Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
Quality Account 2012/13
Improving the quality of care for our patients
Contents
Introduction
4
Statement on Quality from the Chief Executive
5
Statement of directors‟ responsibilities in respect of the Quality Account
7
Grant Thornton Audit Assurance Statement
8
Priorities for improvement in 2013/14
13
Review of Services
21
Participation in clinical audit
22
Participation in clinical research
31
Goals agreed with Commissioners
33
Statement from the Care Quality Commission and Inspections
38
Data Quality Statements
40
2012/13 Quality Performance
43
Who has been involved in the development of this Quality Account?
111
Statements from Partner Organisations
112
Please give us your feedback
117
Glossary of Abbreviations
118
Introduction
Ealing Hospital NHS Trust became an Integrated Care Organisation from 1st April
2011, with the Trust now incorporating:


Ealing Hospital – district general hospital; and
Community Services for the boroughs of Brent, Ealing & Harrow
The Ealing Hospital acute site has over 350 beds, with a further 160 beds in the
community service sites. These include Willesden hospital in Brent, Clayponds
hospital and Meadow House hospice in Ealing, and Denham intermediate care unit
in Harrow.
This Quality Account is split into three main sections:
1. Part One introduces the Trust and highlights our planned local quality
priorities for 2013/14;
2. Part Two reviews clinical governance activities in 2012/13, including delivery
against initiatives agreed under the Commissioning for Quality and Innovation
scheme;
3. Part Three reviews 2012/13 progress on priorities that we had set out within
last year‟s Quality Account, along with achievement against a range of key
performance indicators.
Whilst we have sought to avoid the use of abbreviations as far as possible, a
Glossary of Terms is included at the final page of this Quality Account, for ease of
reference.
For more information about the Trust, please visit our website:
www.ealinghospital.nhs.uk
Ealing Hospital NHS Trust is planning for a proposed organisational merger with
North West London Hospitals NHS Trust. Further information is available via our
website, as above.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
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Statement on Quality from the Chief Executive
We welcome this opportunity to reflect on the quality of care that
we have provided for our patients over the past year. The Trust
is committed to maintaining and improving the quality of care
and the experience for all of our patients. Quality, patient
experience and clinical outcomes are reviewed at every Board
meeting and our Board reports containing more detail are
available through the trust website.
The report gives an overview of our performance in 2012/13 and how we fared
against the priorities for improvement outlined in last year‟s report. It also sets out
our Quality Priorities for 2013/14. You will see from reading the report that we have
met the majority of local and National standards. Where we have not met standards
or we feel that we can do better we have explained the actions that we are taking to
put things right.
We were particularly pleased in 2012/13 to see a significant improvement in patient
experience measured both through the National Patient survey and the newer
Friends and Family test. Staff across the ICO have worked hard over the past year
to improve the care that we deliver and we are gratified to see this reflected in
these results. This does not mean that we are complacent and we recognise that
we need to build on this work to further improve patient experience in the coming
year which is why we have retained improving patient experience as one of our top
priorities for 2013/14. Our key priorities developed by our staff relate have been
chosen to have the greatest impact on quality for our patient population and these
are:
•
•
•
•
•
Improving patient satisfaction and engagement
Continued development of the urgent care pathway
Promoting harm free care
Safeguarding of vulnerable adults and children
„Out of Hospital‟ strategy for patients with long term conditions
The actions we intend to take to improve quality in these areas are described in
detail within the Quality Account.
This Quality Account has been developed by our staff working with local partners
including our commissioners and Healthwatch who have now replaced LiNK.
Changes were made after initial feedback from these partners to reflect their
concerns and to cover any areas not included within the document. Their own
commentary on our Quality Account is also included at the end of the report.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
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We look forward to strengthening our relationship with partners in the coming year.
2013/14 will pose a number of challenges for us as a Trust and we are determined
that during this time we will keep patient safety and the quality of patient care as
our main focus. We are developing plans to merge with the North West London
Hospitals Trust (NWLH) as we believe that by merging we will be „Stronger
Together‟ and in a much better position to meet the needs of our patients and staff
– more detail on the merger process can be accessed through the trust website
www.ealinghospital.nhs.uk.
There is also a plan to reconfigure services across North West London known as
Shaping a Healthier Future which if approved by the Secretary of State in 2013/14
would see a substantial change in the services provided through Ealing Hospital in
the much longer term. The Trust will therefore be working closely with Ealing
Clinical Commissioning Group (CCG) and other local partners to make sure that
any change is planned and managed carefully to preserve safety and improve the
quality of the health care that is provided to local residents. Specifically in 2013/14
we will be working with the CCG on a joint vision for Ealing Hospital and the
services that will be delivered from this site long into the future.
Signed
David McVittie, Chief Executive Officer
June 2013
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
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Statement of directors’ responsibilities in respect of the
Quality Account
The directors are required under the Health Act 2009 to prepare a Quality
Account for each financial year. The Department of Health has issued guidance
on the form and content of annual Quality Accounts (which incorporates the legal
requirements in the Health Act 2009 and the National Health Service (Quality
Accounts) Regulations 2010 (as amended by the National Health Service
(Quality Accounts) Amendment Regulations 2011).
In preparing the Quality Account, directors are required to take steps to satisfy
themselves that:

the Quality Accounts presents a balanced picture of the trust‟s
performance over the period covered;

the performance information reported in the Quality Account is reliable
and accurate;

there are proper internal controls over the collection and reporting of the
measures of performance included in the Quality Account, and these
controls are subject to review to confirm that they are working effectively
in practice;

the data underpinning the measures of performance reported in the
Quality Account is robust and reliable, conforms to specified data quality
standards and prescribed definitions, and is subject to appropriate
scrutiny and review; and

the Quality Account has been prepared in accordance with Department
of Health guidance.
The directors confirm to the best of their knowledge and belief they have
complied with the above requirements in preparing the Quality Account.
By order of the Board
Patricia Williamson, Chair
27th June 2013
David McVittie, Chief Executive
27th June 2013
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
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Grant Thornton Audit Assurance Statement
INDEPENDENT AUDITORS’ LIMITED ASSURANCE REPORT TO THE
DIRECTORS OF EALING HOSPITAL NHS TRUST ON THE ANNUAL
QUALITY ACCOUNT
We are required by the Audit Commission to perform an independent limited
assurance engagement in respect of Ealing Hospital NHS Trust's Quality
Account for the year ended 31 March 2013 (“the Quality Account”) and certain
performance indicators contained therein as part of our work under section
5(1)(e) of the Audit Commission Act 1998 (the Act). NHS trusts are required by
section 8 of the Health Act 2009 to publish a Quality Account which must include
prescribed information set out in The National Health Service (Quality Account)
Regulations 2010, the National Health Service (Quality Account) Amendment
Regulations 2011 and the National Health Service (Quality Account) Amendment
Regulations 2012 (“the Regulations”).
Scope and subject matter
The indicators for the year ended 31 March 2013 subject to limited assurance
consist of the following indicators:

Percentage of patient safety incidents that resulted in severe harm or death;
and

Percentage of patients who were admitted to hospital and who were risk
assessed for venous thromboembolism during the reporting period.
We refer to these two indicators collectively as “the indicators”.
Respective responsibilities of Directors and auditors
The Directors are required under the Health Act 2009 to prepare a Quality
Account for each financial year. The Department of Health has issued guidance
on the form and content of annual Quality Accounts (which incorporates the legal
requirements in the Health Act 2009 and the Regulations).
In preparing the Quality Account, the Directors are required to take steps to
satisfy themselves that:
• the Quality Account presents a balanced picture of the trust‟s performance
over the period covered;
• the performance information reported in the Quality Account is reliable and
accurate;
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
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•
•
•
2012/13 Quality Account
there are proper internal controls over the collection and reporting of the
measures of performance included in the Quality Account, and these controls
are subject to review to confirm that they are working effectively in practice;
the data underpinning the measures of performance reported in the Quality
Account is robust and reliable, conforms to specified data quality standards
and prescribed definitions, and is subject to appropriate scrutiny and review;
and
the Quality Account has been prepared in accordance with Department of
Health guidance.
The Directors are required to confirm compliance with these requirements in a
statement of directors‟ responsibilities within the Quality Account.
Our responsibility is to form a conclusion, based on limited assurance
procedures, on whether anything has come to our attention that causes us to
believe that:

the Quality Account is not prepared in all material respects in line with the
criteria set out in the Regulations;

the Quality Account is not consistent in all material respects with the sources
specified in the NHS Quality Accounts Auditor Guidance 2012/13 issued by
the Audit Commission on 25 March 2013 (“the Guidance”); and

the indicators in the Quality Account identified as having been the subject of
limited assurance in the Quality Account are not reasonably stated in all
material respects in accordance with the Regulations and the six dimensions
of data quality set out in the Guidance.
We read the Quality Account and conclude whether it is consistent with the
requirements of the Regulations and to consider the implications for our report if
we become aware of any material omissions.
We read the other information contained in the Quality Account and consider
whether it is materially inconsistent with:

Board minutes for the period April 2012 to June 2013;

papers relating to the Quality Account reported to the Board over the period
April 2012 to June 2013;

feedback from the Commissioners dated 10/06/2013;

feedback from Local Healthwatch dated 21/06/2013;

the Trust‟s 2012/13 complaints report published under regulation 18 of the
Local Authority, Social Services and NHS Complaints (England) Regulations
2009;
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
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
feedback from other named stakeholders involved in the sign off of the
Quality Account;

the 2012 national patient survey;

the 2012 national staff survey;

the Head of Internal Audit‟s annual opinion over the trust‟s control
environment dated May 2103;

the annual governance statement dated 04/06/2013;

Care Quality Commission quality and risk profiles dated 31/03/2013;

the results of the Payment by Results coding review dated May 2013.
We consider the implications for our report if we become aware of any apparent
misstatements or material inconsistencies with these documents (collectively “the
documents”). Our responsibilities do not extend to any other information.
This report, including the conclusion, is made solely to the Board of Directors of
Ealing Hospital NHS Trust in accordance with Part II of the Audit Commission Act
1998 and for no other purpose, as set out in paragraph 45 of the Statement of
Responsibilities of Auditors and Audited Bodies published by the Audit
Commission in March 2010. We permit the disclosure of this report to enable the
Board of Directors to demonstrate that they have discharged their governance
responsibilities by commissioning an independent assurance report in connection
with the indicators. To the fullest extent permissible by law, we do not accept or
assume responsibility to anyone other than the Board of Directors as a body and
Ealing Hospital NHS Trust for our work or this report save where terms are
expressly agreed and with our prior consent in writing.
Assurance work performed
We conducted this limited assurance engagement under the terms of the Audit
Commission Act 1998 and in accordance with the Guidance. Our limited
assurance procedures included:
 evaluating the design and implementation of the key processes and controls
for managing and reporting the indicators;

making enquiries of management;

testing key management controls;

analytical procedures;
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
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
limited testing, on a selective basis, of the data used to calculate the
indicators back to supporting documentation;

comparing the content of the Quality Account to the requirements of the
Regulations; and

reading the documents.
A limited assurance engagement is narrower in scope than a reasonable
assurance engagement. The nature, timing and extent of procedures for
gathering sufficient appropriate evidence are deliberately limited relative to a
reasonable assurance engagement.
Limitations
Non-financial performance information is subject to more inherent limitations than
financial information, given the characteristics of the subject matter and the
methods used for determining such information.
The absence of a significant body of established practice on which to draw allows
for the selection of different but acceptable measurement techniques which can
result in materially different measurements and can impact comparability. The
precision of different measurement techniques may also vary. Furthermore. The
nature and methods used to determine such information, as well as the
measurement criteria and the precision thereof, may change over time. It is
important to read the Quality Account in the context of the criteria set out in the
Regulations.
The nature, form and content required of Quality Accounts are determined by the
Department of Health. This may result in the omission of information relevant to
other users, for example for the purpose of comparing the results of different
NHS organisations.
In addition, the scope of our assurance work has not included governance over
quality or non-mandated indicators which have been determined locally by Ealing
Hospital NHS Trust.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
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Conclusion
Based on the results of our procedures, nothing has come to our attention that
causes us to believe that, for the year ended 31 March 2013:

the Quality Account is not prepared in all material respects in line with the
criteria set out in the Regulations;

the Quality Account is not consistent in all material respects with the sources
specified in the Guidance; and

the indicators in the Quality Account subject to limited assurance have not
been reasonably stated in all material respects in accordance with the
Regulations and the six dimensions of data quality set out in the Guidance.
Graham Nunns
Senior Statutory Auditor
for and on behalf of Grant Thornton UK LLP
Grant Thornton House
Melton Street
London
NW1 2EP
27 June 2013
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
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Priorities for improvement in 2013/14
The Trust is committed to continuous quality improvement across our Integrated
Care Organisation and a wide range of quality improvement initiatives are
contained within our departmental and organisational objectives.
As we reflected in 2011/12 Quality Account, this is a period of change for the
NHS as a whole as well as for us as an organisation and supporting staff in new
ways of working to improve quality and patient care remains central to success.
In addition to delivering against all national performance standards, the following
key local quality priorities for 2013/14 are highlighted within this year‟s Quality
Account:
Priority 1
Improving patient satisfaction and engagement
Priority 2
Continued development of the urgent care pathway
Priority 3
Promoting harm free care
Priority 4
Safeguarding of vulnerable adults and children
Priority 5
‘Out of Hospital’ strategy for patients with long term conditions.
The selection and development of these priorities has been undertaken via
consultation with a variety of internal and external stakeholders. This includes
meetings with the NHS Trust Development Authority (TDA) and regular
governance forums with Commissioners, such as our monthly Clinical Quality
Group meeting. The Trust has also reviewed available data during the year,
across our acute and community services.
Specifically, we have taken into account:

Areas where the users of the service have identified where improvements
could be made. This is often through feedback from comments, concerns
and complaints.

National priorities and quality improvements that all NHS organisations are
required to deliver.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
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
Issues that have been identified by staff through incident reporting.

Areas highlighted by external organisations, including Commissioners,
Local Authorities and LINKs/Healthwatch.

Areas of quality improvement agreed with Commissioners through
Commissioning for Quality and Innovation (CQUIN) schemes.

Performance benchmarking with similar organisations, i.e. identifying
where scope exists for improvement. Examples of this are through the use
of the national NHS Quality Dashboard and NHS Safety Thermometer.
Priority 1: Improving patient satisfaction and engagement
The Trust is committed to continuous improvement in the experience of patients
across the range of services provided by our Integrated Care Organisation. For
2013/14 we will focus on ensuring that we have an updated strategy focused on
delivering sustained improvement, with appropriate accountability, and to further
enhance our patient feedback systems.
Priority 2: Continued development of the urgent care pathway
The Trust is committed to working with local partners to improve the urgent care
pathway to achieve sustained performance against our targets, the best possible
patient outcomes and improved patient experience. Our commissioners have
developed detailed out of hospital strategies underpinned by local Quality,
Innovation, Productivity and Prevention (QIPP) schemes to reduce pressure on
acute providers. We will work with them to support the delivery of this strategy.
Specifically the Trust will continue to work with partner organisations to provide
suitable alternate pathways that avoid the need for patients to attend an acute
hospital for treatment.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
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Priority 3: Promoting harm free care
Over recent years the Trust has focused on a number of patient care initiatives to
improve patient experience and safety. In 2013/14 we will continue to promote
harm free care and monitor this through the national NHS Safety Thermometer
and the wider NHS Quality Dashboard, which includes a range of clinical and
operational indicators. Key priorities under this will be reducing pressure ulcers,
reducing avoidable falls and improving urinary catheter care.
Priority 4: Safeguarding of vulnerable adults and children
As part of the Trust‟s ongoing focus to ensure appropriate safeguards for
vulnerable adults and children across all our services, and in recognition of a
number of high-profile national incidents (e.g. Francis Report, Savile Inquiry), the
Trust will add further emphasis and monitoring to this key aspect of our service
provision. This will include staff training and ensuring that all vulnerable adults
and children have timely and appropriate access to services, working with
partner organisations as necessary.
Priority 5: Supporting ‘Out of Hospital’ strategy for patients with long term
conditions
In conjunction with priority 2 (as above), the Trust will continue to work with
Commissioners to redesign pathways to move care from hospital to primary
and/or community settings for patients with long term conditions such as heart
disease (cardiac) and diabetes (endocrinology).
Process for monitoring and reporting achievement against the priorities
The progress against the individual measures and milestones will be included,
where appropriate, within the monthly Trust performance reports and clinical
safety scorecards which are reviewed at Trust Board meetings.
In addition a Quality Account progress report will be presented to the Trust Board
in October 2013 and January 2014. This report will be available through the Trust
website and will be shared with commissioners through the joint clinical quality
group. Copies will also be shared with other stakeholders.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
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Priority 1
Improving patient satisfaction and engagement
Objectives:

Patient Experience Strategy updated with a view to implementing an
overarching framework that drives improvement and accountability

Strengthen mechanisms for real time patient information feedback,
including the Friends and Family test, to enable services to more rapidly
respond and drive improvements

Increase patient involvement particularly in co-design of services

Measure values and behaviours within the organisation with new initiatives
that support staff to translate values into behaviours and practice at the
front line

Improve experience of elderly and dementia patients
Measures of Success:

Improved national patient survey results

Friends and Family test and improvement in the net promoter score

Reduction in the number of complaints

Regular monitoring of the NHS Quality dashboard, embedded into the
Trust‟s performance framework

Regular review and feedback of patient comments via NHS Choices

Patients‟ inclusion in service transformation and change initiatives
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
Page 16 of 119
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2012/13 Quality Account
Priority 2
Continued development of the urgent care pathway
Objectives:

Agree improvement trajectory and actions arising from the outcome of the
joint audit (Trust and Commissioner) of short stay admissions /
readmissions carried out in Autumn 2012

Develop plans with Commissioners to redesign urgent care pathways to
reduce the number of A&E attendances and emergency admissions

To fully implement the Intermediate Care (Ealing) Service and to continue to
work with Ealing CCG on a shared vision and strategy for integrated care in
the Borough

Develop robust links with neighbouring secondary care providers for the
redirection of Ealing CCG patients from A&E/UCC services

Active participation within the Ealing Urgent Care Network Board, working
collaboratively with Commissioners, Care UK, London Ambulance Service
and neighbouring Trust clinical representatives.

Active participation through our community services with the Harrow and
Brent Urgent Care Network Boards.
Measures of Success:

Reduction in number of A&E presentations

Reduction in the number of urgent (non-elective) admissions

Reduction in the number of avoidable readmissions

Improvement in the patient experience within the A&E department

Sustained achievement of 4 hour and other urgent care-related targets
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
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Priority 3
Promoting ‘Harm Free’ care
Objectives:

Reduce the number of grade 3 & 4 pressure ulcers that develop after
patients have entered our care in the acute or community setting
-

Reduction in harm from avoidable falls
-

Implement the Fall Safe Care bundle in 2013.
Reduction in Urinary Catheter Associated Infections
-

Enhance existing Tissue Viability service across both acute and
community services
Roll out the ‘Your Turn’ campaign to raise awareness around pressure
ulcer prevention
Regular review of root cause analyses with Commissioners,
developing additional actions where points of learning are identified
Implementation of the „Catheter Passport‟ across the ICO
Ensure staff are up to date with appropriate mandatory and statutory
training
Measures of Success:

Reduction in the number of grade 3 & 4 pressure ulcers

Implementation of the Fall Safe Care bundle in 2013 and a reduction in the
number of falls leading to harm

Increased number of patients with the urinary catheter passport across the
ICO

Reduction in urinary catheter-related E coli bacteraemia (EHT
acute/community specific)

Meet statutory training compliance rates
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
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Priority 4
Safeguarding of vulnerable adults and children
Objectives:

Achieve the organisation‟s targets in relation to Child Protection supervision
and Safeguarding training (Adults and Children)

Implement agreed action plans, with relevant commissioners and Local
Authority, to ensure that initial and review health assessments for Looked
After Children are delivered to agreed quality and timescales

Improve the recognition of dementia and other causes of cognitive
impairment in adults over age 75 admitted as an emergency using the FAIR
(Find, Assess, Investigate and Refer) principles within the dementia
2013/14 CQUIN.
Measures of Success:

% of eligible staff completing mandatory Adults Safeguarding training

Full achievement of the Dementia CQUIN in 2013/14

% of eligible staff completing mandatory Children‟s Safeguarding training

% of staff receiving child protection supervision within statutory timescales

% Looked After Children initial health assessments completed within target
timescales

% Looked After Children review health assessments completed within
target timescales
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
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Priority 5
‘Out of Hospital’ strategy for patients with long term conditions
Objectives:

To work with commissioners in all 3 Boroughs to support the development
and implementation their strategy to promote integrated care with health
and social services.

To work with Commissioners to redevelop pathways and support the move
of appropriate Cardiology services from a hospital to a primary / community
base (Ealing specific)

Diabetes – Support the transfer of eligible patients into community clinics
and accelerate the community based diabetic service and facilitation of
patient discharge into primary care (Ealing specific)

End of Life – Seek to shift services towards a community based model of
care which support proactive palliative and end of life care management
Measures of Success:

Reduction in acute activity in agreed areas relating to QIPP programmes

Increasing the number of patients who die at home if this is their wish
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
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Part 2
Statements of Assurance from the Board
2012/13 Quality Account
Review of Services
During 2012/13 the Ealing Hospital NHS Trust provided and/or sub-contracted 31
Acute and 54 Community NHS Services.
Ealing Hospital NHS Trust has reviewed all the data available to it on the quality
of care in all 85 of these NHS services.
The income generated by the NHS services reviewed in 2012/13 represents
100% of the total income generated from the provision of NHS services by Ealing
Hospital NHS Trust for 2012/13.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
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Part 2
Statements of Assurance from the Board
2012/13 Quality Account
Participation in clinical audit
Clinical audit is used to evaluate our practice and identify areas for improvement.
National audits allow us to compare our practice with other similar services. In
addition we encourage all of our departments to perform their own local audits to
evaluate care provided.
The Trust has a strong clinical audit team and a detailed breakdown of all of our
audit activity is available upon request.
National audits during 2012/13
During 2012/13, 27 national clinical audits and 1 national confidential enquiry
covered NHS services that Ealing Hospital NHS Trust provides.
During that period Ealing Hospital NHS Trust participated in 93% national clinical
audits and 100% national confidential enquiries of the national clinical audits and
national confidential enquiries which it was eligible to participate in.
The national clinical audits and national confidential enquiries that Ealing
Hospital NHS Trust was eligible to participate in during 2012/13 are as follows:
Table: Participation in National Audit 2012/13 - audits are listed with the total number of cases
submitted and, where applicable, the percentage of eligible cases.
National Audits conducted for all or part of
2012/13
Participated
(yes/no)
Cases submitted
ANDA: National Diabetes Audit
Yes
2,538 cases (100%)
BOA Hip Fracture database
Yes
82 cases
British Thoracic Society: adult asthma
Yes
31 cases (100%)
British Thoracic Society: COPD discharge audit
Yes
28 cases (100%)
British Thoracic Society: Adult Community
Acquired Pneumonia
Yes
Data collection
underway – deadline
end of May 2013
British Thoracic Society: Emergency use of
oxygen
British Thoracic Society: Non Invasive
Ventilation
British Thoracic Society: Paediatric asthma
Yes
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
Yes
Yes
31 cases (100%)
20 cases (100%)
25 cases (89%)
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Statements of Assurance from the Board
2012/13 Quality Account
National Audits conducted for all or part of
2012/13
Participated
(yes/no)
Cases submitted
British Thoracic Society: Paediatric Pneumonia
Yes
20 cases (83%)
College of Emergency Medicine: Fractured neck
of femur
College of Emergency Medicine: Paediatric
fever
College of Emergency Medicine: Renal colic
Yes
Emergency Laparotomy
Heart Failure Audit
Yes
Yes
40 cases (80%)
50 cases (100%)
50 cases (100%)
Audit Data collection will commence in
2013/14. To be reported in next year‟s
Quality Account
Yes
262 cases (100%)
ICNARC CMPD: adult critical care
Yes
ICNARC NCAA: cardiac arrest
No
MINAP (inc ambulance care): acute myocardial
infarction (AMI) & other acute coronary
syndromes (ACS)
Yes
Data collection currently
underway. Deadline end
of May 2013
National Audit of Dementia
Yes
40 cases (100%)
National Comparative Audit of Blood
Transfusion
National Joint Registry (NJR)
Yes
National Promotion of Health in Hospitals
Yes
432 cases (100%)
271 cases (100%)
155 cases (86%)
This national audit was abandoned
NHS blood and transplant potential donor audit
Yes
3 potential cases
NBOCAP: bowel cancer
Yes
59 cases (100%)
Yes
Data collection currently
underway. Deadline end
of May 2013
NLCA: lung cancer
Yes
90 cases (100%)
Parkinson‟s UK: National Parkinson‟s Audit
Audit conducted in 2010/11
NICOR: Coronary angioplasty
Yes
RCS: Oesophagus-gastric cancer
Data collection currently
underway. Deadline end
of May 2013
RCP Inflammatory Bowel disease
No
RCP National Childhood Epilepsy Audit
Audit conducted in 2011/12
RCPCH National Childhood Epilepsy
Yes
RCP National Falls and Bone Health Audit
Audit conducted in 2011/12
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
20 cases (100%)
Page 23 of 119
Part 2
Statements of Assurance from the Board
National Audits conducted for all or part of
2012/13
2012/13 Quality Account
Participated
(yes/no)
Cases submitted
RCPCH: Diabetes (Paediatric)
Yes
2,498 cases
TARN: severe trauma
Yes
73 cases
National Confidential Enquiries (NCEPOD)
NCEPOD is a national programme where data is collected from Trusts, looking at
the care of patients being treated for specific conditions. The numbers of cases
from any one Trust is small but by looking at data across a wide range of Trusts
important lessons can be learnt about how to organise and deliver care for that
group of patients.
There was one national confidential enquiry that Ealing Hospital NHS Trust was
eligible to participate in for 2012/13, as follows:
National Confidential Enquiries into Perioperative Deaths
(NCEPOD) study
Subarachnoid Haemorrhage
Cases
submitted
4 (100%)
Action plans arising from national audits
The reports of three national clinical audits were reviewed by the provider in
2012/13 and Ealing Hospital NHS Trust intends to take the following actions to
improve the quality of healthcare provided:

Re-audit of Bedside Transfusion Practice
100% of all 48 patients being transfused had a printed identification band,
as the Trust strictly adheres to the policy of “No wristband, no transfusion;
no exceptions”. 75% of applicable staff had transfusion training within the
last year and the Transfusion Practitioner is working towards achieving the
100% target in 2013/14.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
Page 24 of 119
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Statements of Assurance from the Board

2012/13 Quality Account
Improving Dementia Care at Ealing Hospital NHS Trust
The hospital has introduced dementia screening for all patients admitted
over the age of 65, and care of patients with dementia is part of all staff
induction programme. Appropriate staff have undertaken dedicated
training facilitated through NHS London and this is being rolled out to
clinical teams.
Ealing Hospital now has an onsite, seven day a week, Psychiatry service.
This service is working with hospital clinical staff in the management of
patients with dementia.
To support patients and families the Trust has appointed a Nurse
Specialist in Dementia and introduced a “This is Me” Care Plan for all
admitted patients with a diagnosis of dementia. The hospital is supported
by a dementia Concern Advocate who works closely with patients and
families.

College of Emergency Medicine (CEM) – Renal Colic
Following on from national audit, a specific renal colic checklist has been
created to document the care in accordance with the College of
Emergency Medicine standards. The management of renal colic
admission will be audited in 2013/14 using the new checklist to ensure
that patients are receiving timely checks and medication.
Local clinical audit
The Trust encourages local audit in all clinical departments as a way to evaluate
our own practice and improve the quality of the care that we provide.
The reports of 26 local clinical audits were reviewed by the provider in 2012/13
and Ealing Hospital NHS Trust intends to take the following actions to improve
the quality of healthcare provided. Full details of the local audit activity will be
available in the Trust‟s Annual Clinical Audit and Effectiveness Report.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
Page 25 of 119
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2012/13 Quality Account
Brent Community Services
•
NICE Autism audit
- Teaching session / afternoon for all new junior doctors covering NICE
guidelines to include the different diagnostic pathways
- Summary sheet of NICE auditable standards to be produced to go in to
the Junior Doctor‟s Induction folder
- Follow up with a specified professional to be offered within 6 weeks.

Dental services
- Purchase of single use sterile water bottles for irrigation to be used by
staff during dental surgical procedures.

Goal Attainment Scaling (GAS): Robertson Rehabilitation Unit
- Ensure that there are at least 3 members of the Multidisciplinary team
present at GAS assessments and if the discharge date for the patient
is extended, a new GAS assessment will be conducted.

VTE Audit: Willesden Centre
- Review VTE assessment form and add in weight indicators for doses
- Re-issue the NWLH „Pocket Guide: Guidelines and Protocols for the
management of Thromboembolism in adults‟.
Ealing Community Services

Clayponds screening for neurological patients
- To have a section in the nursing notes where Stroke Aphasia
Depression Questionnaire from the previous weeks are filed so that
symptoms can be monitored over time
- In addition plans are being developed so that the clinical
neuropsychologist to come to the ward on a Wednesday afternoon to
support nursing staff in completing the questionnaire.

Vestibular Rehabilitation, measuring the service against best
practice guidelines: Ealing Day Centre
- The audit identified specific training needs regarding assessment and
treatment of Benign paroxysmal positional vertigo (BPPV)
- Although the outcome measures used were appropriate, they were not
used 100% of the time. It is planned that an assessment proforma will
be formulated and used with this client group.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
Page 26 of 119
Part 2
Statements of Assurance from the Board
2012/13 Quality Account
 Paediatric Occupational Therapy
- Parents will be contacted ahead of their child‟s yearly review, to invite
them to attend so that they are involved in their child‟s O.T. treatment
plans
- Parents will also be invited to meet the therapist and discuss their
child‟s O.T. treatment programmes in the autumn term.
Harrow Community Services

Coronary Heart Disease Diagnostics - Patient Satisfaction Audit
- Patients will be assured on the day of their appointment that
confidentiality will be strictly observed at all times when it comes to
their personal information
- In addition, the service will provide information about who to contact
after 5:00 pm if they encounter any problem, this will include advice
about going to the urgent care centre, hospital A&E, calling the
ambulance or HARMONI.

3 months post discharge follow up from Denham Unit
- Changes brought about by the audit include, additional input of
physiotherapy service to maintain patients level of independence to
prevent further injuries, as well as development of a personalised
health care programme for people seen in medical outpatients and
frequently admitted to reduce re-admissions.
Ealing Hospital (Acute)

Haematology documentation audit
- To discontinue the use of transfusion books and continue using the
stamp in clinical notes to document transfusions details.

Pharmacy Cold Chain Audit
- Ward based medicines management technician team to conduct one
to one training sessions with nursing staff to educate them about cold
policy and the corrective procedures to take if there is a temperature
breach.
- Memorandum to be sent to ward managers, outlining procedure for
reading the fridge thermometers.
- The Medicines Management intranet page to be updated with all
procedures relating to fridge temperature monitoring, including audit
documentation.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
Page 27 of 119
Part 2
Statements of Assurance from the Board
-
2012/13 Quality Account
All wards to be audited weekly for six weeks and results to be fed back
to ward sisters‟ forum.

Oral Methotrexate audit
- Consideration of only allowing Registrars to prescribe oral
methotrexate.
- All patients own supplies of oral methotrexate must be checked by a
pharmacist before it is administered by a nurse
- Administration of oral methotrexate will require a check by a second
nurse.

Prevention of VTE post knee/hip surgery audit
- All patients to be counselled at Joint school prior to admission and
issued with a Medicines Information card. Rivaroxaban patients to be
issued with a Patient Information Leaflet.
- Ward nurses to be educated about the correct procedure for
administering 1st dose of Rivaroxaban from ward stock.
- Upon discharge all patients to be re-counselled by the pharmacy
discharge team
- Thromboprophylaxis guidelines to be reviewed to include procedure for
switching one agent with another in case of proved contra-indication.
- Guidelines to also include key information regarding discharging
patients on a thromboprophylaxis agent post-operatively.

CT imaging in the initial assessment of Acute Pancreatitis
- Education regarding diagnosis and complications of Acute Pancreatitis
and updating the trust guidelines
- Change of protocol so that early CT imaging in Acute Pancreatitis
patients must be discussed with a surgical consultant.

Management of dislocated shoulder
- Following this audit, a walk in CT coronary calcium score for the
appropriate patients referred to chest pain clinic, was initiated. The
service has been running from 1st December 2012 and the re-audit on
the outcome will be conducted.

Management of C.diff patients in hospital & community audit
- Reduction of use of Tazocin & augmentin as they were the most used
antibiotics
- The importance of using stool chart in hospital cases
- There were a number of patients on laxatives who developed
diarrhoea afterwards, the use of laxatives will be reduced.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
Page 28 of 119
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2012/13 Quality Account

Patient Transfers from Ealing Hospital Emergency Department
- The trust will develop a guideline for patients being transferred
including who should accompany non-intubated patients who require
an escort, and ensuring that all patients are haemodynamicly stable
- A re-audit will be conducted following implementation of the guideline.

Urology Catheter audit
- Catheter care staff knowledge to be updated specifically around the
differences of long and short term catheters;
- Address catheter storage issues.

Endoscopic Biopsy and Anti-platelet Agents audits
- There is a wide variation in the endoscopic biopsy practice on patient
taking anti-platelet agents leading to postponement and rescheduling
of procedure. A local policy will be formulated in the endoscopy user
group meeting to address this.

Surgery Acute Upper GI bleed audit
- As the trust was not meeting specific targets for endoscopy times and
documentation, a new upper GI bleed endoscopy request form will be
devised. These will be more widely available on wards.
- Emergency endoscopy slots will be created.
- Re-audit based on new NICE guidelines following implementation of
recommendations will be conducted.

Day Surgery, Pain Audit
- The audit found that some patients were given intravenous morphine in
recovery prior to returning to the day ward and this may account for the
fact that patients return to the ward with mild pain scores.
- As pain scoring on patients collected from recovery is essential, a
policy will be drawn up to ensure this; this will include the need for
orthopaedic patients to be given analgesia prior to being seen by the
physiotherapist.

Maternity, Major Obstetric Haemorrhage (MOH)
- The MOH proforma will be redesigned and available in each room
- Blood product prescribing must be 100%; therefore, proforma use and
key findings will be included in the midwifery mandatory training days.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
Page 29 of 119
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2012/13 Quality Account

Maternity, Vaginal Birth After Caesarean Section (VBAC)
- We have put in place a multidisciplinary VBAC crisis group, and
streamline the VBAC clinics with access at earlier gestations. This will
be supported by standardised VBAC booklets and risk-benefit stickers
which will be implemented;
- Clinic staff are booked for educational sessions in consistent but
individual antenatal counselling techniques;
- Completion of this audit cycle is scheduled for June 2013.

Paediatrics, Gastroenteritis audit
- Studies on the use of probiotics indicate that probiotics may be useful
in the management of children with diarrhoea. The current trust
guideline does not recommend the use of probiotics and this will be
amended.

Paediatrics, Standardised Electronic Neonatal Database (SEND)
- Complete SEND at the time of admission using the maternal notes,
and where possible by the admitting doctor;
- Training will be made available, however the need for a paper
proforma will be instigated if the electronic SEND is unavailable.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
Page 30 of 119
Part 2
Statements of Assurance from the Board
2012/13 Quality Account
Participation in clinical research
In 2012/13, Ealing Hospital was involved in conducting 31 clinical research
studies (27 open to recruitment & 4 interventional studies currently in follow-up)
of which we were the lead organisation for one.
The number of patients receiving NHS services provided or sub-contracted by
Ealing Hospital in 2012/13 that were recruited during that period to participate in
research approved by a research ethics committee was 2,785.
The Trust continues to maintain its strong research track record, particularly in
the fields of risk screening for cardiovascular disease, cancer, infectious
diseases, peripheral vascular disease and diabetes research.
We continue to be the lead site and sponsor for the „LOLIPOP‟ Programme, an
internationally renowned programme of research looking at genetic and
environmental causes of cardiovascular disease in Asian and Caucasian
populations.
Our research portfolio has increased the number of studies we offer to our
patients and allows a greater diversity of patients into our high quality research
projects.
The portfolio includes research into cancers in the majority of tumour sites,
cardiovascular disease and diabetes research. Patients with haematological
cancers are now enrolled into a wide range of studies as part of their standard
treatment and are also invited into genetic studies.
We continue to work closely with our local Research Networks as well as the
Local Comprehensive Research Network and we are in the process of
developing Patient and Public Involvement also.
The research activity can be viewed by anyone at the following web address;
http://www.guardian.co.uk/healthcare-network-nihr-clincal-researchzone/table/2012-trust-research-activity. For a small acute trust we are performing
well for recruitment into clinical studies compared to other organisations of a
similar size.
Our research governance framework meets the requirement of the National
Research Support Services as well as the National Institute for Health Research
(NIHR) national targets.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
Page 31 of 119
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2012/13 Quality Account
We are particularly excited at the research collaboration that we hope will come
out of us joining the Academic Health Sciences Partnership (AHSP) and
Network (AHSN) in the near future.
We anticipate that the research activity at the Trust will be further strengthened
by the proposed organisational merger with the North West London Hospitals
NHS Trust.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
Page 32 of 119
Part 2
Statements of Assurance from the Board
2012/13 Quality Account
Goals agreed with commissioners
A proportion of Ealing Hospital NHS Trust‟s income in 2012/13 was conditional
on achieving quality improvement and innovation goals agreed between Ealing
Hospital NHS Trust 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 (CQUIN) payment framework.
Further details of the agreed goals for 2012/13 and for the following 12 month
period are available electronically at http://www.ealinghospital.nhs.uk/aboutus/quality-account/
A summary of our achievement against 2012/13 CQUIN schemes is shown
below. Final achievement is, at the time of writing, still subject to formal
agreement.
Acute Services
%
achieved
Achievement
Rating
% of patients receiving assessment
100.0%
Achieved
Composite indicator on responsiveness to personal needs from
adult in-patient survey
25.0%
Partial
achievement
Case finding
100.0%
Achieved
Diagnostic assessment
0.0%
Not achieved
Referral to specialist diagnosis
0.0%
Not achieved
100.0%
Achieved
100.0%
Achieved
100.0%
Achieved
100.0%
Achieved
100.0%
Achieved
100.0%
Achieved
0.0%
Not achieved
Description of Goal
Indicator Description
VTE screening
Improved patient experience
Diagnosis of dementia
NHS Safety Thermometer
NWL Integrated Formulary
compliance
NWL GP Real-Time
Information
Collection of data in patient harm using the NHS Safety
Thermometer
90% of drugs prescribed to outpatients should be chosen from the
NWL integrated formulary
GP notification of an A&E attendance within 4 hours of discharge
from A&E
GP notification of an emergency admission within 24 hours of the
decision to admit
GP notification of discharge planning within 24 hours of admission
(patients with predicted LOS > 7 days)
Full discharge summary available to GPs 24 hours after discharge
takes place
GP notification of Outpatient care delivered within 2 days of
appointment
Surgical consultant ward
rounds at weekends
Two consultant surgical ward rounds per day at weekends
End of Life (EOL)
Training of Clinical staff; initiating EOL discussions, and supporting
patients to end their life in the preferred place of death
Improving end of life care for people with a reduction in the number
of people on an EOL pathway dying in hospital and achieving the
specific quality standards
Total
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
51.9%
23.0%
19.0%
Partial
achievement
Partial
achievement
Partial
achievement
60.5%
Page 33 of 119
Part 2
Statements of Assurance from the Board
2012/13 Quality Account
Specialist Commissioning
%
Achievement
achieved
Rating
Description of Goal
Indicator Description
Implementation of
Specialised Services
To implement the routine use of specialised services clinical
dashboards
100.0%
Achieved
NICU
Reducing avoidable admissions
100.0%
Achieved
Supporting patients to register with GPs
100.0%
Achieved
Communication with GPs about the care of HIV patients
100.0%
Achieved
To improve cost effectiveness of treatment
100.0%
Achieved
Audit of HIV QIPP plan
100.0%
Achieved
HIV
Total
100.0%
Brent Community Services
Description of Goal
Indicator Description
%
Achievement
achieved
Rating
Pressure Ulcers
100.0%
Achieved
Falls
100.0%
Achieved
Urinary Tract Infection in Catheterised patients
100.0%
Achieved
VTE
100.0%
Achieved
0.0%
Not achieved
0.0%
Not achieved
92.5%
Partial
achievement
100.0%
Achieved
100.0%
Achieved
Increase uptake of 2 - 2.5 Year Health reviews
100.0%
Achieved
Identification and support for post natal depression
100.0%
Achieved
75.0%
Partial
achievement
NHS Safety Thermometer
Patient Experience
Malnutrition
Health Visiting
End of Life (EOL)
To improve the responsiveness to personal needs of patients
receiving in-patient care at Willesden Hospital
To improve the responsiveness to personal needs of patients
receiving health visiting services
Implementation of Malnutrition Universal Screening Tool
(MUST)
Health Visiting Service Model Development incorporating
alignment of the 'Healthy Child Programme'
Improvement in the Identification of Mothers requiring Breast
Feeding Support
Increase in the number of EOL patients who have a
personalised care plan reflecting best practice around GSF,
PPC and LCP (recorded on 'Coordinate My Care')
Total
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
84.3%
Page 34 of 119
Part 2
Statements of Assurance from the Board
2012/13 Quality Account
Ealing Community Services
Description of Goal
Indicator Description
%
Achievement
achieved
Rating
Pressure Ulcers
100.0%
Achieved
Falls
100.0%
Achieved
Urinary Tract Infection in Catheterised patients
100.0%
Achieved
VTE
100.0%
Achieved
63.2%
Partial
achievement
25.0%
Partial
achievement
NHS Safety Thermometer
Patient Experience
Integrated Care to Improve
Paediatric Asthma
Diagnosis and
Management
Health Visiting
To improve the responsiveness to personal needs of patients
receiving in-patient care at Clayponds Hospital and Meadow
To improve the responsiveness to personal needs of patients
receiving the following services: District Nursing, Adult
Audiology and Adult and Paediatric Speech and Language
Reduce Paediatric Asthma Secondary Care activity (Children
aged 0 to 17 (to 18th birthday))
Increased use of Care Bundles for Children discharged
following Asthma admissions
Health Visiting Service Model Development incorporating
alignment of the 'Healthy Child Programme'
Improvement in the Identification of Mothers requiring Breast
Feeding Support
Increase uptake of 2 - 2.5 Year Health reviews
CSCNS - Pathways for TB
and Epilepsy to improve
expertise and service
responsiveness and reduce
unnecessary hospital
activity for epilepsy by 5%
End of Life (EOL)
Admission Avoidance Reduction in number of
Ealing PCT registered
patients who die in hospital
Total
Develop evidence based pathways underpinned by robust
policies, SOPs and governance arrangements to improve
service responsiveness and increase out of hospital activity
Fully implement the pathways for epilepsy and TB that will
evidence staff competence, increase out of hospital activity
and reduce non elective activity for epilepsy by 5%
Fully develop the links, network and support system for the
EOLC Rapid Response Service to deliver at full capacity
To support the Marie Curie EOLC Rapid Response Service to
prevent 400 patients registered with an Ealing GP to die out of
hospital
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
50.0%
75.0%
73.8%
Partial
achievement
Partial
achievement
Partial
achievement
100.0%
Achieved
100.0%
Achieved
0.0%
Not achieved
0.0%
Not achieved
100.0%
Achieved
100.0%
Achieved
65.2%
Page 35 of 119
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Statements of Assurance from the Board
2012/13 Quality Account
Harrow Community Services
Description of Goal
Indicator Description
%
Achievement
achieved
Rating
Pressure Ulcers
100.0%
Achieved
Falls
100.0%
Achieved
Urinary Tract Infection in Catheterised patients
100.0%
Achieved
VTE
100.0%
Achieved
0.0%
Not achieved
0.0%
Not achieved
District Nurse training in the assessment tool
100.0%
Achieved
Dementia assessment for over 75s
100.0%
Achieved
Documentation of mini-assessment score
100.0%
Achieved
Notification of GP at next case review
100.0%
Achieved
NHS Safety Thermometer
Patient Experience
To improve the responsiveness to personal needs of patients
receiving in-patient care at the Denham Unit
To improve the responsiveness to personal needs of patients
receiving District Nursing services
Dementia risk assessment
Identifying Vulnerable
Children
Monthly meetings between health visitor and GP practice
75.0%
Identification of children for follow up at monthly meetings
75.0%
Record keeping for vulnerable children
75.0%
Recording of onward referrals
75.0%
Total
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
Partial
achievement
Partial
achievement
Partial
achievement
Partial
achievement
79.8%
Page 36 of 119
Part 2
Statements of Assurance from the Board
2012/13 Quality Account
2013/14 CQUIN Schemes
The table below summarises the agreed CQUIN schemes for 2013/14. These are
made up of national priorities that apply to all NHS provider organisations, plus
North West London sector-wide and local priorities. These apply to acute and/or
community services. Final confirmation of these schemes is, at the time of
writing, still subject to formal agreement with Commissioners.
Stream
Applicable to Description
National
Friends and Family Test
Acute &
Community
NHS Safety Thermometer
Dementia
VTE risk assessment
Sector
Out of Hospital schemes
GP real-time information
Clinical Standards
Acute
Acute Psychiatric Liasion Service
GP telephone line
Neonatal Intensive Care (NICU) - Improved access to breast milk in preterm
infants
Human Immunodeficiency Virus (HIV) - Registration and communication with
GPs about the care of HIV patients
Local
Brent: Case Management and District Nursing Dementia
Brent: District Nursing / STARRS Transfer of Care
Ealing: Intermediate Care Dementia
Community
Ealing: Paediatric Admission Avoidance
Ealing: Tele-Health
Harrow: Unscheduled Care Priority District Nursing Referrals
Harrow: Dementia
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
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2012/13 Quality Account
Statement from the Care Quality Commission
Statement from the Care Quality Commission
Ealing Hospital NHS Trust is required to register with the Care Quality
Commission and the Trust‟s current registration status is unconditional.
The Care Quality Commission has not taken enforcement action against Ealing
Hospital NHS Trust during 2012/13.
Ealing Hospital NHS Trust has not participated in any special reviews or
investigations by the CQC during the reporting period.
Inspections
Care Quality Commission Inspection Ealing Hospital
The Care Quality Commission (CQC) regularly inspects healthcare organisations
against essential standards of quality and safety.
The Care Quality Commission carried out an unannounced inspection at Ealing
Hospital on the 15th October 2012 as part of their programme of planned reviews.
The standards inspected included:





respecting and involving people who use services;
care and welfare of people who use services;
cleanliness and infection control;
management of medicines; and
assessing and monitoring the quality of service provision.
The inspection team observed how people were being cared for, talked to staff,
reviewed information from stakeholders and talked to numerous people using the
services at Ealing Hospital. The CQC‟s judgement was that Ealing Hospital was
meeting all the essential standards of quality and safety inspected.
In October 2012, the Care Quality Commission also conducted an audit on
Outcome 9 (Management of Medicines) and were satisfied that the Trust was
compliant with this standard. The CQC concluded that patients at the Trust were
protected against the risks associated with medicines as the Trust has
appropriate arrangements in place to manage medicines.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
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2012/13 Quality Account
Statement from the Care Quality Commission
Joint OFSTED/CQC Inspections
There was an integrated inspection of Safeguarding and Looked After Children‟s
(LAC) services in Harrow between the 8th and 12th May 2012.
The purpose of the inspection was to evaluate the contribution made by the
relevant local services in Harrow towards ensuring children and young people
are properly safeguarded and determine the quality of service provision for
Looked After Children and care leavers.
The inspection carried out found that Safeguarding and Looked After Children
arrangements were overall adequate. An action plan was implemented to deliver
sustained improvement across children‟s services which would lead to improved
outcomes for children in Harrow. The action plan has focussed on tackling those
areas of greatest risk first and lays the foundation for much more effective
practice.
There are monthly meetings to review the action plan and report progress into
Harrow Clinical Governance meetings and the Trust‟s Safeguarding meetings.
There have been further improvements in a number of key areas and we
continue to work with staff and local authority in Harrow to meet the key
recommendation identified in the report.
Improvements in key areas are as follows:





Looked After Children receive timely, comprehensive health assessments;
Looked After Children and care leavers are fully engaged in the delivery of
the being healthy agenda;
There are agreed mechanisms of accountability and reporting to ensure
fulfilment of contractual requirements and service delivery expectations in
relation to healthcare for Looked After Children;
Health membership at the Multi-Agency Risk Assessment Conferences
(MARAC) has been reviewed;
Training around health visitors and school nurses understanding of risk
assessment.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
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Part 2
2012/13 Quality Account
Statement from the Care Quality Commission
Data Quality
Ealing Hospital NHS Trust will be taking the following actions to improve data
quality.
The Trust has a well-established multi-disciplinary Data Quality Management
Group. This provides the oversight for monitoring and improving data quality and
completeness across the organisation. This is now being supplemented by
monthly Data Quality Monitoring Groups for both acute and community data with
focussed work streams of activities.
During 2012/13 we have undertaken spot audits in relation to community data
recording and as a result are developing plans to improve data recording and
monitoring. We have also undertaken reviews including processes around tracing
and recording of NHS Numbers as well as making more use of the National
Spine related services for patient identification.
During 2013/14 we will target improvements in the timeliness and completeness
of recording activity data by:

Focussed work streams addressing specific issues. Already identified are
recording VTE risk assessments and screening for MRSA colonisation
within acute services, and district nursing activity recording in community
services.

Data validation and cleansing in support of migration onto a new Patient
Administration System (to be completed in 2013/14).

Introduction of data quality performance reports and dashboards for
specified services.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
Page 40 of 119
Part 2
2012/13 Quality Account
Statement from the Care Quality Commission
Data submission to National Databases
Ealing Hospital NHS Trust submitted records during 2012/13 to the Secondary
Uses service for inclusion in the Hospital Episode Statistics which are included in
the latest published data. The percentage of records in the published data:
- which included a valid NHS Number was:
98.4% for admitted patient care;
99.3% for outpatient care; and
75.7% for accident and emergency care
- which included a valid General Medical Practice Code was:
100% for admitted patient care;
100% for outpatient care; and
98.2% for accident and emergency care
It should be noted that the above values for accident and emergency care also
include data submitted on behalf of Care UK, operators of the Urgent Care
Centre at Ealing Hospital. The percentage of records with valid NHS Number
within the Trust‟s Emergency Department only was 95.5%.
Information Governance
In line with all NHS organisations we are required to submit an annual
Information Governance Toolkit return that assesses our standards in managing
information assets. This covers 45 individual standards, all of which need to be
met to achieve an overall „satisfactory‟ score. Whilst this is a self-assessment
process, the Trust‟s scores were subject of a formal internal audit review and
have been formally approved by Trust Board.
Ealing Hospital NHS Trust‟s Information Governance Assessment Report overall
score for 2012/13 was 74% and was graded „Satisfactory‟. All of the 45 individual
standards were met.
Assessment
Overall score
Grade
2012
74%
Satisfactory
2011
72%
Not satisfactory
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
Page 41 of 119
Part 2
2012/13 Quality Account
Statement from the Care Quality Commission
Clinical Coding error rate
Ealing Hospital NHS Trust 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 diagnoses and treatment
coding (clinical coding) were:
Obstetrics




4.9% for primary diagnosis incorrect
2.5% for secondary diagnosis incorrect
0.0% for primary procedure incorrect
0.0% for secondary procedure incorrect
Thoracic procedures and disorders




2.5% for primary diagnosis incorrect
4.5% for secondary diagnosis incorrect
0.0% for primary procedure incorrect
0.0% for secondary procedure incorrect
The Assurance Framework this year involved targeted admitted patient care
audits on Healthcare Resource Group (HRG) sub chapters NZ for Obstetrics and
DZ for Thoracic procedures and disorders. These were targeted and small audit
samples and may not be representative of all activity at the Trust.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
Page 42 of 119
Part 3
Review of Quality Performance 2012/13
2012/13 Quality Account
2012/13 Quality Performance
This section incorporates a review of Trust quality performance in 2012/13 for:

Objectives highlighted in our previous year‟s Quality Account

Mandated national quality indicators as per Quality Account guidance

Other national and local key performance indicators

Community services provision - for Brent, Ealing and Harrow respectively

Local developments in relation to maternity services and medicines management.
The Trust monitors over 100 performance and clinical safety indicators and these are not reproduced in full within the
Quality Account. Our full Trust performance scorecard is updated each month and can be accessed through the public
Trust Board papers.
These are published at: www.ealinghospital.nhs.uk.
Alternatively a copy can be obtained by writing to the Chief Executive Officer, Ealing Hospital NHS Trust, Uxbridge Road,
Southall, UB1 3HW.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
Page 43 of 119
Part 3
Review of Quality Performance 2012/13
2012/13 Quality Account
REVIEW OF 2012/13 QUALITY PRIORITIES
(as defined in prior year Quality Account)
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
Page 44 of 119
Part 3
Review of Quality Performance 2012/13
2012/13 Quality Account
Review of 2012/13 Quality Priorities
We said we would
Progress at end March 2013
Patient experience

Retain and reinforce action plans from
2011/12 to deliver the national CQUIN
(Commissioning for Quality and Innovation)
indicator for patient experience.

The Trust has demonstrated sustained improvement in the
overall in the net promoter patient experience score, with
the average score increasing from 59.9 in 2011 to 63.1 in
2012

Implement the „WardPro‟ patient survey
application in Out Patients Pharmacy. This
will enhance patient experience, in particular
for patients who are unable to communicate
in English, and will inform further actions
from analysis of results to improve out
patients pharmacy services to patients.

WardPro‟ was implemented in April 2012. Results are
monitored weekly in the dispensary meeting and noted on
the pharmacy department and patient services scorecard.
Since implementation over 2400 patient surveys have
been completed. Having purchased a second device we
are collecting similar data for inpatients with a view to
feeding back to pharmacy staff on a regular basis. Both
surveys are also available on the Trust Internet website.

The results show that we are achieving 89.9% patient
satisfaction with the outpatient pharmacy service provided.
The survey questions were reviewed in October 2012 to
reflect requirements of the CQC regarding medicines and
patient experience. We have recently added a question
similar to the “friends and family question” to allow us to
bench mark with pharmacy departments in other Trusts
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
Page 45 of 119
Part 3
Review of Quality Performance 2012/13
2012/13 Quality Account
We said we would
Progress at end March 2013
 Outpatient feedback has led to purchase of new outpatient
seating and has also allowed us to launch our new
pharmacy SMS prescription collection service allowing
patients to be notified by text message once their
prescription is ready for collection.
Patient safety
Please note that a Patient Safety Report is provided to Trust
Board on a monthly basis.


Continue to work with other partners in North
West London to strengthen clinical pathways
and in particular to complete our planned
organisational merger North West London
Hospitals NHS Trust. The case for merger is
built on a clinical vision of being „Stronger
Together‟ in a clinically led and patient
centred organisation. The Full Business
Case is now being finalised for submission to
Trust Boards and partner organisations for
approval in September 2012.

Full Business Case is under review with NHS London.

Due and Careful Enquiry and Clinical Due Diligence
processes have been completed.

Clinical vision and case for change has been approved by
both Trust Boards in June 2012
To follow through the implementation of long
term recommendations following the
Safeguarding and Looked After Children
reviews in Ealing and Brent Community
Services.

Targeted recruitment and agency staffing, concentrating on
new birth visits and clinics to free up permanent staff to
focus on child protection and enhanced cases.

Appointment of Health Visitor Team Managers and Clinical
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
Page 46 of 119
Part 3
Review of Quality Performance 2012/13
We said we would

Roll-out a new Early Warning Score
observation chart across Ealing Hospital
from June 2012.
2012/13 Quality Account
Progress at end March 2013
Service Managers to provide strong leadership for the
health visiting services and maintain a close collaborative
working relationship with the Named Nurse and team.

Fortnightly meetings between Named Nurse and Clinical
Service Managers.

Joint Working Group has been established in Brent with
representation from Brent Council and NHS Brent to take
forward the recommendations in the report within the
required timescales.

The Working Group has now been superseded by a LAC
Service Review Group led by NHS Brent to implement a
new service model in 2013-14

New Early Warning Score observation chart was rolled out
to all wards in the hospital during July 2012. Chart
compliance was audited in December 2012 with results as
below:
98.5% of the patients had their observation completed in
line with the Royal College of Physician at the prescribed
frequency and correct time.
Between 94 - 100% of patient had the full range of clinical
observation completed
Between 90-100% of their patients.
The Trust is seeing an increased number of deteriorating




Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
Page 47 of 119
Part 3
Review of Quality Performance 2012/13
We said we would
2012/13 Quality Account
Progress at end March 2013
patients being identified and managed earlier.

This is evident by patients being referred to the Intensive
Care medical team earlier and admitted to the ICU earlier
in their deterioration.

Prior to the roll out of the chart the median patient‟s length
of stay in the ICU was 3.5 – 4.5 days. The current median
length of stay of patient in the ICU is 3 days since the roll
out of the NEWS chart. This is suggestive of patients being
identified and managed on time, thus preventing avoidable
deterioration and extended ICU length of stay.

Go-live on Phase 2 of the Hospital at Night
project from August 12, including review of
24x7 site management support.

Hospital at Night site management structure is now in
place. The Site Practitioner now leads the handover at
night with the Medical SpR. They are supported by Band
7.This occurs every night and at weekends.

Aim to reduce grade 3 & 4 community
acquired pressure ulcers by 10% through a
multi-agency approach, by improving the
uptake of Tissue Viability training and a refocused specialist Tissue Viability Nurse
service that reflects the standards of the
Pressure Ulcer Policy.

Total number of pressure ulcers has increased, which is in
part due to improved reporting of pressure ulcers.

Since May 2012, Tissue Viability Nurses are required to
review Grade 2 pressure ulcers across all community
services.

All root cause analyses are reviewed by the Director of
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
Page 48 of 119
Part 3
Review of Quality Performance 2012/13
We said we would
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
2012/13 Quality Account
Progress at end March 2013
Nursing and are reviewed with commissioners.

An overarching action plan has been developed and
reviewed by the Clinical Governance Committee.

Community Pressure Ulcer Policy has been revised.

„Your Turn' campaign to raise awareness around pressure
ulcers prevention and management with key stakeholders,
particularly patients, families and carers.

Community inpatient services have implemented
intentional Care Rounding.

National Safety Thermometer data is collected and
analysed on a monthly basis for the 4 avoidable harms:
Pressure Ulcer, Falls, Catheter Acquired Infection and
VTE.

NHS Ealing have set a 95% trajectory - the Trust achieved
96.21% for acute services in Q4, although the overall
position for the Trust including Community Services is
92.72%.
Page 49 of 119
Part 3
Review of Quality Performance 2012/13
We said we would

Continue to collect and submit the data
relating to the 4 harms of the national Safety
Thermometer as required in the national
CQUIN indicator.

Continuous achievement of adult inpatient
admissions having had a VTE risk
assessment.

Upgrade an organisation-wide incident
reporting IT system to support consistent risk
identification and management.
2012/13 Quality Account
Progress at end March 2013

VTE target has been consistently met in each reporting
month (94% year to date, against target of 90%).

The new Trust-wide incident reporting system is now in
use across the Trust. Training and support continue to be
provided to help staff use the new system.
Integrated pathways of care

Continue to work with our local
commissioners and general practitioners to
develop integrated services between the
acute hospital and the community, and in
particular to further progress the pilot areas
commenced in 2011/12 – care of diabetes,
elderly care and sexual health.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
 As per a revised Service Specification for 2012/13, Ealing
Community have developed an intermediate care service for
Diabetes creating community based clinics. This started at
Grand Union Village in January 2012, Southall in May /
June 2012 and with a third clinic in Ealing established in
December 2012. The Diabetic Community team have
relocated to a base in Southall and the team added a 4th
Diabetic Nurse Specialist (Nov 2012) and nurse consultant
to lead the expanded team (Feb 2013).
Page 50 of 119
Part 3
Review of Quality Performance 2012/13
We said we would
2012/13 Quality Account
Progress at end March 2013
 KPI‟s include shifts in activity : from Ealing Hospital to GP
 from Ealing Hospital to community
 from Community to GP
 Elderly Care – as of September 2012 established an
intermediate care service in Ealing of nurses, therapist,
doctors and social workers for referrals from A&E, Urgent
Care Centres and GPs. Also supporting implementation of
the Integrated Care Pilot for Diabetes and Elderly Care with
staff across all disciplines involved in the monthly
multidisciplinary case conferences for patients.
 Sexual Health – commissioners advised the Trust in
September 2012 that they no longer wish to commission an
integrated service. A shared acute & community IT system
is now in live use supporting joint working between the two
services.
Out of Hospital Care

Implementation a new Intermediate Care
Service from July 2012.
 Contract signed off for the development of the Intermediate
Care Service in April 2012.
 Service commenced in September 2012 (Ealing A&E)
identifying patients who didn‟t need acute admission and
transferring them to the nurse-led step up ward at
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
Page 51 of 119
Part 3
Review of Quality Performance 2012/13
We said we would
2012/13 Quality Account
Progress at end March 2013
Clayponds Hospital.
 October 2012 rolled out access to all GP practices in Ealing.
 Target is to achieve a reduction of 875 A & E referrals (3 per
day) and 3600 emergency admissions (300 per month)
End of Life care

Reduction in the number of people on an
EOL pathway dying in hospital
 End of Life Strategy has been ratified
 Training Strategy and training needs analysis undertaken
 Ground Round Education Sessions have taken place
 Priorities of Care document rolled out
 Protocol developed for all staff around Communication with
GPs Practices
 Liverpool Care Pathway (LCP) Audit completed
Care of Older People

Introduction of screening for dementia in
patients over 65 using the abbreviated
mental test screening (AMTS) and where
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow

Dementia screening has been implemented from
September 2012. This is incorporated into a mandated
admissions checklist and can be audited via system-
Page 52 of 119
Part 3
Review of Quality Performance 2012/13
2012/13 Quality Account
We said we would
Progress at end March 2013
appropriate then screen to eliminate delirium.
generated reports. Where delirium is identified, appropriate
treatment pathway is adopted in conjunction with
psychiatry liaison team.

This has been rolled out across the Trust.

Develop an individual care plan for patients
with dementia based on the Royal College of
Nursing and Alzheimer‟s Society “This is Me”
care plan.

Information for relatives and carers is currently being
printed. Information from Ealing Dementia Concern is also
available.

Develop and implement information for
carers on dementia.

Communicating with patients and respecting patients
dignity is incorporated into a range of staff training.

Review and amend clinical training provision
for staff to reflect the themes reported by
patients and their family/carers from
complaints and PALS relating to
communication & dignity with the aim of
improving our scores in the National patient
survey relating to these two important
aspects of care.

Staff training has been amended to reflect these themes
and it is covered during induction and annual mandatory
training

The hospital has introduced particular training relating to
patients with dementia and cognitive impairment. These
modules were developed by NHS London in 2012 and now
form the basis of staff training. Communication is a specific
module within the series.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
Page 53 of 119
Part 3
Review of Quality Performance 2012/13
We said we would
Maternity Services

To deliver on the full action plan approved by
Trust Board in April 2012, following an
external review jointly initiated and managed
with our commissioners.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
2012/13 Quality Account
Progress at end March 2013

Trust Board received a final report from the Overarching
Steering Group in December 2012. They approved
disbanding of the group and the future monitoring
arrangements.

Very positive changes have been made in the service and
this has been recognised by the trust Board and our
Commissioners.

Commitment to Care campaign and staff pledge is in place.

Electronic booking of appointments for GPs via secure
email address and Choose and Book.

Self-Referral also enabled (electronic (E-mail & website),
paper or self-presentation).

Commissioners are working with GP practices to improve
referrals as early as possible.

94% of women referred before 12+6 are seen within target;
overall 77.5% of women are seen within target.

New building work started on the refurbishment of Triage
and the Midwifery Led Unit to be completed in April 2013
Page 54 of 119
Part 3
Review of Quality Performance 2012/13
We said we would
2012/13 Quality Account
Progress at end March 2013

“Together to Improve Value” project with NHS London and
McKinsey Consultancy focusing on increasing bookings to
the unit.

Sustained reduction in non-elective
Caesarean Section rates.

Weekly and monthly reporting of the C-Section rates
continue. February 2013 elective rate 6.9% (YTD 10.1%)
and emergency rate 19.6% (YTD 17.5%). The updated
Action Plan remains in place and quarterly audit reports are
presented to Commissioners

Increase the number of women booking
before the end of week 12 of their
pregnancy.

The joint “As Soon As you are Pregnant (ASAP)” campaign
with Public Health remains active.
Communication with patients, general
practitioners and other agencies

Deliver the agreed CQUIN indicators in
respect of timely clinical correspondence
with General Practitioners, via an agreed
secure electronic communication approach.

CQUIN scheme and staged milestones have been agreed
with commissioners, including project plan for electronic
systems integration. Milestones relating to A&E and
Inpatient/Day case correspondence have been met;
outpatient trajectories are being deferred into 2013/14
recognising the challenges presented.

Launch a new Trust-wide Antibiotic Patient
Information Leaflet. This will contain

An Antibiotic Patient Information Leaflet (for adults) is
about to be rolled out across the acute trust. The re-audit
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
Page 55 of 119
Part 3
Review of Quality Performance 2012/13
We said we would
information on general antibiotic side-effects
with reference to manufacturers‟ information
for specific adverse events. The impact of
this will also be audited in 2012/13.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
2012/13 Quality Account
Progress at end March 2013
showed an improvement in patient awareness regarding
their antibiotic medication when the patient information
leaflet was utilised. Further adaptations for other
specialities are being considered for 2013/14.
Page 56 of 119
Part 3
Review of Quality Performance 2012/13
2012/13 Quality Account
MANDATORY QUALITY INDICATORS
For the 2012/13 Quality Accounts, there are a number of mandatory quality indicators that the Trust is
required to include. The data reported is as made available to Ealing Hospital NHS Trust by the Health
and Social Care Information Centre (HSCIC).
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
Page 57 of 119
Part 3
Review of Quality Performance 2012/13
2012/13 Quality Account
Indicator 1a: The value and banding of the summary hospital-level mortality indicator (SHMI) for
the Trust for the reporting period.
Unit
Trust
Previous
Value
Trust
Current
Value
National
average
Highest
national
score
Lowest
national
score
Score
89.3
85.2
100.0
121.1
68.5
Indicator Periods & Notes
Previous value: October 2010 to September 2011
Current value: October 2011 to September 2012
Ealing Hospital NHS Trust considers that this data is as described for the following reasons: The Trust has historically
maintained a mortality rate below the national average and continually monitors its performance with Commissioners
through regular quality governance meetings.
Ealing Hospital NHS Trust intends to take the following actions to improve this rate, and so the quality of its services, by
continuing to work with our Commissioners and key stakeholders in the monitoring and reviewing of SHMI information and
to take action as appropriate. The Trust has committed to undertake an annual audit which will take place during the year
and will be shared with Commissioners.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
Page 58 of 119
Part 3
Review of Quality Performance 2012/13
2012/13 Quality Account
Indicator 1b: The percentage of patient deaths with palliative care coded at either diagnosis or
specialty level for the Trust for the reporting period.
Unit
Trust
Previous
Value
Trust
Current
Value
National
average
Highest
national
score
Lowest
national
score
%
17.4%
24.4%
18.9%
43.3%
0.2%
Indicator Periods & Notes
Previous value: October 2010 to September 2011
Current value: October 2011 to September 2012
Ealing Hospital NHS Trust considers that this data is as described for the following reasons: The coding of patient activity
is regularly audited by both internal and external auditors. No issues have been identified to raise any alerts over any
inappropriate coding of palliative care. The Trust has a strong Clinical Coding team with highly qualified and experienced
staff.
Ealing Hospital NHS Trust has taken the following actions to improve this percentage and so the quality of its services, by
the continuous training of coding staff and through regular internal spot audits on clinically coded activity.
Ealing Hospital NHS Trust
Integrated Care Organisation
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Page 59 of 119
Part 3
Review of Quality Performance 2012/13
2012/13 Quality Account
Indicator 2: The patient reported outcome (*) measures scores for:
(i) groin hernia surgery
Unit
Number
Trust
Previous
Value
*
Trust
Current
Value
*
National
average
0.090
Highest
national
score
0.153
Lowest
national
score
0.017
Indicator Periods & Notes
Previous value: April 2011 to March 2012
Current value: April 2012 to December 2012
Note: (*) indicates that, due to reasons of confidentiality,
figures between 1 and 5 have been suppressed by HSCIC
Ealing Hospital NHS Trust considers that this data is as described for the following reasons: The volume of activity
recorded was below the minimum number of five that the Health and Social Care Information Centre disclose due to
reasons of confidentiality.
Ealing Hospital NHS Trust has taken the following actions to improve this number, and so the quality of its services, by
strengthening the collection and reporting of PROMs data for all appropriate patients and to enhance the reporting of the
results within the Trust.
(*) Patient Report Outcomes (PROMs) assess the quality of care delivered to NHS patients from the patient perspective. PROMs
calculate the health gains after surgical treatment using pre- and post-operative surveys. [definition from Health & Social Care
Information Centre]
Ealing Hospital NHS Trust
Integrated Care Organisation
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Page 60 of 119
Part 3
Review of Quality Performance 2012/13
2012/13 Quality Account
(ii) varicose vein surgery
Unit
Number
Trust
Previous
Value
*
Trust
Current
Value
*
National
average
0.089
Highest
national
score
0.138
Lowest
national
score
0.027
Indicator Periods & Notes
Previous value: April 2011 to March 2012
Current value: April 2012 to December 2012
Note: (*) indicates that, due to reasons of confidentiality,
figures between 1 and 5 have been suppressed by HSCIC
Ealing Hospital NHS Trust considers that this data is as described for the following reasons: The volume of activity
recorded was below the minimum number of five that the Health and Social Care Information Centre disclose due to
reasons of confidentiality.
Ealing Hospital NHS Trust has taken the following actions to improve this number, and so the quality of its services, by
strengthening the collection and reporting of PROMs data for all appropriate patients and to enhance the reporting of the
results within the Trust.
Ealing Hospital NHS Trust
Integrated Care Organisation
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Page 61 of 119
Part 3
Review of Quality Performance 2012/13
2012/13 Quality Account
(iii) hip replacement surgery
Unit
Number
Trust
Previous
Value
*
Trust
Current
Value
*
National
average
0.429
Highest
national
score
0.500
Lowest
national
score
0.328
Indicator Periods & Notes
Previous value: April 2011 to March 2012
Current value: April 2012 to December 2012
Note: (*) indicates that, due to reasons of confidentiality,
figures between 1 and 5 have been suppressed by HSCIC
Ealing Hospital NHS Trust considers that this data is as described for the following reasons: The volume of activity
recorded was below the minimum number of five that the Health and Social Care Information Centre disclose due to
reasons of confidentiality.
Ealing Hospital NHS Trust has taken the following actions to improve this number, and so the quality of its services, by
strengthening the collection and reporting of PROMs data for all appropriate patients and to enhance the reporting of the
results within the Trust.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
Page 62 of 119
Part 3
Review of Quality Performance 2012/13
2012/13 Quality Account
(iv) knee replacement surgery during the reporting period.
Unit
Number
Trust
Previous
Value
0.313
Trust
Current
Value
*
National
average
0.321
Highest
national
score
0.408
Lowest
national
score
0.201
Indicator Periods & Notes
Previous value: April 2011 to March 2012
Current value: April 2012 to December 2012
Note: (*) indicates that, due to reasons of confidentiality,
figures between 1 and 5 have been suppressed by HSCIC
Ealing Hospital NHS Trust considers that this data is as described for the following reasons: The volume of activity
recorded was below the minimum number of five that the Health and Social Care Information Centre disclose due to
reasons of confidentiality.
Ealing Hospital NHS Trust has taken the following actions to improve this number, and so the quality of its services, by
strengthening the collection and reporting of PROMs data for all appropriate patients and to enhance the reporting of the
results within the Trust.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
Page 63 of 119
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2012/13 Quality Account
Indicator 3(a): The percentage of patients aged 0 to 14 readmitted to a hospital which forms part
of the Trust within 28 days of being discharged from a hospital which forms part of the Trust
during the reporting period.
Unit
%
Trust
Previous
Value
6.92%
Trust
Current
Value
7.90%
National
average
10.15%
Highest
national
score
128.16%
Lowest
national
score
0.00%
Indicator Periods & Notes
Previous period: 2009/10
Current period: 2010/11
Note: Extract for patients aged below 16
Ealing Hospital NHS Trust considers that this data is as described for the following reasons: The Trust has a readmission
rate for this cohort of patients significantly below the national average and continues to work across the healthcare
community to prevent unnecessary readmissions to hospital.
Ealing Hospital NHS Trust has taken the following actions to improve this percentage, and so the quality of its services, by
continuing to work with our Commissioners and other healthcare partners to prevent unnecessary readmissions. This is a
key priority and will be progressed through the delivery of the 2013/14 quality objectives as set out in this Quality Account.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
Page 64 of 119
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2012/13 Quality Account
Indicator 3(b): The percentage of patients aged 15 or over, readmitted to a hospital which forms
part of the Trust within 28 days of being discharged from a hospital which forms part of the Trust
during the reporting period.
Unit
%
Trust
Previous
Value
11.59%
Trust
Current
Value
12.25%
National
average
11.42%
Highest
national
score
53.31%
Lowest
national
score
0.00%
Indicator Periods & Notes
Previous period: 2009/10
Current period: 2010/11
Note: Extract for patients aged 16 and over
Ealing Hospital NHS Trust considers that this data is as described for the following reasons: The Trust continues to
closely monitor the rate of readmissions and is disappointed to record an increase in this rate compared to the previous
period. Work is currently in progress to update the readmissions improvement plan which was previously published in
June 2011.
Ealing Hospital NHS Trust has taken the following actions to improve this percentage, and so the quality of its services, by
working with Commissioners to review the reasons for higher than average levels of readmissions through the urgent care
pathway review and overall provision of alternative settings of care across the local health community. A number of the
CQUIN schemes in 2013/14 are focussed on admission avoidance.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
Page 65 of 119
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2012/13 Quality Account
Indicator 4: The Trust’s responsiveness to the personal needs of its patients during the reporting
period.
Unit
Trust
Previous
Value
Trust
Current
Value
National
average
Highest
national
score
Lowest
national
score
Number
61.9
59.9
67.4
85.0
56.5
Indicator Periods & Notes
Previous period: 2010/11
Current period: 2011/12
Ealing Hospital NHS Trust considers that this data is as described for the following reasons: The Trust is disappointed to
record a decline in the rate in respect of responsiveness to the personal needs of its patients compared to the previous
period. Detailed analysis of the areas requiring improvement and the associated action plan is available in the National
Patient Survey Action Plan on the Trust website.
Ealing Hospital NHS Trust has taken the following actions to improve this number, and so the quality of its services, by
implementing the actions as set out in the response to the National Patient Survey plan. This is a key priority and will be
progressed through the delivery of the 2013/14 quality objectives as set out in this Quality Account.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
Page 66 of 119
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2012/13 Quality Account
Indicator 5: The percentage of staff employed by, or under contract to, the Trust during the
reporting period who would recommend the trust as a provider of care to their family or friends.
Unit
Trust
Previous
Value
Trust
Current
Value
National
average
Highest
national
score
Lowest
national
score
%
50.20%
54.23%
64.51%
94.20%
35.34%
Indicator Periods & Notes
Previous period: National NHS Staff Survey 2011
Current period: National NHS Staff Survey 2012
Ealing Hospital NHS Trust considers that this data is as described for the following reasons: The Trust was pleased to
report an improvement in this indicator compared to the rate achieved in 2011. However, the rate is below the national
average and actions to improve this position are set out in this Quality Account.
Ealing Hospital NHS Trust has taken the following actions to improve this percentage, and so the quality of its services, by
delivery of the 2013/14 priorities as set out in this Quality Account.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
Page 67 of 119
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2012/13 Quality Account
Indicator 6: The percentage of patients who were admitted to hospital and who were risk
assessed for venous thromboembolism during the reporting period.
Unit
Trust
Previous
Value
Trust
Current
Value
National
average
Highest
national
score
Lowest
national
score
%
91.3%
93.5%
93.9%
100.0%
0.0%
Indicator Periods & Notes
Previous value: 2011/12
Current value: 2012/13
Ealing Hospital NHS Trust considers that this data is as described for the following reasons: The Trust has continued to
increase the compliance rate for VTE assessment and this is closely monitored on a regular basis.
Ealing Hospital NHS Trust has taken the following actions to improve this percentage, and so the quality of its services, by
continuous enforcement and training of staff to ensure risk assessments for VTE are completed for all appropriate
patients. The Trust is focussed on driving improvement to achieve the revised standard of 95% in 2013/14.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
Page 68 of 119
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2012/13 Quality Account
Indicator 7: The rate per 100,000 bed days of cases of C. difficile infection reported within the
Trust amongst patients aged 2 during the reporting period.
Unit
Trust
Previous
Value
Trust
Current
Value
National
average
Highest
national
score
Lowest
national
score
Rate
19.8
21.7
21.8
51.6
0.0
Indicator Periods & Notes
Previous period: 2010/11
Current period: 2011/12
Ealing Hospital NHS Trust considers that this data is as described for the following reasons: Vigilance in minimising the
number of hospital acquired C. difficile infections remains a high priority in the Trust. We are pleased to have achieved the
standard in 2012/13, with 15 reported cases against an overall maximum target of 18.
Ealing Hospital NHS Trust has taken the following actions to improve this rate, and so the quality of its services, by
maintaining its progress on reducing the overall number of hospital acquired C. difficile infections.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
Page 69 of 119
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2012/13 Quality Account
Indicator 8: The number and, where available, rate of patient safety incidents reported within the
Trust during the reporting period, and the number and percentage of such patient safety
incidents that resulted in severe harm or death.
Number of patient safety incidents reported
Unit
Trust
Previous
Value
Trust
Current
Value
National
average
Highest
national
score
Lowest
national
score
Number
1,260
1,169
1,812
4,545
815
Highest
national
score
Lowest
national
score
Indicator Periods & Notes
Previous period: April 2011 to September 2011
Current period: April 2012 to September 2012
Note: Values relate to Small Acute Trusts only
Rate of patient safety incidents reported
Unit
Rate
Trust
Previous
Value
5.61
Trust
Current
Value
5.31
National
average
7.14
17.16
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
3.48
Indicator Periods & Notes
Previous period: April 2011 to September 2011
Current period: April 2012 to September 2012
Note: Values relate to Small Acute Trusts only
Page 70 of 119
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2012/13 Quality Account
Number of patient safety incidents that resulted in severe harm or death
Unit
Number
Trust
Previous
Value
8
Trust
Current
Value
10
National
average
16.5
Highest
national
score
69
Lowest
national
score
2
Indicator Periods & Notes
Previous period: April 2011 to September 2011
Current period: April 2012 to September 2012
Note: Values relate to Small Acute Trusts only
Percentage of patient safety incidents that resulted in severe harm or death
Unit
Trust
Previous
Value
Trust
Current
Value
National
average
Highest
national
score
Lowest
national
score
%
0.635%
0.855%
0.909%
2.474%
0.120%
Indicator Periods & Notes
Previous period: April 2011 to September 2011
Current period: April 2012 to September 2012
Note: Values relate to Small Acute Trusts only
Ealing Hospital NHS Trust considers that this data is as described for the following reasons: Details on incidents are set
out later on in this section of the Quality Account.
Ealing Hospital NHS Trust has taken the following actions to improve this number, rate and percentage, and so the quality
of its services, by implementing the actions set out in this Quality Account, in particular those detailed within our 2013/14
priorities and the review of quality performance in 2012/13.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
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2012/13 Quality Account
OTHER NATIONAL AND LOCAL
KEY PERFORMANCE INDICATORS
This sub-section of the Quality Account also includes supporting commentary covering key themes
discussed with our Commissioners in clinical quality group meetings over the year.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
Page 72 of 119
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2012/13 Quality Account
Accident & Emergency
Indicator
4 hour A&E target
Standard
Performance
greater than or
equal to 95%
96.9%
Data source: UNIFY2
% A&E attendances seen w ithin 4 hours (all types)
100
2011/12
2012/13
98
96
94
92
90
03/2013
02/2013
01/2013
12/2012
11/2012
Period
10/2012
09/2012
08/2012
07/2012
06/2012
05/2012
04/2012
03/2012
02/2012
01/2012
12/2011
11/2011
10/2011
09/2011
08/2011
07/2011
06/2011
05/2011
04/2011
BaseLine 1.00.018
The Trust achieved the national A&E
standard for 2012/13, with 96.9% of patients
attending being seen and treated within 4
hours. This includes attendances at both the
Ealing Hospital Emergency Department and
the Urgent Care Centre operated and
managed by Care UK. Overall attendances to
either unit on the Ealing Hospital site rose by
1.4% compared to 2011/12, from 102,923 to
104,578.
Although the overall target on a site basis
was achieved, the Ealing Hospital Emergency
department for the year was 93.1%, below
the 95% standard.
Performance was
particularly challenging in the last quarter of
the year (January to March 2013), which saw
an overall increase in attendances to the
Emergency Department of 4.8% compared to
the same period in 2011/12. A range of
mitigating actions has been agreed with
Commissioners and this standard remains a
high priority for the Trust, working with our
healthcare partners, to deliver in 2013/14.
The Trust made significant progress in
reducing the number of delays exceeding one
hour in the handover of patients between
ambulance and A&E from 53 in 2011/12 to 13
in 2012/13.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
Page 73 of 119
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2012/13 Quality Account
18 Week Referral to Treatment
Indicators
Standard
18 week referral to treatment - admitted
patients
18 week referral to treatment - non
admitted patients
Performance
greater than or
equal to 90%
greater than or
equal to 95%
93.7%
98.6%
We monitor two key elements to help us do
this:
Data source: UNIFY2
a) The percentage of patients whose
treatment ends at the outpatient stage
(non-admitted).
% admitted patients seen w ithin 18 w eeks
100
98
96
94
92
90
88
86
84
82
80
78
76
74
72
70
2011/12
In working to reduce waiting times and
improve clinical outcomes, we focus on the
whole pathway to help manage our capacity
more effectively.
2012/13
b) The percentage of patients whose
treatment ends with an admission
(admitted).
03/2013
02/2013
01/2013
12/2012
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
11/2012
Period
10/2012
09/2012
08/2012
07/2012
06/2012
05/2012
04/2012
03/2012
02/2012
01/2012
12/2011
11/2011
10/2011
09/2011
08/2011
07/2011
06/2011
05/2011
04/2011
BaseLine 1.00.018
In overall terms, the Trust achieved all
Referral to Treatment standards in 2012/13.
During the year, a small number of specialties
experienced pressures in demand which
required remedial actions to rectify. Once
again, the specialty with the largest excess
demand (when matched to contracted levels)
was Oral Surgery. This resulted in a
suspension of service for routine referrals
from December 2012 to March 2013.
The Trust will continue to deliver optimal
waiting times to national standards in 2013/14
in line with commissioned levels of activity.
Page 74 of 119
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2012/13 Quality Account
6 Week Diagnostic Waiting Times
Indicator
Standard
Diagnostic patients waiting
longer than 6 weeks
Acute Services
Performance
0.0%
less than or
equal to 1%
Community
(Audiology)
0.1%
Data source: UNIFY2
In 2012/13, for diagnostics provided by
Ealing Hospital, the standard of no more
than 1% waiting over six weeks was
achieved. This is shown in the adjacent
table and graph.
% patients w ith diagnostic w ait over 6 w eeks
5.0
2011/12
For many patients, diagnostic tests form a
core and essential path within their
treatment. To ensure that these tests are
carried out promptly we closely monitor
waiting times for a set of 15 nationally
defined tests, including daily internal
tracking and weekly external reporting.
2012/13
4.5
4.0
3.5
3.0
2.5
2.0
1.5
1.0
0.5
0.0
03/2013
02/2013
01/2013
12/2012
11/2012
10/2012
09/2012
08/2012
07/2012
06/2012
05/2012
04/2012
03/2012
02/2012
01/2012
12/2011
11/2011
10/2011
09/2011
08/2011
07/2011
06/2011
05/2011
04/2011
BaseLine 1.00.018
Period
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
Page 75 of 119
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2012/13 Quality Account
Cancer Waiting Times
Indicators
Standard
Performance
2 week wait for suspected cancer
greater than or
equal to 93%
94.3%
2 week wait for breast symptoms other than
suspected cancer
greater than or
equal to 93%
93.7%
31 day diagnosis to treatment for first
definitive treatment
greater than or
equal to 96%
98.3%
31 day diagnosis to treatment for subsequent
treatment (drugs)
greater than or
equal to 98%
100.0%
31 day diagnosis to treatment for subsequent
treatment (surgery)
62 day urgent referral to treatment for first
definitive treatments (GP & Dental)
greater than or
equal to 98%
100.0%
greater than or
equal to 85%
81.5%
62 day urgent referral to treatment for first
definitive treatments (screening)
greater than or
equal to 90%
40.0%
62 day urgent referral to treatment for first
definitive treatments (consultant upgrade)
greater than or
equal to 85%
95.2%
Data source: National Cancer Database
Ensuring that patients with suspected
cancer receive prompt diagnosis - and
treatment if required - is key to improving
cancer outcomes.
In respect of cancer waiting times, the
Trust reports against eight national
performance standards, as shown. Six of
these standards were met in 2012/13.
Unfortunately, the Trust has not achieved
the 62 day pathway standards for
referrals from GP & Dental and the
national screening service for a second
consecutive year. Whilst the volume of
patients
for
these
pathways
is
comparatively low, the Trust recognises
the need to ensure each and every
patient receives care to the highest
possible standard. To this end, in Quarter
4 we requested the assistance of the
National Intensive Support Team to
review our processes and identify
remedial actions to improve performance.
The key findings of this review, received
in May 2013, are set out overleaf.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
Page 76 of 119
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2012/13 Quality Account
Cancer Waiting Times – Intensive Support Team Review
Key issues identified

Pathways that cut across providers contribute to a large proportion of the breaches. Communications between the
Trust and other provider organisations to resolve these pathway issues and define appropriate escalation
procedures, have not been effective enough

Limited clinical and managerial engagement around delivery of cancer performance standards

There is a need for more robust, systematic, demand and capacity modelling and planning

Internal tracking reports are basic and give a retrospective view, hence not supporting proactive management.
Action Plan
The Trust‟s proposed action plan and formal response to all review recommendations will be submitted to Trust Board for
formal approval in July 2013.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
Page 77 of 119
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2012/13 Quality Account
Venous thromboembolism (VTE)
Indicator
VTE risk assessment for inpatient
admissions
Standard
greater than or
equal to 90%
Performance
93.5%
Data source: UNIFY2
% VTE assessments
100.00
2011/12
VTE is a condition in which a blood clot
(thrombus) forms in a vein. VTE embraces
both the acute conditions of deep vein
thrombosis (DVT) and pulmonary embolism
(PE).
The requirement to carry out VTE risk
assessments became mandatory in
2010/11. The minimum national standard of
achievement is for at least 90% of patients
to receive a risk assessment upon
admission.
2012/13
98.00
96.00
94.00
92.00
90.00
This is a clinically led programme, with
significant focus on ensuring compliance
across the whole organisation. Delivery of
the VTE standard is also a national CQUIN
target.
88.00
86.00
84.00
82.00
80.00
03/2013
02/2013
01/2013
12/2012
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
11/2012
Period
10/2012
09/2012
08/2012
07/2012
06/2012
05/2012
04/2012
03/2012
02/2012
01/2012
12/2011
11/2011
10/2011
09/2011
08/2011
07/2011
06/2011
05/2011
04/2011
BaseLine 1.00.018
The Trust has made continuous and
sustained progress in meeting this clinical
standard and achieved performance of
93.5% for 2012/13.
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2012/13 Quality Account
Healthcare-acquired infections (HCAIs)
Methiciliin-resistant Staphylococcus aureus (MRSA)
Indicator
Hospital acquired MRSA Bacteraemia
Standard
less than or
equal to 1
Data source: Public Health England
Performance
2
MRSA is a bacteria that is carried on the
skin and can cause serious infection in
vulnerable patients. The most serious
consequence of MRSA is a blood stream
infection (MRSA bacteraemia) and these
cases are tracked and reported to the
Department of Health.
The Trust has seen a sustained reduction in
MRSA bacteraemia over the past 10 years.
The target for the Trust in 2012/13 was set
at no more than 1 hospital-acquired case.
The Trust reported two cases for the year,
one above the target. The total number of
cases was equal to the number for last year.
We continue to maintain a clear focus on
preventing all possibly avoidable healthcare
acquired infections.
For 2013/14 the national standard has been
set at zero cases.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
Page 79 of 119
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2012/13 Quality Account
Clostridium difficile (C. diff)
Indicator
Hospital acquired Clostridium Difficile
Standard
less than or
equal to 18
Data source: Public Health England
Performance
15
C. diff is a bacterial infection of the intestine
which causes severe diarrhoea. It occurs
most frequently in the healthcare setting
after use of antibiotics although increasingly
cases are being reported in the community.
The Trust has seen a steady reduction in C.
diff cases over the past 5 years and
achieved the required standard in 2012/13.
During this period we reported 15 cases of
C. diff compared to 23 in 2011/12.
The full year target for 2013/14 has been set
at 17 cases.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
Page 80 of 119
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2012/13 Quality Account
Maternity Services
Indicator
Caesarean Section Rate (planned)
Caesarean Section Rate (emergency)
Standard
less than or
equal to 12%
Mothers not smoking during pregnancy
Mothers breast feeding upon discharge
from hospital
Women booked before end of week 12 of
pregnancy
Data source: Ealing Hospital NHS Trust
Performance
10.1%
17.5%
94.4%
greater than or
equal to 90%
85.5%
98.2%
The overall assessment of maternity services is measured across
a broad spectrum of key performance indicators (KPIs).
The Trust has continued to develop and enhance our „maternity
scorecard‟, in partnership with commissioners, during 2012/13 to
manage and monitor delivery of maternity services. A copy of the
full scorecard report is available upon request and is reported to
the Trust Board once every three months.
The Trust has worked hard to improve quality of maternity services
during the year and some of these achievements are set out
overleaf. The Trust is pleased to report significant and
demonstrable improvements in performance during 2012/13, and
these have been recognised and acknowledged by
Commissioners.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
As described in last year‟s Quality Account, the
Trust has implemented the recommendations of
the external maternity services review which was
carried out in 2011/12.
The Trust has maintained its level 1 assessment
score in respect of the Clinical Negligence Scheme
for Trusts (CNST) assessment.
The target rate for Caesarean Sections, as a
proportion of total deliveries, was set at 12% for
2012/13. For planned caesarean‟s the Trust
achieved this target. For emergency caesarean‟s
the Trust achieved a rate of 17.5%, which although
exceeded the target, did represent a significant
improvement on the rate in 2011/12.
The other key maternity quality indicators of the
proportion of mothers not smoking during
pregnancy, mothers breast feeding upon
discharge from hospital and to have seen a midwife
or healthcare professional for health and social
care assessment of needs, risks and choices by 12
weeks and 6 days of pregnancy. The Trust
achieved two out of these three standards. For the
breast feeding at discharge, the Trust has now
recruited a specialist breast feeding midwife, which
will support improved compliance rates in 2013/14.
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2012/13 Quality Account
Maternity Services - Staff Pledge and Commitment to Care.
Following the external review carried out in 2011/12, the resultant action plan was overseen and monitored by an overarching Steering Group with senior Executive and Non-Executive representation. Some of the key service improvements
the Trust has implemented are set out below:
Staff have pledged to:





Value the opinions and contributions of everyone we work with
Treat everyone as we would like to be treated ourselves
Develop a culture of giving and receiving constructive feedback and
challenge bad behaviour
Communicate effectively with everyone
Use every opportunity to progress our maternity service keeping women
and babies as our focus
Commitment to Care
Staff were surveyed for their ideas about „what does good look like‟ and the
findings were collated into a Commitment to care campaign with badges,
posters and a welcome banner.
Care Pathways
The Trust revised a number of maternity care pathways, using best practice and evidence based information. The
pathways were agreed with wider medical and health care partners, for example, Mental Health staff and GPs, to ensure
that women can access appropriate and seamless care from the beginning to the end of their maternity care.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
Page 82 of 119
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2012/13 Quality Account
Access to Services
The maternity team have worked with Public Health and local Commissioners to increase the number of women
accessing maternity care before the end of the 12th week of pregnancy. It is recognised that access to care as early as
possible in a pregnancy allows the woman greater choices of screening and care pathways, both for herself and her baby.
The ASAP (As Soon As you are Pregnant) campaign which is a poster/information card giving information, both pictorial
and word format, to encourage early contact with maternity services.
There is also a direct referral system for women to access the service without having to see their GP first. This can be
accessed via the Trust website, paper form or face to face contact with a midwife in the Children Centres.
Facilities
The maternity department has also seen physical improvements this year. There is now a three bedded, low risk,
Induction of Labour bay in the ward area, two refurbished triage rooms and a defined Birth Centre. The Birth Centre has
three rooms, two with birthing pools, plus access to an inflatable pool. The hospital was delighted to welcome Professor
Cathy Warwick to formally open the Birth Centre in April 2013.
User Feedback
Maternity services have revitalised their patient/user feedback mechanisms. There are „drop coin boxes‟ for instant
feedback which rotate around the different areas of the department and also the option for written feedback/comments.
The Head of Midwifery, Matron and Ward Manager regularly walk around the wards to talk to mothers and families to gain
real time feedback from women. The members of the Maternity Service Liaison Committee also undertake a „walk the
patch‟ exercise to understand women‟s experiences and gather information to assist the continual improvement of the
service.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
Page 83 of 119
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2012/13 Quality Account
Some examples of the comments we have received presented below:
“All staff are very kind
and nice and helpful. I
was worried how I will
handle my baby alone
but now I am very
happy and did not miss
my family because you
were like my family”
“I had a very quick labour and for
the first time tried water as pain
relief. I found it amazing”
“… and did all your best to deliver my baby
safely although my labour and delivery
weren‟t the easiest ….”
“I wanted to express my thanks to all
the midwives at Ealing for the
fantastic experience I had. I will
definitely be recommending Ealing as
a first choice of birth place to all my
friends and family”
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
“The staff have been exceptional.
The staff have been wonderful –
friendly, caring and professional,
thank you so much”
Page 84 of 119
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2012/13 Quality Account
Pharmacy Services - Medicines Management
Medicines management is one of the essential services required to support safe, high quality and efficient care to our
patients, whether as an inpatient or an outpatient. The following sets out examples of quality and safety improvements
made to the service during 2012/13, which were quality priorities committed to in our prior year Quality Account.
Patient involvement and feedback
Following implementation of the WardPro patient survey, in 2012/13 we collected feedback from over 2,400 outpatients
(as summarised in the table below). This has allowed us to identify areas for further work in promoting improved patient
experience. An example of this is the introduction of a new outpatient seating area in response to many comments
collected on WardPro. Our target is to collect responses from approximately 50 patients per week, with the results being
reviewed at our weekly dispensary meeting.
Month
April 2012 – June 2012
July 2012 – September 2012
October 2012 – December 2012
January 2013 – March 2013
Total
Number of
Responses
547
543
705
644
2439
Overall Patient
Score (%)
84.7
84.8
92.9
97.3
89.9
The results show that over the year we achieved an overall 89.9% patient satisfaction score with the outpatient pharmacy
service provided, with a clear improvement in the second half of the year, as we responded to the feedback provided.
For 2013/14 we are looking to add a similar version of the “friends and family question” to allow us to determine how likely
patients would be to use our service again in the future and to bench mark with pharmacy departments in other Trusts
who have similar technology in place.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
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A baseline inpatient pharmacy survey was conducted in July 2013. We received responses from 203 patients who were
asked about whether they were given the opportunity to discuss their medications with the ward pharmacy team. This
included patients views on whether the ward pharmacy team informed them about changes to medications, any side
effects and whether they understood the information given.
Overall the results were very positive, although they do help reinforce our commitment to ensure that all patients are given
the opportunity to discuss their medications with the ward pharmacy team. It is encouraging that 92% of patients reported
they had understood the information when given.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
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Outpatient Prescriptions
For outpatients we have implemented a Prescription Tracking System that facilitates the management of all outpatient
prescriptions. The system allows tickets to be issued, further supporting the counselling process in confirming patient
identity and reducing errors. The system has recently been upgraded and now provides functions such as text messaging
alerts when prescriptions are ready, an enhanced warning system highlighting when prescriptions will breach target
waiting times and a message board to communicate information to patients. Using the system we have shown continued
improvements in reducing outpatient waiting times, with 100% adherence to our target average of less than 25 minutes.
Inpatients Service
The implementation of a pharmacy discharge team during 2012/13 has led to reductions in turnaround times for
discharge medicines and an increase in the number of patients counselled on their medicines at discharge (and during
their inpatient stay). This indicator has improved from less than 100 patients per month in early 2012, to over 240 patients
per month from December, rising to more than 300 in March.
This work has also supported improvement in the majority of medicines related questions within the inpatient survey that
are focussed around discharge (when compared with prior year), as summarised below.
Discharge: not fully told purpose of medications
Discharge: not fully told side-effects of medications
Discharge: not told how to take medication clearly
Discharge: not given completely clear written/printed information about medicines
Discharge: not fully told of danger signals to look for
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
improved
Improved
improved
improved
same
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Pressure Ulcers
Total number of reported Pressure Ulcers developed in the ICO
Grade 1 & 2
Location
Grade 3 & 4
2011/12
2012/13
2011/12
2012/13
Ealing Hospital
62
107
2
11
Brent Community Services
36
10
15
21
Ealing Community Services
97
140
62
54
Harrow Community Services
Total
37
232
28
285
4
83
14
100
Data source: DATIX
The identification and treatment of pressure ulcers is a
key measure of nursing quality and safety. When
pressure ulcers occur they can have severe
consequences for patients and can increase the length
of time patients spend in hospital or remain under the
care of community services.
Over the last 12 months Ealing Hospital Trust has seen
an increase in the number of pressure ulcers reported.
These results are disappointing, although it is likely that
this increase will in some part reflect greater staff
awareness of incident reporting requirements.
The reduction of pressure ulcers remains a key priority.
During the year we have implemented a range of improvement strategies at service and patient level, including:






Increased training and enhanced risk assessments for staff within both acute and community services
More timely intervention from Tissue Viability Specialist Nurses
Improved Care Planning for patients to ensure that equipment is provided in a more timely manner
Information leaflets for patients and families to educate and support carers around prevention of pressure ulcers
Working more closely with social care colleagues to ensure that there is consistent best practice applied across
both health and social care.
Two-hourly Care Rounds embedded at Ealing Hospital (commenced from October 2011).
Pressure Ulcer Grade
Definitions:
Grade 2: Partial thickness skin loss
Grade 3: Full thickness skin loss involving damage to subcutaneous tissue (the deepest layer of skin)
Grade 4: Full thickness skin loss involving muscle, bone or supporting structures
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
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Patient Falls
of which:
Number of falls resulting in:
low, moderate or severe harm
2011/12
2012/13
Total number of reported falls
Location
2011/12
2012/13
Ealing Hospital
527
504
133
25.2%
136
27.0%
Brent Community Services
173
84
31
17.9%
14
16.7%
Ealing Community Services
195
94
78
40.0%
0
0.0%
Harrow Community Services
111
105
39
35.1%
9
8.6%
Total
1,006
787
281
27.9%
159
20.2%
Data source: DATIX
Falls make up one of our most
frequently reported clinical incidents
and can be very distressing for
patients and their families, even when
no harm has been sustained. The
majority of these incidents result in no
harm but clearly it is very important to
track these events and take action to
reduce falls that lead to patient harm.
The Trust has taken a number of steps
in 2012/13 to ensure that we
strengthen our approach to minimising
the risk of patient falling
We are pleased that the number of falls has reduced by 17%, and the number of patients who have sustained harm as a
result of falling has also been reduced by 14%. These improvements have been achieved through the following
measures:






Care Rounds audit showed that 97% of patients had a falls risk assessment completed
Increased staffing in key areas where patients are at higher risk of falling
Greater use of lower level beds, with lights under them that assist patients in orientating themselves at night
All wards implementing „nurses in the bay at all times overnight‟
Increased falls awareness via new training packages
Stock of non-slip socks on all wards.
Safeguarding and Looked After Children
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
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Safeguarding and Looked After Children
Safeguarding Arrangements
There have been a number of national profile cases in recent times which have highlighted the need for all organisations
to be vigilant in ensuring the dignity, respect and safety of patients in high risk groups is at all times maintained.
In response to these cases the organisation has undertaken a comprehensive review of its arrangements with a specific
focus on safeguarding access to patients, including that afforded volunteers or celebrities and listening to and acting on
patient concerns. In addition the Winterbourne Review into the care and treatment of clients with learning disabilities has
set out some clear recommendations in relation to this group. In response to these national drivers and lessons learnt
from incidents within our own organisation the following steps and improvements have been made.




Policies and procedures have been strengthened in relation to protecting vulnerable patients, these include our VIP
policy, Volunteers Policy, Visitors Policy and Work Experience Policy
Agreed and rolled out clear guidance around Mental Capacity Assessment
Implemented a Community Learning in Disabilities Group
Strengthened patient transfer protocols.
During the summer of 2012, we engaged more proactively with the government‟s strategy to tackle terrorist activity. The
Prevent Strategy, re launched in 2011, seeks to stop people becoming terrorists or supporting terrorism. From a health
perspective the strategy is aimed at supporting health care workers to identify vulnerable patients who present in health
care and are vulnerable to being radicalised. The activity across our Trust services during the summer was primarily
driven in response to the growing concern of potential increased terrorist activity during the Olympic Games. To date the
Trust now has four Home Office approved trainers – and we have trained 60 frontline staff in support of the Prevent
Strategy.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
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All Trust recruitment practices follow the six NHS Employment Checks standards and we only use Agency staff from
framework agencies who meet these standards. Safer Recruitment is covered as part of the recruitment training.
Disclosure & Barring Service was launched on 1st December 2012 and the Trust has implemented changes in line with the
recommendations.
There are named professionals across the organisation to lead on issues in relation to safeguarding children and young
people. The Director of Nursing is the Trust‟s Executive Director lead for Safeguarding Children across our Integrated
Care Organisation, reporting directly to the Trust Board on issues relating to Safeguarding Children and Young People.
The Trust is also represented on the Local Safeguarding Children Board and relevant sub-groups.
Ealing Hospital NHS Trust has a robust safeguarding/child protection training matrix and strategy in place with regard to
delivering safeguarding/child protection training that reflects local and national requirements. This training is mandatory
for all staff working in the organisation.
Reviews & Audits
They have been a number of local Safeguarding audits that have taken place this year:




Health Visitors Enhanced Case Load Audit
Progress Against E-Safety Strategy
Readmissions Audit and Maternity Records Audit (Care Quality Commission)
Paediatric Safeguarding and Mental Health A&E Audit
During 2012/13 there have been no new serious case reviews and no Independent Management Reviews.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
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Safeguarding Children
The Trust‟s three borough-based Community Services directorates have each made progress in terms of responsibilities
for the safeguarding of children following CQC/OFSTED inspections. For Ealing and Harrow the overall effectiveness
rated as „Good‟ and for Brent the rating was „Adequate‟.
In the current climate of increasing demand for these services, the Trust has invested additional resources to support
delivery of these services to expected standards, and to target service improvement where these have been highlighted in
external inspections. For example, in Harrow we have appointed a new Safeguarding Children Advisor. This has resulted
in a significant increase in Child Protection supervision and Safeguarding Children training. In addition, the Safeguarding
Children Team also ensures that systems and processes are in place to safeguard children and young people and
promote their welfare.
The challenge for 2013/14 is the increase in pressures on families and the improved collective ability of practitioners,
agencies and the public to identify children who need protection. This has huge implications on how the Safeguarding
Children Service works to support front-line practitioners who work directly with children and families (e.g. Health Visitors,
School Nurses) and those working in adult services, in responding effectively to the needs of these vulnerable groups.
Looked After Children (LAC)
In Brent, the OFSTED/CQC multi-agency inspection of services for Safeguarding and Looked after Children (LAC) in
October 2011 gave a grading for Looked After Children services across the Borough of „adequate‟, but specifically
highlighted the “Be Healthy” component of LAC as „inadequate‟. The key issues identified by the inspectorate related to
the quality and timeliness of the health assessments undertaken and a lack of joined up working between health and
social care. A Joint Task and Finish Group was therefore established to oversee the implementation of the Improvement
Action Plan between November 2011 and June 2012, comprising of membership from Brent Community Services, the
Local Authority and NHS Brent.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
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During the year external audits were undertaken of LAC health assessments in Brent in order to assess the level of
improvement in quality. Although initially these demonstrated an improvement, unfortunately performance deteriorated
towards the end of the year. In response the Trust developed an urgent remedial action plan whose implementation is
being closely monitored by the Trust‟s Safeguarding Children‟s Group. We will continue to prioritise improving quality in
this service during 2013/14 and providing an appropriate level of assurance internally and to our commissioners. The
Looked after Children pathway is complex and is delivered in partnership by both health and social care. Work has also
been undertaken to review how the agencies work together to share information and to clarify roles and responsibilities in
line with national guidance.
For Ealing, Community Services provide an integrated service for LAC with the London Borough of Ealing. There is
currently a joint action plan in place with Ealing CCG and London Borough of Ealing to redress a number of issues
identified in respect of a backlog of LAC health assessments and plans. Delivery of this plan is monitored on a regular
basis. As part of these actions, the service is also in negotiations with Ealing CCG to expand the resources in the team
on a recurrent basis.
In Harrow, the overall effectiveness was rated as „adequate‟ but the “Be Healthy” component was deemed „inadequate‟. A
number of areas for improvement were identified as follows:




All Looked After Children have access to timely, comprehensive health assessments
All Looked After Children to have comprehensive and meaningful healthcare plans
Improved record keeping
Enhanced supervision processes required
Significant progress has been made against these actions and these will continue to be closely monitored and reported.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
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Tri-Borough Community Services
Service integration
Since the inception of the ICO in April 2011, the strategic intent of the organisation continues to be the effective
integration of appropriate clinical services across the three community boroughs in line with the agreed business case.
The integration of services has several recognised benefits including:




Better services for patients through harmonised clinical practices
Standardised operating procedures and policies
Delivery of best practice across all boroughs, thus realising efficiency gains
Flexible deployment of staff, supported by clear and structured leadership
Work has taken place throughout the past two years on these goals, with examples relating to both the Podiatry and
Dental services. This has included both internal and external involvement and engagement.
Health Visiting
The recruitment and retention of Health Visitors is a recognised issue nationally, and this is reflected in vacancy rates
both across the ICO and London as a whole. There are a multitude of reasons for this, including a workforce approaching
retirement age, variation in Inner and Outer London pay and an overall reduction in the numbers of newly qualified Health
Visitors wishing to work in areas of higher social and economic deprivation. The three community borough services are
working closely together in the ICO Health Visiting group to develop a Trust wide initiative, „Embracing the Best‟, aimed at
developing local initiatives to improve recruitment. This includes regular meetings with CCGs and the Local Authority, to
discuss current pressures and agreement of action plans and recruitment strategies.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
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Communications with Primary Care
In 2012/13 Commissioners identified communication between Community services and General Practice as a key priority
in improving the quality of care provided to patients. This requirement was applied to both District Nursing and Health
Visiting and required meetings on either a fortnightly or less frequent i.e. monthly or six-weekly basis, dependant on the
number of registered patients at each GP practice. In general the Trust has struggled to meet this requirement although
performance has improved during the year. This will continue to be an area of focus for 2013/14.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
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Brent Community Services
District Nursing Service
“Case Management” was piloted as an integral part of the District Nursing Service in Brent in 2011. This is where a
patient‟s care is co-ordinated and proactively managed by a central professional and is particularly helpful for supporting
patients with a Long Term Condition, e.g. diabetes, heart failure and to reduce the need for admissions to hospital. The
pilot was evaluated and it was agreed with commissioners at NHS Brent to extend it across the borough in 2012/13.
There have been some real benefits for patients that we have been able to measure and quantify. The amount of time
that clinicians have been able to spend directly with patients has increased significantly from 55% to 80% which has been
sustained over time. Furthermore, a review of 50 case-managed patients identified a 50% reduction in the likelihood of
further emergency admissions in the six months after a case management referral had been made. Patient and staff
feedback has indicated an increased level of patient confidence in managing their own health or long term condition.
Supporting the Development of Integrated Care Pathways
A major theme throughout 2012/13 was supporting the implementation of Integrated Care Pathways (ICPs). Members of
the District Nursing Service and the Diabetes Specialist Nursing Team have been actively involved in attending local
Multi-Disciplinary Group meetings for Elderly Care and Diabetes respectively to ensure that the pathways of care for
these patients are clear and that effective care planning arrangements are in place so as to facilitate hospital admissions
avoidance.
Consistent with Ealing and Harrow, strident efforts have been made by the District Nursing Teams to improve regular
communications with local GP Practices in response to Commissioner requirements.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
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Nutrition and Dietetics Service
The M.A.P (Move Away from Pre-diabetes) Programme is a unique, clinically and cost-effective programme delivering
significant health improvements for people at risk of developing diabetes. Patients are identified through the NHS Health
Checks Programme. M.A.P. also works towards reducing the health risks of obesity, as 75% of those referred are
overweight or obese.
The bespoke service includes tailored expert dietetic support and free access to the local leisure facilities. Of the patients
who have completed the programme, 70% have improved their blood glucose levels and 30% have moved out of prediabetes, increasing the number of years they are disease-free and providing financial benefits to the local health
economy. The Brent Local Authority Taskforce Report supports the preventative agenda and takes the approach that the
prevalence of diabetes has to be tackled by managing obesity and preventing diabetes in the highest risk patients.
Step-up Beds Service
A new Step-up Beds Service commenced at Willesden Community Rehabilitation Hospital in May 2012. Since then it has
prevented the need for over one hundred admissions to acute hospital care. The beds generally care for patients who are
too unwell to be at home, but do not require specialist acute care at this time. Admissions to step up beds come from
either the A&E department or directly from a referral from the community (usually via a GP) which are vetted by the Brent
STARRS Rapid Response Team. The expected length of stay for patients is a maximum of ten days and the discharge
arrangements often involve Social Services, District Nursing and Case Management.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
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Ealing Community Services
Adult Diabetes Service
In 2012/13 the community diabetes team expanded the current community service opening a third clinic in Ealing
Hospital, recruiting a new Diabetes Nurse Specialist to increase the service and a Nurse Consultant who comes to Ealing
with significant experience from a neighbouring Trust.
Intermediate Care
This service started in October 2012 and is based on the 9 th floor of Ealing Hospital. The service provides an admission
avoidance service for GP or A&E referrals, 7 days a week, 8am to 8pm with a team of multidisciplinary staff including
doctors, nurses, therapists and social services staff.
On referral the service will make contact with a patient within 2 hours and be with them within 4 hours. The service can
provide immediate support assessing a patient and putting in place a plan of care for up to 3 days with the aim of helping
to keep the patient at home and avoiding unnecessary admission. If additional support is required then a patient may be
admitted to a nurse led ward at Clayponds hospital for a short stay. If necessary patients will be sent to A&E if the team
believe their condition requires more significant assessment and or emergency admission. Between October 2012 to
March 2013 referrals were taken by the team from 65 (out of 79) GP practices in Ealing.
Musculoskeletal Services (MSK)
Ealing provides a popular Musculoskeletal service for patients which has seen a significant increase in demand for
physiotherapy in 2012/13. The service will be extended during 2013 to take more referrals directly from all GPs in Ealing
for assessment and management. In this way patients who need access to physiotherapy and other care can be offered
this quickly and effectively including early assessment of those who need to be referred straight on to a consultant
orthopaedic surgeon for treatment.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
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Harrow Community Services
Health Visiting Service
It is clearly established that the start of life is a crucial time for children and parents in laying the foundations of good
health and wellbeing in later years, which contributes to a strong and stable society. The Department of Health‟s “Health
Visitor Implementation Plan (HVIP) 2011- 2015 – A Call to Action” (DH 2011), acknowledges the crucial role health
visitors play in facilitating this. Harrow Community Services is fortunate in having high quality Health Visitors and we are
extremely pleased that a member of our staff Tanya Dennis won the UK Health Visitor of the Year Award 2012. This is a
testament to her hard work and commitment to the service.
Breastfeeding Support Service
Harrow is well served with Breastfeeding support services. There is a breastfeeding team consisting of 2 breastfeeding
peer support co-ordinators and approximately 28 breastfeeding peer supporters, who are local mothers who volunteer to
support other breastfeeding mothers. There are numerous breastfeeding support groups throughout the week, a local
breastfeeding support website (www.breastfeedinginharrow.org), and breastfeeding peer supporters who can provide
telephone support and carry out home visits. As a direct result of all the work around breastfeeding, Harrow had now
achieved both stage 1 and stage 2 accreditation from the UNICEF Baby Friendly Initiative. The third and final stage
assessment to receive full Baby Friendly accreditation took place during 2012 and Harrow Community Services was
formally awarded the prestigious title of “Baby Friendly” status in December 2012. Harrow is the second Community
service in London to have achieved this status.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
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Urgent Care Centre (UCC) at Northwick Park Hospital
An updated Urgent Care Centre model of care was implemented in June 2012, with the operational delivery of the service
now sub contracted to a private provider, Greenbrook. However, the Trust retains the overall responsibility for the running
of the service and overseeing the sub-contractor‟s provision.
Since June 2012 the Urgent Care Centre has been open 24 hours a day, 7 days a week, and has developed its pathways
and increased the range of services that it provides. This has had a positive impact in helping to manage overall
pressures on A&E and urgent care services at Northwick Park Hospital. Approximately 46% of patients presenting on the
Northwick Park site are now seen solely within the Urgent Care Centre.
The Urgent Care Centre now has the capacity and capability to treat patients attending with minor injuries. The nursing
staff continue to enhance their skills by attending minor injury and minor illness courses so all are fully qualified to treat all
attendances at the Urgent Care Centre.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
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Incident Reporting
Reporting of both clinical and non-clinical incidents has continued to increase in 2012/13. The Trust considers that this
increased reporting is a positive sign that our staff have raised pro-active awareness of risk identification and reporting.
Total number of reported incidents
Ealing Hospital
Indicator
2011/12
2012/13
% change
2,766
2,575
(6.9%)
Non-clinical Incidents
646
583
(9.8%)
Medication Incidents
Total
252
3,664
362
3,520
43.7%
(3.9% )
Clinical Incident
Community Services
Indicator
2011/12
Clinical Incident
Non-clinical Incidents
Medication Incidents
Total
2012/13
1,053
Data not
available
All clinical incidents are reported every month
to the National Patient Safety Agency. The
Care Quality Commission also receives
anonymised information on all incidents with a
risk score of „moderate‟ or „major‟. The Trust is
committed to the promotion of a learning and
fair blame culture in which staff are able to
report all incidents. The Trust‟s Clinical
Governance Committee reports to the Trust
Board and is required to monitor the
implementation of all action plans following
serious incidents. Incidents are also used
[anonymously] as case studies to ensure we
share the learning from patient safety incident
investigations. Again, the aim is to reduce
incident occurrence.
345
65
1,463
Data source: DATIX
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
From 2013 the Trust will also implement the
Duty of Candour and ensure that patients,
relatives or carers of incidents that are scored
Moderate or above are informed about the
incident and (where appropriate) this will be
followed up in writing.
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Never Events
„Never Events‟ are incidents that can lead to serious patient harm which are considered to be completely preventable if
best practice and policies are adhered to. A national policy on Never Events was introduced in the NHS from April 2009.
This policy is designed to promote transparency and accountability when serious patient safety incidents occur.
In 2012/13 the Trust reported three incidents categorised as Never Events, two related to retained vaginal swab postdelivery and one related to a retained glove fragment post abdominal surgery. All never events are investigated through
root cause analysis (RCA) and discussed with Commissioners through appropriate governance forums.
Contractual Notices
The Trust was in receipt of a number of contractual notices from Commissioners in 2012/13 in respect of nonachievement of a number of contracted quality standards. Most of these related to Brent and Harrow community services,
with one concerning acute services in respect of A&E performance. Financial penalties were levied in respect of the
community notices.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
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Patient Experience and Inpatient Survey
Understanding and responding to what matters to patients is central to our approach in driving improvements in care
across our services. We are therefore pleased that significant progress have been made across many areas in 2012/13,
notably the National Inpatients survey, Accident and Emergency and the adult inpatient survey.
Responses to the National Patient Survey
2011
2012
2012 vs 2011
Questions about the emergency / A&E department
7·2/10
8.2/10
Improved
Questions about waiting lists and planned admissions
6·8/10
9.0/10
Improved
Questions about waiting to get to a bed on a ward
6·8/10
6.8/10
Same
Questions about the hospital and ward
7·5/10
7.8/10
Improved
Questions about doctors
7·8/10
8.3/10
Improved
Questions about nurses
7·4/10
7.6/10
Improved
Questions about care and treatment
6·6/10
7.2/10
Improved
8/10
8.3/10
Improved
Questions about leaving hospital
6·5/10
6.9/10
Improved
Questions about overall views and experiences
5·4/10
4.8/10
Worsened
Questions about operations and procedures
It should be noted that the national survey questions, and number within each theme, varies between years. Therefore,
although a direct comparison of questions is not possible, the results by theme do provide a valid picture of overall trends.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
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We continue to implement measures that ensure we are capturing real time patient feedback at the front line, specifically
the Friends & Family Test and „Back to the Floor‟ walkabouts by the senior nursing team and executive directors.
Nonetheless, we recognise that further work is required, particularly in Community services, to better understand and
respond to the experiences of all patients and carers who access our services.
Friends and Family Test has been rolled out to all areas and we are consistently achieving the target response rate. The
overwhelming majority of patients tell us that they are extremely likely or likely to recommend our services to Friends and
Family. Communication materials and leaflets have been made available for patients and members of the public.
We successfully applied to Macmillan Cancer Care for a grant to create an information room in outpatients, for use by
patients and by the Macmillan Nurses to provide one to one support post diagnosis of cancer. The Macmillan Oncology
Nurses have all received training for providing Cancer Information Prescriptions, with the aim to provide tailored
information for patients based on their information needs. We have updated all clinic letters so that patients are aware
they can bring a friend or relative to their hospital appointment for support. We aim that by the end of 2013 all
Multidisciplinary team members who have direct contact with Cancer patients will have completed their Advanced
Communication Skills Training. Nursing staff and allied health professionals in the hospital have been attending the 3-day
principles of Cancer Care Course at the Royal Marsden School.
In outpatients we have strengthened the way we communicate to patients in relation to waiting times in clinic areas, and
we have adapted the outpatient letter to include how and when patients will receive their test results.
On other key service areas, improvements include:




Refurbishment of the cardiac catheter area to maximise privacy and dignity for patients
„This is me‟ approach for patients with dementia, together with developing information for carers of patients with
dementia.
„Ward-Pro‟ real time feedback tool in Pharmacy, enabling us to swiftly identify and respond to concerns of patients
Revised the times, schedule and location of BCG clinics in Harrow in response to patient feedback.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
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Review of Quality Performance 2012/13
2012/13 Quality Account
Complaints
Number of formal complaints received and responded to within 25 days
2011/12
2012/13
% change
Response
rate %
Ealing Hospital
219
167
(23.7%)
87.0%
Brent Community Services
28
20
(28.6%)
80.0%
Ealing Community Services
23
37
60.9%
81.0%
Harrow Community Services
19
31
63.2%
93.0%
Total
289
255
(11.8%)
85.0%
Location
Data source: Ealing Hospital NHS Trust
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
We are very concerned when
patients have not had a positive
patient experience. We are
committed to responding to their
concerns in a timely and sensitive
way, ensuring that we learn from
the things that have gone wrong
and put things in place to prevent
them from happening again.
Performance in respect of response
times is summarised in the table
shown. Further work will be
undertaken in 2013/14 to ensure
that we are more responsive to
patients when they raise concerns
as well as a range of measures to
enhance current practice and to
reflect the key elements of the
Francis Report.
Page 105 of 119
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Review of Quality Performance 2012/13
2012/13 Quality Account
Learning from patient complaints
Although our figures show a reduction in the number of complaints, down by 34 in comparison to 2011/12, the key areas
within the complaints received are broadly consistent with those in 2012/13. These involve issues relating to clinical
treatment, verbal communication, staff attitude, nursing care and delay in treatment. Although we have shown
improvements in areas relating to clinical treatment and verbal communication, further work is required in the other areas
outlined below.
Areas of concerns identified by patients/carers:










Delays in Accident and Emergency
Prolonged discharge
Lack of information regarding treatment plans
Inadequate information regarding follow up
Ward staff being rude to patients
Doctors rude and abrupt in clinics
Missed community home visits
Attitude of District Nurses
Failure to provide privacy and dignity
Issues around consenting patient prior to a
procedure
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
Trust responses to address concerns raised:







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Streamlining of triage to reduce waiting times
On line discharge summaries available
Treatment plans discussed at Care Rounds
Communication performance included in staff
appraisal and at regular team meetings
Review of staffing skill mix and establishment at
peak times
Red pegs signalling care in progress has been
reinforced
Refurbishment of key clinical areas – x-ray
department and Cardiac catheter lab
Colposcopy department amended its consent form
Page 106 of 119
Part 3
Review of Quality Performance 2012/13
2012/13 Quality Account
Patient Involvement
Patient/User involvement in service development for improvement is important to us. During 2012/13 we involved patients
and carers in a wide range of services leading to significant service improvements.
In cancer services we built on the work of last year when Ealing Hospital joined fifty one other hospitals around the UK
and signed up to the Breakthrough Service Pledge for Breast Cancer. The Service Pledge was developed by
Breakthrough Breast Cancer as a tool for healthcare professionals and patients to work together towards better breast
cancer services. Breast cancer patients at Ealing Hospital have been asked about the services they received and any
improvements they would like to see. Staff and patients then worked with Breakthrough Breast Cancer to develop a local
Service Pledge, setting out the standards of care patients can expect and the improvements, suggested by patients,
which we are continuing to work towards. Further to this, a self- help/support group Sunflowers was set up, the group
gives breast patients an opportunity to talk to people who understand what they are going through and spend time with
people who share or understand their experience.
In Community Services patients and carers have been involved in redesigning the community diabetes pathway, playing a
key role in choosing location of clinics.
In Maternity services, mothers were actively involved in the design of the new Midwifery led unit.
For patients with learning disability, the organisation has built on the success of last year‟s „The Big Health Check‟ day,
whereby patients are involved in a day of providing feedback around the services they access at the Trust.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
Page 107 of 119
Part 3
Review of Quality Performance 2012/13
2012/13 Quality Account
Care Rounds
In our Quality Account for 2010/11 we made a commitment to introduce Care Rounds with the aim of enhancing the
patient experience and reducing patient safety incidents. The Care Round was introduced at Ealing Hospital from October
2011. Since that time the profile of Care Rounds has been raised nationally and we have continued to monitor their use
and effectiveness.
Formal review of the Care Round was undertaken in 2012/13, and this identified:

95% of patients reported that they were checked on regularly and felt cared for with their privacy and dignity
maintained

For those patients who were at risk of malnutrition and dehydration all had a care plans in place and there was
evidence of assistance with feeding

Of those patients who were identified as being at risk of developing a pressure sore – the majority has been
formally risk assessed and all had appropriate care plan in place

All wards reported a positive impact on care and on the relationship between nurse and patient.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
Page 108 of 119
Part 3
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2012/13 Quality Account
Junior Doctor Training
The General Medical Council (GMC) performs an annual survey of Doctors in training.
The 2012 survey identified three areas where the scores for trainees at Ealing Hospital were lower than expected.

Clinical supervision: Some trainees felt they were asked to cope with clinical problems beyond their experience
without sufficient support.

Feedback: In some areas trainees felt that they were receiving insufficient feedback on their performance.

Behaviour of colleagues: Some trainees felt that they were subject to behaviour in the workplace that eroded their
confidence and undermined their training experience.
As result the Postgraduate Faculty Group within the Trust has set up Local Faculty Groups within each speciality. These
are led by a designated member of the consultant body with the aim of monitoring and dealing with any concerns from
trainees as they arise. Specific actions were also taken within individual departments highlighted by the GMC report.
The 2013 GMC survey has now been completed and results will be available in June 2013.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
Page 109 of 119
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Review of Quality Performance 2012/13
2012/13 Quality Account
Decommissioned Services
The following services were decommissioned during the reporting period:
Harrow Community Services

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Continence Service
Learning Disabilities
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
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2012/13 Quality Account
Who has been involved in the development of this
Quality Account?
The Quality Account has been developed with input from different staff groups in
the Trust. The Trust has shared this document with key stakeholders. These
included:

Ealing, Brent and Harrow Clinical Commissioning Groups (CCGs)

Healthwatch Ealing, Brent and Harrow

Overview and Scrutiny Committees for the London Boroughs of Ealing,
Brent and Harrow

Ealing Hospital Trust Board

External Auditor - Grant Thornton
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
Page 111 of 119
2012/13 Quality Account
Statements from Partner Organisations
The Trust has received feedback from some of its key stakeholders, as
documented below. The Trust will ensure that we work to address the comments
and issues highlighted.
Since the publication to stakeholders on the 20th May of the first full draft of the
2012/13 Quality Account for comment and feedback, a number of amendments
have been made to the document. The majority of these were minor textual
changes to improve readability and the correction of some typographical and
presentational errors, a number have been in response to feedback from
stakeholders, in particular Healthwatch Ealing. For changes of a significant
nature these are listed in the table below.
Description of change
Nature of
change
Statement on Quality from the Chief Executive
External Audit (Grant Thornton) Assurance Statement
Local Clinical Audit – Brent Community Services
 Appropriate prescribing of nutritional supplements
 Malnutrition and oral nutrition in nursing homes
Goals agreed with Commissioners
2013/14 CQUIN schemes
Mandatory Quality Indicators
Tri-Borough Community Services Performance Review 12/13
Never Events
Contractual Notices
Decommissioned Services
Who has been involved in the development of this Quality
Account?
Addition
Addition
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
Deletion
Deletion
Addition
Addition
Updated
Addition
Updated
Addition
Updated
Updated
Page 112 of 119
2012/13 Quality Account
1.
Ealing, Brent and Harrow Clinical Commissioning Groups
Commissioners in Ealing, Brent and Harrow agreed to review Ealing Hospital
NHS Trust‟s Quality Account, incorporating both acute and community services,
for the year 2012/3.
Commissioners accept that the new Trust has had another difficult year given the
uncertainties caused by the on-going merger discussions with North West
London Hospitals, and the discussions on and final outcome of the Shaping a
Healthier future discussions. This has understandably been the focus of
management and staff attention which has undoubtedly impacted on the areas
needing improvement as detailed below.
The Trust has performed well in some areas which it has clearly demonstrated.
For example, special mention should be made of the work in maternity services
which have seen real improvements in one to one care in labour, consultant
presence on the labour ward and care of women and their babies on the post
natal ward. Caesarean Section rates have also been the focus on much attention
and there have been notable improvements in performance. The maternity
service is to be congratulated that 100% of babies discharged have received a
BCG (TB) vaccination. It is also noted that the Trust had 2 MRSA cases during
the year, and worked very hard to ensure that levels of the C Difficile infection did
not exceed the previous year‟s figure (15 cases). The Trust has also actively
participated in the Integrated Care Pilot that includes General Practices and other
staff across the 3 Boroughs. The focus in 2012/13 has been on better care
planning for frail elderly people over 75 and diabetics. The Trust has also worked
hard with Ealing CCG on transforming out of hospital care in relation to Diabetes.
Stable patients are being transferred back into the community and there has
been strong support for the programme across the health economy.
However the Trust did not meet all expectations. The Trust struggled at the end
of 2012/13 to maintain its main site performance on A&E standards and
Commissioners issued a Performance Notice that has resulted in an action plan
and improvements in performance recently. The Trust also struggled to meet two
of the national cancer waiting time targets – 62 days urgent referral to treatment
(GP & Dental, and Screening). The Trust has asked for external help in reviewing
its performance and commissioners will be working closely with the Trust to
oversee the implementation of a sustainable improvement plan.
Although there were improvements in a majority of the acute areas of the
national patient survey, commissioners continue to be concerned with the step
change needed in a number of categories compared to other similar trusts.
Although a number of other initiatives and positive comments received from
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
Page 113 of 119
2012/13 Quality Account
patients and service users are shown, commissioners are keen to see how
trends from real-time feedback will be used in 2013/14 to improve patient
experience. Although community services complaints are reflected within the
quality accounts, commissioners will be looking to see how the organisation
plans to monitor and improve out of hospital services particularly when the level
of complaints in two of the three boroughs have increased significantly.
Commissioners were also concerned during the year at the Trusts‟ ability to
identify patients whose health in hospital was deteriorating. This was highlighted
following two Serious Incidents. In discussion with the NWL Critical Care Network
the Commissioners oversaw the Trust‟s agreement to rollout the National Early
Warning (NEWS) scoring system which helps identify patients at risk. The NWL
Critical Care Network also worked with the Trust to improve its performance on
key critical care indicators.
Commissioners have also been concerned at the Trust performance in a number
of key areas for community services. Again Commissioners do not think that the
Trust has maximised the benefits of being an integrated care organisation to
improve patient pathways across community and acute services. It would have
been useful to understand how the ICO has developed over the last year and
how healthcare provision has changed to identify and implement opportunities to
support greater integration and delivery of care across seamless pathways.
In Ealing concern has been expressed at the high rate of health visitor vacancies
and the impact of this on the Trust‟s ability to deliver to the agreed service
specification. An action plan has been developed which focuses on recruitment
especially as there is an expectation that additional services should be provide
under the national framework for health visiting. Performance notices were also
issued by commissioners in Brent and Harrow on the Trust‟s performance on
Child Safe safeguarding training, and the number of Looked After Children
whose health checks were not completed in the agreed time framework. These
areas have constantly been identified by clinical commissioners of very high
importance and in need of focused work.
Commissioners were also concerned at the apparent high number of pressure
ulcers reported by the Trust. However this did lead to pro-active work on training
and better guidance on this area and Commissioners recognise that by
highlighting this area staff awareness has been raised and that this may have
resulted in more active reporting of cases.
It is disappointing to note that Commissioners concerns regarding the level of
community-delayed transfers of care (DTOCs) are not mirrored by the Trust.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
Page 114 of 119
2012/13 Quality Account
Performance Notices have also been issued by Commissioners highlighting poor
data quality. Harrow CCG have raised particular concerns on how the impact of
lack of suitable information regarding the performance of services which does not
allow Commissioners to make adequate assessments of the real causes for
concern and any underlying problems with the ICO. As a consequence Harrow
CCG is not assured of the quality and safety of the provider at this time and the
targeted improvements in timeliness and completeness of data will be essential
in 2013/14 in order to provide the required assurance.
In summary, Commissioners believe that performance is of mixed quality and
that there is a greater focus needed in the quality of community services in
particular. Nevertheless Commissioners will support the Trust to achieve its
priorities and improvements set out for the next year balanced by a focus in
ensuring that the quality of services will not be affected during this period of
strategic change.
Dr Mohini Parmar, Chair, Ealing Clinical Commissioning Group
Jo Murfitt/Kathryn Magson, Chief Operating Officer, NHS Ealing
2.
Healthwatch Harrow
Thank you for inviting Healthwatch Harrow to make its response to your 2012/13
Quality Accounts.
As a Local Healthwatch Organisation for Harrow, we feel it is appropriate that
you have chosen your top five priorities to focus on i.e. Improving patient
satisfaction and engagement; Continued development of the urgent care
pathway; Promoting harm free care; Safeguarding of vulnerable adults and
children; Out of Hospital‟ strategy for patients with long term conditions.
We are keen to work with you in our monitoring capacity as well as a critical
partner in providing feedback and support where practical. We are though,
unable to provide a detailed response to this QA which would normally be based
on research, community and local organisations feedback due to the time
limitation imposed on us to meet your submission deadline. We do however, look
forward to be able to do so next year.
Yours sincerely,
Ash Verma
Interim Chair, Healthwatch Harrow
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
Page 115 of 119
2012/13 Quality Account
3.
Healthwatch Ealing
Healthwatch Ealing has had the opportunity to review the draft EHT‟s Quality
Accounts. We have raised a number of issues most of which have been clarified
in the final version.
Whilst celebrating the improvements made by the Trust over the last year we still
have concerns regarding overall patient satisfaction, failure to reach cancer
targets and the numbers of falls recorded.
We feel comfortable with the future priorities identified but would like to have
seen more measurables attached to them.
As a new organisation we are confident that we can build a strong relationship
with the Trust and work collaboratively to improve outcomes for all patients.
Carmel Cahill
Chair – Healthwatch Ealing.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
Page 116 of 119
2012/13 Quality Account
Please give us your feedback
We welcome any feedback about content, style or any other issues relating to
this Quality Account.
If you want to comment either use the comments section on our website
www.ealinghospital.nhs.uk or write to: the Chief Executive, Ealing Hospital NHS
Trust, Uxbridge Road, Southall, UB1 3HW.
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
Page 117 of 119
2012/13 Quality Account
Abbreviations
AHSN
AHSP
A&E
ACS
AMI
ESBL
BCS
CQG
CEO
COPD
CCG
CNST
CQG
C. diff
CEM
CQUIN
CT
DVT
DoH
DIPC
ECS
EHT
EOL
GI
GAS
HCS
HSCIC
HPA
HCAI
HDU
ICO
IST
ITU
KPI
LINKs
LAC
MRI
MOH
Academic Health Sciences Network
Academic Health Sciences Partnership
Accident and Emergency department
Acute Coronary Syndromes
Acute Myocardial Infarction
Antibiotic-resistant E. Coli
Brent Community Services
Care Quality Commission
Chief Executive Officer
Chronic Obstructive Pulmonary Disease
Clinical Commissioning Group
Clinical Negligence Scheme for Trusts
Clinical Quality Group
Clostridium Difficile
College of Emergency Medicine
Commissioning for Quality and Innovation
Computed Tomography (X-Ray)
Deep Vein Thrombosis
Department of Health
Director of Infection, Prevention and Control
Ealing Community Services
Ealing Hospital NHS Trust
End of Life
Gastro Intestinal
Goal Attainment Score
Harrow Community Services
Health and Social Care Information Centre
Health Protection Agency
Healthcare Acquired Infections
High Dependency Unit
Integrated Care Organisation
Intensive Support Team
Intensive Therapy Unit
Key Performance Indicator
Local Involvement Networks
Looked After Children
Magnetic Resonance Imaging (X-Ray)
Major Obstetric Haemorrhage
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
Page 118 of 119
2012/13 Quality Account
MUST
MRSA
NCEPOD
NHS
NIHR
NICE
NJR
NPSA
NWLHT
OT
ONS
OSC
PAS
PALS
PCT
RTT
RCP
RCS
SUS
SEND
TDA
UCC
VBCA
VTE
Malnutrition Universal Screening Tool
Methicillin-Resistant Staphylococcus Aureus
National Confidential Enquiries into Perioperative Deaths
National Health Service
National Institute for Health Research
National Institute of Clinical Effectiveness
National Joint Registry
National Patient Safety Agency
North West London Hospitals NHS Trust
Occupational Therapy
Oral Nutrition Supplements
Overview and Scrutiny Committee
Patient Administration System
Patient Liaison and Advisory Service
Primary Care Organisation
Referral to treatment time
Royal College of Physicians
Royal College of Surgeons
Secondary Users Service
Standardised Electronic Neonatal Base (Paediatrics)
Trust Development Authority
Urgent Care Centre
Vaginal Birth after Caesarean Section
Venous Thromboembolism
Ealing Hospital NHS Trust
Integrated Care Organisation
Incorporating the Community Services of Brent, Ealing and Harrow
Page 119 of 119