board reports by Sep
2013.
Final report formats
to be in place by Dec
2013.
3. Patient Experience
There is no systematic approach to gathering and
reviewing patients’ views about their experiences of
care at the Trust. Complaints are not addressed in a
timely manner and learning is not shared effectively
The panel saw evidence of ward level collection and review of patient
experience data and recommends that this is urgently implemented across
the Trust.
This should be linked to a single route of accountability within the division
structure and combine all patient related contact services (PALS, complaints,
patient engagement, claims).
By Dec 2013
Trust (Chief
Nurse)
14
Key issue
across divisions. Patient and public concern about the
quality of care for patients presenting as emergencies.
Agreed actions
Owners
Timescales
Put in place consistently high standards for addressing patient complaints
across all divisions with clear Board level accountability.
Put in place an effective process for capturing and reviewing the experience
of patients presenting acutely to the Trust.
4. Clinical and operational effectiveness: There
appears to be a lack of organisation-wide
monitoring.
There are a number of improvement projects in the
early stages of planning or implementation, which
have not been brought together as part of a TrustWide safety and improvement strategy. In addition,
although the Trust is a medium reporter of incidents,
feedback from staff revealed some confusion around
the definition of what constitutes an incident, a
reluctance to report incidents due to fear of blame and
lack of confidence in improvement actions resulting
from their reporting.
5. Patient safety
Ineffective Bucks Urgent Care Service (NHS 111)
service for the Community Hospitals. There is an
opportunity for the Trust to work to enhance the 111
service as an aid to the public in signposting the
appropriate point of entry to the Trust.
The Trust to commission an external safety culture review, using the
Manchester Patient Safety Framework (“MaPSaF”).
Trust (Chief
Nurse)
Assessment within 68 weeks.
Complete by end Sep
2013.
Report to Oct 2013
Board.
Produce an integrated quality and patient safety strategy. Development
of this strategy to be informed by the outcome of the formal assessment of
the safety culture, detailed above.
Ensure systematic implementation of the strategy.
The Trust should bring together all improvement projects as part of a Trustwide safety strategy, to address the causal factors associated with the
apparently high mortality. These should be incorporated as part of a
recognised improvement methodology and their progress reviewed. (E.g.
Trust to review INTERMOUNTAIN programme to assess if this is the optimal
approach)
Trust (Chief
Nurse and
Chief
Executive)
Subsequent to the
above. Complete by
Nov 2013.
Work with patient and carer group/NHS 111 provider and CCGs to improve
functionality of NHS 111 for this healthcare system.
CCGs
Trust (Chief
Operating
Officer)
Dec 2013
15
Key issue
6. Workforce: inadequate medical staffing levels
and skills mix
There was a concern over staffing levels of senior
grades in particular out of hours. The Nursing staffing
levels and skills mix was also found to be suboptimal
in places.
Training & development for staff varies and does not
appear to be prioritised consistently.
Some nursing staff said that it was difficult to obtain
places on essential internal courses (for example, in
order to be permitted to administer IV antibiotics or
fluids).
The spinal unit and other wards across sites are
understaffed while other exemplar wards confirmed
they had very low vacancy levels.
Agreed actions
Owners
Timescales
The Trust should review the staffing levels and mix throughout the
organisation (including senior support for Junior doctors), working towards
high quality seven day cover arrangements for all services, to address
concerns about weekend and out of hours care. This should include review
of services in community hospitals in relation to their sustainability at the
current level of use and include a review of capacity across acute and
community teams to ascertain specialty requirements along the urgent care
pathway e.g. respiratory.
Trust (Medical Full review by Dec
Director and 2013.
Chief Nurse)
Review of
requirements along
the urgent care
pathway by end Sep
2013.
Review of current training and development plan against training needs
analysis and implement changes e.g. administering IV antibiotics or fluids.
Trust (HR
Director and
OD/Chief
Nurse)
Dec 2013
A variety of two-way communications are in place in the organisation and
these should be included in the safety culture review and development of
quality and patient safety strategy.
Trust (Chief
Executive)
Dec 2013
Develop a recruitment and retention plan based on the staffing levels and
mix review to address the difficulties in recruiting nursing staff and the
significant variation in the make-up of staffing levels on individual wards
between Trust staff and bank or agency staff.
Trust (Director Dec 2013
of HR and
OD/Chief
Nurse)
16
Appendices
17
Appendix I: Risk Summit Attendees
Organisation
Name and Role
NHS England
Andrea Young, Regional Director (South) - Summit Chair
NHS England
Nigel Acheson, Regional Medical Director (South) - Chair of RRR Panel
NHS England
Liz Redfern CBE, Chief Nurse (South)
Thames Valley Area Team
James Drury, Director of Finance
Thames Valley Area Team
Jan Fowler, Director of Nursing
Buckinghamshire Healthcare NHS Trust
Anne Eden, Chief Executive
Buckinghamshire Healthcare NHS Trust
Dr Kathy Cann, Interim Medical Director
Buckinghamshire Healthcare NHS Trust
Lynne Swaitczak, Chief Nurse and Director of Patient Standards
Buckinghamshire Healthcare NHS Trust
Neil Dardis, Chief Operating Officer & Deputy Chief Executive
Buckinghamshire Healthcare NHS Trust
Andrew McLaren , Divisional Chair
Aylesbury Vale CCG
Louise Patten, Chief Officer
Chiltern CCG
Annet Gamell, Chief Clinical Officer
Aylesbury Vale and Chiltern CCGs
Jane McVea, Assistant Director of Quality
CQC
Adrian Hughes, Regional Director of Operations (South)
CQC
Lisa Cook, Compliance Manager
NHS Trust Development Authority
Stephen Dunn, Director of Delivery and Development (South)
NHS Trust Development Authority
Julie Blumgart, Clinical Quality Director (South)
GMC
Kirstyn Shaw, Employer Liaison Adviser – South Central
Public Health England
James Mapstone, Interim Centre Director for Thames Valley
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Organisation
Name and Role
Health Education England
Wendy Russell, Head of Operations and Development – Education & Quality
Health Education England
John Clark, Director of Education and Quality
Buckinghamshire County Council
Jane O’Grady, Director of Public Health
Buckinghamshire Health & Wellbeing Board
Patricia Birchley, Cabinet member for Health & Wellbeing
South Central Ambulance Service NHS Foundation Trust
Maria Langler, Area Manager
Rapid Responsive Review Panel representative
Chris Gordon, Programme Director, NHS Leadership Academy
Rapid Responsive Review Panel lay representative
Neeta Mehta, Patient/Public panellist
Rapid Responsive Review Panel lay representative
Derek Prentice, Patient/Public panellist
PwC Moderator
Sarah Leavey, Independent Moderator
PwC Recorder
Charlie Clover, Recorder
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