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:
Part 1 – Introduction .................................................................................................................................... 3
1.1
Chief Executive’s Statement on Quality and Priorities for Improvement....................................................... 3
1.2
What is a Quality Account?............................................................................................................................. 6
1.3
About the Trust ............................................................................................................................................... 8
1.4
Statements of Assurance ................................................................................................................................ 9
1.5
Care Quality Commission ................................................................................................................................ 9
Part 2 – Looking Back at Quality during 2014/2015 ................................................................................... 12
2.1
National comparator indicators .................................................................................................................... 12
2.2
Improvement priorities 2014/2015 .............................................................................................................. 15
2.3
Patient Safety ............................................................................................................................................... 18
2.4
Patient Experience ........................................................................................................................................ 29
2.5
Clinical Effectiveness .................................................................................................................................... 39
Part 3 – Looking Towards 2015/2016 ........................................................................................................ 60
Part 4 – Appendices ................................................................................................................................... 66
4.1
Statements from External Organisations...................................................................................................... 66
4.2
Changes made to the final Quality Account after receipt of statements: .................................................... 73
4.3
Statement of Directors’ Responsibilities in respect of the Quality Account ................................................ 74
4.4
Glossary ........................................................................................................................................................ 75
4.5
Thank you ..................................................................................................................................................... 77
APPENDIX 1: Summary of CQC Findings .................................................................................................... 78
APPENDIX 2: Services Registered and Provided by Hinchingbrooke Health Care NHS Trust ................... 80
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Welcome to Hinchingbrooke Health Care NHS Trust’s Annual Quality Account. This report provides an overview of quality achievements from 01 April 2014 to 31 March 2015.
Hinchingbrooke employs more than 1,700 staff in clinical and non-clinical roles, each of whom bring unique skills and experience to their role. Every member of staff working for the Trust contributes to the delivery of services for our patients and the Executive Team and I should like to take this opportunity to formally record our thanks to our staff for their valuable contributions.
In last year’s Quality Account, we led with Hinchingbrooke winning the national CHKS
Award for Quality of Care. This clearly demonstrated the level of quality that the Trust can provide. This year has been a challenging year for us all and one of personal and staff shock and disappointment, when an inspection undertaken by the Care Quality
Commission [CQC] in September 2014 identified significant deficits that resulted in the
Trust being placed into special measures in January 2015.
Services rated as ‘good’ in that inspection were Outpatients, Maternity and Gynaecology and Critical Care. I know that I speak for all staff when I thank our patients and community for the support they have shown by continuing to turn to us to provide their care. There has been unhelpful speculation about the inspection but we have not allowed this to distract us from our focus on patient care. I should like to state again categorically that the Trust remains committed to bringing about the improvements that will benefit our patients. A comprehensive quality improvement programme was developed to address the concerns identified by the CQC and I am pleased to report that, at the time of writing this introduction, the Trust has achieved two thirds of the improvement measures identified. We have been supported with our programme by the Trust Development Authority [TDA] and an Oversight
Committee comprising representatives from:

Cambridgeshire and Peterborough Clinical Commissioning Group

Cambridgeshire County Council

Health Education, East of England

Healthwatch

Huntingdonshire District Council

NHS England

Trust Development Authority
The Trust has not yet benefited from the appointment of an Improvement Director or a
‘buddy’ trust but we appreciate the significant efforts that are being made by the TDA to try to identify appropriate support.
Hinchingbrooke has experienced a number of subsequent visits and inspections from the
CQC, the Clinical Commissioning Group [CCG] and other external agencies and individuals to provide independent overview and feedback on our services. We are grateful to the many individuals who have given up their time to support us with external
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challenge, review and feedback. Again, I am pleased to report that quality improvements have been confirmed by external scrutiny.
The year has also been fraught with financial and capacity challenges, as we experienced increased emergency attendances [11.5% increase], a high ratio of patients with delayed transfer out of the acute care setting [6396 days], such that the Trust has been unable to meet the associated target in a single month of the year and a high reliance on agency and locum staff to meet the required staffing levels on each shift. This was also the third year of our partnership with Circle and it was with great sadness that we witnessed the end of the franchise on 31 March 2015. I should like to thank our colleagues within Circle for their incredible support and collaboration over recent years, during which time there has been a substantive refurbishment of the Trust, transformation of its catering services, achievement of a national award for quality and improvements in clinical outcomes for our patients.
Our aspiration to become one of the country’s top 10 district general hospitals has remained our primary goal, supported by four strategic goals to achieve the best in staff engagement, patient experience, value for money and clinical outcomes. It is through the achievement of these goals that we will best serve our patients and their families. Our focus for Hinchingbrooke Hospital remains true: creating tomorrow’s healthcare today, because people matter .
This Quality Account is an opportunity for stakeholders to review our performance over the past year and to see the priorities for quality improvement in 2015/2016. Our community deserves a local hospital that meets its needs and which listens and responds to feedback received from patients, members of the public, commissioners, staff and other stakeholders.
The establishment of a new Trust Board and a return to NHS management from 01 April
2015 is an opportunity to re-pledge our commitment to safe, effective, high quality care with good stewardship of resources. Throughout April 2015, all of our teams have attended vision and strategy sessions outlining th e Trust’s strategic plans for the year ahead, and setting the scene for how personal behaviours and objectives contribute to team and organisational delivery of the Trust’s 16-point plan, overleaf.
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The information contained in this Quality Account is to the best of my knowledge an accurate account of the quality of our services.
With best wishes,
Hisham Abdel-Rahman
Chief Executive
Hinchingbrooke Health Care NHS Trust
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What are the required elements of the Quality Account?
The Health Act 2009 required all healthcare providers to produce a Quality Account and the NHS [Quality Accounts] Regulations 2010 specified the requirements for the reports produced. Our Quality Account is an annual report produced by Hinchingbrooke Health
Care NHS Trust. It aims to give an overview of the quality of services provided by our organisation. The report can be used by the public to support them to make informed choices about where they receive care.
How did we produce our Quality Account?
We have used the Department of Health’s [DH] Quality Accounts Toolkit 2010/2011 as a guide for our Quality Account.
To supplement the mandatory elements of the account, we have also worked hard to ensure that this account truly reflects the quality measures in place, and provides readers with an accurate and comprehensive insight into the organisation, focusing on the following three areas of quality healthcare:

Patient safety

Patient experience

Clinical effectiveness
How to use this report
To make the report easier to use we have split it into the following sections:
Part 1 – Introduction
The Chief Executive of the Trust has overall accountability for the quality of the services provided and opens the report with an overview of the year.
Throughout 2014/2015 we continued to work with our partners, Circle PLC, to progress the clinical leadership model and continue to strive to be a top 10 district general hospital.
Throughout our partnership with Circle PLC, we have remained a NHS Trust staffed by
NHS employees. As such, we remain accountable to the Department of Health. Mandated indicator data is included as Appendix 1 of this report.
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Part 2 – Looking Back at Quality during 2014/2015
In order for the Trust to continue improve the quality we provide, we use information from a number of different internal and external sources, such as data collections, audit and research, to identify targets for priority actions.
Part 3 – Looking Towards 2015/2016
We outline our priorities for improvement with the plans we have for 2015/2016.
Part 4 – Appendices
We continue to work with local patient representatives and commissioners to ensure we provide a quality service tailored to our local population and we are grateful to be able to include in the Quality Account 2014/2015 independent statements from local stakeholders, including the Cambridgeshire County Council
’s Adults Wellbeing and Health
Overview and Scrutiny Committee and Healthwatch, Cambridgeshire.
Any changes to the report made as a result of the above statements.
Glossary
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Hinchingbrooke Health Care NHS Trust is a district general hospital, providing health care for the people of Huntingdon and surrounding areas. More than 160,000 people rely on our hospital for a range of services and we are grateful for the outstanding community support we receive from our patients and public. The Trust is fortunate to receive support from many volunteers, who undertake a range of activities, including provision of nutrition and hydration support to patients, manning the hospital reception area and signposting visitors and patients, mobile shop provision, community event support and a myriad of other activities. We are truly grateful for the immense support that is so generously given.
Hinchingbrooke Hospital is a modern purpose-built building opened in 1983, although some departments moved to this location from the Huntingdon County Hospital several years before that. We provide a wide range of specialties, many in conjunction with
Cambridge University Hospital NHS Foundation Trust [CUH] and Peterborough and
Stamford NHS Foundation Trust [PSHFT]. We are an Acute Trust with 235 general and acute beds. In our Treatment Centre, the £22m unit which opened in 2005, there are an additional 21 beds specifically for day cases, alongside 25 cabins in the procedure unit.
The Trust also has an Emergency Department, Maternity Centre with 40 beds and dedicated facilities for self-funded and private patients, which contribute to our income.
There are also an additional six beds in the current Critical Care Unit. We have a £1.2 million Acute Assessment Unit. A growing number of joint appointments are being made with CUH and an increasing number of referrals are now coming from family doctors in areas that traditionally referred to other hospitals. The main purchaser of our Trust’s services [c95%] is Cambridgeshire and Peterborough Clinical Commissioning Group
[C&PCCG], and we also provide services for a range of commissioners across
Peterborough, Bedfordshire, Northamptonshire, Norfolk, Lincolnshire and Suffolk.
Total income (including private patients) for 2014/2015 was £110.4m. Private income was
£1.07m which equates to 1% of the income received.
The average proportion of Black, Asian and Minority Ethnic [BAME] residents in
Cambridgeshire is lower than that of England [5.2% vs 14.6%]. The deprivation index is lower than the national average.
The Hinchingbrooke Health Care NHS Trust site is also home to a Special Care Baby Unit and a Children’s Unit, run by Cambridgeshire Community Services.
The services we provide
Throughout 2014/2015 the Trust was organised into corporate directorates and eight clinical divisions, with each division being managed by a Clinical Lead, Operational
Manager, Divisional Head of Nursing and Administration Co-ordinator. These operational teams are accountable through the Chief Operating Officer to the Chief Executive.
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Clinical Division
Acute Medicine
Speciality
Emergency Department, Transitional Unit, Ambulatory Care Unit
Eyes, Ears, Nose and Throat
[EENT]
Gastro-intestinal and General
Surgery [GIGS]
Ophthalmology, Audiology, Ears, Nose and Throat, Treatment Centre
Integrated Services for Medicine and Rehabilitation [ISMR]
General Medical Outpatient Department, Neurology/Stroke services,
Liaison Psychiatry, Dementia, Parkinson’s Rehabilitation, Palliative
Care, Cardiorespiratory, Diabetes, Endocrine, Old Age Psychiatry
Musculoskeletal
Endoscopy, Surgical Outpatients, Vascular, Plastics, Colorectal,
Urology, Bowel Screening, Stoma Care, Surgical Care
Support Services
Trauma and Orthopaedics Outpatients, Fracture Clinic, Pain Service,
Rheumatology, Orthopaedics
Pathology*, Pharmacy, Radiology, Business Continuity Plans, Major
Incident Planning
Theatres and Critical Care Theatres, Critical Care, High Dependency Unit, Outreach,
Resuscitation, Anaesthetic Pre-Op [Treatment Centre]
Women’s Health Maternity and Gynaecology services including termination of pregnancy
* Pathology services have transferred to The Pathology Partnership
This section includes mandatory statements within the Quality Account, as instructed by the Department of Health. The aim of this is to provide information to the public that is common to Quality Accounts across all Trusts. These statements demonstrate whether the organisation is:

Performing to essential standards

Measuring clinical processes and performance

Involved in national projects and initiatives aimed at improving quality
The data reviewed covers the three dimensions of quality, which are:

Patient safety

Clinical effectiveness

Patient experience
We have a duty to provide health care services in line with Health and Social Care Act
2008 [Regulated Activities] Regulations 2014. The following statement sets out our registration status:

The Trust has two locations and is registered with the CQC to provide seven regulated activities under the Health and Social Care Act.
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The CQC’s intelligent monitoring report has consistently reported a low number of risks based on assessment of the Trust against a range of more than 90 indicators of performance.
The CQC carried out a comprehensive inspection of the Trust in September 2014, which included an announced inspection visit between 16 and 18 September and subsequent unannounced inspection visits on 21, 28 September 2014. The Trust also received an unannounced inspection of a smaller selection of services on 02 January 2015. The CQC carried out these inspections as part of its new system of inspection. Prior to the first inspection visit, a number of listening sessions were arranged for members of the public to share their views and experiences of the care received by the Trust. In addition, the inspection team spoke with a number of patients and staff during its inspection. Prior to the September inspection, the CQC requested information and comments from the following external organisations:

Cambridgeshire and Peterborough Clinical Commissioning Group

NHS England

Health Education England

General Medical Council

Nursing and Midwifery Council

Royal College of Nursing

College of Emergency Medicine

Royal College of Radiologists

Local Healthwatch
The services reviewed by the CQC included

Urgent and Emergency Services [A&E]

Medical Care, including older people’s care

Surgery

Intensive/Critical Care

Maternity and Gynaecology

End of Life Care

Outpatients
The inspection rated 18/33 inspected areas as ‘good’ [55%], 9/33 as ‘requiring im provement’ [27%] and 6/33 as ‘inadequate’ [18%], with seven instances of noncompliance with Regulations identified. This led to an overall rating of ‘inadequate’, as set out in the table overleaf.
As a result, the Trust was placed into special measures and has since been working with the Trust Development Authority and other external agencies to address the concerns raised by the CQC. A comprehensive Quality Improvement Plan [QIP] has been developed and the Trust continues to progress these actions, monitored by an Oversight
Committee.
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The CQC conducted a limited, unannounced follow up inspection on 02 January 2015, focused on the areas in which they had greatest concern in their initial inspection. Each of the areas inspected, namely Urgent and Emergency Services, Medicine, including Older
People’s Services, and Surgery, were judged to have made improvements in the domains reviewed, with the uninspected areas carrying forward the previous ratings. As at the point of developing this Quality Account, the overall rating is that the Trust ‘requires improvement’, as detailed below:
It remains a clear priority for the Trust to complete the actions set out in the improvement plan [attached as Appendix 1] and to sustain this such that we establish a position in which ‘good’ is the minimum standard achieved and ‘outstanding’ is our aspiration.
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Prescribed indicator information Trust performance
2014/2015
The value and banding of the summary hospital-level mortality indicator [SHMI] for the trust for the reporting period.
97.26
– Band 2 'as expected' (using latest
SHMI which is Oct 13 -
Sept 14)
33.8% The percentage of patient deaths with palliative care coded at either diagnosis or specialty level for the trust for the reporting period.
The percentage of patients who were admitted to hospital and who were risk assessed for venous thromboembolism during the reporting period.
Quarter 1 - 98%
Quarter 2 - 98%
Quarter 3 - 98%
Quarter 4 - 99%
TOTAL: - 98.3%
2014: 60.14% 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. [2014 NHS Staff Survey]
FFT Inpatients who would recommend the
Trust as a provider of care to their family or friends
The Trust’s responsiveness to the personal needs of its patients during the reporting period
[using overall score from CQC’s 2014
Inpatient Survey].
The percentage of patients 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.
0 to 15 years 14.7%
16 years or over, 6.8%
Mar 2015 - 98%
Feb 2015 - 97%
Jan 2015 - 98%
Dec 2014 - 97%
Nov 2014 - 97%
Oct 2014 - 98%
Sept 2014 - 95%
Aug 2014 - 96%
Jul 2014 - 96%
Jun 2014 - 97%
May 2014 - 97%
Apr 2014 - 86[score]
7.9/10
Trust performance
2013/2014
100.92 'as expected’ banding (using the Apr
13 to Mar 14 data)
37%
98.5%
59%
Average score = 79
N/K
12.4% [0-14]
5.9% [15 and over]
The rate per 100,000 bed days of cases of C difficile infection reported within the trust amongst patients aged 2 or over during the reporting period.
[ National data available only for 13/14 ]
13.04
[extrapolated from trust data: number of incidences per bed day x 100,000 =
12/92013X100000]
8.5
National
2014/2015
100
25.3%
96%
2014: 67.45%
Mar 2015 -
95%
Trusts ≤6 17%
Trusts 7-7.9
11%
Trusts ≥8 73%
N/A
11.45%
[2011-12 data]
2013/14
18.7 [attributed to CCG]
34 [All incidences]
CCG level only
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The number and, where available, rate of patient safety incidents reported within the trust during the reporting period
[six month period]
The number and percentage of such patient safety incidents that resulted in severe harm or death
[six month period]
Patient reported outcome measures
[PROMs]
Groin Hernia
Primary Hip Replacement
Primary Knee Replacement
Varicose Vein
April to September
2014: 2259 incidents, rate per 1000 bed days = 67.54
17 incidents; 0.8% of reported incidents total
March – September
2013; 1378 incidents
[bed day rate not available]
13 incidents; 0.9% of reported incidents total
290, 287
[bed day rate not available]
1%
EQ-5D Index
% improving
66.7%
66.7%
68.4%
Not available due to small numbers
EQ-5D Index
% worsening
National
50.2%
66.7%
56.5%
40.9%
National
Groin Hernia
Primary Hip Replacement
Primary Knee Replacement
Varicose Vein
14.8%
16.7%
26.3%
Not available due to small numbers
17.4%
22.5%
29.8%
40.8%
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In the Quality Account for 2014/2015, the Trust identified four key improvement priorities:
1. To demonstrate good open leadership with evidence of a sound governance and assurance framework.
The Trust recognises that, in addition to patient outcomes and operational performance, staff experience at work is a key reflection of an organisation’s governance and culture. The national staff survey 2014 saw a modest improvement in the Trust’s overall rating, which is now exactly equal to the national average. We are pleased that the latest survey shows improvement over the year in most areas.
Areas of statistically significant improvement were:

% of staff appraised in the last 12 months

% of staff having well-structured appraisals in the last 12 months

% of staff receiving health and safety training in last 12 months

% of staff having equality and diversity training in last 12 months
Areas of statistically significant deterioration were:

% of staff experiencing physical violence from staff in last 12 months

% of staff reporting errors, near misses or incidents witnessed in the last month
Timely and interactive staff engagements, and opportunities to develop and learn, are crucial elements of quality, as each and every individual working at our hospital plays a part in delivering quality services, care and experience. Over the past twelve months, we have continued to invest in these areas, including establishing a quarterly ‘STARs’ recognition scheme for staff, and a new appraisal and development framework. Regular face-to-face meetings -
‘
Take a Break
’ - between staff and the chief executive are well-established and supported by a monthly video
- ‘ Teamtalk ’ - with members of the Board sharing news, updates and successes with staff through a dedicated Youtube channel. Leadership and development programmes for clinical and nursing staff are widely promoted and supported, as are e-learning modules.
In the unannounced inspection conducted by the CQC in September 2014, the
Trust was rated as ‘inadequate’ in the domain considering how well led was the organisation. This was not re-inspected as part of the more recent January 2015 inspection. The Trust recognises that the changes introduced since the initial inspection will require time to demonstrate their impact and before their sustainability can be assessed and assured. An external review of governance, conducted by the Good Governance Institute in November and December 2014 concluded that the basic model of governance was sound and built on the right principles but had been implemented to a variable standard and there was confusion in identifying where lay the ‘controlling mind’.
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The Trust’s risk management was assessed by internal auditors as providing limited assurance.
2. To improve patient outcomes with a key focus on reducing length of stay and access to 24/7 care in key service areas without a decrease in experience or outcome.
The Trust has experienced a significant rate of delayed transfers of care, at [6396 days], predominantly associated with the availability of care outside of hospital. The
Trust has taken successful steps to improve the efficiency of its internal processes and a system wide group is working in collaboration to tackle the continuing external challenges, which are well recognised. Delayed transfers of care significantly impact on the patients who remain in a hospital setting because they are unable to be safely discharged to their home or into a community care setting and also on new patients requiring acute hospital care. On average, the Trust has experienced the daily equivalent of 17 patients who no longer require acute inpatient care , with ‘escalation beds’ needing to be opened to facilitate patients requiring admission through the emergency department. The CQC reported that they found instances of staff
‘unable to prevent service demands from severely impinging on the quality and kindness of care for patients ’.

There are 11 diagnosis groups attracting statistically significantly higher than expected long LOS.

There are five procedure groups attracting statistically significantly higher than expected long LOS.
The Trust has moved to a new radiographer and imaging system roster, which offers seven-day booked imaging in CT and MRI, in addition to the on-call service.
This has benefited patients by reducing the time to imaging and has allowed us to secure the 6-week imaging target of 99%.
3. To continue to improve the end-of-life pathway, dementia pathway and colorectal pathways, while continuing to expand on new services, ie cardiac pathway.
End of life care provision at Hinchingbro oke was assessed by the CQC as ‘good’ in the domains of ‘caring’, ‘responsive’ and ‘well led’ but ‘requiring improvement’ in the domains of ‘safe’ and ‘effective’. The Trust has commenced implementation of the
AMBER care bundle and has revised its end of life care policy.
The Trust has piloted a Memory Club and Café, with excellent attendance and participation, and this will be further embedded in 2015/2016. The Trust has also implemented a dementia friendly ward.
The colorectal service has a fully new team, which is demonstrating its quality standards through ongoing audits that it submits externally. Outcomes are demonstrably good.
The Trust now has two cardiology consultants, one with a sub-speciality focus on cardiac failure and echocardiography. The Trust is introducing guidelines for the management of NSTEMI and cardiac failure.
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4. Reducing key themes relating to incidents, continuing to focus on mortality, and improving infection control rates and management.
The Trust is one of seven Trusts [out of 17] within the region who have a HSMR that is statistically significantly lower than expected. Mortality rates have shown a sustained reduction, with HSMR outcomes for January to December 2014 [the most recent reporting period] as follows:

HSMR is 83.54 and is statistically significantly lower than expected

There is no significant difference between weekday and weekend performance. o Weekday HSMR statistically significantly lower than expected o Weekend HSMR statistically significantly lower than expected

All Diagnosis SMR is 82.97
and is statistically significantly lower than expected o Death in low risk diagnosis groups
– within the expected o Deaths after surgery – within the expected

SHMI July 2013 – June 2014 [the most recent available data] is 100.99
and is statistically within the expected .
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Patient safety incidents are routinely monitored, reported and reviewed to identify learning that may help to prevent recurrence.
The Trust has experienced no ‘Never
Events’ [using national definition] in 2014/2015. Incident reporting has continued to improve, and the Trust reported 5044 events in year (27 severe harm and 9 deaths), with
98% of these resulting in no or low harm [76% no harm or near miss]. High reporting levels combined with high levels of low or no harm outcomes are recognised as indicative of a positive safety culture. The National Reporting and Learning System [NRLS] national data was published on 08 April 2015 for April 2014 to September 2014 data [the most recent reporting period]. For the first time, Hinchingbrooke has been compared against
140 acute non specialist Trusts and is placed 2 nd
for reporting. For the data reported to
September 2014 per NRLS there were 2259 incidents, 13 severe and 4 deaths. This clearly demonstrates a commitment from our staff to identifying and reporting safety events.
Six-month comparison data from NRLS: Hinchingbrooke versus all acute cluster trusts
Degree of harm - % Comparison
NRLS Data - Apr 2014 to Sep 2014
[published Apr 15]
All Acute Cluster
Hinchingbrooke
None
73.70%
79.30%
Low
21.80%
18.50%
Moderate
4.00%
1.40%
Severe
0.40%
0.60%
Death
0.10%
0.20%
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Breakdown of incidents reported in 2014/2015:
Cause Group
Patient Treatment/Management
Diagnostic Issues
Accident
Organisational Issues
Medication Issues
Staffing
Maternity
Clinical Records
Infection Control
Violence & Harassment
Medical Devices
Surgical / Theatre
Security
Manual Handling
7%
5%
3%
2%
2%
1%
1%
1%
% incidents
17%
16%
15%
11%
10%
8%
Needle /Sharp Injury 1%
TOTAL 100%
There were 43 serious incidents registered in year, three of which were subsequently redacted or reassigned to another Trust, leaving an overall total of 40 serious incidents.
All have been subject to root cause analysis investigation, to identify learning and areas for improvement.
The development of a severe pressure ulcer accounted for 35% of the serious incidents reported [14 instances], with 71% of these identified through investigation as having been unavoidable [10/14]. There were eight unexpected deaths reported, of which seven have completed investigations. Four of the investigated deaths that occurred had the potential to have been prevented if alternative treatment decisions had been made. There were six patient falls resulting in severe harm. Infection prevention and control events accounted for five reported serious incidents.
The Trust also received a Regulation 28 letter from the Coroner in response to identified deficits in the care of a patient who died whilst an inpatient of the Trust. The care deficits were not considered to have had a significant contribution in the death of the patient but required action to reduce risk to others. Action was taken, which included a programme of further staff training in the use of early warning scores to identify a deteriorating patient, and subsequent audit has identified substantial improvement.
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Breakdown of serious incidents reported in 2014/2015:
Incident type
Unavoidable Pressure Ulcer
Unexpected death
Fall with severe harm
Infection prevention and control
Avoidable Pressure Ulcer
Information governance breach
Allegation of assault [investigation not yet concluded]
CQC concerns in respect of safeguarding of patients
Failure of screening [impact not yet known]
Failure to act on test results *
1
1
1
2
1
5
4
Number
Incidents
10
8
6 of
Unlawful termination of pregnancy due to incomplete documentation 1
TOTAL
* This incident occurred in 2010 but was not identified until 2014
40
The Trust has taken action that will improve both the timeliness and quality of reporting in
2015/2016, as four events requiring investigation were not identified until sometime after they occurred.
The Trust ’s annual harm-free care rate for 2014/2015 has achieved an above target rate of 93% harm-free care, and this figure rises further, to >97%, when any harms acquired before a patient came into our care are excluded.
As reported above, t he Trust’s mortality rate continues to be ‘as expected’, at 100.99, using Standardised Hospital Mortality R atio [SHMI] calculations and ‘significantly lower than expected’, at 83.54, using Hospital Standardised Mortality Ratio [HSMR] calculations.
The difference in outcomes is accounted for by patients in receipt of palliative care, which are excluded from HSMR calculations.
Infection Prevention and Control [IPC] has been a focus of improvement activity during the year. The Trust has, for the second year running, experienced no hospital acquired
MRSA bacteraemia but it has breached its target for no more than seven Clostridium difficile infections, with 14 cases identified in year, with two cases being non-sanctioned.
The Trust had three cases of Methicillin Sensitive Staphylococcus Aureus [MSSA] during
2014/2015. There is no Department of Health target to reduce MSSA at present.
The Trust had 67 cases of Escherichia coli [E.coli] during 2014/2015. There is no
Department of Health target to reduce E.coli at present.
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East of England regional E. coli [cumulative] - 2014 - 15
West Suffolk
QE Kings Lynn
Sothend
Princess Alexandra
Peterborough and Stamford
Papworth
Norfolk and Norwich
Mid Essex
James Paget
Ipswich
Hinchingbrooke
Colchester
Cambridge
Basildon and Thurrock
0 50 100 150 200 250
Outbreaks of Infection in 2014/2015
Clostridium Difficile
– April 2014
The Trust experienced a C.difficile outbreak during April 2014, as three patients had been identified to have C.difficile.
Group A Streptococcus [iGAS] - June 2014
There was an outbreak of invasive Group A Streptococcus [iGAS] within the maternity service during June – August 2014. This outbreak affected two patients and one member of staff.
Influenza A - December 2014
During December 2014 and January 2015 the Trust had 14 confirmed patient cases of influenza A [H3] and two staff cases.
Full root cause analysis investigations of these outbreaks were undertaken and identified a number of lessons, which were disseminated to staff across the organisation.
During the year there were a number of quality inspection visits by the CCG, Public Health
England and TDA, the last in February 2015, which reported a number of positive points, most notably the excellent antimicrobial leadership of the Trust’s antimicrobial pharmacist lead. Inspectors witnessed some excellent hand hygiene practices but advised that further work was required to improve trust-wide compliance with the ‘bare below the elbow’ concept. It was particularly pleasing to hear that the inspectors had witnessed ‘real staff engagement
’ with infection prevention and control. The Trust has appointed a substantive microbiologist and they will be commencing in July 2015.
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In March 2015, the IPC team held a hand hygiene day in conjunction with UNISON, which was open to all staff and visitors. The stand was well attended and there was good feedback received through Link Practitioners. The development and roll out of the ‘ Stop the bug’ communication pathway, led by the Executive Director of Nursing, Midwifery and
Quality
, who is the Trust’s named Director of Infection Prevention and Control [DIPC], has proved to be a novel and effective method of maintaining timely staff engagement with any new developments and policy updates. This initiative complements the monthly ‘ Quick
Picks Bulletins
’,
which are clinically driven and policy focused.
For 2015/2016, the Trust’s C.difficile target has been set at no more than 11 cases and to maintain zero avoidable cases of MRSA bacteraemia. The IPC team will be holding a
National Hand Hygiene Awareness Day on 07 May 2015 and, during the year ahead, will be focusing on risk assessments related to high impact interventions, documentation and the roll out of a revised Aseptic Technique policy. The team will also focus on building the
Link Practitioner Programme and embedding newly revised Clostridium difficile and MRSA policies.
Falls prevention is a major focus for safety improvement activity, particularly as the Trust has a high rate of older adult inpatients. The Trust has experienced a total of 213 falls with harm, representing 4% of the total incidents reported in the past year [ 614 falls per 1000 bed days]; six resulted in severe injury, such as a fractured neck of femur. The overall falls trend has remained static across the Trust for the past six months.
A Falls Prevention Steering Group reports to the Patient Safety Committee. A number of initiatives are being led by this Group, including trial and evaluation of items of falls prevention equipment, trial of an alternative bed, review of the risk assessment tool and training opportunities for staff.
A new identifying symbol, a falling leaf, is being introduced to highlight to staff on case notes and bed boards those patients most at risk of falling; this symbol is also being used on the new information leaflets that are currently in production.
Number of Falls Number of Falls resulting in Harm
100
80
60
40
20
0
Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15
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Prevention of pressure ulcer development is also a key focus and the Trust is pleased to report that it has achieved its target of <34 avoidable pressure ulcers [grades 2 - 4] and has exceeded its reduction trajectory by >50%. The Trust reported 24 avoidable pressure ulcers in year. There were 14 severe ulcers identified, of which four were deemed avoidable.
Medication error reporting has increased modestly during the course of the year and makes up 10% of all incidents reported in year. Incomplete or incorrect prescription charts and missed doses are the primary causes of these incidents. Overall, 108 medication errors resulted in harm to a patient, none of which were severe. As part of the Trust’s improvement plan, work is to be undertaken with an external lead to identify targeted actions to reduce medication errors.
The Trust recognises the additional pain and distress experienced by patients undergoing treatment who then fall, succumb to hospital-acquired infection, encounter issues with their medication or who develop a pressure ulcer. Each of these event types will remain as focus areas for improvement in the year ahead.
The ‘ Reporting of Injuries, Diseases and Dangerous Occurrences Regulations’
[RIDDOR] require the Trust to report to the Health and Safety Executive certain designated accidents connected with work. This applies to employees, patients and visitors.
During 2014/2015 the Trust reported nine incidents, eight of which involved staff members and one involved a patient. Of the eight incidents involving staff members, three were the result of moving and handling activities, two resulted from falls, one was a needle stick injury and one was a fracture. The incident involving the patient was a fracture following a fall.
Our aim during 2015/2016 will be to continue to learn from reportable incidents and to review systems where appropriate in order to reduce the numbers of incidents requiring external reporting.
The Trust ’s Health and Safety policy includes a requirement to pro-actively monitor health and safety performance once per year. This reflects good practice guidance issued by the
Health and Safety Executive. Within the Trust, it takes the form of a questionnaire sent to
34 departments. In 2014, this was issued prior to the CQC inspection in September 2014.
Twenty seven of the 34 issued questionnaires, including local risk registers, were completed and returned; the majority included action plans where deficiencies had been identified. The process has started for 2015 and remains essentially unchanged apart from minor amendments to the list of recipient departments. Our aim in the current year will be to improve the response rate and audit a minimum of 105 of completed returns.
Work Related Stress [WRS] continues to be a significant cause of sickness absence within the healthcare system and, if we are to reduce its impact, we need to pro-actively assess the causes and put in place plans to mitigate. For a number of years the Trust has utilised the Health and Safety Executive ’s ‘Management Standards’ for WRS as a basis for intervention programmes. This initially took the form of departmental focus group meetings facilitated by the Occupational Health service and the Trust ’s Health and Safety
Manager. During these meetings, causes were identified, risk assessments developed
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and action plans agreed. More recently we have been using the HSE analysis toll as a precursor to focus group meetings. This gives a good basis for discussion and highlights general themes and perform ance against the ‘Management Standards’. The Trust’s model now includes a multi-disciplinary team meeting to review findings and, although it can be a lengthy process, results have been encouraging. During 2014/2015 seven separate departments were issued survey questionnaires, although not all have yet seen the process through to completion.
For 2015/2016 we aim to continue to promote the benefits of participation in the WRS programme and we will continue to identify those departments that might benefit from the process. We will also consider how we can analyse separate results to form a Trust wide overview of common contributory factors.
Adult Safeguarding achievements in 2014/2015 include:

All clinical and non-clinical staff employed by the Trust must attend adult safeguarding training at Trust Induction and 3 yearly mandatory updates. The Trust has increased the proportion of staff trained in adult safeguarding by 17% this year: o March 2014 – 78% o March 2015 – 95%

Development of easy read adult safeguarding leaflet and poster

Update to the Trust
’s training needs analysis to include Mental Capacity Act and
Deprivation of Liberty Safeguarding training for identified clinical staff

Development of Mental Capacity Act and Deprivation of Liberty Safeguards training and audit programme

Development of Mental Capacity Assessment Record Form

Mental Capacity Act and Deprivation of Liberty Safeguards best practice guidance and procedure document
Referrals made by the Trust are as follows:
Trust’s own care or treatment of a patient
Patient’s care in the community
16
47
Improvement plans for 2015/2016 include audit of the use of the Mental Capacity
Assessment Record Form, review of all adult safeguarding policies, procedures and training in relation to the Care Act and development of additional Deprivation of Liberty
Safeguards [DOLS] training for identified staff.
The Trust has recently appointed a new named nurse and a midwifery lead for child safeguarding and is currently recruiting a new named doctor.
Recruitment of additional paediatric trained nurses in the emergency department has taken place in response to concerns raised by the CQC during its inspection in September
2014. T he service level agreement with the onsite provider of children’s services has also been reviewed and includes a programme of rotation between the two Trusts. Joint working is already in place, with joint/combined Clinical Governance meetings and joint
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pathways [12 paediatric pathways have been jointly developed]; the rotation programme will further support this collaboration.
Safeguarding Children Level 1 – currently 98% of the Trust are compliant
Safeguarding Children Level 2
– 963 clinical staff currently have this competency
Safeguarding Children Level 3
– 141 clinical staff have completed some form of Level 3 training in the last 3 years
As at end April 2015, the Trust could not report L2 and L3 training completion as a percentage of relevant staff. Work is in progress mapping clinical training subjects to staff across the organisation. Once this work is complete, all of the above training subjects will be reportable as a percentage rate of those requiring training. Unvalidated data in May
2015 indicates the Trust is below compliance targets for L2 and L3 training [78% and
64%, respectively] and has implemented additional in-house training sessions to address this.
Additional available training includes:

Safeguarding Level 3 [new training packages/opportunities for staff to complete level 3]

Safeguarding Level 4 [external]

PILS [Paediatric Intermediate Life Support]

EPLS [European Paediatric Life Support course]

CAKES [C hildren’s Assessment Knowledge Assessment Skills]

Train the trainer [enables seniors to become trainers and teach higher levels of training]
The Trust completes a non –accidental injury screening on all paediatric patients.
Supplementary Information Form [SIF] data from social care is recorded on a database and reported back to the individual staff members on a monthly basis to enable learning from referrals and there are quarterly SIF form audits [joint working]. There are robust pathways, policies [pre mobile baby] and guidance in place for staff to use when dealing with child safeguarding issues.
The Trust routinely participates in the following audits:

Supplementary information forms

Sudden unexpected death in infancy

Non-accidental injury 3+ attendances

Documentation

Child sexual exploitation

Paediatric satisfaction feedback forms
Improvement plans for 2015/2016 include a reconfiguration of the structure of paediatric meetings to facilitate Trust-wide representation, improved learning from serious case review, development of a revised pathway for underage termination of pregnancy, development of a joint pathway with a local mental health trust for children presenting to the emergency department in crisis, development of paediatric pathways for abdominal
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pain and burns management and improved development and delivery of action plans in response to lessons learned from local, regional and national events.
Information Governance within the Trust is seen as a safety issue and is managed and controlled within the implementation of the Information Governance policy and Information
Governance Framework. The IG policy has been endorsed by the Executive Board and it is owned by the Information Governance Steering Group.
In 2014/2015 the Trust had an overall compliance score of 79% [Level 2] against version
12 of the Information Governance Toolkit and was graded ‘green’.
A programme of information asset ownership is on-going with both clinical and non-clinical divisions, with nominated Information Asset Owners and Information Asset Administrators leading on information, risk management and governance for their area. These areas will continue collating information asset registers and identifying information flows. The IG team also has a responsibility to undertake an auditing cycle of every asset register within the Trust, which will improve significantly information risk management and compliance with the Data Protection Act 1998.
We take our responsibility for Information Security seriously, and as a result we have made Information Governance training mandatory for all our staff. All new staff to the
Trust must undertake their IG training in a face-to-face setting, attending the Trust induction. This helps to assure patients that their personal information is treated in line with the law and good practice. The Trust achieved 90% compliance with staff mandatory training in 2014/2015.
Annual refresher training is undertaking by any of the following options;

Intranet PowerPoint Presentation

IG Workbook

E-Learning
In 2014/2015 the Trust reported three level 2 breaches. Level 2 confirmed IG SIs must be reported to the Information C ommissioner’s Office, Department of Health and other central bodies/regulators.
The three breaches related to;

Ward handover sheet found within the laundry of a patient

Ward handover sheet found on a table in the staff dini ng room by a patient’s relative

Ward handover sheet found in one of the on-site car parks
A serious incident was also raised in relation to a data leak which related to the media publication of correspondence between the CQC and the Trust; in this instance it was not possible to identify the source of the leak from within the multiple agencies who had received a copy of the correspondence. The Trust was able to confirm that no electronic forwarding of the correspondence had been undertaken by the few staff individuals who
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had been in receipt of the correspondence but could not definitively exclude the possibility that a hard copy was made and released.
The Trust firmly believes that data quality is a patient safety issue, with accurate data recording an essential element of caring for patients. Data is recorded in a number of ways but primarily in medical records and electronic patient records. We believe that by ensuring data is accurate and recorded in line with best practice standards we can positively affect patient outcomes.
The information in patient’s medical records about their diagnosis and treatment is also used to record the volume of work undertaken. This information helps us and our commissioners to decide whether we are providing our local health population with value for money.
The DoH recognises the importance of data quality and has asked for the statement below to be completed.
Hinchingbrooke Health Care NHS Trust submitted records during April – February
2014/15 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 the patient’s valid NHS number was:
99.7% for admitted patient care;
99.8% for outpatient care; and
99.7% for accident and emergency care.
The percentage of records in the published data that included the patient’s valid General
Medical Practice Code was:
100% for admitted patient care;
100% for outpatient care; and
99.8% for accident and emergency care.
The high percentage of patient records with valid NHS number recorded demonstrates that the Trust has a reliable process for the recording of information.
The Payment by Results [PbR] audit approach was redesigned for 2014/2015; in previous years all acute hospitals were required to undertake a PbR inpatient audit. In 2014/2015, the audit was changed to focus on the worst performing 20% of Trusts. The Trust had worked hard over the past three years to increase the accuracy of reporting and as a result has significantly lower than national error rates and was not, therefore, subject to the Audit Commission ’s Payment by Results clinical coding audit during 2014/2015.
The Trust did undertake a mixed speciality internal clinical coding audit in-year, with the following finding:
‘The medical records were in good order and no records were deemed unsafe to audit.’
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Primary Diagnosis
Secondary Diagnosis
Primary Procedure
Trust Coding
%
100
84.5
100
IG Toolkit recommended accuracy targets, Level 2
%
>=90
>=80
>=90
Secondary Procedure 88.89 >=80
The above table shows that the primary diagnosis and primary procedure recording was good, at 100% and that secondary diagnosis and procedure recording were both above the IG Toolkit Level 2 recommended accuracy targets.
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Formally reported patient experience indicators per month include a range of waiting times, long lengths of hospital stay, complaints and compliments received and results from the national programme of Friends and Family Test.
Waiting times for referral to treatment within 18 weeks have consistently been delivered above target, with achievement of 94.6% actual against 90% target for admitted patients and a 99% actual against a 95% target for non-admitted patients. The six week target time for diagnostics was not met in four of twelve months, with an overall achievement of
97.7% against a 99% target. The four-hour waiting time in A&E target was met in five of twelve months, with an overall achievement rate of 92.6% against a 95% target.
Nationally, type 1 A&E units [major] have achieved 90.4% and units of all types, including single speciality and minor injury units, achieved 93.6%.
Breaches of targets carry financial penalties with, for example, fines of 1 - 2% of contract value per month [£70,000 - £140,000 risk]. In 2014/2015, the Trust had penalties amounting to £2,308,567.
The Trust has, however, delivered 90% of the Commissioning for Quality and Innovation payments [CQUIN], receiving approximately £1.9m additional income as a result.
A total of 6,396 days of care were for patients with a delayed transfer of care [DTOC] out of the hospital, the equivalent of 17.5 patients every day being unable to be discharged when medically fit to leave acute inpatient care. The predominant cause of these delays has been attributed to the availability of community care to support timely, safe discharge home or into other community settings. Internal inefficiencies were also identified through specialist review and the Trust has worked actively to address these in accordance with the Emergency Care Intensive Support Team [ECIST] recommendations, including ‘ Break the Cycle’ weeks to embed changes in our ways of working. Internal actions have been
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15
10
5
0 impactful and patients and staff have experienced benefit from improved efficiency and effectiveness. Despite this and the significant system-wide efforts to address recognised challenges, the level of DTOC has remained high.
35
30
25
20
The Trust received 247 complaints during 2014/2015, with 375 issues raised.
Top 10 issues raised by category [n=315]:
Source of complaint Number of complaints
Standards Of Care
Failure In Care - Nursing
Diagnosis Problems
Communication/Info to Patients
Failure In Care - Medical
Waiting Time - Other
Attitude of Staff [Medical]
Attitude of Staff [Nursing]
Clinical Treatment
Discharge Arrangements
Total
54
51
44
37
26
24
22
21
20
16
315
Complaints acknowledged within 3 working days: 224 [ 90.5%]
Re-opened complaints: 7 [ 2.8% ]
Requests for information: 3 [ 1.2%]
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Ombudsman review
Draft reports received: 1
This was partially upheld with recommendations for an apology, details of improvements made and financial remedy to £500.00 in recognition of distress. [Awaiting final report]
Final reports received: 3
Two were not upheld . One was upheld with a recommendation of financial remedy of
£1,000.00 in recognition of the distress caused and the loss of opportunity to the family to spend better quality time with their loved one before death.
Learning from complaints is an area identified for improvement in 2015/2016, as the current system for recording complaints does not properly support the extraction and collation of key findings. The Trust has invested in an integrated risk management system that will enhance the ability to extract key areas of learning.
Issues raised within complaints [n=375]
Premises - Unclean
Policy & Commercial Decisions
Personal Records [complaint]
Patient Status Discrimination
Operation [IP] Cancellation
Medication Error - Wrong Drug
Medication Error - Route
Hotel Services - Other
Failure In Service - General
Consent to Treatment
Code of openness of complaints
Appointment [OP] Delay
Appointment [OP] Cancellation
Aids & Appliances
Waiting List - OP Consultant
Waiting List - IP Operation
Medical Negligence
Maltreatment
Loss of Personal Property
Under Staffing
Premises - Access to
Operation - Adverse Outcome
Hotel Services - Food Choice
Failure to Follow Procedures
Equipment
Confidentiality
Waiting Time - Appointment
Other Complaint
Attitude of Staff [Admin]
Discharge Arrangements
Clinical Treatment
Attitude of Staff [Nursing]
Attitude of Staff [Medical]
Waiting Time - Other
Failure In Care - Medical
Communication/Info to Patients
Diagnosis Problems
Failure In Care - Nursing
Standards Of Care
0 5 10 15 20 25
Series1
30 35 40 45 50 55
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In addition to the countless verbal ‘thank you’ messages and cards given to staff, 263 formal compliments were forwarded to corporate teams for recording purposes.
We have taken many approaches to understand and enhance the patient experience at
Hinchingbrooke Health Care NHS Trust. One of the approaches has been use of the
Friends and Family Test, which is a one question measure used across the organisation asking ‘ Would you recommend the service to friends and family in they were to have similar treatment or procedure
’
.
The following graph is the collated promoter scores for Hinchingbrooke’s In-Patients,
Maternity and Emergency departments for the years 2013/2014 and 2014/2015 with a benchmark score at 75. This is a local benchmark target set by the Trust.
NET pro yearly comparison 2013 - 2015
84
82
80
78
76
74
72
70
68
April May June July Aug Sept Oct Nov Dec
2013/2014 80 80 80 77 80 79 79 77 76
2014/2015 81 74 78 77 77 73 77 79 77
Jan
78
79
Feb Mar
78
81
78
82
The below graph shows Hinchingbrooke recommendation % rates for the years
2013/2014 and 2014/2015.
Total recommendation as %
100%
99%
98%
97%
96%
95%
94%
93%
92%
91%
90%
April May June July Aug Sept Oct Nov Dec Jan Feb Mar
2013/2014 97% 95% 95% 95% 95% 94% 93% 99% 96% 94% 96% 96%
2014/2015 97% 96% 96% 97% 95% 97% 96% 96% 98% 96% 97% 98%
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This table shows the breakdown of ‘promoters’, who are extremely likely to recommend
Hinchingbrooke, ‘passives’, who are likely to recommend, and ‘detractors’ who would not recommend.
Breakdown of NET Promoter responses
100%
80%
60%
40%
20%
2012/2013
2013/2014
2014/2015
0%
Promoters Passives Detractors
The Trust is pleased to be able to demonstrate year on year increase in those extremely likely to recommend Hinchingbrooke Health Care NHS Trust to their friends and families.
The Trust wants our community, patients, carers and visitors to actively participate in the review process of the hospital against key benchmarks. We believe that by engaging patients and the public, it will provide us with a clearer understanding of what is wanted from their Hospital. It will also build relationships, partnerships and an open line of communication with our stakeholders. To facilitate this, the Patient Experience Group
[PEG] was re-launched as a voice for our patients. The Patient Experience Group is chaired by the Director of Nursing, Midwifery and Quality, with representation from Clinical
Divisions, Chaplain, Communications, Patient Experience Lead, Specialist Nurses, Health and Wellbeing Manager, Patient Champions, Local GP Representatives, Healthwatch,
Alzheimer’s Society and six patient representatives. The committee met six times during
2014/2015 and received regular updates on the Patient Experience Strategy and divisional patient experience action plans. In January 2015, the terms of reference for the group were reviewed and monthly meetings have now been arranged.
We have actively promoted all patient and carer feedback via the Patient Advice and
Liaison Services comment boxes, patient experience surveys, Friends and Family Test responses, social media [Twitter and Facebook], NHS choices, Patient Opinion, patient stories, public Trust Board Meetings and regular patient focus groups. The Trust understands that there is no single method for collecting data and we place equal importance on quantitative data [numbers] and qualitative data [narrative, patients ’ stories]. Feedback has been used throughout the hospital to help improve our services.
Patient stories have been discussed at the Trust Board as part of our commitment to strengthen the p atient’s voice within the Trust. The Patient Story provides an insight into the personal experiences of being a patient at the hospital and how care and treatment was perceived. These stories were then used to:
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
Examine all aspects of the patient’s journey through the feedback they provide and used it to redesign the clinical service we provide

We used the information as a training tool for our nursing team with regards to the relational aspects of care through education and reflection

To support the audit process and the innovative projects underway within the Trust with the consideration to the patient journey/experience
The Patient Advice and Liaison Service [PALS] is accessible to everyone and PALS staff can be asked to intervene for a variety of reasons. Not all of those who avail themselves of this service do so because they have concerns; help is sought to access other services within the NHS and/or for signposting to non-NHS services. PALS is also a valuable point of contact for those who are interested in learning more about the services provided by the Trust.
The role of PALS is to provide, wherever possible, ‘on the spot’ help and advice, often supporting patients and their relatives during meetings with clinical staff.
Within the Trust, PALS provides support to the Clinical Divisions by sharing data through divisional quality dashboards, alongside formal complaints ’ data, Friends and Family feedback and incident data.
During 2014/2015 PALS assisted with 590 separate enquiries with 708 enquiry elements raised.
PALS enquiries by Category Type:
Category Type Number of elements
2014/2015
Number of elements
2013/2014
Information
Quality of care
208
153
163
143
Communication
Waiting
Attitude of Staff
139
126
50
145
105
31
Environment 21 33
Access
Total:
11
708
9
629
The Trust‘s outcomes in respect of Patient Surveys are reviewed and disseminated across the Trust, to feedback to staff where we are doing well in addition to highlighting areas that we need to target for improvement.
In the 2014 National Inpatient Survey, the Trust was rated as ‘about the same’ as all other
Trusts in all eleven domains:

Emergency department

Waiting lists and planned admissions

Waiting to get a bed on the ward

The hospital and ward
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
Doctors

Nurses

Care and treatment

Operations and procedures

Leaving hospital

Overall views of care and services

Overall experience
In 2014, 406 responses were received from the 850 Hinchingbrooke patients to whom the
CQC issued the survey. Underlying these domain ratings are sixty specific questions covering topics associated with each of the eleven areas above. Of these, the Trust was rated as ‘about the same’ in 59, with one indicator rated ‘better’ than national rate; this question was about patients, during their hospital stay, being asked to give their views about the quality of care.
Patient led assessment of the care environment audit took place in April 2015 and will be published later this year. The Trust anticipates that a similar high pass result as experienced in the previous financial year [upper quartile].
In respect of environment, the Trust has planned or completed a number of improvements, some of which are outlined below:
Three years ago, the Trust launched the Woodlands Appeal . With the help of colleagues, the Woodlands Centre Manager embarked on a journey to raise funds for an extended cancer treatment centre at the hospital to improve patient experience and clinical effectiveness.
Hinchingbrooke’s Woodlands Appeal became well known locally and over time has gathered the support of countless numbers of staff, patients, members of the local community and the local press, raising a staggering £600,000. This figure has received matched funding from the T rust’s Charitable Funds Committee, which includes the generous support of the Temple Bowyer legacy.
With £1.2 million committed towards the new centre, the Trust was delighted to announce earlier this year that the national cancer support charity, Macmillan, would take the helm to launch a fresh fundraising campaign to raise a further £1.2 million so that the vision for a new £2.4million Macmillan Woodlands Centre could become a reality. The new
Macmillan Woodlands Centre will transform the care that cancer patients living in
Huntingdon and surrounding areas receive at our hospital. With the number of patients needing treatment at Woodlands set to double to 3,000 by 2016, our new centre means that we will be able to provide them with the care they deserve and need.
The new centre will provide:

New reception and information areas

An increased number of chemotherapy stations, from nine to fifteen, and two single rooms for treatment

A sensory garden

Space for complementary therapies.

Much needed extra space for our dedicated staff to work in more efficiently
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The Trust is truly grateful for the incredible support it has received to help make this vision a reality for our patients.
In November 2014, the Trust opened its new Garden Restaurant with new flooring, a modern seating area and tables, Wi-Fi area and sofas, together with an additional meeting room. The refurbishment was paid for from John Temple Bowyer’s legacy fund, for which the Trust is incredibly grateful. The food served in the restaurant is of an extremely high standard, and the Trust has a Silver award by by the independent certifiers, the Soil Association. Meals are freshly prepared at the hospital, using fresh, locally sourced ingredients wherever possible. There has been a demonstrable increase in patient satisfaction since the revision of menus. The Trust views nutrition as a critical health element and works hard to ensure that patients receive high quality food. The Trust is developing picture menus to further support patients.
Also in November 2014, the Trust opened its Treetots Nursery, a purpose-built nursery, which is conveniently located at the rear of the hospital. The nursery operates on a not-for profit basis, with the provision of outstanding, cost effective and flexible day care at its core. Treetots is a community service and any profit made is put towards developing activities that support local families.
Work on the new Critical Care Unit started in August 2014 and is due for completion in
2015. The new facility, which has the benefit of being located centrally in the hospital, will provide state of the art equipment and a vastly improved environment for patients and staff.
Work on a new and improved facility to house the Audiology and ENT department also started in August 2014. This project was necessary because of the significant growth in the number of audiology patients and the need to provide more child-friendly facilities, including a more appropriate area for hearing screening for new-borns and a separate waiting area for children. The new department opened in the spring of 2015.
Community engagement
There can be a great deal of fear and anxiety generated for children coming into hospital.
They are often unwell or in pain and may be frightened by seeing people in uniforms or by the unfamiliar environment. The Hinchingbrooke staff working with these children are predominantly adult trained and may also have some anxieties about looking after children. With this in mind, a ‘999 club for schoolchildren’ was set up in April 2014 with the aim of alleviating some of the anxiety on both sides and to further promote engagement with the local community.
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The first club invited a class of 32 children aged 7-9 years into the hospital. The club starts with a talk on X-rays, delivered by a radiographer. The talk is fun and informative and the children are encouraged to guess what the pictures of the X-rays are, for example a shoe, a watch and a starfish.
We then split the class into two groups. Two nurses lead one group on a tour around the hospital, visiting areas such as the emergency department - sometimes taking a peek in the back of an ambulance, if available and appropriate - pharmacy, Holly Ward, the chapel, medical records department and sterile services department. Other areas of interest are pointed out and the children get to meet the staff and ask questions. The favourite activities appear to be running around the chapel garden, putting on sterile hats and masks and watching the pharmacy robot in action.
Whilst one group tours, the children in the other group stay in the room and rotate around four different stations;
 Infection control, where the children use a special hand lotion, wash their hands and then put their hands under a light box to see the ‘germs’ they missed.
Following this, we often find that when the children are washing their hands prior to lunch it takes rather a long time!

A play leader hosts another station, where the children get to learn about what it is like to go to the operating theatre, trying on the gowns and an example of the mask that would normally be used during sedation. There is also a special ‘blood taking bear ’ that the children can use a syringe on.

An emergency department nurse hosts another station where the children get to learn, touch and feel all sorts of different equipment, such as neck collar, wrist splints, oxygen mask, nebuliser, steristrips, cannula [without needle] and bandages. They can also check their observations with the machine that measures pulse, BP and oxygen levels.

Occupational health host the health promotion station where the children can learn about the dangers of smoking and the benefits of healthy eating. There are weighted bean bags in the shape of chips, crisps, biscuits and chocolate bars and staff explain that, if they were to eat these in addition to their normal intake, the weight of the bean bag would be how much weight they could put on in a month.
The children are given lots of
‘Change for Life’ postcards, activity cards and healthy eating stickers so they can take these home to their families and continue the learning.
When the children have completed the tour/stations, there is a short break for a drink and a snack and the children can watch a specially programmed 3D TV, which is used on the children’s ward.
The children get the opportunity to watch their teacher have a below elbow plaster cast put on and then to check whether it has set properly. Sometimes the children insist that the teacher leaves it on until it is time to go.
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When all of the children have completed the activities and the tour, there is a trip to the
Garden Restaurant for lunch provided by the hospital. The children can excitedly chat about the events and time is given for them to complete a feedback form.
The evaluation of these visits has been exceptional with children writing that it has been
‘the best day’ of their lives and that some of them now want to work at Hinchingbrooke when they get older.
Although initially set up to help alleviate the fears of children who may come into hospital, it has become apparent that the club has more to offer. It often ties in with a health topic on their curriculum at school, provides health promotion and gives children the opportunity of seeing a range of careers available within the hospital. For the staff helping to run the club they have also gained additional skills and increased their confidence in teaching simple subjects to a young audience.
To date, the club has hosted seven primary school classes and has now been extended to the children of hospital staff to give them an opportunity to see where their parents work.
Scout and cub groups have visited or booked in for a visit and there three visits booked for
June and July 2015.
The future plan is to continue running monthly 999 clubs, with the hope of expanding into secondary schools and to invite other groups, such as children with learning disabilities,
Duke of Edinburgh award participants and young carers.
The further aim is to extend the event to a whole day, involving the ambulance, fire and police services, alongside hospital staff.
Following the success of the 999 club for school children, the Learning Disability Liaison
Team has been running their own version of the club, the learning disabilities’ 999 club
.
For people with learning disabilities or autism, hospitals can be unfamiliar, confusing or scary places. There have been five clubs and, to date, 65 people with learning disabilities/autism have attended, with three people returning because they enjoyed it so much the first time.
The Club begins with a tour of the hospital with engagement from staff from various departments, who are really proud of their areas of work and delighted to show people what they do. After the tour, the group meets for refreshments and an informative education session about the importance of keeping active and healthy. This includes information about the importance of nutrition, hydration and exercise, correct hand washing techniques and some familiarisation with common items of hospital equipment.
The feedback from people with learning disabilities/autism and their carers has been really positive, with many participants stating that they now feel much more comfortable and less frightened about visiting the hospital. Additional clinical areas, such as theatres and endoscopy suites, have expressed an interest in supporting the club and will be developing this in the future.
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The Trust has continued to make huge strides to increase its research and development
[R&D] capability and capacity, demonstrated by the annual rise, with a rise in the number of studies in 2013/2014 compared to the previous year [n=18 to 28] and greater than double increase by the end of 2014/2015 [n=59].
Number of studies
Total number of studies Q1-Q4
Further categorised as:

Portfolio
59
45

Non-portfolio 14
Industry-led [5 portfolio and 1 commercial] 6
Non-commercial 53
The number of patients receiving NHS services provided by Hinchingbrooke Health Care
NHS Trust in 2014/2015 who were recruited during that period to participate in clinical research approved by the Ethics Committee was 413.
Finances
For 2014/2015 the R&D department received £225k from CRN Eastern to support the
R&D staff and the range of R&D activities.
Key achievements

Software has been implemented to help manage the range of R&D studies

R&D website is active on the main page and will report on NIHR objectives in
Performance in Initiating and Delivering Research [PID]

Monthly R&D newsletters commenced publication in January 2015

Successful Research Dinner held at the Trust on Wednesday 10 September 2014, with a further event planned for October 2015

Monthly lunchtime R&D seminars commenced in February 2015 and are open to all
Trust staff, with opportunities to learn and hear about research taking place at the
Trust.

R&D department has re-sited under the Trust ’s Directorate of Governance and Risk
[rather than being a standalone department] to strengthen opportunities for Trustwide learning.

A Trust consultant has been appointed as Chief Investigator on a national multicentre respiratory study
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Planned Performance in 2015/2016
Both the number of studies and potential recruitment is set to increase further. The number of industry-led studies will have also increased with the increase in the number of feasibilities submitted to the CRN.

HHCT is piloting the new SSC application form from 01 April 2015

Two Patient Research Ambassadors have been appointed

HHCT appointed its own Trust-based CRN research facilitator, who will commence in post in June 2015

R&D Clinical Lead has been appointed as Chief Investigator on a national multicentre glaucoma study

The Research and Development department will be celebrating International
Clinical Trials Day on 20 May 2015 in the Treatment Centre. Radio stations, as well as other media campaigns, have been fully engaged to promote this day and to maximise patient and public engagement in research at the Trust
Areas of current study:
Genetic Relevance
Hepatology (Genetics)
Meds for Children
Tissue Donation
Genetics
Respiratory
Neurology
Diabetes
Urology
Cancer
Health Services
Geriatrics
ENT
Dementia
Gastroenterology
Infectious Diseases
Rheumatology Orthopaedics
Haematology
Ophthalmology
Womens Services
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During 2014/2015, 31 national clinical audits and three national confidential enquiries covered NHS services provided by Hinchingbrooke Health Care NHS Trust.
During that period, Hinchingbrooke Health Care NHS Trust participated in 93.5% of national clinical audits and 100% of national confidential enquiries of those in which it was eligible to participate.
The national clinical audits and national confidential enquiries that Hinchingbrooke Health
Care NHS Trust was eligible to participate in during 2014/2015 are detailed in the table below.
The national clinical audits and national confidential enquiries that Hinchingbrooke Health
Care NHS participated in, and for which data collection was completed during 2014/2015, are listed in the table below alongside the number of cases submitted to each audit or enquiry, where possible, as a percentage of the number of registered cases required by the terms of that audit or enquiry.
The reports of all national clinical audits were reviewed by various groups within the Trust in 2014/2015.
Key:
Took part Did not take part Not applicable - service not provided
# Title Key findings Key actions in response
1 National Audit of Seizure
Management [NASH]
2 Major Trauma: The Trauma
Audit & Research Network
[TARN]
Acute

100% submission.

Average outcome 59.4 vs national 59.5.

5/7 had outcomes better than national.
Areas highlighted for improvement were
1) Temperature taken in the
ED 70 (Nat'l 91.6)
2) Plantars examined 13.3
(36.7)
Participation in the audit was requested by the CCG as part of the contracted reporting.
Although set up to participate, changes to staff roles, sickness and general capacity resulted in no data being submitted.
On-going data collection
 Entered onto the Unit’s risk register to ensure regular attention

Emergency Department to be advised for action

Electronic system to be reviewed for potential cause of documentation issues
The Trust has requested that participating in TARN for next year is not a requirement as the number of major trauma patients attending is low;
Hinchingbrooke is not a major trauma centre so the cost of preparing and submitting data is high compared with the benefits from access to TARN data
Action as required 3 Case Mix Programme [CMP]
Adult Critical Care
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4
5
6
7
8
9
National Joint Registry [NJR]
National Emergency
Laparotomy Audit [NELA]
A total of 856 Joint replacement surgeries have been undertaken. Of this 724 were reported [85%].
There is one per cent improvement in the reporting from last year.
Anaesthetics and surgery are working together on the project. In the first feedback for Year 1, all patients meeting the criteria had been included and initial feedback indicated that Hinchingbrooke’s mortality was lower than the national benchmark for both elective and emergency procedures.
Please see separate table Medical and Surgical Clinical
Outcome Review Programme,
National Confidential Enquiry into Patient Outcome and Death
[NCEPOD]
Adult Community Acquired
Pneumonia below for participation figures in the three projects in which we participate.
Cases collected 01 December
2014 – 31 January 2015; data collection on-going.
Non-Invasive Ventilation - adults No data collection this year.
Last data collection period in
2012/2013 was not possible due to workload [previously documented].
Pleural procedures
A message has been forwarded to the relevant surgeons by the
Clinical Director that improvement is expected.
An emergency surgery pathway is being developed to increase the quality of surgical patients’ peri-operative care.
Closing date for submission 31
May 2015. Action to follow report
The Trust plans to participate in the next British Thoracic
Society [BTS] data collection set.
100% of the appropriate cases were submitted.
Outcome:

100% of procedures were performed or supervised by
ST3 or above and had consent

50% had documented observations within 60 minutes of procedure.

75% were performed on respiratory ward.

100%. ultrasound guidance used
Plan:
[1] review documentation of pleural procedures and nursing guidance for post-procedure observations;
[2] education of nursing staff required;
[3] submit additional cases under ‘local’ audit protocol, as this small number of patients may not be representative. This is on-going.
10 National Comparative Audit of
Blood Transfusion programme
Blood
The Trust participated in the
National Red Cell Use Survey.
A total of 46,111 units of red cells were reported across both cycles and data completeness was good.
Please see below for further information.
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Cancer
11 Bowel cancer [NBOCAP]
Head and Neck oncology
[DAHNO]
113 submitted and 94 required. This figure is for patients diagnosed between
01 April 2013 and 31 March
2014.
12 National Prostate Cancer Audit 89 cases submitted. These figures are for 2014/2015.
The final number of cases is not known at this stage.
13 Lung cancer [NLCA] This data is for patients first seen in 2013 as the audit has changed recently in the takeover by the Royal College of Physicians. Patients for
2014 are submitted based on date of diagnosis.
14 Oesophago-gastric cancer
[NAOGC]
32 submitted, 40 wanted.
These figures are 2013/2014 submission.
Not enough cases to participate
15
16
National Cardiac Arrest Audit
[NCAA]
4 reports per year
National Heart Failure Audit
Heart
01 April 2014 to 31 December
2014, 45 cases were submitted
Data reflects time, day, place of arrest, patient age and gender, mortality for trends.
Comparable survival and neurological outcome in Q3 report.
Following a difficult period for collecting data, where few cases were able to be submitted, a total 94 of 153 cases were submitted being
61% of eligible patients
The data is still to be collated for 2014/2015; submission deadline in October.
be submitted.
The deadline for the 2014 patients is 29 May 2015.
It is expected that 66 cases will
Data for 2014/2015 is still be collated and will be submitted in
October.
Information followed up, where appropriate
The action implemented was to organise help with data collection and entry, as the low submission rate prevented appropriate review and recommendation development.
Further cases expected to be included.
Pulmonary Hypertension
[Pulmonary Hypertension Audit]
National Adult Cardiac Surgery
Audit
Cardiac Rhythm Management
[CRM]
Coronary Angioplasty/National
Audit of PCI
17 Acute Coronary Syndrome or
Acute Myocardial Infarction
[MINAP]
Coronary angioplasty
On-going data collection.
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19
20
21
18
Chronic Kidney Disease in primary care
Diabetes [Adult]
Long Term Conditions
Hinchingbrooke provides secondary care i. The Trust participated in the National Diabetes
Inpatient Audit and patient survey reported in 2014 that is run on one day per year.
Treatment was better than the national average for a. Medication, Prescription and Management errors b. Mild hypoglycaemic episodes c. Appropriate glucose monitoring d. 94.6% received foot assessments (43.8% nationally) but fewer were within the 24 hour target e. 80.6% received a visit from the specialist diabetes (34.5% nationally)
It was worse than average for severe hypoglycaemic episodes 13.0% (9.2% nationally). ii. National Pregnancy in
Diabetes - participating iii. National Diabetes
Footcare Audit –
Hinchingbrooke patients are included by
Cambridgeshire
Community Services in a multi-disciplinary, cross
Trust service. . iv. National Diabetes Audit.
This is a joint project with primary care. Information about Hinchingbrooke’s patients is included but the work is done by primary care
Actions

Regular multi-disciplinary foot team meetings set up

Every patient admitted now has a thorough foot examination within 24hrs
Monday to Friday documented via completion of foot stamp

Relevant referral to Tissue
Viability so vascular or orthopaedic teams involved promptly Monday to Friday .

Diabetes, insulin, DKA and
HHS charts updated with
Pharmacists to reduce medication errors.

new clinical mandatory update sessions and drug administration update days.

Staff education ongoing

Hypo Boxes re- launched on every ward with guidelines

Hypoglycaemia awareness and treatment is covered as above

Incorrect treatment of
Hypoglycaemia is reported as an incident

Training on individual wards as required.
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22 UK Parkinson’s Audit
[previously known as National
Parkinson's Audit]
23
24
Inflammatory Bowel Disease
[IBD] programme
Rheumatoid and Early
Inflammatory Arthritis
National Vascular Registry
22 cases were reported:

No integrated clinic
(doctors and nurses);

Noted that not all clinics are specialist clinics;

Information, Non-motor questionnaire, Barthel,
Cognitive test, Mood testing not available at all clinics

No discussion re: end of life or Lasting Power of
Attorney in notes audited
All portions of this audit were sent data. Most data amalgamates individual patient issues e.g. other diseases, treatment when admitted, reason for admission.
100% scores for weight and diet assessment (above national), prophylactic heparin given (national 91%), surgical complications lower than national, more followed up within a month (83%)
Baseline forms uploaded to 30
January 2015 put
Hinchingbrooke in 9th place for submissions at 34 per
100,000 population when the first year data concluded [55 actual submissions]. It has increased since then for the second year but has not concluded.
Some of the actions agreed included:

discussing findings with the
Parkinson’s UK representative and

use of updated questionnaire at clinic.
A Parkinson’s nurse is due to start with a follow-up project planned.
The recommendations were shared with relevant clinical staff
Actions to be determined
25 National Chronic Obstructive
Pulmonary Disease [COPD]
Audit Programme
Data on 78 patients submitted to BTS National COPD audit.
Please see below for the findings.
Please see below for the actions.
26 Falls and Fragility Fractures
Audit Programme [FFFAP]
Older People
192 submitted as required =
100% 130 patients achieved best practice = 68%
Those not meeting the standard were due to:

38 theatre delays e.g. medically unfit patients.

22 delays in geriatrician visits.

A restructured Falls Team is in development

NICE guidance re: falls is being reviewed via other projects
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27
28
SSNAP Sentinel Stroke
National Audit Programme i. Organisational ii. ii] Patient Care
National Audit of Intermediate
Care
Renal replacement therapy
[Renal Registry]
Hinchingbrooke is not a full stroke service provider but works on a ‘hub and spoke’ system where acute care is provided elsewhere and rehabilitation is provided for patients not fit to return to their home environment. i) The Trust submitted data for the organisational portion of the programme.
Generally the staff employed by
Hinchingbrooke in conjunction with CCS was lower than in other organisations. ii) The Trust provides rehabilitation care for patients who have received acute care at other hospitals in the region. We are not currently entering data due to staffing issues and potential changes to stroke provision.
Provided by Cambridgeshire
Community Services NHS
Trust
It is a concern that the comparisons might be against different types of service provision and clarity about the comparisons for the staff numbers is being pursued in order to better understand the deficiencies.
Action is restricted due to the complex arrangements involving a number of different
NHS organisations.
Audits regarding meeting of the contractual arrangements have been relayed to the group but no action has so far resulted.
29
30
31
32
Elective surgery [National
Patient Reported Outcome
Measures Programme] -
Elective surgery: i. i.
Hip ii. Knee iii. Groin hernia
Varicose veins
Other
The most recent available information about this programme is shown below this table .
Participation levels (in the area where hospital staff have some influence) are above the national level with the exception of varicose veins which is very poor.
The reason for the poor return for varicose veins has been followed up again and determined to result from patients who do not attend an out-patient clinic and need to complete the questionnaire on the day of the procedure.
Where this poses a difficulty with theatre times, the questionnaire is not completed.
Education will be scheduled next year.
Prescribing Observatory for
Mental Health [POMH]
National Confidential Inquiry into Suicide and Homicide for people with Mental Illness
[NCISH]
National Ophthalmology Audit
Not confirmed during the period or by 22 April 2015
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33 Maternal, Newborn and Infant
Clinical Outcome Review
Programme [MBRRACE-UK]
Wome n’s Health
Every record is believed to have been reported.
Outcomes are individual.
Risks are discussed at regular meetings.
Where a problem is found, corrective actions are put in place.
Children/Paediatric
Neonatal Intensive and Special
Care [NNAP]
Paediatric Intensive Care Audit
Network [PICANet]
Paediatric Pneumonia
Paediatric Asthma
Diabetes [paediatric] [NPDA]
Children’s in-patient and outpatient treatment is provided on the Hinchingbrooke Health
Care NHS site by Cambridgeshire
Community Services NHS
Trust.
Please see the CCS Quality
Account for these projects.
Not applicable
Child health clinical outcome review programme
Congenital Heart Disease
[paediatric cardiac surgery]
[CHD]
The Trust participated in three of the National Confidential Enquiries into Patient Outcome and Death [NCEPOD].
NCEPOD studies 2014/15
Sepsis
Gastrointestinal Haemorrhage
Tracheostomy Care
Cases included
5
4
6
Cases excluded
0
1
1
Overall cases submitted
5
2
6
Organisational questionnaire returned
1
1
1
The local projects completed during the named period would often have been commenced during 2013/14 although projects started/registered at the beginning of the year are included. If more than one cycle is completed during the year, only the latest is included here.
The project types include clinical audit, baseline measures, patient and staff surveys, benchmarking, data collection etc. rather than pure ‘audit’.
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# Local Projects reported and reviewed by the provider during the period
1. 23 hour Breast Surgery Audit
2. Satisfaction with Gastroenterology and Colorectal Nurse specialist telephone ‘help line’ service
3. Management of Paracetamol Overdose
4. Use of Fascia Iliaca Compartment Blocks (FICBs)
5. Use of sedation and analgesia reversal agents within Endoscopy
6. Bowel Preparation Quality Audit
7. Colonoscopy Completion Rate Audit
8. Comfort levels for patients undergoing colonoscopy 2013
9. Report of OGD completion audit
10. Correct Use of Patient Group Directions (PGDs) in Magnetic Resonance Imaging (MRI) and
Computerised Tomography (CT).
11. Audit of management of migraine against NICE guidance 150
12. Essure Hysteroscopic Sterilisation
13. Gynaecology Re-admissions Audit Report Oct 2013 – Apr 2014
14. Uterine Rupture /Dehiscence baseline
15. Severe Sepsis and Septic Shock Audit
16. Revlimid patient review TA171
17. Venous thromboembolism Census
18. Adalimumab, Etanercept, Golimumab and Infliximab for Psoriatic Arthritis. NICE TAG199, Re-audit
19. Haematology Patient satisfaction survey
20. Audit of use of rituximab for treating ANCA associate vasculitis NICE TA308
21. Epidural Pain Review
22. Tonsillectomy bleeds
23. Multiple pregnancy and birth
24. Data Quality in Audiology
25. Acute Confusion: Recognition
26. Care of Women in Labour (4th cycle)
27. Immediate post op complications of operations on Achilles tendon
28. Compliance and appropriate use of NICE guidance for patients requiring transfer to a new oral anticoagulants (NOAC) NICE TA 249 and 256
29. Baseline measure of Abdominal Myomectomy NICE Guidelines [CG44] Heavy Menstrual Bleeding (HMB)
30. Antimicrobial Point Prevalence Audit
31. External Cephalic Version Audit
32. Emergency oxygen prescribing in adult medical inpatients.
33. Acute Stroke investigations between Hyper Acute Stroke Units and Hinchingbrooke
34. Re-audit of Blood Culture Standards 2014
35. Patient Satisfaction Survey for Cancer of Unknown Primary.
36. Audit of patients admitted with Neutropenic Sepsis.
37. Patient Satisfaction Survey: Urology
38. Colposcopy Patient Satisfaction Survey
39. Review of appointments required following Colposcopy Multi-disciplinary meetings
40. Audit of the number of dementia screen forms completed for patients over 75 years on surgical ward
41. 1. Mothers Experiences in Maternity Baby Friendly Initiative results
2. Supplements Given in Clinical Practice
3. Baby Friendly Initiative
4. Maternity Staff Education BFI Results
42. Patients’ Own Drugs at Discharge
43. Operative vaginal delivery
44. Cyclodiode Audit (Glaucoma)
45. Medical Termination of Pregnancy Patient Satisfaction Survey
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46. Ozurdex for macular oedema in Retinal Vein Occlusion: delivery metrics and treatment outcomes
47. Pancreatitis Audit
48. Pain results 6 months after facet joint injections
49. Newborn Hearing Screening Satisfaction
50. Learning disability reasonable adjustment audit
51. Quality of communication and use of SBAR for handovers to doctors on call for general medicine
52. Adult Squint Surgery 2nd cycle
53. 3rd and 4th Degree tear
54. Plain film radiograph requesting in acute admissions for abdominal presentations (multiple cycles)
55. Correct identification of colonic tumour position
56. Follow-up Patients In Rheumatology NICE CG79
57. Obstetrics Post Anaesthetic Care Follow-up
58. Rheumatoid arthritis – drugs for treatment after a failure of a TNF inhibitor TA195
59. Management of Anaemia in Pregnancy: baseline projects
60. Febuxostat Audit NICE TAG164
61. Documentation of Operative Notes
62. Re-excision rate following breast conservation surgery for breast cancer
63. Adherence to analgesic enhanced recovery programme after colorectal surgery
64. Rate of mastectomy surgery as a proportion of all surgery for breast cancer
65. Tonsillectomy mortality and morbidity (two projects within period)
66. Colorectal Cancer: Urgent 2 week wait NICE CG27
67. Unexpected transfers of children from Emergency to another provider
68. Venous thromboembolism: Adherence to NICE guideline CG92 (surgical patients)
69. 2 nd
cycle of timely administration of intravenous antibiotics on a surgical ward
70. Cataract Surgery 9 th
cycle
71. Patient Satisfaction Survey New Patient Clinic (Cancer)
72. Patient Satisfaction Survey 24hr Helpline
73. MEWS & Observation chart and the Escalation Algorithm
74. Staffing Maternity
75. Caesarean Sections 12 month running audit (Q3 only reported of the 4 per year )
76. Dispensary workflow
77. Use of capnography outside theatres
The Trust also participates in other projects with national information coverage, such as
KC65 for colposcopy services and National Pregnancy in Diabetes Audit.
We take part in national audits of various Royal Colleges, for example the College of
Emergency Medicine projects, such as Paracetamol Overdose [Adults].
On occasion, we work with other Trusts for national audits. There are projects which collect information about Hinchingbrooke patients that are not reported here but by associated care groups, such as local GPs or on-site staff from other Trusts. The National
Diabetes Footcare Audit is counted as CCS activity happening in Hinchingbrooke. In the case of the Ambulance Service national audit of outcome of Myocardial Infarction patients, we provide the requested outcomes about patients brought to Hinchingbrooke by the East of England Ambulance Trust.
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National Chronic Obstructive Pulmonary Disease [COPD] Audit Programme
Data on 78 patients submitted to BTS National COPD audit.

92% of patients given antibiotic within 24 hours.

90% given steroids within 24 hours.

70% had an ABG taken, of which only 23% had FiO2 documented.

56% of patients did not have an estimated MRC dyspnoea score prior to admission.

56% managed on Medical Assessment Unit/Acute Assessment Unit

49% seen by a respiratory consultant; 60% seen by any member of the respiratory team

32% prescribed oxygen on medication chart, of whom 92% had target range 88-
92%

25% of patients managed on respiratory or respiratory High Dependency Unit

Discharge: 41% discharged under care of a respiratory consultant; in 64% there was no evidence of discharge under the COPD team

82% had no documentation of consideration for Pulmonary Rehabilitation; 40% given smoking cessation advice
Plan:
1 Review of inpatient management of COPD patients required, as there has been insufficient input from the respiratory team. Since the audit period, a Specialist
Respiratory Nurse has been in post, which will have made a significant impact to those patients not on Respiratory ward
2 Enhanced training required for oxygen prescription [nursing staff and junior doctors] and smoking cessation
Antimicrobial Audits
The UK Clinical Pharmacy Association [UKCPA] Pharmacy Infection Network runs a competition every year to see who can design and implement the most effective campaign. Hinchingbrooke’s Advanced Clinical Pharmacist, Emma Cramp, won a national award for her European Antibiotic Awareness campaign.
A number of Trust-wide audit projects to provide information about various aspects of antibiotic care are now taking place routinely.
National Comparative Blood Transfusion: Red Cell Survey
The specialty where the red cell units were used was categorised into three broad groups:

Medical

Surgical

Obstetrics and Gynaecology
It was noted that the Obstetrics and Gynaecology section used a higher amount of red cells [9.3%] than the national figure [5.8%] and, while this could related to a number of
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causes that do not represent inadequate practice [eg cardiac surgery, the highest surgical user at 6.0%, not being undertaken here] this was highlighted to the clinical team. The
Obstetrics and Gynaecology team promptly undertook a project to review the usage against appropriate standards, which is currently underway.
Regional projects include those undertaken regularly by the Pharmacy group and special projects, such as the Peterborough and Cambridgeshire Diabetic Eye Screening
Programme and the introduction of a drug trolley safety alarm to prevent the problem of open and unattended drug trolleys, which is being led by a team in King’s Lynn.
Local- Drug Wastage:
Prior to 2004, it was nationally accepted that all drugs that a patient brought into hospital should be sent to the pharmacy and destroyed for safety. This is no longer appropriate and to reduce this wastage, ward based pharmacy teams and a patient’s own drug scheme were introduced where patients brought their own drugs into hospital and those that were suitable were used during the patient’s stay in hospital and returned to the patient at discharge. As expected with audit projects, the review continues until it is deemed no further improvements will be achieved.
The below graph shows savings made during the cycles of this audit.
Graph 3: Value of Drug Waste [£]
Cycle 5
Cycle 4
Cycle 3
Cycle 2
Cycle 1
0 200 400 600 800 1000 1200 1400
Drug waste (£)
Nine actions resulted from this project including reviewing high cost drug waste and identifying ways in which this can be minimised and improving the security of drug returns on the ward by sourcing and trialling the use of secure boxes/containers.
Where our internal risk assessments have indicated we need attention, we undertake local projects as they are able to collect and specify data on the potential causes [which the national audits cannot sensibly provide] with a much quicker time to implementation of corrective action than national projects [which may require further exploration into the local causes of the outcomes]. We are committed, therefore, to balance our audit/quality reviews from local to national projects.
In addition, local projects provide the opportunity to teach auditing skills that nationally designed and reported projects may not. It is believed that this is a responsibility of every
Trust in order to improve the quality, reliability and usefulness of audit and other quality projects. At the present time, these skills are not covered in national medical training. We involve staff in carrying out the whole process, with suitable support, to provide the best
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system for learning. We also provide a project review against some of the Healthcare
Qual ity Improvement Partnership’s [HQIP] Criteria and Standards for Best Practice in
Clinical Audit. This reviews the reliability of the project in providing dependable findings.
Some of the local projects undertaken include:

Plain Film requesting in acute abdominal presentation [further cycle]

Severe sepsis and septic shock

Emergency oxygen use in adult patients

Dementia screening forms completed for patients over 75 years

Epilepsy: pharmacological treatment by syndrome NICE CG137

Missed medication on drug administration on hospital ward

Management of hypertension in post-acute-phase stroke patients prior to discharge [NICE CG34 and part 162]

Dispensary workflow

Pregnancy and multiple birth

Acute oncology service – 24 hours to antibiotics
Every month, the quality and risk management dashboards are discussed in the relevant divisions. As part of this, ward performance is reviewed covering such areas as:

Compliance with hand hygiene standards

Compliance with sharps

Compliance with outcome eight standards

Compliance with saving lives urinary catheter care bundle

VTE assessment score

Prophylaxis score

Documentation standards

Central venous catheter – insertion and on-going care

Peripheral lines

Surgical site infections

Urinary catheter insertion and on-going care

Ventilated patients
Surveys are also used to improve the quality of our service in relation to the views expressed by patients. Some of these surveys are:

Urology nursing satisfaction

Newborn hearing screening [Hinchingbrooke provides the audiology service for
Cambridgeshire Community Services patients]

Endoscopy patient satisfaction

Patient satisfaction with 24 hour helpline
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100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Patient Reported Outcome Measures [PROMS]
Copyright The Health and Social Care Information Centre. All Rights Reserved.
The Patient Reported Outcome Measures [PROMS] are a national means for patients to feed back their views about the success of the procedure. This is done by questionnaires provided pre-operatively as well as at a set time following the procedure. Information is now coming through, if the patient consents, so that individual surgeons will be able to see the changes resulting from the procedure of their patients’ and address any areas that might need improvement.
The accuracy of the information depends on the number of questionnaires returned to the nationally approved organisation for analysis. The use of an outside group is a national requirement to address a possible bias. Our participation rates for the pre-operative questionnaire, which Trust staff distributes are:
Procedure
Hip replacement
Knee replacement
Groin hernia
Varicose veins
Pre-op questionnaires returned
166
181
107
8
Hinchingbrooke return rate
101.20%
102.30%
81.70%
22.90%
National return rate
86.10%
96.60%
58.30%
42.40%
The percentage return rates over 100% result from dates of operations, dates of questionnaires being filled in and monthly courier collection. In some cases the preoperative questionnaire is completed a considerable time before the operation while others are very soon before which may place the receipt of these questionnaires so that the tally does not match the timing of the operations effectively. Thus the overall return over an extended period is necessary to gain an accurate rate.
April to September 2014 [reported February 2015]
Hip replacement Knee replacement Groin hernia Varicose veins
Hinchingbrooke return rate National return rate
P atients’ perceptions of the improvement from the operations are measured by a variety of systems. The one shown below is five key questions concerning general health, used because it is common to all of the procedures.
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Percentage improving
Groin Hernia
Primary Hip Replacement
Primary Knee Replacement
Varicose Vein
EQ-5D Index
66.7%
66.7%
68.4%
Not available due to small numbers
EQ-5D Index
National
50.2%
66.7%
56.5%
40.9%
Percentage getting worse National
Groin Hernia
Primary Hip Replacement
14.8%
16.7%
17.4%
22.5%
Primary Knee Replacement 26.3% 29.8%
Varicose Vein
Not available due to small numbers
40.8%
The Trust is delighted to report that it achieved 90% of national and local quality improvement goals agreed with commissioners, resulting in £1.9 million of
Commissioning for Quality and Innovation [CQUIN] payments. The CQUIN payment framework enables commissioners to reward excellence, by linking a proportion of healthcare providers' income to the achievement of such goals. The CQUIN schemes relevant to the Trust are detailed below:
CQUIN
Number
Scheme Type
CQUIN 2014/2015
Description C&P CCG calculation
1 Friends &
Family
0.12%
2.1
2.2
NHS Safety
Thermometer
NHS Safety
Thermometer
National Implementation of staff FFT as per guidance, according to the national timetable
National Reduction in the number of attributable* avoidable grade 2, 3 and 4 pressure ulcers.
A policy explicitly defining avoidable and unavoidable PUs will be developed by the providers and agreed across all Trusts and the CCG by the end of April 2014.
National Support given to Partner Agencies where grade 2, 3 and 4 pressure ulcers have been attributed to the agency by the Provider. A letter and RCA template for Partner
Agencies is attached. The Provider will send this communication and template to
Partner Agencies where it has found that a grade 2, 3 or 4 Pressure Ulcer is attributable to the Partner agency, asking that it is completed and returned to the
Provider, and will offer the Partner Agency
0.25%
0.12%
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advice on receipt of the RCA and provide feedback and learning.
3.1 Dementia
Care
3.2 Dementia
Care
3.3 Dementia
Care
4.1 Training
4.2 Training
National The proportion of patients aged 75 and over to whom case finding is applied following emergency admission, the proportion of those identified as potentially having dementia who are appropriately assessed, and the number referred on to specialist services. Each patient admission can only be included once in each indicator but not necessarily in the same month, as the identification, assessment and referral stages may take place in different months.
National Named lead clinician for dementia and appropriate training for staff
National Ensuring carers feel supported
0.08%
0.01%
0.04%
Local
Local
Implementation of the AMBER Care
Bundle, according to the national AMBER
Care Bundle roll out guidance. The
AMBER care bundle is a tool used in hospitals when clinicians are uncertain whether a patient may recover and is at risk of dying in the next 1-2 months. It encourages relevant staff to make active management plans for patients and to communicate with patients and families – allowing continuation of treatment in hope of a recovery while talking openly about the patient’s wishes and putting plans in place should the worst happen. This contributes to people being treated with dignity and respect and helps patients and their carers to be fully involved in making decisions and knowing what is happening with their care.
By having conversations about preferences and wishes, and ensuring that everyone involved is aware of care plans, people are more likely to have their needs met.
End of Life Care. The More Care, Less
Pathway Report stated that hospitals must stop using the Liverpool Care Pathway in
June 2014. It also called for improvements in communication with patients and relatives, and mandatory training for clinical staff who care for end of life care patients
0.07%
0.07%
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5.1
6
Vulnerable
Older Adults
5.2 Vulnerable
Older Adults
IT
Local
Local
Local
Frailty Screening - Frailty is a term widely used to denote a syndrome of loss of reserves [energy, physical ability, cognition, health] that gives rise to vulnerability. It is recognised by a constellation of signs and symptoms including weight loss, fatigue, muscle weakness, slow or unsteady gait declines in activity. Patients admitted as an emergency often have complex social and health needs that, if not identified, will not be met. Screening for frailty in older adults can identify those most vulnerable and assist in targeting interventions to improve quality and efficiency of care and improve quality of information that can be used to prevent future avoidable emergency admissions.
Comprehensive Geriatric Assessment
Many frail older people, once identified through the frailty screening above, will require Comprehensive Geriatric
Assessment [CGA] [British Geriatrics
Society, 2010] . This is defined as a ‘multidimensional interdisciplinary diagnostic process focused on determining a frail older person’s medical, psychological and functional capability in order to develop a coordinated and integrated plan for treatment and long-term followup’.
Patients identified as frail enough to potentially benefit from CGA [CQUIN 5.1] will have a CGA carried out by an older people ’s specialist nurse. The outcomes from the CGA will be shared with GPs and community MDTs to improve future planning and co-ordination of care and treatment in this vulnerable group of patients.
Primary Care Information Sharing
Increase A&E and AAU staff access to primary care, care plans for older people.
This CQUIN shall be delivered in two parts:
1. Access to care plans via the SystmOne
CRV
2. Investigate and scope capability to integrate primary care information
[principally care plans for older people] into hospital information systems such as
Symphony or eCamis.
0.25%
0.73%
0.16%
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7.1 7 Day
Working
Local Diagnostics. All inpatients to have access to 7 day scheduled diagnostic services, to include: X-Ray, Ultrasound, CT, MRI;
Pathology, and;
Reports available to be viewed within 12 hours of diagnostic test or as soon as a result is available where this is not
7.2 7 Day
Working
Local achievable, ie histopathology, microbiology and other tests not normally available within
12 hours.
Time to First Consultant Review. All emergency medical and surgical admissions to be seen by a suitable consultant within 14 hours of admission
The proposed CQUIN for 2015/2016 are detailed below:
CQUIN
NO
Scheme Type Description
1 Acute Kidney
Injury
National Percentage of patients with AKI treated in hospital whose discharge summary contains four items [stage, medication review, blood tests required and frequency].
2 Sepsis
3 OPAT at home
National Identification of patients with sepsis, screened and treated appropriately.
Local Where outpatient antibiotic therapy is to continue for 3 days or more, 80% of consenting under 65's to be taught to selfadminister. To create an algorithm that will indicate pathway for patient to follow to selfadminister fully, partially [with hospital checks] or stay in the hospital setting.
Support of patients at home is critical and details of particular drug regimens and ramifications will need to be worked through in conjunction with the CCG. The service is to empower the patient but patient safety is paramount through the whole process.
National Reduce emergency admissions 4 Urgent &
Emergency
Care
5 Welcome to
Hinchingbroo ke - increase discharges by
1pm
6 Quality of
Electronic
Discharges
Local
Local
Increase the number of patients discharged before 1pm.
Improve quality of electronic discharge summaries - minimise errors/omissions in information and move to single intuitive system.
0.29%
0.29%
C&P CCG calculation
0.25%
0.25%
0.35%
0.25%
0.25%
0.30%
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7.1 CQC Quality
Improvement
Plan
Local Improvements in handover between shifts so nurses understand their patient needs better and patients are more involved in the decision making. Providing more complete care plans with completed risk assessments, higher quality and completed assessments for waterlow, falls, urinary catheter, venuous cannula, MEWS and
MEOWs and links to MCA and DOLs to ensure safeguarding of the patient.
Improving Palliative Care
0.30%
7.2 CQC Quality
Improvement
Plan
7.3 CQC Quality
Improvement
Plan
8 Medication
Safety
Thermometer
Local
Local
Local
Patient moves at night
Rollout and implementation of the National
Medication Safety Thermometer tool.
0.10%
0.10%
0.10%
The Trust’s Maternity Department underwent quality assurance assessment of the provision of Maternity Antenatal and Newborn Screening in November 2014.This was an external review undertaken by the UK National Screening Committee as a part of it routine inspection regime. The UK National Screening Committee and NHS Screening
Programmes are part of Public Health England [PHE], an executive agency of the
Department of Health.
The review looked across the whole screening pathway, including the laboratory services provide by The Pathology Partnership and Cambridge University Hospitals NHS
Foundation Trust and the care provided by Cambridge Community Services NHS Trust to the babies receiving neonatal care. The Trust’s audiology department was also involved in the screening assessment, as they provide the newborn hearing screening programme.
The NHS Antenatal and Newborn Screening Programmes consist of:

Infectious Diseases Screening [IDS]

Sickle Cell & Thalassaemia Screening [SCT]

Screening for Fetal Anomalies [FASP]
 Down’s Syndrome Screening [DSS]

Fetal Anomaly Ultrasound

Newborn Bloodspot Screening [NBS]

Newborn Hearing Screening [NHSP]

Newborn Physical Examination [NIPE]
During 2014, the department had met all key performance indicators for the nine standards that are reported on quarterly. In seven of these standards, they had achieved the highest national standard achievable. The Trust is unable to report on four standards due to the methods of laboratory reporting undertaken by the regional laboratory.
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There were 23 areas of good practice identified and 15 recommendations made across all the screening programmes, of which two related to TPP, one to CCS and two to the Area screening team. The peer review team did not identify any patient/clinical risks that were deemed to need immediate action.
The Trust has developed an action plan in response to the recommendations, against which it is monitoring progress.
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It is a clear priority for the Trust to be taken out of special measures within 2015/2016. The Trust has developed a Quality Improvement Plan
[QIP], which is monitored internally on a weekly basis and presented to a monthly Oversight Group. The QIP provides details of the specific objectives and timelines for completion and is published to the Trust’s Internet for open access by the public http://www.hinchingbrooke.nhs.uk/about/cqc-quality-report
Priority areas for improvement in 2015/2016, identified either within the QIP or as a result of analysis of Trust performance information, are summarised below. Please note that QIP actions completed prior to April 2015 are not listed:
PRIORITY AREA AIM SUMMARY OF KEY METRICS
DEADLINE
Staffing
To ensure that there are sufficient numbers of appropriately trained staff on duty in all clinical areas.
 Meet ‘Safer Staffing’ ratio

Nurse recruitment event Phase 2

Audit patient and staff experience at night

Repeat audit of patient, visitor and staff experience in critical care

Revise SLA with Cambridgeshire
Community Services Trust

Implement rotation of nurses between
ED and CCS’ Holly Ward

Review medical workforce [including activity and service coverage by speciality] and implement agreed actions in line with national implementation timescales

Review medical engagement using recognised tool

Interim Medical Director in post until
 recruitment
Substantive Medical advertisement goes live
Director

March 2016 [fully year compliance]

September 2015

April 2015

October 2014

June 2015

July 2015

April 2015

September 2015

December 2015

June 2015
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Care and welfare of people
To ensure that patients receive safe care that is appropriate to their needs and that involvement in decision making is documented and reflected in care plans.
Assessing and monitoring
Implement required changes to the governance and assurance mechanisms in use within the Trust and ensure learning from local, regional and national events is extracted and communicated to staff. Establish mechanism for review of all deaths in hospital.

Review and improve risk assessment, high impact intervention and care plan documentation to support delivery of care and involvement of patients – three phase, including training roll out

Induction segment and mandatory training to demonstrate competence

Review and improve handover processes, including training roll out

Repeat audits of outcomes following implementation

Introduce electronic integrated reporting system

Review and revise statutory and mandatory training programmes

Develop patient experience and dementia strategies

Develop and deliver action plan following external review of governance

Repeat inspection to assure standard

Implement new governance structure demonstrating floor to board communication and oversight/escalation
 Refresh the Trust’s complaints handling process

Revise monitoring and reporting to demonstrate organisational learning and actions taken in response to emerging and actual concerns

Monthly review of deaths to identify points of learning

July 2015

June 2016

May 2015

July 2015

August 2015

June 2015

April 2015 and July 2015

March 2016

March 2016

July 2015

June 2015

July 2015

June 2015
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Safeguarding people
Infection prevention and control [IPCC]
To ensure that prompt identification of abuse risk is made, with preventative measures put in place and correct actions taken in response to allegation of abuse. To ensure there are suitable arrangements in place to protect patients against the risk of unlawful control or restraint and that staff are trained in the use of ethical control and restraint.
To secure improved infection prevention and control support and ensure staff follow associated policies and procedures.

Implement mandatory training on the
Mental Capacity Act and Deprivation
 of Liberty Safeguards
Repeat external review of safeguarding

Develop and deliver action plan in response to findings

Commence a programme of child safeguarding audits

Undertake peer review of IPCC and develop and deliver action plan in response to findings

Implement campaign to raise awareness of IPCC
 Introduce ‘secret shopper’ audits to complement existing programme

Strengthen IPCC support and oversight

December 2015

June 2015

August 2015

July 2015

March 2015

June 2015

July 2015
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Respecting and involving people
Staff appraisal training and
To ensure timely response to call bells and to assist vulnerable patients with nutrition and hydration in a dignified, respectful manner.

Commence quarterly observation/audit of responses against standard

Revision of intentional rounding documentation and implementation of action plan

Undertake review of use of red jugs/trays

Implement and audit effectiveness of screening tool for nutritional status

Observations of care by nutrition specialist and DHON to include competency sign off and benchmarking

Training programme for volunteer dining companions

Audit of effectiveness of patient experience strategy

Develop draft Compassion in Practice strategy

Transfer of Patients procedure revised
To ensure that staff are adequately supported through appraisal, supervision and training to deliver care to patients

February 2015

June 2015

July 2015

August 2015

Ongoing, in line with mandatory training updates

June 2015

November 2015

July 2015

July 2015

March 2016

August 2015

April 2015

Roll out revised appraisal system

Extend opportunities for clinical supervision

Implement workforce and engagement strategy

Training needs analysis repeated to agree statutory training programme
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Palliative care
Patient safety culture
To ensure that all relevant patients receive timely referral to Palliative Care
Services and access to support seven days per week
To drive an open culture that supports patient safety

Increase rate of QELCA [Quality End of
Life Care] trained staff

Continue to demonstrate compliance with requirements in respect of consultant on call and specialist nursing access

Review and agree palliative care team and service delivery composition

Develop and implement plan for the
Last Days of Life pathway, with engagement of external stakeholders

Gap analysis against Francis recommendations [Freedom to peak Up report]

Develop and deliver action plan in response to findings

Communication of revised policies and procedures encouraging staff to speak up

Leading by example objectives agreed by all executives, monitored through appraisal

Introduce revised reporting on actions taken in response to concerns raised

Implement an integrated risk management software system

Improve communication with staff side partners in partnership work to drive an open culture

Develop a strategic workforce plan that includes a focus on engagement

Monitoring of Duty of Candour metrics

February 2016

March 2016 [full year compliance]

April 2015

August 2015

July 2015

March 2016

July 2015

June 2015

July 2015

January 2016

September 2015

April 2015

March 2016 [annual reporting]
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Medicines management
To improve medicines management and reduce the level of incidents resulting in harm

Commence participation in the ‘Drug
Guardian’ project

Involve external expert in developing actions

Develop and deliver action plan in response to medication audits’ findings

Introduce medicines safety thermometer reporting

Introduction of training plan

April 2015

April 2015

April 2015

June 2015 [pilot of three wards]

March 2016 [full implementation]

September 2015
Falls
Improved management metrics risk
Improved reporting of compliance with NICE guidance
To reduce the rate of patient falls and those causing severe harm
To establish and report on clear metrics in respect of preventable deaths [zero tolerance], ‘open’ complaints volumes, identification and reporting of serious incidents
To establish Trust-wide reporting mechanism

Pilot of falls prevention equipment, followed by evaluation and recommendations

Zero tolerance approach to preventable death

Gradated metrics for complaints response timelines by complexity [Low
0-20 days, Moderate 0-40 days, High 0-
60 days]

Achievement of agreed metrics for the timeliness and quality of serious incident investigations

Capture of Stop the Line events

Introduce standard operating procedure, reporting mechanism and monitoring oversight responsibilities


March 2016

July 2015

March 2016 [full year compliance]

August 2015

August 2015
July 2015
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Cambridgeshire and Peterborough Clinical Commissioning Group - received 19
June 2015
Cambridgeshire and Peterborough Clinical Commissioning Group (the CCG) has reviewed the Quality Account produced by Hinchingbrooke Health Care NHS Trust
(HHCT) for 2014/15.
The CCG and HHCT work closely together to review performance against quality indicators and ensure any concerns are addressed. There is a structure of regular meetings in place between the CCG, HHCT and other appropriate stakeholders to ensure the quality of HHCT services is reviewed continuously with the commissioner throughout the year.
The CCG flagged concerns in relation to a range of areas in 2014/15, including timeliness of investigation and learning from complaints. The Trust carried out a complete review of the complaints process and additional resource was bought in to clear the backlog. HHCT is creating a weekly bulletin that will show lessons learnt to staff. A briefing paper has been presented to the Trust Board to say what has been done on complaints in the past six months. The Governance structure at HHCT has changed and there is increased focus on incidents, complaints and learning from complaints.
The CCG and HHCT have joint concerns around discharge management including electronic discharge summaries sent to GPs. A Delayed Transfer of Care (DTOC)
Summit has been held and a system-wide action plan is in place. The HHCT Quality
Account attributes delays predominately to availability of community care. However, action is required within the Trust in relation to early mobilisation of patients and improvements in discharge planning.
The Care Quality Commission (CQC), the independent regulator of all health and social care services in England, carried out a comprehensive inspection in September 2014 and gave HHCT an overall rating of Inadequate, with the Trust being put into a Special
Measures process. This process is designed to ensure there is a timely and coordinated response after the CQC judge the standard of care to be inadequate. There was a further focused follow-up inspection in January 2015 to determine if the care provided in the areas of most concern had improved. This showed some improvement had taken place but not all areas were reinspected on this occasion. The overall rating was changed to
‘Requires Improvement’. However, as the ‘Well Led’ domain remains Inadequate until a further inspection takes place, the Special Measures process remains in place.
The CQC initial inspection flagged significant areas of concern within the Trust and the
CCG is working with the Trust to drive improvements. HHCT has an in-depth Quality
Improvement Plan in place to address the CQC concerns although minimal detail of this is
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given in the Quality Account. The Quality Account gives a positive approach to improvement but does not reflect the seriousness of the concerns raised.
Following the CQC report, an Oversight Committee was established with national and local stakeholders including the CCG, and this group has supported the Trust in improving quality of care. The CCG has carried out a range of unannounced visits to observe practice and talk to staff and patients about quality of care, which highlighted areas where improvements have been made and where additional work is needed.
There was also a series of visits in 2014/15 to review progress with infection prevention and control systems in the Trust, following concerns raised in 2013/14. HHCT continued to address these issues and recruited additional staff in 2014/15. The Trust exceeded its ceiling for the healthcare acquired infection C Difficile. The CCG continues to work with the Trust to drive infection prevention and control improvements and progress has been made in this area.
The statement of the Chief Executive acknowledges the importance of the staff in the work of the Trust, and this is emphasised in a range of national reports, particularly in relation to safe staffing. The requirement to report staffing ratios on wards and carry out regular workforce establishment reviews was introduced in 2014, and HHCT has implemented these requirements, setting up a system of monitoring and escalation to ensure safe staffing. With regard to Medical Workforce, the CCG raised concerns about the numbers of Consultant medical staff in place and the Trust carried out an in-depth review to highlight any gaps and concerns with activity levels. These issues are being addressed.
The Trust has invested in staff engagement and the 2014 NHS national staff survey shows improvements in several areas, with a slight improvement in the overall staff engagement result. Initiatives include establishment of a quarterly ‘STARs’ recognition scheme for staff, and a new appraisal and development framework which has led to significant improvement, following concerns about appraisal rates in 2014.
The CCG commented in 2014 that the goals and actions to achieve improvement for the
Trust’s priorities for 2014/15 were not clear, and it is difficult to tell from the 2014/15
Quality Account whether the priorities were achieved. The 2015/16 priorities cover the key quality issues raised by the CQC, but once again they are generic and give little detail of what the Trust aims to achieve. However, HHCT’s Quality Improvement Plan gives detailed measurable actions that the Trust is taking forward in order to move out of special measures, and this plan is signposted in the Quality Account.
The discussion of the 2014/15 priority that includes a focus on mortality discussed the positive hospital standardised mortality rates for the Trust. However, the CCG carried out a themed review in 2014/15 which identified significant gaps in the systems in place for identification and review of deaths in hospital. This should be addressed as part of the
Assessing and monitoring priority for 2015/16.
The principle of collecting and learning from feedback from service users and carers is embedded in the NHS Constitution. HHCT has achieved high levels of patient satisfaction with improved scores in 2014/15 for the Friends and Family test, which asks patients if they would recommend the Trust to their friends and family. The Quality Account
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highlights a range of initiatives to engage with patients and the public, including a Patient
Experience Group launched as a voice for patients.
Quality Accounts offer a transparent way for trusts to report on innovation, learning and research. HHCT’s Quality Account shows participation in research and examples of the areas where the Trust has learnt from its Clinical Audit programme. Details of the number of incidents reported in HHCT are included. It would be useful to give a summary of lessons learnt which would show how HHCT is using its incident reporting system to improve patient care.
The HHCT Quality Account is clearly set out and easy to navigate for patients and the public, with pictures adding to the text. The challenges faced in 2014/15 are discussed and the Quality Account repledges the Trust’s commitment to safe, effective and high quality care. However, the CQC findings and detail of the Quality Improvement Plan could be more explicit. The report includes a list of services provided and the nationally mandated sections, although benchmarking data is not given. The CCG has reviewed the data presented in the Quality Account and most appears to be in line with other data published. However, the figure for the delivery of the Commissioning for Quality and
Innovation payment is incorrect.
Healthwatch – received 22 June 2015
Healthwatch Cambridgeshire has reviewed the Quality Account for Hinchingbrooke Health
Care NHS Trust and welcomes the opportunity to comment.
This has been a challenging year for the Trust. An ‘Inadequate’ CQC rating, being placed in Special Measures and the transfer of management back to the NHS has combined to present the Trust with a set of unique challenges. Healthwatch Cambridgeshire has been pleased to support the Trust in its patient and public engagement work during this period of extensive change.
Changes in governance arrangements, structures and personnel continue to be complex and Healthwatch Cambridgeshire is aware that turnover of staff and vacancies being carried particularly at senior and middle management levels continue to pose difficulties for implementing the required improvements. Healthwatch Cambridgeshire is also aware that a new complaints process is in development and we look forward to this being responsive, effective and embedding learning from feedback.
Healthwatch Cambridgeshire has actively sought feedback from the public and patients and has been pleased to advise the Trust on the development of its Patient Experience
Strategy and supporting activity. Healthwatch Cambridgeshire welcomes the work of the
Patient Experience Group on menu choice and supporting people with dementia. There is however still some way to go in making both the membership of the more reflective of the community the Trust serves and making its role more meaningful.
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It is noted that the ‘Respecting and Involving People’ priority area, as identified by the
Trust for 2015-16, is rather limited in its scope. There is much wider potential than call bell response rates and eating and drinking, important as these are. Healthwatch
Cambridgeshire looks forward to continue to work with the Trust during the coming year, in particular developing new approaches to engagement and learning from feedback.
Huntingdonshire District Council Overview and Scrutiny Panel [Social Well-Being] -
– received 23 June 2015
The Overview and Scrutiny Panel may have comments on the report in due course, but they don’t feel it necessary for scrutiny to influence the report before publication. The report however may help inform any future work of the Panel when looking at Health
Scrutiny.
Cambridgeshire County Council Health Committee – date to be confirmed.
The statement will be included following receipt of the ratified statement after their July
2015 meeting and will be taken into account by the Trust.
Trust’s Auditors - received 30 June 2015
INDEPENDENT AUDITORS’ LIMITED ASSURANCE REPORT TO THE DIRECTORS
OF HINCHINGBROOKE HEALTH CARE NHS TRUST ON THE ANNUAL QUALITY
ACCOUNT
We are required to perform an independent assurance engagement in respect of
Hinchingbrooke Health Care NHS Trust’s Quality Account for the year ended 31 March
2015 (“the Quality Account”) and certain performance indicators contained therein as part of our work. 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 2015 subject to limited assurance consist of the following indicators:

Rate of clostridium difficile infections

Percentage of patient safety incidents resulting in severe harm or death.
We refer to these two indicators collectively as “the indicators”.
Respective responsibilities of Directors and auditors
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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;

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 2014-15 issued by DH on
26 March 2015 (“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 2014 to April 2015;

papers relating to quality reported to the Board over the period April 2014 to April
2015;

feedback from the Commissioners dated June 2014;

feedback from Local Healthwatch dated 22 June 2015;
 the Trust’s complaints data for 2014/15 as submitted to the Department of Health;

feedback from other named stakeholders involved in the sign off of the Quality
Account;
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
the latest national patient survey dated 2014;

the latest national staff survey dated 2014;
 the Head of Internal Audit’s annual opinion over the trust’s control environment dated April 2015;

the annual governance statement dated 2 June 2015;
 the Care Quality Commission’s intelligent monitoring report dated May 2015
.
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
Hinchingbrooke Health Care NHS Trust .
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 Hinchingbrooke Health Care 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 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;

limited testing, on a selective basis, of the data used to calculate the indicator 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,
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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 Hinchingbrooke Health
Care NHS Trust .
Basis for qualified conclusion
Under regulations 8, 9 and 10 of the National Health Service (Quality Accounts)
Regulations 2010 as amended the Trust is required to provide a draft copy of the Quality
Account to the relevant clinical commissioning group, appropriate Local Healthwatch organisation and the appropriate Overview and Scrutiny Committees by 30 April. The
Trust provided an initial draft to the Cambridgeshire and Peterborough CCG on 4 May and to the other organisations on 7 June. The Quality Account we have reviewed included statements from all the organisations consulted, with the exception of Cambridgeshire
County Council Health Committee.
Qualified conclusion
Based on the results of our procedures, with the exception of the matter reported in the basis for qualified conclusion paragraph above, nothing has come to our attention that causes us to believe that, for the year ended 31 March 2015:

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.
Neil Harris
Director
Ernst & Young
Luton
30 June 2015
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Page
8
8
11 & 58
12
13
14
14
17
12 - 13
31
38
40
40 - 48
46
53
58 - 61
58
59 - 64
65
67
68
74
76
Change
Addition of paragraph outlining the range of support provided by volunteers
Inclusion of total income plus private patients for 2014/2015.
Inclusion of sentence ‘Attached as Appendix 1’
Date
15 June 2015
15 June 2015
21 June 2015
28 June 2015 Range of 14/15 Trust and national data updated with most recently published information [SHMI/ Palliative care coding of of patient deaths/ VTE total/ NHS staff survey of staff recommending the Trust to family and friends]. Clarification of sources used for C.difficile. Typographical error changed
[2013/15 to 2013/14]
Changed the number of incidents from April to September
2014 to 2259 from 2611
19 June 2015
Inclusion of % of staff appraised in the last 12 months in section ‘Area of statistically significant improvement’
Moved % of staff reporting errors, near misses or incidents witnessed in the last month to section ‘Area of statistically significant deterioration ’
Inclusion
‘For the data reported to September 2014 per NRLS there were 2259 incidents, 13 severe and 4 deaths ’.
15
15 June 2015
19
June 2015
June 2015
Inclusion of benchmark data for national comparator indicators 21 June 2015
Inclusion of ‘This is a local benchmark target set by the Trust.’ 15 June 2015
Revision of text, from ‘double’ to ‘a rise in’.
Inclusion of the number of patients receiving NHS services provided by Hinchingbrooke Health Care NHS Trust in
18 June 2015
2014/2015, who were recruited during that period to participate in clinical research approved by an ethics committee was 413
21 June 2015 Revision of national clinical audit list, to provide actions taken in response to findings and insertion of full local clinical audit list
Inclusion of additional NCEPOD Enquiry that the Trust had participated in.
Corrected error for CQUIN % achievement to 90%, which is the final agreed figure that was reported on page 28.
29 June 2015
15 June 2015
Inclusion of summary of key metrics
Insertion of Trust Quality Improvement Plan link to Trust’s
23 June 2015
23 June 2015 website
Inclusion of deadlines within summary of key metrics 2015/16 28 June 2015
Inclusion of CCG statement
Inclusion of Healthwatch statement
19 June 2015
21 June 2015
Inclusion of External Auditor statement
Inclusion of CQC Findings
Inclusion Appendix 2: Services Registered and Provided by
Hinchingbrooke Health Care NHS Trust
29 June 2015
29 June 2015
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The Directors* are required under the Health Act 2009 to prepare a Quality Account for each financial year. The Department of Health [DoH] 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 Regulation
2011].
In preparing the Quality Account, Directors are required to take steps to satisfy themselves that;
 The Quality Account present 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 i n accordance with the DOH’s guidance.
The Chief Executive, as the Accountable Officer of the Trust, and the Executive Directors confirm to the best of their knowledge and belief they have complied with the above requirements in preparing the Quality Accounts.
The Trust Board in fulfilling its public accountability obligations confirm to the best of its knowledge and belief that the Quality account complies with the above requirements.
By order of the Board.
Dated: 30 June 2015 ...................................... Chairman
Dated: 30 June 2015 ............................................................................ Chief Executive

During 2014/2015 the Trust continued to be operating under the franchise agreement which commenced on the 1 st
February 2012. The franchise is regulated by a franchise contact to which the NHS Midlands and East Strategic Health Authority, the Trust and the franchise partner, Circle, were co-signatories. Under this agreement the Trust Board consists of three non-executive directors, one of whom is the Chair. The Board has reserved functions as set out in the Franchise Agreement and the Intervention Order. This includes fulfilling the Trust’s public accountability obligations as set out in Schedule 8 of the
Franchise Agreement, Part 2 Reserved Matters [paragraph 2[c].
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FFT
GGI
GIGS
GMC
HQIP
HSE
HSMR
ICO
IG
IGAS
IPC
ISMR
DHON
DIPC
DoH
DOLS
DTOC
ECIST
ECOLI
EENT
EPLS
AKI
BAME
CQC
CQUIN
CUH
Acute Kidney Injury
Black, Asian and Minority Ethnic
CAKES
CCG
CCS
C.Diff
CEM
CGA
Children’s Assessment Knowledge Assessment Skills
Clinical Commissioning Group
Cambridgeshire Community Services
Clostridium Difficile
College of Emergency Medicine
Comprehensive Geriatric Assessment
CHKS
COPD comparative Health Knowledge System
Chronic Obstructive Pulmonary Disease
C&PCCG Cambridgeshire and Peterborough Clinical Commissioning Group
Care Quality Commission
Commissioning for Quality and Innovation
Cambridge University Hospital NHS Foundation Trust
Divisional Heads of Nursing
Director of Infection Prevention and Control
Department of Health
Deprivation of Liberty Safeguard
Delayed Transfer of Care
Emergency Care Intensive Support Team
Enchiridia Coli
Eyes, Ears, Nose and Throat
European Paediatric Life Support
Family Friends Test
Good Governance Institute
Gastro-Intestinal and General Surgery
General Medical Council
Healthcare Quality Improvement Partnership
Health and Safety Executive
Hospital Standardised Mortality Ratio
Information Commissioner Office
Information Governance
Invasive Group A Streptococcus
Infection Prevention Control
Integrated Services for Medicine and Rehabilitation
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MCA
MEWS
Mental Capacity Act
Modified Early Warning Score
MEOWS Modified Early Obstetrics Warning Score
MRSA Methicillin Resistant Staphylococcus Aureusis
MSSA Methicillin Sensitive Staphylococcus Aureusis
NCEPOD National Confidential Enquiries into Patient Outcome and Death
NHS/E
NMC
NRLS
National Health Service/England
Nursing Midwifery Council
National Reporting and Learning System
PALS
PbR
PEG
PHE
PID
PILS
PLACE
PROMS
PSHT
Patient Advice & Liaison Service
Payment by Results
Patient Experience Group
Public Health England
Performance in Initiating Delivering Research
Paediatric Intermediate Life Support
PU
RCA
RCR
Root Cause Analysis
Royal College of Radiologists
R&D Research and Development
RIDDOR Reporting of Injuries, Diseases and Dangerous Occurrences Regulations
Quality Improvement Plan QIP
SCBU
SHMI
SLA
SI
TDA
TPP
Patient Led Assessment of the Care Environment
Patient Reported Outcome Measures
Peterborough and Stamford NHS Foundation Trust
Pressure Ulcers
Special Care Baby Unit
Summary Hospital level Mortality Indicator
Service Level Agreement
Serious Incident
Trust Development Authority
Transforming Pathology Partnership
VTE
WRS
Venous Thrombo Embolism
Work Related Stress
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We would like to thank you for taking the time to read our Quality Account and hope you found it informative, interesting and that, most importantly, it has enabled you to have a better understanding of the Trust, of our goals for quality and our commitment to the delivery of safe, effective and high quality care.
If you would like to provide feedback on the content of this report and/or suggest improvements for future Quality Accounts please email fcarey1@nhs.net
or write to
Frances Carey, Director of Governance and Risk, Hinchingbrooke Health Care NHS
Trust, Hinchingbrooke Park, Huntingdon, Cambridgeshire, PE29 6NT.
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Inadequate
Requires improvement
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Inadequate Good

Good
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Good
Requires improvement


2ww -Breast Care Service, Hinchingbrooke Hospital

2ww Breast Service Surgeon Led -Hinchingbrooke Hospital,

2WW Clinical Haematology Service, Woodlands Centre,
Hinchingbrooke Hospital

2WW Endoscopy Service, Hinchingbrooke

2WW-Haematuria Rapid Access Investigation Service
Hinchingbrooke

2WW Head and Neck Service, (ENT) Hinchingbrooke
Hospital

2WW HepatoPancreatoBiliary, Hinchingbrooke Hospital,

2WW Lower GI Service, Hinchingbrooke Hospital

2WW Lower GI Service Male Only - Hinchingbrooke Hospital

2WW Lung Service, Hinchingbrooke Hospital

2WW - Penile Service Cambridge & Huntingdon Urology
Network, Hinchingbrooke Hospital

2WW Raised PSA/Prostate Service-Cambridge &
Huntingdon Urology Network-Hinchingbrooke Hospital

2ww-Rapid Access Gynaecology- Hinchingbrooke Hospital

2WW Renal Service Cambridge & Huntingdon Urology
Network, Hinchingbrooke Hospital

2WW Skin Plastic Service, Hinchingbrooke Hospital

2WW Testicular Service, Cambs & Huntingdon Urology
Network, Hinchingbrooke Hospital

2WW Upper GI Hinchingbrooke Hospital

Acute Urology Service - Hinchingbrooke Hospital

Ante Natal 1st (Nuchal Translucency) Scan, Hinchingbrooke
Hospital

Back Service - Orthopaedics, Hinchingbrooke Hospital ls
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
Bone Densitometry (DEXA), Hinchingbrooke Hospital

Breast Care Service-Hinchingbrooke Hospital

Breast Reduction and Enlargement Service- Plastic Surgery-
Hinchingbrooke Hospital

Breast Service Surgeon Led, Hinchingbrooke Hospital

Cardiology Service-Hinchingbrooke Hospital

Clinical Haematology Service, Woodlands Centre,
Hinchingbrooke Hospital

Colorectal Service-General Surgery-Hinchingbrooke
Hospital

Colorectal Service Male Only-General Surgery-
Hinchingbrooke

Colposcopy Service-Hinchingbrooke Hospital

Community Echo Service- Hinchingbrooke Hospital

Corneal and External Eye Disorders-Ophthalmology-
Hinchingbrooke Hospital

Direct Access ECG Holter Service - Hinchingbrooke Hospital

Dyspepsia Without Alarm Features (Non Fast-Track),
Hinchingbrooke Hospital

Endocrinology General Medicine Service-Hinchingbrooke
Hospital

ENT General GPSI Hinchingbrooke Hospital

ENT General-Hinchingbrooke Hospital

ENT General (Paediatric)-Hinchingbrooke Hospital

Erectile Dysfunction-Cambridge& Huntingdon Urology
Network-Hinchingbrooke Hospital-RQQ Details

Eye Service (Paediatric) (Consultant led)-Ophthalmology-
Hinchingbrooke Hospital


Fields Testing (linked to Glaucoma Service)-Hinchingbrooke
Hospital

Foot & Ankle Service, Orthopaedics-Hinchingbrooke
Hospital

Gastroenterology Service-Hinchingbrooke Hospital

General Diabetic Medicine Service, Hinchingbrooke Hospital

General Medicine Service One - Hinchingbrooke Hospital

General Medicine Service Two -Hinchingbrooke Hospital

General Surgery Service One, Hinchingbrooke Hospital

General Surgery Service Two, Hinchingbrooke Hospital

Geriatric Medicine Service -Hinchingbrooke Hospital

Glaucoma Service-Hinchingbrooke Hospital

Gynaecology General-Hinchingbrooke Hospital

Gynaecology - Infertility Service - Hinchingbrooke Hospital

Gynaecology Perineal Service, Hinchingbrooke Hospital

Gynaecology - Urogynaecology Service-Hinchingbrooke
Hospital

Hand Service Complex patients Orthopaedics-
Hinchingbrooke

Hand Surgery Minor Service, Hinchingbrooke Hospital

Hip & Knee Service- Hinchingbrooke Hospital

Knee & Soft Tissue Service Orthopaedics-Hinchingbrooke

Lid, Orbit and Lacrimal-Ophthalmology, Hinchingbrooke
Hospital

Lipids and Metabolic Service, Hinchingbrooke Hospital

Lumps & Bumps- Clinical Assessment Service -NO
PATIENT ATTENDANCE-Hinchingbrooke Hospital

Lung Function Test Service, Hinchingbrooke Hospital

Maternal Medicine Service-Hinchingbrooke Hospital

Medical Retinal Eye Service-Hinchingbrooke Hospital

Metabolic Stones Service, Hinchingbrooke Hospital
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
Neurology General - Hinchingbrooke Hospital

Ophthalmology Adult Ocular Motility-Hinchingbrooke
Hospital

Ophthalmology Triage Service NO PATIENT ATTENDANCE
REQUIRED - Hinchingbrooke Hospital

Ortho-Geriatrician Service, Hinchingbrooke Hospital

Orthopaedic General Paediatric, Hinchingbrooke Hospital

Orthopaedics General Service, Hinchingbrooke Hospital

Ortho/Plastic Hand Complex Service, Hinchingbrooke
Hospital,

Orthoptics (Paediatric)-Ophthalmology-Hinchingbrooke
Hospital

Paediatric General Surgery, Hinchingbrooke Hospital

Plastic Surgery Service One, Hinchingbrooke Hospital

Plastic Surgery Service Two, Hinchingbrooke Hospital

Pregnancy Advisory Service, Hinchingbrooke Hospital

RAC ACUTE Rheumatology Service-Hinchingbrooke
Hospital

Rapid Access Chest Pain - Cardiology Service,
Hinchingbrooke Hospital

Rheumatology Service-Hinchingbrooke Hospital

Ring Pessary Clinic Service, Hinchingbrooke Hospital

Shoulder and Elbow Service Orthopaedics-Hinchingbrooke
Hospital

Spinal and Back Pain Service Hinchingbrooke Hospital

Thoracic Medicine Service-Hinchingbrooke Hospital

Upgraded Hysteroscopy Service, Hinchingbrooke Hospital

Upper Gastro Intestinal General Service-General Surgery-
Hinchingbrooke Hospital

Urology General-Cambridge & Huntingdon Urology Network-
Hinchingbrooke Hospital


Vascular Service-General Surgery-Hinchingbrooke Hospital

Audiology – Hinchingbrooke Hospital

Clinical Physiology – Hinchingbrooke Hospital

Private Patients
– Inpatient and Outpatient – Hinchingbrooke
Hospital

Radiology – CT – Hinchingbrooke Hospital

Radiology MRI – Hinchingbrooke Hospital

Radiology – Nuclear Medicine – Hinchingbrooke Hospital

Radiology – X-Ray – Hinchingbrooke Hospital

Radiology – Ultrasound – Hinchingbrooke Hospital

Radiology – Interventional Radiology – Hinchingbrooke
Hospital

Ophthalmology – Cataract – Hinchingbrooke Hospital

Pain Service – Hinchingbrooke Hospital

General Surgery – Hinchingbrooke Hospital

Critical Care – Hinchingbrooke Hospital

Oncology
– Hinchingbrooke Hospital

Acute Oncology
– Hinchingbrooke Hospital
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