Quality Account
2009/10
Patients first Honesty
Respect Excellence
Trust Equality
“To be the specialist orthopaedic hospital of choice by providing outstanding patient care, research and education.”
Its purpose is to meet patient needs and demands through building a strong academic evidence base supported
by an appropriate range and scale of high quality accessible neuro-musculoskeletal service lines.
The Royal National Orthopaedic Hospital’s clinical vision is:
“To provide the scale and range of service lines that ensure clinical volume, complexity and outcomes are appropriate
to a world class service. This will support the Trust’s role in cascading clinical practice throughout the NHS. The
RNOH will also provide a vision and network of support for trauma services.”
The Royal National Orthopaedic Hospital’s academic vision is:
“To be recognised as a world leading clinical centre of excellence for complex neuro-musculoskeletal disease through
translational research and multidisciplinary education.”
Quality Account 2009/10
The overall aim of the Royal National Orthopaedic Hospital is:
02/03
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Ro ua
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O al ity
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H pae ona e
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The Royal National Orthopaedic Hospital NHS Trust (RNOH) is the largest orthopaedic hospital in the UK and regarded
as a leader in the field of orthopaedics both in the UK and world-wide. We provide a comprehensive range of neuromusculoskeletal healthcare, ranging from acute spinal injuries to orthopaedic medicine and specialist rehabilitation
for chronic back sufferers. This broad range of neuromusculoskeletal services is unique within the NHS.
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We remain committed to our values
Our values
We show this through...
Patients
first
◆
◆
◆
◆
◆
◆
◆
Honesty
◆ Explaining decisions that have been made
◆ Sharing key messages, whether good or bad
◆ Admitting when we don’t know and asking for help
Respect
◆
◆
◆
◆
Excellence
◆ Learning from experience, evidence, education and research
◆ Working across departments and professional boundaries to achieve Trust-wide
goals and targets
◆ Rewarding and celebrating good performance
◆ Maximising the benefit of partnerships
◆ Paying attention to detail
Trust
◆ Speaking well of each other
◆ Maintaining confidentiality for patients and colleagues
◆ Empowering staff to achieve their potential
Equality
◆
◆
◆
◆
◆
Achieving positive outcomes for our patients
Providing a clinically safe environment
Rigorous monitoring of standards
Treating all our patients with honesty, openness and respect
Protecting patients’ rights to courtesy and dignity
Treating patients as individuals
Responding to patients’ needs and expectations
Challenging inappropriate behaviour from patients or colleagues
Being constructive rather than blaming
Listening more than telling
Understanding difference
Celebrating the diversity of our staff
Valuing the diversity of ideas, roles and backgrounds
Ensuring fair and consistent employment practice
Recognising achievement at all levels of the Trust
Challenging prejudice and discrimination
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In 2009/10 we reported:
◆ Zero serious medication errors
◆ A reduction in clostridium difficile infections (from
five cases in 2008/9 to two cases in 2009/10)
◆ Continued low incidence of MRSA Bacteraemia
(one case in 2009/10)
◆ A reduction in pressure sores
◆ Continued low rates of wound infection following
hip replacement, knee replacement and spinal
surgery
In 2009/10 we implemented:
◆ Patient safety walk rounds
◆ A patient experience improvement committee
In December 2009 our brand new central London
Outpatient Assessment Centre opened in Bolsover Street
and on 31 March 2010 the Secretary of State for Health,
gave the go ahead for an £81 million redevelopment of
the RNOH’s Stanmore site.
A rebuild of the Stanmore site will provide a new
inpatient ward block comprising space for approximately
159 beds and a new imaging department. The project
is the first stage of a proposed two-phase
redevelopment of the site designed to function as a
stand-alone development or as an integrated unit
alongside proposed future developments. It will provide
the Trust with over 60% single rooms, compared to
20% currently.
The scheme will also replace a substantial proportion of
the hospital's existing estate - much of which dates back
to the 1940s and is no longer appropriate for the
delivery of a modern healthcare environment -with
modern healthcare premises that will enhance and
support the delivery of treatment and care.
We confirm that to the best of our knowledge the
information contained in this document is accurate.
◆ Matrons’ inspections
◆ Patient experience reports to the Trust Board and
clinical directorates
◆ Real-time patient feedback
Signed.....................................
Rob Hurd Chief Executive
◆ The productive ward initiative was introduced
in six wards
◆ A Trust nutrition group
Signed..................................... Donald
Hoodless Chairman
Quality Account 2009/10
04/05
D
Keeping patients safe and providing exemplar care
remains at the heart of our organisation. Minimising
hospital acquired infections and pressure sores remains
a top priority at the RNOH and following a Care Quality
Commission Hygiene Code inspection in 2009, we
received a positive report into the cleanliness of the
hospital.
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Pr pr me ce
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Priorities and improvement
Throughout 2009/10 we identified and developed programmes for a number of quality and safety initiatives and
we have again assessed what our priorities should be in 2010/11 against the three domains of quality outlined in
“High Quality Care for All.”
In setting out objectives we have considered patient need, clinical views and our service developments.
Patient safety
Clinical effectiveness
Patient experience
pr Pr
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Bo o m f
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06/07
im
Our five key priorities for 2010/11 will be
Implement the national VTE assessment tool
Roll out real time patient feedback to outpatients
Improve service to children
Better complaints management
Quality Account 2009/10
Reduce pressure sore incidence
nd
r
fo t a
s en
tie m f
r i e t o om
io ov n fr
Pr pr me ce
im ate ran rd
st su o a
as e B
th
Priority
Outcome
How we will measure this
Overseeing
committee
Reduce pressure
sore incidence.
No patient will acquire a
pressure sore at the RNOH.
Monthly reporting of pressure sore
incidence to wards, directorates and
the Trust Board.
Clinical
governance.
Implement the
national VTE
assessment tool.
All patients admitted to the
RNOH will have appropriate
assessment of risk of venous
thromboembolism.
Monthly auditing of patient
assessments and reporting to wards,
directorates, Trust Board and
commissioners via CQUINs.
Clinical
governance.
Roll out of realtime patient
feedback to
outpatient areas.
We will receive feedback from
patients in our Outpatients
Department, which informs
service development.
Monthly summary of the amount of
patients surveyed will be produced
and monitored by the patient
experience improvement committee.
Patient
experience.
Improve services
and environment
for children
receiving care at
the RNOH.
Children will be cared for in a
dedicated post-operative care
unit during the acutest stage
of their patient journey.
Ensure we provide
appropriate outpatient
facilities for children.
The action plan will be monitored by
the Children’s Services Committee.
Children’s
services.
Better complaints
management.
Ensure that all complaints are
answered within 25 days.
Learning from complaints and
using them to change and
improve service delivery.
Monthly reporting of response times to
wards, directorates and the Trust Board.
Action plans related to complaints will
be monitored by the patient experience
improvement commitee.
Patient
experience.
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08/09
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During 2009/2010 the RNOH provided and subcontracted eleven services.
The RNOH has reviewed all the data available to them on the quality of care of all of these NHS services.
The eleven clinical services provided by the RNOH are:
◆ London Spinal Cord Injury Centre
◆ Rehabilitation and therapy
◆ Joint reconstruction
◆ Paediatric and adolescents
◆ Peripheral nerve injury unit
◆ Anaesthesia
◆ The Sarcoma Unit
◆ Radiology
◆ Spinal surgical unit
◆ Integrated back unit
◆ Clinical neurophysiology
Quality Account 2009/10
The income generated by the NHS services reviewed in 2009/2010 represents 100% of the total income generated
from the provision of NHS services by the RNOH for 2009/2010.
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During 2009/10, eight national clinical audits and three national confidential enquiries
covered NHS services that the RNOH provides.
During this period the RNOH participated in 86% (7/8)
national clinical audits and 100% (3/3) national
confidential enquiries of the national clinical audits and
confidential enquiries which, it was eligible to participate
in.
The national clinical audits and national confidential
enquiries that the RNOH was eligible to participate in
during 2009/10 are as follows:
The national clinical audits and national confidential
enquiries that the RNOH participated in during
2009/2010 are as follows:
◆ National elective surgery patient reported outcome
measures: hip and knee replacements
◆ National joint registry: hip and knee replacements
◆ National re-audit of bedside transfusion
◆ National elective surgery patient reported outcome
measures: hip and knee replacements
◆ National comparative audit of the use of fresh frozen
plasma
◆ National joint registry: hip and knee replacements
◆ National comparative
collection process
◆ Intensive Care National Audit and Research Centre
Case Mix Programme: Adult Critical Care Units
◆ National re-audit of bedside transfusion
◆ National comparative audit of the use of fresh frozen
plasma
◆ National comparative audit on the blood collection
process
◆ National comparative audit of the use of red cells
in neonates and children
◆ Royal College of Physicians continence audit
◆ NCEPOD: elective and emergency surgery in the
elderly
◆ NCEPOD: surgery in children
◆ NCEPOD: peri-operative care
audit
on
the
blood
◆ National comparative audit of the use of red cells
in neonates and children
◆ Royal College of Physicians continence audit
◆ NCEPOD: elective and emergency surgery in the
elderly
◆ NCEPOD: surgery in children
◆ NCEPOD: peri-operative care
Number
of cases
required
by the audit
Number
Percentage
National elective surgery patient reported outcome
measures: hip and knee replacements
734
596
82%
National joint registry: hip and knee replacements
686*
670
98%
National re-audit of bedside transfusion
40
20
50%
National comparative audit of the use of fresh frozen
plasma
40
29
73%
National comparative audit on the blood collection
process
40
34
85%
National comparative audit of the use of red cells in
neonates and children
40
12
30%
Royal College of Physicians continence audit
40
12
30%
Peri-operative care
98
90
92%
Cases submitted
Table 1: cases submitted to national audits 2009/10
*920 hip and knee replacements were undertaken by RNOH consultants in 2009/10.
234 using additional capacity at SPIRE.
Quality Account 2009/10
The national clinical audits and national confidential
enquiries that the RNOH participated in, and for which
data collection was completed during 2009/10, are listed
below alongside the number of cases submitted to each
audit or enquiry as a percentage of the number of
registered cases required by the terms of the audit or
enquiry.
10/11
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Because of the specialist nature of the services that the
RNOH provides, the Trust was not eligible to participate
in many of the national audits and national confidential
enquiries, including studies from the Centre for Maternal
and Child Enquiries (CMACE) or the National
Confidential Inquiry (NCI) into suicide and homicide by
people with mental illness (NCI/NCISH).
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The report of one national clinical audit was reviewed by the provider in 2009/10 and
the RNOH intends to take the following action to improve the quality of healthcare
provided:
◆ Increase public and patient engagement in clinical audit, and raise awareness of
specific clinical audits that are taking place within the Trust
The reports of 28 local clinical audits were reviewed by the provider in 2009/10 and the
RNOH intends to take the following actions to improve the quality of healthcare
provided:
◆ Improved patient information. This is to include increased web resources for adults
and children, information about the wards and information to support choice of
treatment options
◆ World Health Organisation safer surgery checklist is to be fully implemented
throughout the Trust and this is to be monitored
◆ All clinic letters to be copied to patients to ensure that they are actively involved in
their care
◆ Improved process for the risk assessments of venous thromboembolism, and
improved education around the issue
◆ Raised awareness of the importance of taking appropriate, high quality consent.
◆ Increased training around the taking of consent
◆ All inpatients to have a nutritional assessment completed when they are admitted
to the hospital
◆ A full review of patient documentation is to be carried out, along with increased
education and awareness regarding the importance of good note taking
◆ Waiting times for imaging to be monitored
◆ Ongoing awareness and monitoring of pressure sores to maintain the huge
Improvements in practice
◆ Improved procedures relating to the review of urgent radiological investigations
◆ Changes to theatre lists to ensure that children are given an appropriate time for
their operation
ar
ch
se
This increasing level of participation in clinical research
demonstrates the RNOH’s commitment to improving the
quality of care we offer and to making our contribution
to wider health improvement.
The RNOH was involved in conducting five CLRN
supported clinical research studies and additional 40
studies not supported by the CLRN. The RNOH
completed 75% of these studies as designed within the
agreed time and to the agreed recruitment target.
The RNOH used national systems to manage the studies
in proportion to risk. Of the 25 studies given permission
to start, 99% were given permission by an authorised
person less than 30 days from receipt of a valid complete
application. 80% of the studies were established and
managed under national model agreements and 5% of
the 25 eligible research involved used a research
passport. In 2009/10 the NIHR supported five of these
studies through its research networks.
In the last three years, six publications have resulted from
our involvement in NIHR research, helping to improve
patient outcomes and experience across the NHS.
A proportion of the RNOH’s income in 2009/10 was
conditional on achieving quality improvement and
innovation goals agreed between the RNOH and any
person or body they entered into a contract, agreement
or arrangement with for the provision of NHS services,
through the commissioning for quality and innovation
payment framework.
Further details of the agreed goals for 2009/10 and for
the following 12 month period are available on request
from the Trust by emailing enquiries@rnoh.nhs.uk
What others say about the RNOH
The RNOH is required to register with the Care Quality
Commission (CQC) and its current registration status is
registered without any conditions.
Quality Account 2009/10
The number of patients receiving NHS services provided
or sub-contracted by the RNOH in 2009/10 that were
recruited during that period to participate in research
approved by a research ethics committee was 85 for
Comprehensive Local Research Network (CLRN) studies
and 120 for all other studies. This is an increase on the
previous year during which only 52 patients were
recruited into CLRN supported studies. This is in line with
the national target of doubling the number of patients
recruited into National Institute of Health Research
(NIHR) portfolio studies.
Goals agreed with commissioners
12/13
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The number of patients receiving NHS services provided
or sub-contracted by the RNOH in 2009/10 and were
recruited during this period to participate in research
approved by a research ethics committee was 205.
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Statement from the CQC
Data quality
The RNOH is required to register with the CQC. The
RNOH has the following conditions on registration:
none.
The RNOH submitted records during 2009/10 to the
secondary uses service for inclusion in the hospital
episode statistics, which are included in the latest
published data.
The CQC has not taken enforcement action against the
RNOH during 2009/10.
The Trust assessment against national standards for the
period 1 April 2008 to 31 March 2009 was as follows:
The percentage of records in the published data which
included the patient’s valid NHS number was:
93.9% for admitted care
97.0% for outpatient care
Assessment
Quality of services
Meeting core standards
Existing commitment
National priorities
Fair
Partly met
Almost met
Good
The RNOH performed adequately for its assessments;
however it did not perform well enough to receive a
higher overall score.
The Trust underwent a hygiene code inspection by the
CQC in December 2009. No evidence was found on
inspection that the Trust has breached the regulation to
protect patients, workers and others from the risks of
acquiring a healthcare associated infection. One area of
recommendation was made in relation to the process for
cleaning toilet seat raises and the Trust has implemented
a robust plan to address this issue.
The percentage of records in the published data which
included the patient’s valid General Medical Practice
Code was:
99.9% for admitted care
100% for outpatient care
The RNOH’s score for information quality and records
management was assessed using the information
governance toolkit was 77.7%.
The RNOH was subject to the payment by results clinical
coding audit during the reporting period by the Audit
Commission and the error rates reported in the latest
published audit for that period for diagnosis and
treatments coding (clinical coding) were:
Primary diagnosis incorrect 8%
Secondary diagnosis incorrect 4%
Primary procedures incorrect 5%
Secondary procedures incorrect 4%
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Appointment wait times have improved as the Trust has
worked towards the 18 week referral to treatment
pathway and the installation of a digital resonance
machine has improved the flow of patients through
outpatients through timelier imaging.
The complaints related to communication have shown
no pattern however the Trust has ensured that issues
related to communication are discussed with patients as
part of the real time patient feedback initiative to further
understand areas where we can improve.
Issues discussed with our patient advocacy and liaison
service have shown a similar theme with our written
complaints.
In 2009 the RNOH changed the criteria for transport to
and from the hospital, and as a result saw an increase in
complaints related to transport during the change. As
patients have become more familiar with the new
booking system, these complaints have started to
reduce.
200
180
160
Cumulative frequency
140
120
100
80
60
40
20
0
Apr
May
Jun
2009/10
Figure 1: cumulative complaints
Jul
2008/09
Aug
Sep
Oct
2007/08
Nov
Dec
Jan
Feb
Mar
Quality Account 2009/10
The RNOH continues to have a low rate of formal
complaints from patients. Key issues in 2009/10 have
been around appointment delays, patient transport and
communication.
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Review of Quality Performance
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Figure 2 shows the rate of complaints during 2009/10:
5
No. of complaints per 1000 patient contacts
4.5
4
3.5
3
2.5
2
1.5
1
0.5
0
Apr 09 May 09 Jun 09
Jul 09 Aug 09 Sep 09 Oct 09 Nov 09 Dec 09 Jan 10 Feb 10 Mar 10
Number of complaints per 1000 patient contacts
Mean
Figure 2: complaints rate 2009/10
Lower expected limit
Upper expected limit
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Figure 3 shows the categories of complaints we received during 2009/10:
Frequency
0
10
20
30
40
Communication/info to patients
Diagnosis problems
Nursing care
Operation - adverse outcome
Appointment cancellation (inpatient)
Attitude of staff - medical
Hospital transport
Admission arrangements
Appointment cancellation (outpatient)
Attitude of staff - nursing
Failure to follow procedures
Attitude of staff - admin
Discharge arrangements
Appointment delay (inpatient)
Condition building
Personal records
Patient’s privacy and dignity
Aids and appliances
Appointment time
Hotel services - food choice
Loss of personal property
Operation cancellation
Transfer arranegements
Patient’s privacy and dignity
Allied professionals
Figure 3: complaints categories 2009/10
Quality Account 2009/10
Appointment delay (outpatient)
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PALS enquiries
In 2009/10, the Trust received 1082 enquiries to the Patient Advice and Liaison Service (PALS). Figure 4 compares
the cumulative PALS enquiries against 2007/08 and 2008/09:
1200
Cumulative frequency
1000
800
600
400
200
0
Apr
May
Jul
Jun
2009/10
Aug
Sep
2008/09
Oct
Nov
Dec
Jan
Feb
Mar
2007/08
Figure 4: cumulative PALS enquiries
Figure 5 shows the rate of PALS enquires during 2009/10:
% of patient contacts
2.50%
2.00%
1.50%
1.00%
0.50%
0.00%
Apr 09 May 09 Jun 09
PALS rate
Mean
Figure 5: PALS rate 2009/10
Jul 09 Aug 09 Sep 09 Oct 09 Nov 09 Dec 09 Jan 09 Feb 09 Mar 09
Lower expected limit
Upper expected limit
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PALS enquiries
Figure 6 shows the categories of PALS enquiries we received during 2009/10:
Frequency
Appointments
General concern
Ambulance
Clinical
Admissions
Customer care
Caller information
Staffing issues
Documentation
Cancellations
Patient information
Attitude of staff
Other
Building conditions
Car parking
Figure 6: PALS categories 2009/10
50
100
150
200
250
300
350
Quality Account 2009/10
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Real time patient feedback
The Trust commenced real time patient feedback for inpatients in December 2009 using hand held devices allowing
patients to comment on a number of questions. Increased patient contacts from our surveyors and surveys in
outpatients will be a high priority in 2010/11.
Have you been given any information
on new medications which have been
prescribed?
Was the hospital ward or room you
were in clean?
Did you get enough help from the
staff to eat your meals?
Did a member of staff explain the
risks and benefits of your operation
or procedure?
Did you have confidence and trust
in the therapists treating you?
Did you have confidence and trust
in the doctors treating you?
Did you have confidence and trust
in the nurses treating you?
0%
20%
40%
60%
80%
% of patients who responded ‘yes’
Figure 7: real time patient feedback
March 2010
February 2010
January 2010
December 2009
100%
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1130 clinical incidents were reported between April
2009 and March 2010. High incidents made up 1.15%,
medium 30.97%, low 45.75% and very low 22.12% of
the total. The number of incidents reported remains
stable and the highest reported type of incident is
overbooked clinics within the clinical assessment
category.
The serious incidents are investigated by a nominated
multidisciplinary team using the root cause analysis
process.
In 2009/10, the 1519 incidents were reported within the
Trust. Figure 8 compares the cumulative number of
reported incidents against those reported in 2007/08
and 2008/09:
2000
1800
1600
Cumulative frequency
1400
1200
1000
800
600
400
200
0
Apr
2009/10
May
Jun
Jul
2008/09
Figure 8: cumulative clinical incidents
Aug
Sep
Oct
2007/08
Nov
Dec
Jan
Feb
Mar
Quality Account 2009/10
Each incident is classified by risk from low to high and
indicates the categories in which they are reported.
Trends are then identified within each category. The
majority of incidents are graded as acceptable risks,
either due to the rarity of their occurrence, the minimal
harm experienced or the control measures already in
place.
Analysis also shows that slips, trips and falls were the
second highest trend with the majority reported as
patients attempting to mobilise without nursing
assistance. Communication issues are frequently
reported, incidents with doctors not communicating
information to other staff, patients incorrectly
interpreting the information they have been given and
a lack of patient information from other hospitals
regarding patient transfers.
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Incidents
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Figure 9 shows the rate of incidents during 2009/10:
3.00%
% of patient contacts
2.50%
2.00%
1.50%
1.00%
0.50%
0.00%
Apr 09 May 09 Jun 09
PALS rate
Mean
Figure 9: incident rate 2009/10
Jul 09 Aug 09 Sep 09 Oct 09 Nov 09 Dec 09 Jan 09 Feb 09 Mar 09
Lower expected limit
Upper expected limit
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In 2009/10, 49 pressure sores were acquired by patients of the Trust whilst under our care. Figure 10 compares this
figure against 2007/08 and 2008/09.
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Pressure sores
Our matrons continue to work closely with the tissue viability service to reduce the incidence and the Trust has
invested in equipment to protect our patients during long and complex surgery where we are unable to change
patient position.
70
60
50
40
30
20
10
0
Apr
2009/10
May
Jul
Jun
2008/09
Figure 10: cumulative pressure sores
Aug
Sep
Oct
2007/08
Nov
Dec
Jan
Feb
Mar
Quality Account 2009/10
We are pleased that the severity and incidence of sores has decreased from previous years however the Trust
recognises that we have further work to do to reach our target of zero sores.
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Figure 11 shows the rate of pressure sores during 2009/10:
2.00%
1.80%
1.60%
1.40%
1.20%
1.00%
0.80%
0.60%
0.40%
0.20%
0.00%
Apr
May
Jun
Jul
PALS rate
Mean
Figure 11: pressure sore rate 2009/10
Aug
Sep
Lower expected limit
Upper expected limit
Oct
Nov
Dec
Jan
Feb
Mar
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Pressure sores
Figure 12 shows the grades of the pressure sores acquired within the Trust during 2009/10:
Quality Account 2009/10
35
29
30
25
20
18
15
10
5
2
0
Grade 1
Figure 12: pressure sore grade 2009/10
Grade 2
Grade 3
0
Grade 4
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Drug errors
In 2009/10, 30 errors relating to the administration of drugs were reported within the Trust. Figure 13 compares
this figure against 2007/08 and 2008/09:
80
70
Cumulative frequency
60
50
40
30
20
10
0
Apr
May
Jun
2009/10
Figure 13: cumulative drug errors
Jul
2008/09
Aug
Sep
Oct
2007/08
Nov
Dec
Jan
Feb
Mar
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There is a comprehensive infection control teaching programme for induction and annual updates which are held
monthly, with a tailored package for non clinical staff. There is a robust system in place for carrying out surgical
site surveillance. It is envisaged that this surveillance will be extended later in 2010 with the proposed appointment
of an additional infection control nurse.
The Trust is retendering its domestic services contract and the steering group have almost completed a specification
which will go to OJEC in April 2010.
Although the Trust experienced low rates of MRSA and Clostridium difficile for 2009/10, there is no room for
complacency and the Trust will be aiming to reduce these rates further.
Surgical site infections
Table 1 details the surgical site infections reported by the Trust in 2009/10:
Site
Number of infections
Number of operations
%
Hip
1
371
0.3%
Knee
1
363
0.3%
Spine
3
1508
0.2%
Table 1: surgical site infections 2009/10
Quality Account 2009/10
The Trust continues to work to a zero tolerance approach to avoidable infections. The wards carry out monthly
hand hygiene audits and participate in monthly high impact intervention audits relevant to their areas. The senior
nurse for infection control works closely with the facilities department in reviewing and auditing environmental
cleanliness across the Trust.
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Infection control
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MRSA bacteraemia
In 2009/10 there was one case of MRSA bacteraemia contracted by a patient of the Trust. Figure 14 shows this
figure against our target:
Number of infections
2
1
0
Apr 09 May 09 Jun 09
Jul 09 Aug 09 Sep 09 Oct 09 Nov 09 Dec 09 Jan 10 Feb 10 Mar 10
Target
Actual
Figure 14: MRSA bacteraemia
Clostridium difficile
In 2009/10 there were two cases of Clostridium difficile contracted by patients of the Trust. Figure 15 shows this
figure against our target:
Number of infections
2
1
0
Apr 09 May 09 Jun 09
Target
Actual
Figure 15: Clostridium difficile
Jul 09 Aug 09 Sep 09 Oct 09 Nov 09 Dec 09 Jan 10 Feb 10 Mar 10
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Quality Account 2009/10
A monthly cleaning standards audit is carried out to ensure that high standards of cleanliness are maintained
throughout the Trust. Within clinical areas deemed to have a very high infection risk, such as Theatres and ITU,
the Trust aims to achieve a 95% score each month. Figure 16 details our results during 2009/10 against this
target:
100%
90%
80%
70%
Cleaning audit score
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Cleaning standards audit
60%
50%
40%
30%
20%
10%
0%
Apr 09 May 09 Jun 09
Jul 09 Aug 09 Sep 09 Oct 09 Nov 09 Dec 09 Jan 10 Feb 10 Mar 10
Target %
Actual %
Figure 16: cleaning audit scores for very high risk areas
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Cleaning standards audit
Within all other clinical areas, the Trust aims to achieve a 90% score each month. Figure 17 details our results
during 2009/10 against this target:
100%
90%
80%
Cleaning audit score
70%
60%
50%
40%
30%
20%
10%
0
Apr 09 May 09 Jun 09
Jul 09 Aug 09 Sep 09 Oct 09 Nov 09 Dec 09 Jan 10 Feb 10 Mar 10
Target %
Actual %
Figure 17: cleaning audit scores for high risk areas
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The RNOH involved the following stakeholders to influence the content of our quality account for 2009/10:
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Involving stakeholders in quality accounts
◆ Patients (50 respondents)
◆ The RNOH patient group
◆ Our host PCT
◆ Statements from local involvement networks, overview and scrutiny committees and Primary Care Trusts
The North Central London Commissioning Agency has
reviewed this document and is pleased to assure this
Quality Account for the RNOH. We are responsible for
the commissioning of services from all eight acute
hospital Trusts that are located in North Central London.
In this review, we have taken particular account of the
identified priorities for improvement for the Trust during
2010/11 and how this work plan will enable real
improvements for patients and their relatives for their
care. We have also taken account of the views of the
main Primary Care Trust where their local residents
access services from the Trust although we recognise
that the Trust serves a wide number of patients across
England and Wales.
We have made the following specific comments about
the Trust’s plan and have discussed this directly with the
Trust:
◆ Ensuring that detailed comments from NHS London
have been incorporated and reflected as appropriate
The Harrow LINk works closely with the Trust and the
patient group and has reviewed the Quality Account
document. The LINk does not give assurance on any
clinical matters but confirms that the statements made
regarding public and patient involvement is
substantiated by the experience of the LINk in both the
cooperation given by the Trust and the ward inspections
carried out during the year.
The LINk appreciates the difficulties caused by the age
and condition of the estate but was satisfied with the
efforts made by the Trust in rectifying the conditions
report on inspection visits. The LINk notes with pleasure
that financing is approved to construct new wards.
The LINk would like to state its appreciation of cooperation afforded to the LINk at all levels of the Trust
and looks forward to this continuing in the coming year.
Julian Maw
Chair, Harrow LINk
◆ Reflecting how the plans relating to quality of
services shows a real commitment to improvement
◆ Minor textual changes to make it easier to read
and understand
◆ Consideration of how the Trust’s plans will be
monitored and taken forward
We look forward to continuing our partnership with the
Trust in the agreement of how services are provided for
their patients.
Caroline Clarke
Managing Director
North Central London Commissioning Agency
For further copies of this Quality Account visit our website at www.rnoh.nhs.uk or email enquiries@rnoh.nhs.uk
Quality Account 2009/10
◆ Staff (50 respondents)
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For further copies of this report or to request this report in another format (e.g. different language, large print etc.),
please contact the Communications Department on 020 8909 5349 or visit our website www.rnoh.nhs.uk