QUALITY
ACCOUNT
2014/15
Homerton University Hospital NHS Foundation Trust
Quality account 2014/15
www.homerton.nhs.uk
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Homerton University Hospital NHS Foundation Trust Quality Account 2014/15
QUALITY ACCOUNT
www.homerton.nhs.uk
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Homerton University Hospital NHS Foundation Trust Quality Account 2014/15
Quality Account 2014/15
CONTENTS Part One: Our commitment to Quality
1.1Chief Executive’s statement on quality
1.2Our key achievements
Part Two: Priorities for improvement
2.1Progress on our Priorities for Improvement (2014/15)
2.2Statements of Assurance from the Board
2.3National targets and regulatory requirements
2.4Reporting against core indicators
Part Three: Our Quality Plans for 2015/16
3.1Overview on our consultation process
3.2Quality Account Priorities for 2015/16
Part Four:
4.1Our Commissioning for Quality and Innovations (CQUINs) for 2015/16
Annexes
Annex 1: Statements from Commissioners, local Healthwatch organisations,
and Overview and Scrutiny Committees
Annex 2: Statement of Directors’ responsibilities in respect of the Quality Account
Appendices
Appendix A Our CQUIN Values for 2014/15
Appendix B Participation in National Audits
Appendix C Limited assurance statement from external auditors
Appendix D Limited Assurance Statement from External Auditors
Appendix E Glossary of Terms and Abbreviations
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QUALITY ACCOUNT
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Homerton University Hospital NHS Foundation Trust Quality Account 2014/15
Part One: Our Commitment to Quality
Chief Executive’s statement on
quality
I am pleased to present our Quality Accounts for
2014/15, which assures our key stakeholders that we
are continuously striving to provide the highest level
of clinical care. The safety and quality of the care we
provide to our patients remains the number one priority
for our Board, staff and Governors.
We became a Foundation Trust in 2004 and over the
last decade have maintained a reputation as a high
performing provider; delivering quality patient and
service user care whilst achieving compliance with key
performance and regulatory requirements.
During 2014/15, we have made further improvements
in the way we measure and assess for quality and
safety. Through our Quality and Patient Safety Board
we have introduced a process to shape, monitor and
drive improvements with our quality priorities.
Although we are proud of the services that we
offer and the key achievements that we have made
within the year we are also mindful of where the
Trust has fallen short in the level of care we should
be providing. During the past two years it has been
extremely concerning to see five maternal deaths occur
within our services. Each case has been thoroughly
reviewed through our internal processes as well as
all being examined by external experts. There have
been a number of recommendations arising from
both our internal processes and external panel reviews
conducted and the Trust has been acutely focused on
ensuring that these are implemented robustly.
Further to the maternal deaths, the Care Quality
Commission (CQC) paid an unannounced visit to
inspect the service provision followed by an announced
visit. The Trust is awaiting the final inspection report
however, in the meantime, the Trust has responded to
the concerns raised immediately following the visit.
Their feedback highlighted a number of concerns
including issuing three warning notices relating to
regulations 9 (Care and welfare of service users),
10 (Assessing and monitoring the quality of service
provision) and 12 (cleanliness and infection control).
Immediate action was taken and the Trust has since
provided the CQC with confirmation that the issues
raised by their feedback have been addressed.
Our quality improvement programme for 2015/16 will
continue to be influenced by national requirements
or those set out by our commissioners. We remain
positively challenged to ensure that high quality care is
provided at all levels across our Trust.
Whilst every effort has been made to reflect accurately
the position of the Trust against the measures reported
on, there are a number of inherent limitations in doing
this which may affect the reliability or accuracy of the
data reported.
These include:
• Data is derived from a large number of different
systems and processes. Only some of these are
subject to external assurance, or included in internal
audits programme of work each year.
• Data is collected by a large number of teams across
the trust alongside their main responsibilities,
which may lead to differences in how policies are
applied or interpreted. In many cases, data reported
reflects clinical judgment about individual cases,
where another clinician might have reasonably have
classified a case differently.
• National data definitions do not necessarily cover all
circumstances, and local interpretations may differ.
• Data collection practices and data definitions are
evolving, which may lead to differences over time,
both within and between years. The volume of data
means that, where changes are made, it is usually
not practical to reanalyse historic data.
The Trust and its Board have sought to take all
reasonable steps and exercise appropriate due diligence
to ensure the accuracy of the data reported, but
recognises that it is nonetheless subject to the inherent
limitations noted above. Following these steps, to my
knowledge, the information in the document is accurate.
As always, the Trust‘s key strategic quality priorities
remain the focus of our goals and ambitions for the
quality of care we deliver.
Tracey Fletcher
Chief Executive
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1.2 Our key achievements
Our Trust is located in the London Borough of
Hackney and we are an integrated provider of acute
(hospital) and community based services, providing
services across parts of the City of London and the
London Borough of Hackney. As a Foundation Trust,
we continue to maintain our reputation as a high
performing provider; and strive to work in partnership
with our commissioners, local GPs and other voluntary
and statutory groups to ensure that the care we deliver
is safe, effective and a positive experience for our
service users.
Anaesthetic Clinical Services
Accreditation (ACSA)
The prestigious Peer Review Programme of the Royal
College of Anaesthetists has accredited Homerton
University Hospital as the first anaesthetics department
in the country to receive Anaesthesia Clinical Services
Accreditation (ACSA).
During 2014/15, we have made several key
achievements that we are proud of and which support
our drive and commitment to provide quality services.
These include gaining recognition at the Health
Education North Central and East London Quality
Awards ceremony, where we received one winners
medal for our contribution to the success of the
Norwood Centre and five ‘Highly commended’ which
included our work within Child Protection and our
Simulation Centre. The following information contains
a snapshot on some of our key achievements:
• Anaesthetic Clinical Services Accreditation - “the
first hospital to gain such accreditation”.
• The HENCEL Awards. Five ‘Highly Commended’ and
one ‘Winner’.
• Norwood Centre - “moving away from the one size
fits all approach to health care delivery.
• The Green Bag Scheme - supporting patients to
manage their medications.
• A nationwide Child Protection Information Sharing
Project.
• Driving improved patient outcomes through
research.
• ‘Music to our ears’ – launching our choir for
patients and staff.
• Engaging with our key stakeholders to inspect
the ‘PLACE’ (Patient Led Assessment of the Care
Environment).
• Redesigning the Bryning Day Unit for our elderly
patients.
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Our Clinical Lead, Dr Sade Okutubo receiving the award.
Dr Sade Okutubo, Clinical Lead in Perioperative, Critical
Care and Chronic Pain Services said: “The process has
led to our going over every aspect of the service with a
fine tooth comb. We can confidently evidence a high
quality service and care for our patients.”
ACSA is a unique scheme for anaesthetic departments
in the NHS and independent sector that enables
departments to measure their performance against
clearly defined standards and clinical guidelines, and
to progress to become accredited for their quality of
patient care and service delivery. Since the scheme’s
launch in 2013, it has received acclaim from national
regulators and to date, more than 40 NHS anaesthetic
departments have begun working towards meeting the
ACSA standards.
Homerton University Hospital NHS Foundation Trust Quality Account 2014/15
Professor Sir Mike Richards, Chief Inspector of
Hospitals, Care Quality Commission, has recognised
the ACSA process stating: “I strongly support the
work on accreditation being undertaken by the Royal
College of Anaesthetists. The ACSA accreditation
programme should in due course be a very useful
source of information on the quality of anaesthetic
service for the Care Quality Commission. I am
delighted that Homerton Hospital NHS Foundation
Trust is being recognised as the first hospital to gain
such accreditation.”
The HENCEL Awards - five
‘highly commended’ and a winner!
The Health Education North Central and East
London (HENCEL) is a regional organisation with the
responsibility of ensuring that high quality education
and training is provided across the sector. They
recognise that the best education would ultimately
provide the best possible outcomes and experiences for
our patients.
Child protection training
Safeguarding children and working with vulnerable
families has been identified as one aspect of the role
that is most stressful for newly qualified health visitors.
We have committed to providing all their health
visitors with high quality and regular child protection
supervision from the named nurses that shapes and
informs safe practice.
Newly qualified health visitors are provided with
a Continuous Professional Development (CPD)
programme based on the ‘novice to expert’ model
(Benner, 1984) which enables consolidation of
theoretical knowledge, experiential learning and
skills acquisition over time, allowing movement from
competent to proficient, then expert practitioners.
On December 3 2014, in recognition of excellent work
undertaken across our organisation, we successfully
achieved five Highly Commended and one Winners
award at the HENCEL ceremony.
The five highly commended awards were for:
• the use of our Simulation Centre to enhance
training
• our bespoke Child Protection Training
• Apprentice of the Year
• Student of the Year
• Medical Trainee of the Year
We were the overall winner for ‘promoting healthy
living through education and training’ at our Norwood
Centre.
The use of our Simulation Centre to enhance
training
Professional education is critical to achieving the Trust’s
objectives. Our Simulation Centre is designed to deliver
a comprehensive range of learning and development
opportunities based on service and individual need,
giving staff the knowledge, skills and attitude needed
to deliver safe, high quality care for our patients. The
learning opportunities create a culture of learning and
development benefiting all staff and patients.
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QUALITY ACCOUNT
One of our health visiting teams
Health visitors are reassured by this rigorous supervision
programme, and named nurses have confidence that
the values and skills they need in the workforce are
embedded in their clinical practice. This leads to safer
care for our children and their families.
The model of supervision for newly qualified health
visitors was highly commended in the December 2014
Health Education North Central and East London
quality awards (HENCEL).
Return to practice
The Trust recognises the importance of education and
training for staff, which ultimately drives quality care to
our patients.
In addition to the awards received from the HENCEL,
the Trust has also supported three nurses who had
been out of nursing for some time, as part of the
‘return to practice programme’.
The return to practice programme is a combination of
classroom and placement based learning, with study
periods and a minimum of 75 hours of clinical practice
taking place over approximately three-months.
This programme enables previously experience and
mature nurses to return to caring for patients.
Norwood Centre - “moving away from the
one size fits all approach to health care
delivery”
The Norwood Centre provides children and family
services for the orthodox and wider Jewish community
in Hackney. It is well used by the Orthodox Jewish
community and has built up a strong relationship with
the wider community. After-school clubs are run with
sometimes up to 200 children attending.
We have re-established our partnership with Norwood,
Anglo-Jewry’s leading children and family services
charity, to promote access and deliver the Healthy Child
Programme (HCP) at the Norwood Centre.
Our Head of Community Nursing stated:
“This is an exciting opportunity to demonstrate our
commitment to moving away from the ‘one size fits all’
approach to health delivery.”
The Healthy Child Programme (HCP) is a universal
evidence based preventative service for all families
focusing on early prevention and providing good
foundations for future health. It consists of a schedule
of reviews, immunisations, health promotion, parenting
support and screening tests that promote and protect
the health and wellbeing of children from pregnancy
through to adulthood.
The work undertaken at the Norwood Centre was
recognised in the HENCEL Quality Awards in December
2014. It was the overall winner for the category of
‘promoting healthy living through education training’.
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Homerton University Hospital NHS Foundation Trust Quality Account 2014/15
Our Chairman (Tim Melville-Ross CBE) with
Diane Abbott MP and staff from Homerton
and the Norwood Centre
Two of the mothers with their children
at the Norwood Centre
Tim with Rabbi Avraham Pinter
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QUALITY ACCOUNT
The Green Bag Scheme - supporting
patients to manage their
medications
In September 2014, the Green Bag Scheme was
set up to encourage patients to bring in their own
medications when they are coming into hospital. This
would ensure that there is a smooth continuation of
medications administered from home to hospital.
• If patients are being admitted and do not have
their medications with them, then the carer/family
member would be given a green bag and requested
to put all the medications in the bag, and bring it
with them to the ward at their next visit (as soon as
possible).
• The bag with medication would then go with the
patient to the appropriate ward on transfer. This
enables the doctors/nurses/pharmacist to obtain
an accurate drug history for the patient, and
avoid any missed doses (especially if the pharmacy
department is closed or if an item is not in stock).
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In summary, the benefits for our patients
are listed below.
1Promotes greater continuity of
pharmaceutical care from home to
hospital.
2Enables more accurate drug histories
to be taken, facilitating medicines
reconciliation on admission.
3 Reduces prescribing errors on admission.
4Reduces missed doses of medication
that are not stocked on the ward outside
pharmacy hours.
5Ensures drug supply, administration and
discharge are timely and patient centred.
6Saves time at drug rounds and in
dispensary.
• On discharge from hospital, some patients may
not require any further medications to take home
with them, thus reducing the waiting time prior to
discharge.
7Secures savings to the hospitals drug
• Currently the green bags are kept as ward stock
on A&E, Acute Care Unit (ACU), Thomas Audley
and Priestley Wards (which are two of our surgical
wards). Our Bariatric service also encourages
their patients who are coming in for surgery to
bring along their medications in the green bag
on admission (as their admission is planned). The
London Ambulance Service has also been involved
and will supply a green bag to the patient to bring
their medications in at admission.
8Secures savings for the Trust (and the
expenditure, dispensing and disposal
costs.
Homerton University Hospital NHS Foundation Trust Quality Account 2014/15
NHS) through reduction of waste.
Nationwide Child Protection
Information Sharing System
Driving improved patient outcomes
through research
Our Trust went live in November 2014, as a first-oftype site for a nationwide Child Protection Information
Sharing project. The project, which will cost £8.6m over
the next five years, has been developed by the Health
and Social Care Information Centre.
In December 2014,
although we were
unsuccessful as the overall
winner, we nevertheless
joined seven other NHS
Trust as ‘Finalist’ for the
Health Service Journal Clinical Research Impact Award.
Additionally, our clinicians have been successful in a
number of grant applications this year.
• This is a national database which will flag children
identified as vulnerable by social services to NHS
staff if they attend A&E or other unscheduled care
settings, with the information held centrally in a
secure database.
“We wanted to have a seamless
electronic record so clinicians don’t have
extra processes to go through and all the
information is available to them easily
and quickly. What’s currently available
is a portal, so you can have a separate
process where you can go out of the
record, go onto the portal, log in and get
an alert, but we wanted to integrate it
into the record”
• A patient demographic banner with details of any
child protection plan will be displayed on the record
for the duration of the plan, while expired plans
will remain “flagged up” as alerts in the record for
clinicians to check.
• The project will connect emergency departments,
out–of-hours GP services, walk-in centres, paediatric
wards, maternity wards, minor injury units and
ambulance services with IT systems used in local
authorities’ child protection systems.
• This means that when a child who has a child
protection plan in place, or a ‘child looked after’
status goes into A&E, an indicator flag will
automatically appear, informing staff that this is a
child at risk. NHS staff will also be able to see if a
child has recently
visited another
A&E department in
the country.
The Homerton Anal Neoplasia Service Study
(HANS)
• Our Consultant Physician in Sexual Health and
HIV Medicine/Hon Professor in collaboration with
UCL were awarded an NIHR HTA grant award
of £409,562 to investigate the feasibility and
acceptability of home sampling kits to increase the
uptake of HIV testing among black Africans in the
United Kingdom.
• The study aims to develop a home sampling kitbased intervention to increase the provision and
uptake of HIV testing among black Africans using
existing community and healthcare provision.
Our Senior Lecturer/Hon Consultant Neonatologist and
colleagues have been successful in two research grant
applications:
The GBS2 trial
• In collaboration with colleagues from Queen
Mary’s University London (QMUL) and Birmingham
University, was an award of £1.1 million by the NIHR
HTA to investigate the use of Rapid Intrapartum
Group B Streptoccocus (GBS) testing in pregnancies
where the newborn is at high risk of developing
early onset sepsis.
• Also in collaboration with colleagues at QMUL, was
an award of £250,000 by the Barts and the London
Charity for a feasibility study on oral probiotics
administered to pregnant women from early
pregnancy until delivery: The PrePro Study. The aims
of the study are to determine the biological effects
of oral probiotics on the vaginal microbiome, and
the rates of recruitment, retention and compliance
with the study protocol.
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QUALITY ACCOUNT
Neonatology - microbial colonisation
• Our Consultant Neonatologist/Hon Senior Lecturer
and colleagues from the Barts Health NHS Trust and
QMUL have been awarded a large project grant by
Barts and the London Charity worth £413,000.
• This research builds on the established interest
within the department of neonatology in patterns
of microbial colonisation in premature babies and
how the neonatal immune system responds to this.
• The long term aim is to understand better
the factors that influence neonatal microbial
colonisation and immune responses and may
allow the development of strategies for microbial
manipulation and/or modification.
The LOPAC trial:
The LOPAC trial is a randomised controlled trial to study
the effectiveness of Laser Ablation versus Observation
to Prevent Anal Cancer (LOPAC) in men with human
immunodeficiency virus who have high-grade Anal
Intraepithelial Neoplasia (AIN).
We are pleased to offer a number of trials in addition
to the upcoming LOPAC trial within our surgical/sexual
health collaboration, and our service is in demand from
patients as far afield as Northern Ireland and Yorkshire.
The HANS unit has presented in San Francisco and
Atlanta in the USA with its own data and that of the
wider collaboration with St Bartholomew’s Hospital and
University College Hospital.
We are actively working to promote the HRA
technique, and in November 2014 we conducted
the first ever European HRA course with the help of
Chelsea and Westminster Hospital.
We were delighted to have the privilege of hosting
the world’s first ever ‘live operating session’ for our
mixed audience of nurses, sexual health doctors,
gynaecologists and surgeons from around the UK and
Europe.
It is a unit that is growing in research and clinical
stature, and we are proud of its Homerton base.
• Our Consultant in the Department of Sexual Health
and colleagues from Bart’s and QMUL have been
awarded an HTA grant worth £1,484,334.
• LOPAC is a trial to establish whether laser treatment
of anal pre-cancer prevents development of anal
cancer in HIV-positive men who have sex with men.
• The primary objective of this trial is to determine the
long term effectiveness of laser ablative treatment
of high-grade AIN disease in preventing anal cancer
in HIV-positive MSM when compared to six-monthly
active surveillance.
In September 2014 we launched the ‘Homerton
Anal Neoplasia Service’ (HANS). This is a joint venture
between the department of Sexual Health and the
department of Colorectal Surgery.
We offer High Resolution Anoscopy (HRA) and
treatment of AIN by topical treatments, as well
as offering laser ablation under local or general
anaesthetic for high grade AIN – which is unique in the
UK.
We have succeeded in getting anal cancer and its
prevention put up the priority list for London Cancer;
and a pathway that includes HRA is now part of the
guidelines produced by that umbrella organisation.
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Homerton University Hospital NHS Foundation Trust Quality Account 2014/15
‘Music to our ears’ – launching
our choir for patients and staff
Patients and staff on our Regional Neurological
Rehabilitation Unit (RNRU) have launched a choir
to mark Brain Injury Week which was in June
2014. They were joined by members of Headway
East London and staff from our stroke unit.
“The first get together felt
like a celebration and we all
had a good time.
The choir was the idea of the patients, as the
opportunity to come together as a group and join
in a pastime which was both therapeutic and fun!
“Some of us can’t sing but there’s always
some who can. Our leader sings a little bit
at a time and we all pick it up nicely”
“ The room was full and there were
people outside who couldn’t get in”
“I just love music- it makes you feel good”
“There are some people who don’t speak at all- we can’t hear them but you
can see them singing and they believe they can sing. They look at the words
and they sing to you- it’s just you can’t hear it. But they are taking part”
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QUALITY ACCOUNT
Engaging with our key stakeholders
to inspect the ‘PLACE’
(patient-led assessments of the care
environment)
“Good environments matter. Every NHS patient should
be cared for with compassion and dignity in a clean,
safe environment. Where standards fall short, they
should be able to draw it to the attention of managers
and hold the service to account”.
In April 2013, Patient-led Assessments of the Care
Environment (PLACE) replaced the old Patient
Environment Action Team (PEAT) inspections with
the aim of providing a clear message, directly from
patients, about how the environment or services might
be enhanced. The assessment involved local people
going into hospitals as part of teams to assess how the
environment supports patients’ privacy and dignity;
food; cleanliness; and general building maintenance.
The assessment focuses on the environment and
not on clinical care provision or how well staff are
doing their job. The results are reported publicly to help
drive improvements in the care environment and show
how hospitals are performing nationally and locally
(NHS England).
Our last PLACE assessment was undertaken in
February 2015 and was considered as a positive
and useful initiative. Five assessing groups covered
the minimum of the areas required in the PLACE
specification, and beyond. Our overall representation
was very comprehensive and included staff from:
patients experience, facilities, estates, infection control,
corporate nursing, dementia nursing, dietetics, quality
and risk and corporate management.
• Alzheimer’s Society (an organisation which works
to improve the quality of life of people affected by
dementia)
The official PLACE results are due in August 2015, and
in the meantime relevant teams are implementing the
findings and recommendations.
Redesigning the Bryning Day Unit
for our elderly patients
In October 2014, we re-opened our fully refurbished
Bryning Day Unit, which is for our elderly patients. The
refurbishment included a new spacious waiting area,
treatment and consultation rooms.
The Bryning Day Unit has a multidisciplinary team
consisting of Occupational Therapy, Physiotherapy,
Speech and Language Therapy, a social worker,
nursing staff with specialist skills in elderly care and
doctors who specialise in elderly care. We run a
weekly programme of clinics and groups to provide
assessment, rehabilitation and support for older people
with complex problems.
Staff and patients celebrated the re-opening with a
ribbon cutting ceremony with our Chief Executive and
a slice of cake!
Participating patient assessors were or represented:
• Trust Governors
• POhWER (a charity that provides information,
advice, support and advocacy to people who
experience disability, vulnerability, distress and social
exclusion)
• Interlink Foundation (a charity organisation that
aims to strengthen the Orthodox Jewish community
infrastructure, improve access to services and
achieve better outcomes for disadvantaged people)
• Patients’ network
• Carers of service users with disability
• Age UK (the country’s largest charity dedicated to
supporting vulnerable older people)
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Homerton University Hospital NHS Foundation Trust Quality Account 2014/15
Our Chief Nurse Sheila Adam and Consultant
Geriatrician Deblina Dasgupta cutting the cake
Our Chief Executive Tracey Fletcher
cutting the ribbon
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QUALITY ACCOUNT
Part Two: Priorities for improvement and
statements of assurance from the Board
The following section presents an overview of the
progress made during 2014/15 to achieve our chosen
quality priorities for improvement, as well as our
performance on specifically defined measures as
presented within the Statements of Assurance from the
Board.
2.1 Progress on our Priorities for
Improvement (2014/15)
As part of our consultation process to determine
what our priorities should be for 2014/15, our key
stakeholders (which included our patients, staff,
Council of Governors, Commissioners, Healthwatch
and local patient forums) were contacted. In addition,
they were sent a copy of our organisational strategy
Domain
Safe
Effective
Positive
patient
experience
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“Achieving Together - Working Towards 2020” which
outlined our plans for driving quality.
Following the consultation, it was agreed that we
would continue to focus on six of the priorities from
the previous year as there was still the potential to
make further improvements. Six new priorities were
added, which brought the total to twelve quality
priorities for 2014/15. Table 1 below presents a
summary of the agreed priorities.
We set ourselves ambitious priorities to drive high
quality care and positively challenge ourselves to meet
the health needs of our diverse community.
Table 1: Summary of our Quality Improvement
Priorities for 2014/15
Priority Title of the priority for improvement
No.
Carried forward
2013/14
Priority
2014/15
1
A reduction in harm
3
2
Improve our Summary Hospital-level Mortality Indicator
(SHMI) rates
3
3
Improve patient safety through using NEWS scores
3
4
Improve medication errors resulting in harm
3
5
Improve clinical effectiveness
3
6
Reduce avoidable hospital re-admissions
3
7a
Improve maternal mental health - health visiting
element
3
7b
Improve communication with stakeholders to improve
patient care - district nursing element
3
8
Improve dementia care for our patients and carers
3
9
Improve the effectiveness of discharge from our care
3
10
Improving trust and confidence
3
11
Improve the way we communicate - ensuring that
dignity, respect and compassion is given
3
12
Improve the management and control of pain
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Homerton University Hospital NHS Foundation Trust Quality Account 2014/15
Quality Domain - Safe
What did we say we would do?
Priority One:
A reduction in harm
• Use the patient safety thermometer data to identify
a further reduction in the percentage of new harms.
The Trust participates in the National Safety
Thermometer programme, collecting data on our
patients in relation to potential harms. It is a point
prevalence survey (that is the number of harms seen
at a particular point in time) and can be used to show
trends in the number of harms suffered as an indicator
of the safety of our patients over time. Once the data
is collected it is entered into the safety thermometer
software and uploaded to a national portal.
• Provide 95% of harm-free care to our patients by
the end of March 2015.
• Aim to achieve 98% of harm-free care to our
patients during the final quarter of 2014/15
(January to March 2015).
• Aim to reduce pressure ulcers to less than two
incidents (Grade 3 and above) per month.
Every patient in our care is assessed for four specific
areas of harm, including pressure ulcers. This gives an
understanding of the level of harm-free care. We also
monitor the occurrence (incidence) of any pressure
ulcers and the grade of harm for each. Pressure ulcers
are graded from 1 to 4, with 4 being the most severe.
What did we do?
On average, during 2014/15 just over 95% of our
patients received harm free care as can be seen in
Figure 1.
Figure 1: Harm Free Care 2014/15 - All patients
100
100
80
80
% 60
% 60
40
40
20
20
0
0
Apr
Apr
May
2014
Jul
Aug
Sep
Oct
Jul
Aug
Sep
Oct
Harm free 95.16
94.85
93.31
93.92
95.67
95.6
94.75
96.47
Patients
757
777
707
716
841
629
765
744
Nov
Nov
Jun
2014
May
Jun
Dec
Dec
Jan
2015
Jan
2015
Feb
Feb
Mar
Mar
96.23
95.52
94.47
95.57
770
782
742
722
% Average harm free care
Figure 2: Our benchmark for providing Harm Free Care
100
80
89.67
91.62
91.89
91.95
93.63
93.81
93.81
95.13
96.33
60
40
20
0
ry
sbu
Sali
ford
Bed
m
esex
isha
iddl
M
th
Nor
Lew
ord
Salf
n
l
on
rton
evo
iona ittingt
ome
th D
r
H
h
o
W
N
Nat
As the graph above shows, we are above the national average of 93.81% and second highest in our comparative
group with other hospitals in providing harm free care to our patients.
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QUALITY ACCOUNT
Patient ID
Pressure Ulcer
Fall (with harm)
Urine Infection
(in patients with
catheters)
VTE (newly
acquired)
Harm Free?
Patient 1
3
7
3
7
No
Patient 2
7
7
7
3
3
7
7
7
3
No
7
7
No
Patient 3
Patient 4
7
Harm Free Care is measured on whether patients
have not suffered any of the following four harms:
pressure ulcers, falls, urine infections (UTI) and venous
thromboembolism (VTE), which are amenable to
preventative measures. Patients with one or more
of these conditions are not classified as ‘harm free’,
irrespective of where the condition was acquired.
Please see the table below which shows how harm free
care is calculated.
Patient 4 would be classified as ‘harm free’ because
they have none of the four harms. Therefore the
proportion of harm free care would be 25% (1 patient
out of 4 had no harm).
New Harms are where a patient acquires one or more
of the four conditions mentioned above whilst in our
care.
Yes
The Trust succeeded in reducing the number of new
harms caused to patients, not only in quarter 4 as was
the objective, but across the entire year. Less than
1.5% of patients experienced a new harm due to our
care. The data in Figure 3 shows our benchmark position
with regards to reducing new harm. As the graph
shows, Homerton is lower than the national average of
2.37% and has the second lowest level of new harm
when compared against our peers.
We continue to increase the delivery of harm-free care
to our patients with over 95% of patients receiving
harm free care, and recognise and respond to harm
caused by our care. Much of the work and focus of
the Improving Patient Safety Committee is actively
incorporating lessons learnt into our practice. Figure 4
shows the overall harm free care during the 2014/15
Figure 3: 2014/15 average proportion of patients experiencing new harms in our care
(comparative performance)
% Average new harms
6.00
5.00
5.32
4.00
4.16
3.00
2.97
2.00
2.67
2.37
2.35
1.47
1.00
0
ry
sbu
Sali
22
2.7
ford
Bed
m
sha
i
Lew
th
Nor
esex
dl
Mid
ord
Salf
Homerton University Hospital NHS Foundation Trust Quality Account 2014/15
1.26
n
l
on
on
erto
iona ittingt
Dev
m
h
o
t
r
H
Wh
No
Nat
Figure 4: Harm Free Care for the reporting period of 2014/15 by month
100
100
80
80
% 60
% 60
40
40
20
20
0
0
Apr
2014
Apr
May
2014
May
Harm free
Jun
Jun
99.46
No Patients 744
Jul
Jul
Aug
Aug
Sep
Sep
Oct
Oct
Nov
Nov
Dec
Jan
98.28
97.81
97.74
98.60
98.69
99.21
98.95
757
777
707
716
841
629
765
reporting period which includes old harms (i.e. patients
with pre-existing harm before entering our care).
During 2014/15, on average there were 1.8 incidents of
avoidable pressure ulcers each month.
Dec
Jan
2015
Feb
2015
Feb
Mar
Mar
98.83
98.08
98.38
98.34
770
782
742
722
patients suffering a new pressure ulcer: from 1.03% of
patients in 2013/14 to 0.52% of patients in 2014/15. This is extremely encouraging and we continue to focus
efforts on ensuring that efforts are maximised to further
reduce pressure ulcer harms.
Pressure ulcers remain an area of focus for us and we
have seen a significant reduction in the number of
Figure 5: Number of Grade 3 or 4 pressure ulcers
% Average new harms
Grade 4
Grade 3
5
4
3
2
1
0
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Figure 6: Our benchmark position for the number of Grade 3 or 4 pressure ulcers –
comparative performance for 2014/15
% Average new harms
3.00
2.00
2.09
1.65
1.00
1.25
0.99
0
on
ingt
itt
Wh
ry
esex
sbu
iddl
M
th
Nor
Sali
ord
Salf
0.98
0.79
l
iona
Nat
0.58
m
isha
Lew
ford
Bed
0.52
0.39
n
erto
Hom
th
Nor
on
Dev
www.homerton.nhs.uk
23
QUALITY ACCOUNT
We can evidence progress through:
• Review and scrutiny at our Pressure Ulcer Scrutiny
Committee.
• Reports sent to our Improving Patient Safety
Committee.
• Reports sent to our Quality and Patient Safety
Board.
• Data available from the national portal (Health and
Social Care Information Centre).
• Data collected locally through our point prevalence
studies and incidents reports.
• Board performance reports.
In 2015/16 we will:
• Ensure that this remains a priority in 2015/16.
• Deliver harm-free care to 95% of our patients in
every month of 2015/16.
• Reduce the incidence of avoidable pressure ulcers to
less than two per month consistently.
• Link the objectives of the Patient Safety
Thermometer in with our quality and safety
initiatives across the Trust.
Priority Two:
Improve our Summary Hospital-level
Mortality Indicator (SHMI) rates
The SHMI is an indicator which reports on mortality at
Trust level across the NHS in England using a defined
methodology. The SHMI is the ratio between the actual
number of patients who die following hospitalisation
at the Trust and the number that would be expected
to die on the basis of average figures for England.
It covers all deaths reported of patients who were
admitted to and either die while in hospital or within
30 days of discharge.
The SHMI is banded for each Trust as follows:
• Band 1 - where the Trust’s mortality rate is ‘higher
than expected’
• Band 2 - where the Trust’s mortality rate is ‘as
expected’
• Band 3 - where the Trust’s mortality rate is ‘lower
than expected’
What did we say we would do?
• To achieve and maintain a position in the lower
quartile of NHS organisations where the mortality
rate was “lower than expected” by the end of
March 2015.
• To reduce our SHMI from 0.90 to below 0.80 and to
move from Band 2 to Band 3 (where the mortality
rate is lower than expected).
What did we do?
• The Trust remains committed to reducing
unexpected death and this has been one of our
priorities since 2012/13. During 2014/15, through a
variety of initiatives we have strived to improve the
safety of our patients.
• Data made available by the Health and Social
Care Information Centre shows that the value and
banding of the summary hospital-level mortality
indicator (SHMI) for the Trust in 2013/14 was 0.82
(March 2014) compared to a SHMI of 0.94 in
2012/13. This meant that the Trust SHMI moved
from ‘as expected’ to ‘lower than expected’ which
24
Homerton University Hospital NHS Foundation Trust Quality Account 2014/15
was an excellent achievement (Further analysis on
our SHMI performance is presented in Section 2.4:
Reporting against the Core Indicators).
SHMI level varies month to month, and during October
and December 2014 the level rose above 1. However,
this should not be interpreted as an indicator of bad
performance but rather acts as a ‘smoke alarm’ which
requires investigation by the Trust. For more information
please review the SHMI guidance for press teams and
journalists document.
The charts refer to our local data and are not currently
available on the HSCIC website. As Figure 7 below
shows, the average SHMI level for April to December
2014 was 0.88, below the national baseline of 1.0. The
Figure 7: Local SHMI data (April – December 2014)
Summary hospital - level mortality indicator (SHMI) - April to December 2014
1.20
1.00
0.80
0.81
0.89
0.60
1.09
1.06
0.97
0.86
0.83
0.79
0.60
0.40
0.20
0
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
The data in Figure 8 shows a month by month comparison between April to December 2013 and 2014.
Figure 8: Comparison in local SHMI data between 2013 and 2014
Summary hospital - level mortality indicator (SHMI) - April to December 2014 vs 2013
1.20
SHMI 2013
SHMI 2014
1.00
0.80
0.95
0.81 0.81
0.83
0.60
1.09
0.95
0.89
0.72
0.60
1.06
0.97
0.79
0.63
1.17
0.86
0.70
0.65
0.56
0.40
0.20
0
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
The SHMI data is produced and published quarterly by the Health and Social Care Information
Centre (HSCIC).The SHMI values for each Trust are published along with bandings indicating
whether a Trusts’ SHMI value is ‘as expected’, ‘higher than expected’ or ‘lower than expected’.
UCL Partners- UCLP is organised around a partnership approach: developing solutions with
a wide range of partners spanning universities, NHS Trusts, community care organisations,
commissioners, patient groups, industry and government. UCLP works with partners to cocreate, test and implement solutions, ultimately embedding these solutions in normal ways of
working (www.uclpartners.com/).
www.homerton.nhs.uk
25
QUALITY ACCOUNT
Figure 9: Comparison of local SHMI data against the national baseline – April to December 2014.
Summary hospital - level mortality indicator (SHMI)
SHMI
Linear (SHMI)
Target
1.40
1.20
1.00
0.80
0.60
0.40
0.20
We can evidence monitoring of
progress through:
• Reports to our Improving Clinical Effectiveness
Committee.
• Reports to our Quality and Patient Safety Board.
• Data available on the national portal (Health and
Social Care Information Centre).
• Data collected locally through our Informatics Team.
• Performance reports sent to our Board.
Dec 14
Nov 14
Oct 14
Sep 14
Aug 14
Jul 14
Jun 14
May 14
Apr 14
Mar 14
Feb 14
Jan 14
Dec 13
Nov 13
Oct 13
Sep 13
Aug 13
Jul 13
Jun 13
May 13
Apr 13
0
In 2015/16 we will:
• Ensure that progress made is embedded into
everyday practice using specialty specific dashboards
for best care.
• Work with our clinical divisions to ensure that
progress is sustained.
• Identify a programme of work within our clinical
divisions to maintain our ‘lower than expected’
rating and ensure that any learning is captured and
disseminated.
• Monitor data at our Quality and Safety Board for
assurance on progress.
• Learn from and apply any lessons from the UCLP
Deteriorating Patient Programme.
• Work with the NHS Quest – Breakthrough Series
Collaborative.
26
Homerton University Hospital NHS Foundation Trust Quality Account 2014/15
Priority Three:
We have established our Deteriorating Patient Group
(DPG) which will be a forum to review the data, to
support, to discuss and progress all work relating to
deterioration and specifically will cover:
The National Early Warning Score (NEWS) is based on
a scoring system allocated to a patient’s physiological
measurement. There are six simple physiological
parameters which are: respiratory rate, oxygen
saturations, temperature, systolic blood pressure, pulse
rate and level of consciousness.
• cardiac arrests – rate and reduction
Improve Patient Safety through using
NEWS scores
A score is allocated to each factor as they are
measured and if the scores go above a certain level
requiring a response then this shows that the patient
is deteriorating and the urgent need to escalate to a
doctor for immediate action.
There is the potential for the NEWS to drive a step
change improvement in safety and clinical outcomes
for our acutely ill patients.
The Trust has set up this system to ensure an effective
and appropriate response is given to our patients who
become acutely ill.
To further support this work, we have joined two
deteriorating patient collaboratives; one with University
College London Partnership (UCLP) and the other with
NHS Quest.
Participation in both of these collaboratives requires
regular monitoring of the NEWS and data collection
relating to early detection, prevention of deterioration
and correct procedure in the event of deterioration.
What did we say we would do?
• To improve the response to acutely deteriorating
patients and reduce failure to rescue by introducing
the NEWS system.
• To successfully implement the deteriorating patient
pathway across relevant areas of the Trust, and
demonstrate using an early warning scoring system
an agreed response pathway with the ability to flag
high risk scores.
The NEWS was implemented within the Homerton
Hospital on July 28th 2014. All Health Care Assistants
were trained and all Registered Nurses are required to
do the on line training programme.
• DNAR (Do Not Attempt Resuscitation) in relation to
the above
• treatment escalation plans
• improved sepsis recognition and management
• data sets for UCLP and NHS Quest
• EPOCH – national audit on emergency laparotomy,
and
• AKI – acute kidney injury.
Building on participation in the UCLP Deteriorating
Patient Programme, the Trust has taken a coordinated approach to embedding early warning
scoring pathways across acute, maternity and
paediatric services. This supports clinicians to respond
appropriately to our patients who become acutely ill.
Area for
Deteriorating
Patient Pathway
Name of Program
Acute Care
NEWS - National Early Warning
Score
Paediatrics/
Children’s
PEWS - Paediatric Early
Warning Score;
Children’s Early Warning Score
Maternity
MEOWS - Modified Early
Obstetric Warning Score
What did we do?
The Critical Care Outreach Team (CCOT) along with the
Deteriorating Patient Group has collected information
for UCLP and NHS Quest programmes. In addition,
they have undertaken audits on our wards to assess
if patients whose vital signs had deteriorated were
appropriately escalated. Figure 10 overleaf provides a
snapshot audit of NEWS scoring on the observation
chart and responses in patients across different wards
at Homerton. Of those patients requiring an increased
frequency of observations or other escalation, only
52% showed documented evidence that this had
taken place. In some cases, actions had occurred but
there was no record of this on the chart. www.homerton.nhs.uk
27
QUALITY ACCOUNT
Figure 10: NEWS Audit - Patients requiring escalation by hospital ward
NEWS - patients requiring escalation
Escalated
Requiring escalation
Number of patients
1.20
1.00
0.97
0.80
0.60
0.40
The Trust has set up an increased level of training
for staff and on-going audit as well as Ward Sister
oversight as part of their daily patient rounds.
Several actions were implemented with the aim of
improving the number of patients that were escalated
appropriately.
RNRU
Thomas Audley
Templar
Priestley
Lloyd
Lamb
Graham
ECU
Edith Cavell
Delivery suite
Defoe
Cardiology
0
ACU
0.20
We can evidence monitoring of
progress through:
• Audits completed by the Critical Care Outreach
Team.
These include:
• Reports sent to our Quality and Patient Safety
Board.
• Introduce NEWS into mandatory training for all
relevant staff.
• Reports sent to our Improving Clinical Effectiveness
Committee.
• Critical Care Outreach Team (CCOT) and Practice
Development Nurses (PDN’s) to undertake 1:1
training on the wards.
• Discussions held at our Deteriorating Patient
forums.
• Audits reviewed within our Clinical Divisions.
• Ward Sisters to monitor if NEWS is being recorded
on a daily basis and remind all nurses on handover.
To assess the impact of these actions, we plan to reaudit all wards during 2015, and it is expected that
significant improvements will be evidenced.
Hospital Wards
ACU- Acute Care Unit
ECU- Elderly Care Unit
RNRU- Regional Neurological Rehabilitation Unit
In 2015/16 we will:
• Build on progress made during 2014/15 and ensure
that this priority remains for 2015/16.
• Include additional measures which focus on sepsis
and Acute Kidney Injury (AKI).
• Show demonstrable improvements in the Modified
Early Obstetric Warning Score (MEOWS) system
when monitoring and managing the care of high
risk women.
• Apply lessons learnt from the UCLP and NHS Quest
programmes into everyday practice.
28
Homerton University Hospital NHS Foundation Trust Quality Account 2014/15
Quality Domain - Safe
Priority Four:
Improve medication errors resulting in
harm
In line with the key objective to improve patient safety,
the Trust also chose to monitor and reduce the number
of medication errors where harm was recorded.
What did we say we would do?
• To make improvements in the reporting and
consistency of medication errors and a reduction in
numbers of errors resulting in harm
• To decrease the number of medication errors
resulting in harm by 10% from the baseline figure
for 2013/14 which was 52.
What did we do?
During 2014/15 there were several measures
undertaken to support a reduction in medication errors,
these included:
• Monitoring key trends and associated actions within
the multidisciplinary Medication Safety Committee.
The group now has a service user representative
who has fed back that he is very impressed with
the processes that we have to report incidents,
recognise failings and address them.
• We now have an appointed Medication Safety
Officer (MSO) who is registered with Medicines
and Healthcare Products Regulatory (MHRA). On
a monthly basis all medication incidents with any
degree of harm are reviewed together by MSO
& chief pharmacist and signed off. The MSO is
working with MHRA Medicines Safety Team to be
more user-friendly and to reduce the number of
incidents reported and categorised as “other”.
During 2014/15, concerted efforts were made to
monitor the number of medication errors resulting in
harm to ensure that we achieved a 10% reduction on
the baseline of 52 incidents.
A 10% reduction would require no more than 47
medication errors resulting in harm. During 2014/15,
we exceeded this target by 20, achieving 27 medication
errors resulting in harm. Whilst we need to keep any
medication errors to a minimum, the actual proportion
that resulted in harm was 6% which is a relatively low
rate. This is two percentage points lower than the
previous year.
Table 1 below shows that the total number of
medication errors recorded during 2014/15 in
comparison with 2013/14.
Medication Errors
2014/15
2013/14
Difference
No. of medication
errors
488
663
-26%
No. of medication
errors resulting in
harm
27
52
-48%
% of medication
errors resulting in
harm
6%
8%
-2.0
None /
Insignificant
461
611
-25%
Low / Minor Injury
23
49
-53%
Short Term Harm /
>3 days absence
4
3
33%
Major Intervention
/ Permanent or
Long Term Harm
0
0
N/A
Death
0
0
N/A
Harm Categories
www.homerton.nhs.uk
29
QUALITY ACCOUNT
Medication error key trends:
During 2014/15 we identified three key trends within
medication errors; namely allergies, omission of
medicines and medications for discharge.
Allergies
• During the year we have seen a decline in allergy
related incidents, this may be associated with our
collaborative working with Pharmacy to introduce
new labels for identifying allergies.
Omission of medicines
• Our Acute Care Unit (which is an intermediate ward
– between A&E and our wards) has identified a
dedicated person to ensure that medicines arriving
from pharmacy are sent to the appropriate ward
after the patient has been transferred.
• We have also produced laminated cards informing
patients who were off the ward during medication
rounds that they are due medications.
• We have jointly worked with Pharmacy and
continue to embed the Green Bag Scheme to
ensure that medications are not missed during stay
and following discharge.
Discharge medicines
• There have been several incidents relating to
discharge medicines which have been examined
at the Medicine Safety Committee. The incidents
have been used as part of the mandatory clinical
update. We are planning to produce on line clinical
skills training for doctors discharging patients with
medicines.
• To further enhance our learning from incidents we
have used simulation – we have piloted using real
(anonymous) medication incidents as part of the
in situ simulation training. The scenarios include
multidisciplinary team (including pharmacists) and
the feedback has been very positive.
We can evidence monitoring of
progress through:
• Medication incident reporting.
• Reports sent to the Medication Safety Committee.
• Report sent to the Improving Patient Safety
Committee.
• Reports sent periodically to the Joint Prescribing
Group (JPG) and The Prescribing Programme Board
(PPB).
• Discussion and review at our Clinical Quality
Review Meeting (CQRM) which are held with our
commissioners.
In 2015/16 we will:
• Work with our clinical divisions to ensure that
lessons learnt are embedded in everyday practice
across the Trust.
• Continue to audit our practice and report any key
trends in medication errors.
• Continue to monitor our medication incidents and
report finding to the relevant fora.
• Introduce electronic prescribing which will further
enhance patient safety.
30
Homerton University Hospital NHS Foundation Trust Quality Account 2014/15
Quality Domain - Effective
Priority Five:
We can evidence monitoring of
progress through:
Improve clinical effectiveness
The National Institute for Health and Clinical Excellence
(NICE) produce clinical guidelines and quality standards
on specific diseases and the recommended treatment
for our patients. The guidelines are based on evidence
and support our drive to provide effective care. In
2013/14, a target was set to ensure that we received
100% response from clinicians that the guidance
was used and that the NICE baseline assessment was
completed (to identify any gaps in practice).
What did we say we would do?
• Assess all relevant NICE quality standards; identify
any gaps and actions to achieve within two years.
• Reports to our Improving Clinical Effectiveness
Committee.
• Reports to our Quality and Patient Safety Board.
In 2015/16 we will:
• Ensure that progress is made to embed the NICE
guidelines and Quality Standards as part of the
speciality specific dashboard for best care.
• Work with our clinical divisions to ensure that
progress is sustained.
• Continue to report progress to our Improving
Clinical Effectiveness Committee.
What did we do?
• In 2014/15, 22 NICE guidelines were issued, of
which 17 have been identified as relevant for the
Trust.
• The 17 guidelines have been sent to the relevant
clinician to ensure that the detailed baseline
assessment form is completed.
• Of the 17 relevant guidelines, nine have been either
fully implemented or are working towards full
implementation. Five guidelines are currently being
reviewed and the remaining three guidelines are
awaiting review.
www.homerton.nhs.uk
31
QUALITY ACCOUNT
Quality Domain - Effective
What did we say we would do?
Priority Six:
• To reduce the number of patients who are
readmitted within 30 days of discharge.
Reduce avoidable hospital readmissions
• To improve timely discharge.
Reducing avoidable hospital readmissions remains
one of the top priorities for the Trust and in 2013; the
Discharge Management Group (DMG) was established
with the aim of exploring ways to reduce hospital
readmissions.
What did we do?
Table 2 shows that overall our readmission rates are
roughly static, although we have experienced a slight
improvement. Of note, Table 2 includes our sickle cell
patients.
Readmission rates have been targeted for improvement
as lower readmission rates can be taken to indicate a
higher quality service to patients as well as reducing
costs for hospitals.
Table 2: Readmission Rates
Readmission
rates
(30 days)
Post
elective
Post
daycase
Post
emergency
Readmission
rates
(30 days)
32
Period
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
%
%
%
%
%
%
%
%
%
%
%
%
2014/15
2.7
3.1
3.2
4.5
3.2
3.4
2.6
3.6
3.4
2.5
3.0
2.9
2013/14
2.6
2.0
2.3
2.9
2.4
3.0
3.0
3.4
3.3
1.6
3.7
4.0
Difference
0.1
1.1
0.9
1.6
0.8
0.4
-0.4
0.2
0.1
0.9
-0.7
-1.1
2014/15
1.7
1.4
1.5
1.6
1.1
0.8
1.5
1.3
1.1
1.2
1.4
1.2
2013/14
1.6
1.9
1.6
1.5
1.4
1.3
1.9
1.0
1.9
1.2
1.3
1.2
Difference
0.1
-0.5
-0.1
0.1
-0.3
-0.5
-0.4
0.3
-0.8
0.0
0.1
0.0
2014/15
12.2 13.6 15.6 14.6 17.4 14.5 13.5 13.9 12.7 14.4 14.7 14.3
2013/14
14.9 15.1 15.3 14.7 15.4 12.8 16.0 14.6 14.2 14.0 14.9 13.1
Difference
-2.7
-1.5
0.3
-0.1
2.0
1.7
-2.5
-0.7
-1.5
0.4
-0.2
1.2
2014/15
5.9
6.2
6.5
6.9
7.8
6.2
6.1
6.3
5.9
6.2
6.5
6.2
2013/14
6.9
7.1
7.1
6.4
6.8
5.7
7.2
6.7
7.2
6.0
6.7
6.1
Difference
-1.0
-0.9
-0.6
0.5
1.0
0.5
-1.1
-0.4
-1.3
0.2
-0.2
0.1
Homerton University Hospital NHS Foundation Trust Quality Account 2014/15
Table 2a shows our readmission rates excluding our sickle cell
patients. It shows a small reduction in the overall readmission rate.
Table 2a: Readmission Rates excluding sickle cell patients
Readmission
Rates (30days)
Apr
14
May
14
Jun
14
Jul
14
Aug
14
Sep
14
Oct
14
Nov
14
Post elective
1.9%
2.8%
3.0%
4.3%
3.0%
2.9%
2.5%
3.3%
2.7% 2.5 % 2.9%
2.5%
Post daycase
1.8%
1.4%
1.4%
1.5%
1.1%
0.9%
1.4%
1.1%
1.0%
1.1%
Post
emergency
10.9%
10.9% 12.0% 13.9% 13.2% 15.6% 12.7% 12.0% 12.2% 11.2% 12.4% 13.1% 12.8%
Readmission
rates
(30 days)
5.2%
5.6%
6.3%
6.3%
7.2% 5.5%
A number of work streams and projects are underway
to improve the Trust’s discharge process. It is
anticipated these will have a positive impact on the 30day readmission rate.
5.6%
5.5%
Dec
14
5.2%
Jan
15
Feb
15
1.1%
5.4%
1.0%
5.7%
Mar
15
5.6%
We can evidence monitoring of
progress through:
These include:
• Reports to our Improving Clinical Effectiveness
Committee.
• Appointing discharge co-ordinators to be associated
with each ward to liaise with patients and carers
to ensure they are fully aware of discharge plans,
who to contact with queries post-discharge and
to link with the doctors and nurses to ensure all
preparations are in place well in advance of the
planned discharge.
• Reports to our Quality and Patient Safety Board.
• A new Reablement and Intermediate Care Service
(RICS) to be launched in July 2015 that will provide
better out-of-hospital care and reablement for
patients as well as a crisis response team to identify
and resolve problems potentially avoiding a hospital
admission.
• Discussions held at the Discharge Management
Group forum.
• Monitoring readmission rates at our Divisional
performance reviews.
In 2015/16 we will:
• Ensure that this priority remains in 2015/2016.
• Embed the initiatives that commenced 2014/2015.
• Launch our RIC service and monitor its effectiveness.
• The RICS also aims to help identify suitable patients
and input into discharge planning.
• As part of the 2014/15 CQUIN, patients known
to adult community nurses are being reviewed by
the team within 48 hours of admission to begin
discharge planning and are being contacted or
visited within 48 hours of discharge.
www.homerton.nhs.uk
33
QUALITY ACCOUNT
Quality Domain - Effective
What did we say we would do?
Priority Seven (a):
Improve maternal mental health Health Visiting Element
• Participate in the UCL Partners work on developing
and testing a Value Score Card in North East
London in relation to maternal mental health.
Our health visitors work within the local community
and offer a range of services available in local settings
such as children centres, GP premises and health
centres as well as visiting families in their homes. They
support families through pregnancy and up to when a
child becomes 5 years old.
• Increase the identification and management of
mothers at risk of mental health issues.
The Trust is currently one of three pilot sites (including
Barts Health and East London Foundation Trust) to be
involved in the delivery of research and development
projects in partnership with UCL Partners to produce a
value score card to improve maternal health.
UCLP was commissioned by Health Education England
- North Central and East London (HENCEL) to deliver
three pilot projects centred on demonstrating the
contributions of the increase health visiting workforce
to the public health frame work to improve outcomes
for children 0-5 years and their families.
The score card is one of the six high impact areas that
the Department of Health has identified to improve
maternal mental health.
The six High Impact Areas are:
1.Transition to Parenthood and the Early Weeks,
• Ensure that we achieve full compliance with the
NICE guidance.
What did we do?
• During April to June 2014, a detailed action plan
was created in partnership with ULCP. The plan
outlined clear measures to ensure that the value
score card was successfully implemented with the
overarching aim of improving maternal welfare.
• Work was undertaken to review our management
of maternal mood assessments. Our previous
practice was to undertake the assessment at two
key points within the postnatal period, instead
of three key points as identified within the NICE
guidance.
• We developed bespoke quality improvement
training for health visitors.
• We organised a workshop for service users, which
was facilitated by a psychologist – exploring the
development of “I” statements for attachment.
2.Maternal Mental Health,
3.Breastfeeding (initiation and duration),
4.Healthy weight, healthy nutrition (to include
physical activity),
5.Managing minor illness and reducing accidents
(reducing hospital attendance / admissions), and
What did we do?
• Reports to our Quality and Patient Safety Board.
• Discussions at relevant health visiting forums.
6.Health, wellbeing and development of the child
age 2 – Two year old review (integrated review) and
support to be ‘ready for school’.
34
Homerton University Hospital NHS Foundation Trust Quality Account 2014/15
In 2015/16 we will:
• Build on progress made during 2014/15.
• Continue to refine our metrics and roll out across
the service.
• Working in partnership with ‘first steps’ we have
identified a tool to be used to assess attachment/
parent and infant relationship.
• Complete Parent-Infant Relational Assessment Tool
(PIRAT) Trainer - training with UCL (Tool not licensed
to use in UK yet). Validation process underway.
• Quality Improvement Champions have identified
and developed a quality improvement Project which
will focus on-Medical History, EPDS pre and post
listening visit and documenting interventions. It is
anticipated that this will be completed at the end of
June 2015.
www.homerton.nhs.uk
35
QUALITY ACCOUNT
Quality Domain - Effective
Priority Seven (b):
Improve Communication with
stakeholders to improve patient care
(District Nursing Element)
The Adult Community Nursing Team (ACNT) provides
a nursing service to the residents of the City of London
and Hackney. It is made up of approximately 70 nurses
and provides community nursing care to patients with
a range of conditions. The team is divided into four
clusters, which covers Hackney and a part of the City
Corporation of London.
Cluster 1, North West
• Full attendance (100%) at all Multi-Disciplinary
Team (MDT) meetings
Overall the Nursing Teams attended 87% of the
Multi-Disciplinary Team meetings with their named GP
practices. In some cases MDT meetings are held on a
weekly basis rather than a monthly.
There are GP practices where MDT meetings are not
routinely scheduled for those practices the clinical
operations manager has emphasised with the lead
GP and practice manager the need to ensure that
community nursing are able to access the GPs to
ensure information is shared frequently.
Figure 11 below shows the overall attendance at
MDT meetings for each of the four Clusters.
Cluster 2, North East
100
Cluster 3, South West and the City
What did we say we would do?
• To improve communication between Adult
Community Nursing teams and General
Practitioners (GPs) and primary care to improve the
patient’s experience and delivery of care.
This would be demonstrated through:
• Full attendance (100%) at all Multi-Disciplinary
Team (MDT) meetings,
• Full participation (100%) in integrated care planning
by the end of March 2015,
• Improved results from documentation audit by the
end of March 2015, and
• Audit to be undertaken during January – March
2015 relating to the Named Nurse and accessibility
from GP practice in contacting the Named Nurse
(for the patient).
What did we do?
During 2014/15 the Adult Community Nursing Teams
service has targeted their defined measures and made
concerted efforts to improve communication with GPs
and therefore improve the patients’ experience and
delivery of care.
36
80
Number of patients
Cluster 4, South East
60
40
20
0
Cluster 1
Cluster 2
Cluster 3
Cluster 4
Figure 11: MDT meeting attendance
Full participation (100%) in integrated care
planning by the end of March 2015
The Adult Community Nursing Teams have proactively
worked with the GP practices to ensure all the
Care Plans were completed and this has included
undertaking joint visits with the GP and undertaking
independent assessments which are then shared with
all health care professionals involved in the care.
The nursing team has also undertaken assessments
for patients who are not on the caseload but the GP
felt would benefit from a nursing review in terms of
future care planning. The quadrant meetings were
attended by members of the team and a case study
was presented at each meeting.
Homerton University Hospital NHS Foundation Trust Quality Account 2014/15
Improved results from documentation audit
by the end of March 2015
Supported by our Quality and Patient Safety Manager,
regular documentation and record-keeping audits have
been undertaken throughout the year. The results show
that there has been good practice noted in some of the
Clusters; however this was not consistent across the
service and overall the improvement was insignificant.
The documentation audit will be undertaken on a
bi-monthly basis with a clear action plan to show
demonstrable improvements with compliance to the
Nursing & Midwifery Council (NMC) Record Keeping
Standard and our local standards.
Audit relating to the Named Nurse and
accessibility from GP practice in contacting
the Named Nurse (for the patient)
In February 2015, we sought the feedback from our
GPs with regards to the use of our ‘Named Nurse’ who
is allocated to each GP Practice and the response rate
when contacting our Nurses.
Using the Survey Monkey audit tool, 43 GP practices
were contacted of which 21 practices responded (49%
of GP practices responded). Questions asked included:
• Are you aware of who the nurse allocated to your
practice is?
We can evidence monitoring of
progress through:
• Reports to our Quality and Patient Safety Board.
• Discussions held at District Nursing forums.
In 2015/16 we will:
• Ensure that this remains a quality priority for
2015/16.
• Build on progress made with attendance at MDT
meetings and aim to achieve full attendance 100%.
• Continue to embed the integrated care planning
and shared partnership around patient care.
• Introduce ‘home information packs’ for patients
with full details on our service and their Named
Nurse/ team.
• Introduce and implement new documentation
guidelines in June 2015.
• Monitor progress from the audit recommendations
and action plan at our ACNT forums.
• Implement a developmental programme for district
nurses.
• When you attempt to contact your allocated nurse,
do you gain a response within four hours?
Figure 12: Awareness of nurse allocated to GP
practice
Figure 13: Nurse responding within four hours
Are you aware of who the nurse allocated to your
practice is?
When you attempt to contact your allocated
nurse do you gain a response within four hours?
9.52%
9.52%
26.32%
Yes
90.48%
90.48%
No
Always
Yes
No
26.32%
68.42%
68.42%
Sometimes
5.26%
5.26%
Sometimes
Never
Figure 12 shows that in total, 90.48% of respondents
stated that they knew who the nurse allocated to their
practice was.
Always
Never
Figure 13 shows that 26.3% of respondents stated that
they did not get a response within the four hour set
target.
www.homerton.nhs.uk
37
QUALITY ACCOUNT
Quality Domain - Effective
Dementia CQUIN indicators:
Priority Eight:
1. Find, Assess, investigate and refer
Improve dementia care for our
patients and carers
Part of the Dementia CQUIN is to undertake the
abbreviated mental test on at least 90% of eligible
patients and ensure that the management of patients
was appropriate. Figure 14 shows that during the
reporting period this was achieved.
The Trust continues to prioritise improving the quality of
care provided to our patients with dementia and their
carers; this is underpinned by the national dementia
CQUIN. The CQUIN has three agreed indicators for
improvements. These are:
1. Case finding and FAIR assessment
2. Supporting carers, and
3. Leadership and training for staff.
2. Clinical leadership
Led by our Consultant Geriatrician and
our Lead Nurse, we have undertaken
various initiatives to support our priorities
around dementia care.
This has included:
What did we say we would do?
• Achieve full compliance to the national dementia
CQUIN. The three areas of the CQUIN are:
identification and management of patients with
dementia, clinical leadership and supporting carers.
What did we do?
• There are 11 dementia champions currently in post,
with seven additional staff due to start dementia
champion training in May 2015.
CQUIN Indicator
Name
What we set out to do?
Dementia
To undertake the abbreviated
mental test on at least 90% of
eligible patients and ensure that
the management of patients was
appropriate
YES
The data was entered on EPR and over
90% of eligible patients were managed
appropriately
To ensure that the Trust had a
named lead for Dementia and an
appropriate training programme
in place
YES
The Trust has a Medical Consultant as
the named lead for dementia and has
Lead Nurse for Dementia
Implement a questionnaire
specifically aimed at supporting
carers
YES
A questionnaire was devised and
implemented. The results from the
questionnaire are collated and an action
plan is put in place to monitor progress
Find, Assess,
Investigate and
Refer
Dementia
Clinical
Leadership
Dementia
Supporting
Carers
38
• With UCL Partners, the Trust has a one year
dementia training plan to train an additional
750 staff in dementia awareness across acute,
community services and junior doctors. This builds
on the 605 members of staff who have been
trained in the last year.
Did we
achieve it?
Homerton University Hospital NHS Foundation Trust Quality Account 2014/15
What was the evidence?
Abbreviated mental tests
100%
80
60
40
20
0
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Figure 14: The number of Abbreviated Mental Tests undertaken
• Dementia awareness is a mandatory session in
the nurses annual update sessions, and dementia
simulation training has been commissioned for
nursing therapy staff on Elderly Care Unit (ECU).
• The ‘Forget Me Not’ scheme has been initiated on
the Elderly Care Unit, Lamb Ward, Cardiology and
Edith Cavell with plans to roll out across all inpatient
wards by June 2015.
• There is targeted training delivered to the four
district nursing clusters by the lead nurse.
• Regular therapies including reminiscence are in place
on the Elderly Care Unit and patients are encouraged
to eat together at lunch time to enhance wellbeing.
• The introduction of the ‘RAID’ (Rapid Assessment
Interface and Discharge) model in Homerton.
The Homerton Psychological Medicine (HPM) is
the Hackney version and includes innovations
such as the inclusion of consultant geriatricians
alongside old age psychiatrists as members of the
team. Specialist HPM outpatients clinics designed
to follow-up patients who had delirium while in
hospital are in process.
• Regular sessions are held at each of the district
nursing clusters to discuss cases of concern and
to support decision making regarding appropriate
referrals to the local memory clinic or the local
branch of the Alzheimer’s Society.
• The Elderly Care Unit developed an algorithm for
all patients with dementia that are admitted and
for those diagnosed on the ward. This includes
discussion with carer, allocation to dementia care
support workers, needs assessment and referral
to HPM. A Hyper Agitated Pathway is included for
those patients experiencing BPSD.
3. Supporting carers
• The carers’ questionnaire has been redesigned and
completion uptake has increased with support from
the dementia care support workers.
• A personalised care plan ‘This Is Me’ is in place for
all patients with dementia and carers consulted on a
patient’s likes, dislikes, food preferences, life history
and signs to be aware of when a patient is distressed
and what might help alleviate distress.
• A carers’ group started on the Elderly Care Unit –
with an educational and practical focus. Running
on a five week cycle – each week covers a different
topic.
• Topics includes: tips on keeping well as a carer; what
is dementia; meet the professional (with a chance to
understand what each of the professionals do OT,
sister, consultant etc.); carers advice assessments/
benefits and preparing for discharge.
www.homerton.nhs.uk
39
QUALITY ACCOUNT
We can evidence monitoring of
progress through:
• Information shared with UCL Partners for levels of
dementia awareness training.
• Training data and feedback received from our
Learning and development team.
• Increased rates in carer satisfaction from the carers
survey undertaken regularly.
• Reports sent to Quality and Patient Safety Board
outlining progress made with the CQUIN.
Discussions held at our Safeguarding adults fora.
In 2015/16 we will:
Quality Domain – Positive
Patient Experience
Priority Nine:
Improve the effectiveness of discharge
from our care
The Trust continues to prioritise the effective
discharge from our care and several initiatives have
been undertaken to support it. Led by the Discharge
Management Group, a coordinated approach to
discharge has been adopted within the Trust to ensure
that the patient’s experience is improved.
The Timely Discharge Group is a sub-group of the
Discharge Management Group and it has two main
tasks:
(a) Decrease length of stay across all specialties.
• Ensure that this remains a priority for 2015/2016.
• Embed the local strategy for dementia.
• Sustain the role of the dementia care assistants on
the Elderly Care Unit.
(b) Increase volume of discharges before 12 pm.
What did we say we would do?
• Work on creating a dementia friendly environment.
• Continue with dementia awareness training and
commissioning further champions.
• Increase the number of therapies available for
patients with dementia on the Elderly Care Unit and
Mary Seacole Nursing Home.
• Improve joint working between Elderly Care Unit
and Dementia Care Team (ELFT).
• Ensure everyone who has a diagnosis of dementia
and is admitted to Homerton University Hospital is
referred to Homerton Psychological Medicine.
• Improve the effectiveness of discharge from our
care for both non-complex and complex discharges.
What did we do?
The Discharge Management Group continues to
oversee and monitor progress, including:
Timely Discharge - weekend discharges
• The Timely Discharge Group have been looking
into length of stay (LOS) for inpatients and how this
could be reduced to help with bed pressure, and
flow of patients from A&E and the Acute Care Unit,
thereby, improving patient experience.
• There are many trusts in London that have a
dedicated weekend discharge team, however,
current practice at Homerton University Hospital is
for the on-call weekend ward cover junior doctors
to not only review the acutely unwell patients on
the ward, but also review patients for discharge.
To evaluate this further, the ‘Weekend Discharges’
project was created as a sub project of the Timely
Discharge Group.
40
Homerton University Hospital NHS Foundation Trust Quality Account 2014/15
• There is significant focus nationally on moving
towards seven day working as emphasised by the
National Medical Director, Sir Bruce Keogh, in 2013.
It is unclear what this entails and how it will be
implemented. However, patient discharges should
occur throughout the week, and not be delayed by
reduced staffing on the weekend.
• Weekend Discharges was a project that was used
to evaluate how discharges were being carried
out over the weekend at Homerton University
Hospital, and whether there were any limitations
to the current system that could be improved to
allow for more effective discharging of patients.
In particular, one of the questions focused on was
whether Homerton would benefit from a dedicated
weekend discharge team, thereby, not only easing
the workload on the on-call doctors, but also
increasing the number of patients discharged over
the weekend.
Integrated Hospital Discharge Management
Team:
• We are currently working towards integrating
our Hospital social work team and our complex
discharge teams. Collectively they will come
under one Head of Service who was appointed
in December 2014. The process for complex
discharges will be reviewed to reduce delays, target
bottlenecks and improve communication and
understanding across all stakeholders involved.
We can evidence monitoring of
progress through:
• Reports and discussions held at our Discharge
Management Group meetings.
• Reports to our Improving Patient Safety Committee.
• The study provided a snapshot of the limitations of
the current system for weekend discharges from
which recommendations have been made. The
results have shown that it may be more effective to
have a doctor above SHO level to discharge patients
over the weekend so that the more complex cases
are not left till Monday.
• Reports to our Quality and Patient Safety Board.
• Having a dedicated team for weekend discharges
not only alleviates some of the workload for the
on-call weekend ward cover doctors, but also may
increase patient throughput. Consequently, this
may ease bed pressure with the high number of
admissions on Mondays.
• Focus on the patient experience within the
discharge process, ensuring that their needs are
captured.
• The objective is to run an extended pilot over four
months during the winter, with a full discharge
team including a nurse, doctor and pharmacist to
work over the weekend to expedite discharges.
• Prioritise the process of gathering patient feedback.
In 2015/16 we will:
• Ensure that this remains a priority for 2015/16.
• Continue to build on and embed key initiatives such
as the integrated hospital discharge management
team.
• Robustly measure the reasons for and impact (extra
Outlier Bed Days) of Delayed Transfers of Care
(DTOC) on our longer stay wards.
Ward-based discharge co-ordinators:
• These individuals will liaise with patients and carers
to ensure they are fully informed of plans for
discharge.
• They will link with clinical teams on the ward to
ensure all preparations are in place in advance of
the planned discharge.
• They will offer follow-up telephone calls where
appropriate, and ensure patients have information
on what to do if they have any problems postdischarge.
www.homerton.nhs.uk
41
QUALITY ACCOUNT
Quality Domain – Positive
Patient Experience
Priority Ten:
Improving trust and confidence
Improving trust and confidence in nurses and doctors
is one of the measures within the National Inpatient
Survey.
In 2013, the Picker Survey showed that 39% of our
patients (national average 32%) did not always have
confidence and trust in doctors and nurses. Therefore,
four work streams were established, focusing on how
the Trust could improve trust and confidence.
The four work streams for improving trust and
confidence were:
What did we say we would do?
• Improve confidence ratings (%) in nursing and
medical staff (obtained via patient feedback).
• To deliver on specific workstreams, aimed to
improve trust and confidence.
What did we do?
3.improving and maintaining knowledge, skills and
competence levels, and
In 2014, the Picker Survey showed that 32%
(23% national average) of patients did not always
have confidence and trust in nurses. This was an
improvement of seven percentage points on 2013
results (down from 39%), and a positive achievement
for the Trust.
4.management of underperforming staff.
The following measures have supported this:
1.creating a good first impression
2.caring and effective communication and interaction
1. Creating a good first impression
OBJECTIVE
ACTION REQUIRED
CURRENT STATUS
Nurses and patients work
together building a trusting
nurse – patient relationship
Ward-based professional standard for
nurses and nursing assistants
Nursing standards are in place at the
doors on all wards
Nursing staff wear prominent name
badges
All nurses wear prominent named
badges where they can be seen and
read
2. Caring and effective communication and interaction
42
OBJECTIVE
ACTION REQUIRED
CURRENT STATUS
Nurses and patients work
together building a trusting
nurse – patient relationship
“You Said – We Did” Boards, inform
patients, families and carers of changes
made in response to feedback
The boards are monitored during the
senior nurse rounding
The ward Welcome Pack includes
photographs to help identify staff, a
discharge folder and a copy of the
patient menu
The Welcome Pack is audited twice
yearly and updated as required
Nursing staff wear prominent name
badges
All nurses wear prominent named
badges where they can be seen and
read
Homerton University Hospital NHS Foundation Trust Quality Account 2014/15
A timeline was developed for boards in
community areas
3. Improving and maintaining knowledge, skills and competence levels
OBJECTIVE
ACTION REQUIRED
CURRENT STATUS
Nurses and patients work
together building a trusting
nurse – patient relationship
A clinical leadership programme specific
to Ward Sister /Charge Nurse group is
developed and delivered for staff on:
All relevant staff have completed the
programme
• acute site
• community sites
• patients should be part of patient
related care delivery training where
appropriate
Training included patient input where
appropriate
4. Management of underperforming staff
OBJECTIVE
ACTION REQUIRED
CURRENT STATUS
Nurses and patients work
together building a trusting
nurse – patient relationship
Clear guidelines are developed for staff on
highlighting concerns with performance
Guidelines are agreed and in place
We can evidence monitoring of
progress through:
• Reports sent to our Improving Patient Experience
Committee,
• Reports and discussions held at our Patient
Experience and Engagement Forums,
• Reports to our Quality and Patient Safety Board,
and
• Frequent patient feedback through reports at ward/
division/trust level.
In 2015/16 we will:
• Ensure that the work streams remain embedded
into everyday practice,
• Work with our Clinical Divisions to further embed
our Values, and
• Monitor progress made to embed the workstreams
for doctors through the related forum.
www.homerton.nhs.uk
43
QUALITY ACCOUNT
Quality Domain – Positive
Patient Experience
Priority Eleven:
Improve the way we communicate
- ensuring that dignity, respect and
compassion is given
In 2013, the National Inpatient Survey showed that
we needed to improve on treating our patients with
respect and dignity, as 34% of patients had identified
this as a problem (the national average was 28%).
During 2014/15, driven through the Patient Experience
strategy; specific projects have been identified to
improve the way that patients are treated, embedding
the key principles of respect, dignity and compassion.
What did we say we would do?
• Improve the way we communicate and ensure that
respect, dignity and compassion.
• To lead by example and taking responsibility for our
action.
What did we do?
The Picker Survey for 2014 showed that we improved
by 6 percentage points on 2013, as we scored 28%
(national average 19%).
During the year a variety of initiatives have support this,
which includes:
Values:
• Values are now in job descriptions and we have
developed a values based approach to recruitment. Training for recruiting managers on the new
approach started in February 2015 and we plan to
have trained all managers by the end of 2015.
• A copy of the Trust Values and an introductory
presentation is given to staff at corporate induction
sessions.
• We have introduced a new online annual
Performance and Development Review (PDR) system
which requires staff to be assessed against the 4
Trust Values.
44
• The introduction of the new Performance and
Development Review system has been supported
with training for all managers, which includes how
to assess and evaluate performance in relation to
values and behaviours.
• Engagement with frontline staff through
attendance at team meetings and other forums
to discuss the values and the Patient Experience
Strategy.
• We are currently developing a peer to peer coaching
model that is aimed at developing staff within each
clinical area who can act as values champions and
support their colleagues to embed sound values. This programme will be piloted with 20-30 services
in the summer of 2015.
• We have introduced a staff cultural barometer
in April 2014 which is run on a quarterly basis. The results have been used to identify and
target services requiring additional support and
development in relation to staff engagement and
satisfaction.
Patient Experience:
• We have launched a new Trust Patient Experience
Strategy and Improvement Plan. Delivery of the
plan is overseen by the Patient Experience Delivery
Group which meets on a monthly basis and reports
into the Quality and Patient Safety Board.
• In October 2014, we rolled out a new real time
patient feedback system across the Trust which
enables us to measure and assess progress against
our key patient experience priorities.
We can evidence monitoring of
progress through:
• Reports to Patient Experience and Engagement
Forum (PEEF),
• Reports to our Improving Patient Experience
Committee, and
• Reports to our Quality and Patient Safety Board.
In 2015/16 we will:
• Ensure that this remains a priority for 2015/16, and
• Continue to build on improvements made during
2014/15.
Homerton University Hospital NHS Foundation Trust Quality Account 2014/15
Quality Domain – Positive
Patient Experience
Priority Twelve:
Improve the management and control
of pain
Poor pain management can have psychological,
physiological and socioeconomic consequences that can
worsen patient suffering and clinical outcome which
can increase the financial costs of health care.
Pain had been highlighted by the Care quality
commission (CQC) as an area that needed addressing,
with patients reporting dissatisfaction with the timely
administration of analgesics (November 2013).
Pain was also highlighted in the National Inpatient
Survey (2013) which showed that 46% of our patients
were not satisfied that their pain was being well
managed by nursing staff (national average was 31%).
What did we say we would do?
• Improve the management and control of pain.
What did we do?
In 2014, the Picker Survey showed that 31% (30%
nationally) of our patients were not satisfied that their
pain was being well managed. This was a significant
improvement of 15 percentage points on 2013 data
(down from 46%), and a positive achievement for the
Trust.
We undertook a variety of measures to support this that
are highlighted below.
Joint working between the Nurse Practitioner
and Clinical Nurse Specialist (CNS)
• The CNS (for pain) has been attending the
“Joint School” which is a forum led by the Nurse
Practitioner for pre-operative patients who are to
undergo elective Total Knee (TKR) and Total Hip
Replacements (THR).
• This creates the opportunity for the CNS to get a
history of pre-operative pain levels, assess patients
expectations of pain levels post-op, and monitor
actual pain levels post-operative day 1, 3 and then at
the Out Patients Department (OPD) clinic.
Re-audit of pain scores (documentation &
ensuring patient involvement)
• We have noticed a reduction in the documentation
of pain scores since the new “NEWS” chart was
introduced. A trust wide audit has confirmed a
reduction, though some areas are better than
others. This audit report is being completed and
will be shared in next couple of weeks. There is
an action plan which includes the introduction of
electronic documentation.
Background infusion for Patient Controlled
Analgesia (PCA)
• This has been in place now for several months.
Although few patients have been commenced on
this, there is evidence that it has been useful. An
on-going prospective audit is being carried out.
• Clinical Practice: The CNS are proactively going to all
ward areas on a daily basis to identify any delayed/
failed discharges due to poor pain control. Education & training
• There have been several training sessions for both
trained and untrained staff (healthcare support
workers do undertake pain assessments and
documentation on wards). There are training
records maintained. This is on-going.
• We have decided to reintroduce the “Pain
Champion” role to interested registrants who can
be released for training and education. This role
was first introduced a few years ago but due to
staff shortages during maternity leave, was not
sustainable. We are currently planning the training
for this so we can approach the ward mangers.
We can evidence monitoring of
progress through:
• Reports to our Improving Patient Safety Committee,
and
• Reports to our Quality and Patient Safety Board.
In 2015/16 we will:
• Continue to build on improvements made during
2014/15.
This is also an educational opportunity.
www.homerton.nhs.uk
45
QUALITY ACCOUNT
2.2 Statements of assurance from the Board
This section contains a series of statements of
assurance from the Board of Homerton University NHS
Foundation Trust. The terminology ‘we’ or ‘the Trust’
are used.
Review of our Services:
During 2014/15, through our three clinical divisions
(which comprise both acute and community services)
we provided; either directly or via a subcontract 68
relevant health services.
Quality is monitored in each clinical division with
regular review of safety, clinical effectiveness and
patient experience. Each Division reports periodically on
this activity to our strategic quality fora.
The Trust has reviewed the data available on the
quality of care in 68 of these relevant services.
The income generated by the relevant health services
reviewed in 2014/15 represents 100% of the total
income generated from the provision of relevant
health services by the Trust for 2014/15 – this
income is divided into two contracts; an acute and a
community contract.
Participating in National Clinical
Audits
The Trust continues to participate in national audit
programmes relevant to our services and plans are in
place to review our processes to ensure that we have
demonstrable evidence of changes made to practice.
During 2014/15, 34 national clinical audits and three
national confidential enquiries covered relevant
health services that we provide.
We participated in 100% of national clinical audits
and 100% of national confidential enquiries of the
national clinical audits and national confidential
enquiries that we are eligible to participate in.
The national clinical audits and national confidential
enquiries that we participated in, and for which
data collection was completed during 2014/15 are
listed in Appendix B alongside the number of cases
submitted to each audit or enquiry as a percentage
of the number of registered cases required by the
terms of the audit enquiry.
The reports of 34 national clinical audits were
reviewed by the Trust in 2014/15 and we intend to
take the following actions to improve the quality of
health care provided:
To ensure all national audits are discussed at
divisional level and any actions taken as a result
are fed into our Improving Clinical Effectiveness
Committee and lessons learnt are disseminated
across the Trust.
An example of changes from a national audit:
Implementing changes as the result of the
discharge process for children
Asthma is the most common chronic health condition
in the paediatric population. The British Thoracic
Society (BTS) and the Scottish Intercollegiate Guidelines
Network (SIGN) have developed asthma management
guidelines, which are widely used as a national
standard of care and are regularly updated.
46
Homerton University Hospital NHS Foundation Trust Quality Account 2014/15
The aim of the audit was to compare parameters regarding the management and discharge arrangements for
children over 12 months admitted with wheeze and/or asthma against the standard of British Thoracic Society (BTS)
and the Scottish Intercollegiate Guidelines Network (SIGN).
The audit highlighted several recommendations which showed positive factors to improve the discharge from our
care for children.
Steps included:
1.Giving each child/family a detailed written action plan about their care on discharge,
2.Modifying the nursing discharge checklist (see below), and
3.Strengthen advice to child/family to seek follow up from the GP after discharge.
Local audits
Clinical Audit remains a key component of improving the quality and effectiveness of clinical care; with the aim to
ensure that safe and effective clinical practice is based on nationally agreed standards of good practice and evidencebased care. The Trust remains committed to delivering safe and effective high quality patient centred services, based
on the latest evidence and clinical research.
A total of 170 local clinical audits were completed in 2014/15, the following actions will be taken to improve
the quality of health care provided:
We will ensure that all audits are reviewed by our quality forum and recommendations and action plans are
effectively managed within our clinical divisions.
Below are examples of changes that have been made as a result of local audits.
Local Audit Project
Actions Taken
Timely administration of
regular and PRN analgesia
• The audit was carried out over a 4 month period (January-April 2014).
• 94 patients were asked a series of questions about timely administration
of their analgesia and if they felt that nursing staff did everything to
control their pain, thus replicating the question asked in the national
inpatient survey.
• On the whole, the audit was very positive with patients’ being happy with
the care that they had received from staff.
Neutropenic sepsis in cancer
patients
• A new proforma has been developed since the 2013 audit, with A&E
consultants featuring step by step action points to be followed by A&E
staff when caring for unwell cancer patients post anti-cancer treatment.
• Continuing the educational campaign among acute/front-line staff,
to make them aware of acute oncological issues – this includes the
following:
- Monthly teaching session has been organized and implemented with
A&E nursing staff as well as regular teachings with A&E doctors and the
auditor believes that these together with the new proforma maybe the
biggest influencing factor in the improvement seen in this year’s audit.
»
www.homerton.nhs.uk
47
QUALITY ACCOUNT
»
Local Audit Project
Actions Taken
- Developing an electronic flagging system to alert staff of patients’
cancer status.
- There is now a rudimentary EPR flagging system in place. Patients with
known cancer diagnosis and who are on treatment are flagged when
they register in A&E, and staff are advised to do prompt assessment and
treat accordingly.
- Periodic re-audit of neutropenic sepsis incidence.
The implementation of all these shows a significant improvement in this
year’s audit in comparison to last year’s study, showing an increase to 42%
of patients receiving antibiotics within an hour of presentation, compared to
just 18% last year.
Analysis of post-operative
analgesia prescribing in day
case surgery patients
Introduction of patient information leaflet on analgesia.
The use of permanent side
markers on plain imaging
examinations
Compliance with the local departmental policy of using permanent side
markers on >90% of all plain film images produced has improved during and
as a result of the audit process.
The use of the confusion
assessment method for the
intensive care unit
The audit has highlighted that further work needs to be done to ensure
systematic use of the Confusion Assessment Tool on the Intensive Care Unit.
The audit has enabled an action plan to be drawn up and improvements in
practice will, hopefully, be demonstrated when the Confusion Assessment
Tool is next audited.
Consultant review of
The general surgeons will now be released from all elective duties when on
emergency surgical admissions call to allow twice daily review of the patients to reach national emergency
care standards.
Audit of HENRY (health,
exercise, nutrition for the
really young) attendance
sheets
The service has benefited by this audit as we now have a structured process
in regard to completing the attendance sheets. It has been noticed that more
of the boxes have been completed in regard to non-attendance of groups,
the action taken and the reasons for non-attendance.
BMI documentation within
24 hours of admission of
general surgery patients
We raised awareness of the value of BMI recording to nurses in Surgical
Centre as we think the department is the best place to record BMI.
Improving the management and control of pain.
Our nursing teams have undertaken audit to support the management of pain control for our patients to ensure that
our patients receive their medications as required. Feedback from the audit is summarised below.
“Some issues over my prescription of Tramadol,
but sorted out quickly by the nursing staff”
“Three hour wait for analgesia”
“Good pain management only
works when doctors prescribe
adequate analgesia”
48
“Received pain relief on time”
“Care has been exceptional”
“I had to wait over an
hour for my analgesia”
“Extraordinary happy with the care,
nursing staff exemplary”
Homerton University Hospital NHS Foundation Trust Quality Account 2014/15
“Very happy with the care”
“Amazing midwives very happy
with the care received”
Notifying the ‘Substance and Alcohol Midwife’ of drug use (SAAM)
Recommendation
Suggested Actions
Disseminate information on the procedure to
follow when booking a woman who discloses
past or present substance abuse
‘Tip of the Fortnight’ for maternity services
Feedback to individual midwives via email when
identified in audit
Use ‘Maternity Mandatory Training’ sessions to raise
awareness
Make notifying SAAM team as easy to do
as possible and attempt to make it less time
consuming
Re-design of notification form to make it less time
consuming, easier to use and make a printable version
available from the intranet pages
Disseminate SAAM team email address so
notifications are easy to email, as well as to
submit a hard copy
Include new SAAM team address in ‘Tip of the
Fortnight’
Ensure new clinical guidelines are readily
available to midwives
Publish new guidelines on the staff intranet
Review and update Standard Operating
Procedures (SOP) in view of audit findings and
after feedback from midwives
Elective Direct Current Cardio-Version (DCCV) for Atrial Fibrillation and Atrial Flutter
Recommendation
Suggested Actions
Reduce delays in treatment/planning/ performing
of DCCVs
Introduce Transoesophageal Echocardiogram (TOE) guided DCCV in all patients
Improve correspondence with anticoagulation
clinic
List of patients planned for DCCV to be emailed to the
anticoagulation nurse
Improve patients’ information and appointment
letter
Patients’ letter has been amended and will be sent to
the patients from March 2015 onwards
www.homerton.nhs.uk
49
QUALITY ACCOUNT
Participating in research
Involvement in clinical research demonstrates the
Trust’s commitment to improving the quality of care we
offer to the local community as well as contributing to
the evidence base of health care both nationally and
internationally.
As part of its commitment to research, the Government
wishes to see a dramatic and sustained improvement
in the performance of providers of NHS services in
initiating and delivering clinical research. The overall
aim is to increase the number of patients who have the
opportunity to participate in research and to enhance
the nation’s attractiveness as a host for research.
Therefore, all clinical research studies being performed
by Homerton University Hospital NHS Foundation
Trust are subject to new performance benchmarks in
initiation and delivery time:
• Initiation – it should take no more than 70 days
from receipt of a valid research application by the
Research and Development department to the
recruitment of the first patient to the research study.
• Delivery – for all commercial clinical trials hosted by
Homerton, the agreed target number of patients
must be recruited within the agreed timeframe.
We submit quarterly reports to the National Institute
of Health Research (NIHR) setting out the performance
against these metrics. As of December 2014, the
total number of clinical trials underway is 11, and the
number of these trials that meet the benchmark is 10.
The total number of patients (receiving NHS services
provided or sub-contracted by the Trust) recruited
to National Institute for Health Research (NIHR)
portfolio studies between 1 April 2014 and 28
February 2015 was 1209.
Several more patients were recruited to non NIHR
portfolio studies during this period
Participating in research helps to ensure that our clinical
staff stays abreast of the latest treatment possibilities
and active participation in research leads to better
patient outcomes.
This is demonstrated through the following examples:
The PROUD study
• A UK trial that included patients recruited from
the Trust has shown that taking a daily pill called
‘Truvada’ can effectively protect gay men against
infection with HIV, which experts now say offers
hope of reversing the virus’s spread.
• It is believed that taking the drug could become
a daily routine for men who have sex with men
in the same way that the contraceptive pill is for
women. NHS England will now study the results to
determine whether it is cost effective to provide this
drug for men at risk of infection.
Overall Homerton achieved the 70 day benchmark of
1st patient recruitment 85.7% of the time ensuring
that we are one of the highest performing Trusts in this
metric.
• Mean and median time taken to recruit 1st patient
at the Trust is 20 days and 16 days respectively.
We are ranked number one for this benchmark in
comparison to similar sized trusts.
• Mean and median time taken to recruit a first
patient after receiving valid Research Application to
the Trust is 4.7 and 2 days respectively. We are once
again ranked number one for this benchmark in
comparison to similar sized trusts.
50
Homerton University Hospital NHS Foundation Trust Quality Account 2014/15
Quality goals as agreed with our Commissioners (CQUIN)
During 2014/15 the Trust continued to use the Commissioning for Quality and Innovation
(CQUIN) scheme to drive quality improvements across the organisation.
A proportion of our income in 2014/15 was conditional on achieving quality improvement and
innovation goals agreed between ourselves and our commissioners for the provision of relevant
health services, through the Commissioning for Quality and Innovation Payment Framework.
In 2014/15, the Trust continued to hold three major contracts that included a variety of CQUIN
schemes – the Acute Services contract, the Community Health Services contract and the
Specialised Services contract. In addition to these contracts, the Trust also agreed additional
CQUINs with NHS England screening commissioners.
Appendix A provides details on CQUIN values for 2014/15.
Registration with the Care Quality Commission (CQC)
Homerton has been registered with CQC since 2010 and has been subject to regular routine
inspections as well as inspections which test the care of specific groups of patients or specific
types of services.
Homerton University Hospital NHS Foundation Trust is required to register with the Care Quality
Commission (CQC) and it is registered with CQC with ‘no conditions attached to registration’.
CQC carried out a comprehensive inspection of Homerton University Hospital in February 2014,
and published its report in April 2014. The hospital was rated as ‘Good’ overall and awarded
a ‘Good’ rating for each element of the quality and safety of services (safe, effective, caring,
responsive, well-led). Eight core services were assessed; seven services were awarded a ‘Good’
rating these were:
• Medical care (including older people’s care)
• Surgery
• Intensive/Critical care
• Maternity and Gynaecology
• Services for children and young people
• End of life care
• Outpatients
Urgent and emergency services (A&E) were awarded a rating of ‘Outstanding’.
Following a focused follow-up inspection of the hospital based maternity service, CQC issued
three warning notices to Homerton University Hospital NHS Foundation Trust on the 31st March
2015, in relation to the Maternity and Midwifery regulated activity - under the Health and Social
Care Act 2008 (Regulated Activities) Regulations 2010 Regulations 9, 10 and 12*.
The Trust has put in place comprehensive action plans which address these issues.
*(Regulation 9 – Care and Welfare of service users, Regulation 10 – Assessing and monitoring the quality of service
provision and Regulation 12 – Cleanliness and Infection Control
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51
QUALITY ACCOUNT
Quality of data
Data quality
Trust data submitted nationally
The Trust continues for focus on this area to ensure
that high quality information is available to support the
delivery of safe, effective and efficient clinical services.
We submitted records during 2014/15 to the
Secondary Uses Service (SUS) for inclusion in the
Hospital Episode Statistics (HES) which are included in
the latest published data.
The percentage of records in the published data that
included the patients’ valid NHS numbers was:
% of records
2012/13
2013/14
2014/15
For admitted
patient care
95.9%
97.9%
98.6%
For outpatient
care
97.8%
98.6%
99.2%
For accident &
emergency care
87.4%
92.2%
92.9%
Table 3: Percentage of patient records with a valid
NHS data
Data which included the patients valid General Medical
Practice Code was:
% of records
2013/14
2014/15
For admitted patient care
98.0%
99.9%
For outpatient care
99.3%
100.0%
For accident & emergency
care
95.8%
99.9%
Table 4: Percentage of patient records with a valid
GP Practice Code
Overall, our data quality in relation to recording the
patients’ NHS number and GP Practice code continues
to increase.
Building on the work carried out last year we have
begun a programme to further enhance the Trusts data
quality. This work will focus on ensuring that there is
a clear understanding of any issues, their impact, and
management of the resolution.
Additionally, the Trust will be undertaking a strategic
review of its Information Assurance Framework,
of which data quality forms a key component, to
ensure that the appropriate governance is place for
information assets integrity and use.
We will be taking the following actions to improve
data quality:
• Further development of training and
communication programmes to support
colleagues in the creation of high quality data.
• Ensuring that reports, and associated systems
that produce them, are correct and meeting
organisational requirements.
• Embedding data quality management in the
Trusts performance management framework.
• Enhanced audits of medical records and
systems to ensure that they are compliant with
the relevant policies, procedures and national
requirements.
• Broadening the data quality scope beyond clinical
activity.
• Proactive use of benchmarking data to ensure
that the Trust is meeting best practice standards.
Payment by Results
During the 2014/15 the Trust undertook clinical coding
audits in the following specialties; General Surgery,
Gynaecology Day Surgery, General Medicine, and
Paediatrics. No significant issues were identified from
these.
The Trust was not subject to a ‘Payment By Results’
clinical coding audit under the Audit Commissions
Assurance Framework.
52
Homerton University Hospital NHS Foundation Trust Quality Account 2014/15
Information Governance (IG)
During 2014/15, the percentage of staff that
completed their training was 85%. This is the Trust
threshold for its other statutory mandatory training
courses and is a significant improvement from the
compliance rate of 58% that was achieved in 2013/14.
For 2014/15 the Trust achieved a minimum level two
performance across all of the toolkit requirements
and achieved a final score of 77%.
The improvements were attributable to:
The overall rating was therefore assessed as
‘Satisfactory’.
• changes to the overall training process
• linking the training to staff appraisals
The Trust uses the Information Governance
assessment tool to measure its performance against
45 Information Governance requirements, and to
confirm whether information is handled correctly, and
protected from unauthorised access, loss, damage and
destruction.
• effective training strategy which included sending
regular reminders to staff, and
• monitoring by the Information Governance
Committee.
The focus for the next financial year will be to ensure
that continued efforts are made so that the take-up of
IG training remains at 85% or above.
Table 5: Information Governance
Assessment
Level
0
Level
1
Level
2
Level
3
Total
Req’ments
Overall
Score
Initial
Rating
Final
Rating
Version 10
(2012/13)
0
1
28
16
45
77%
Not
Satisfactory
Not
Satisfactory
Version 11
(2013/14)
0
2
26
17
45
77%
Not
Satisfactory
Not
Satisfactory
Version 12
(2014/15)
0
0
30
15
45
77%
Not
Satisfactory
Satisfactory
Considerable work has been done over the past year
in relation to the information governance training
requirement, which had remained at level one for a
number of years. This was an excellent achievement
for us and the first time that we
achieved ‘Satisfactory’
www.homerton.nhs.uk
53
QUALITY ACCOUNT
2.3 National targets and regulatory requirements
Homerton University Hospital endeavours to meet all national targets and priorities. We have provided a summary of
the national targets and indicators (including those set out in Monitor’s Risk Assessment Framework**) in the tables
below. Other national/local priorities are detailed in Part 2 of this publication.
Moniter targets/
indicators
Indicator Description
Target
2014/15
2014/15
2013/14
2012/13
Infection Control Number of Clostridium difficile (C.diff) cases
12
7
2
13
Referral to treatment time (admitted patients) within 18 weeks1
90%
92.5%
93.1%
95.4%
Referral to treatment time (non-admitted
patients) - within 18 weeks1
95%
97.4%
96.7%
99.9%
Referral to treatment time (incomplete pathway) within 18 weeks1
92%
97.8%
96.8%
98.0%
28 day emergency readmission rate
N/A
16.7%
N/A
N/A
A&E - total time in A&E under 4 hours (from
arrival to admission/transfer/discharge)
95%
95.4%
96.2%
96.7%
Cancer 31-day wait from diagnosis to first
treatment
96%
98.4%
100.0%
100.0%
Cancer 31-day wait for second or subsequent
treatment: surgery
94%
97.0%
97.7%
100.0%
Cancer 31-day wait for second or subsequent
treatment: drug treatments
98%
100.0%
100.0%
100.0%
Cancer 31-day wait for second or subsequent
treatment: radiotherapy
94%
N/A
N/A
N/A
Cancer 62 day wait for first treatment (from
urgent GP referral)
85%
88.2%
85.5%
89.3%
Cancer 62 day wait for first treatment (from NHS
Cancer Screening Service referral)
90%
100.0%
N/A
N/A
Cancer two week wait from referral to first
seen date
93%
96.4%
96.6%
95.7%
Cancer breast symptoms two week wait from
referral to first seen date
93%
96.5%
96.4%
96.0%
Community Services data completeness: referral
to treatment information
50%
66.7%
66. 8%
77.3%
Community Services data completeness: referral
information
50%
98.5%
87.5%
79.5%
Community Services data completeness:
treatment activity information
50%
98.2%
75.6%
60.0%
Access
Outcomes
** Monitor is the regulator for health services in England, with the aim of making the health sector work better for patients.
54
Homerton University Hospital NHS Foundation Trust Quality Account 2014/15
National / Local
priorities
Target
2014/15
2014/15
2013/14
Number of MRSA Bacteraemias
Infection Control (hospital acquired) cases
0
3
5
Cancelled
operations
0
0
0
0
Immunisations for DTaP/IPV/Hib - Age 1
85%
85.8%
86.5%
86.4%
Immunisations for PCV - Age 2
83%
89.8%
89.0%
88.4%
Immunisations for Hib/MenC - Age 2
83%
89.4
88.4%
90.0%
Immunisations for MMR - Age 2
83%
89.2%
90.5%
86.5%
Immunisations for DTaP/IPV - Age 5
75%
80.9%
79.4%
78.0%
Immunisations for MMR - Age 5
75%
87.5%
85.7%
79.7%
Breastfeeding coverage (%) at 6-8 weeks
95.1%
98.8%
98.6%
Breastfeeding prevalence (%) at 6-8 weeks
81.8%
82.3%
82.0%
Immunisation*
Breastfeeding
Indicator Description
Number of breaches of 28 day readmission
guarantee as % of cancelled operations
2012/13
2
98.0%
84.1%
1.
For all Referral To Treatment (RTT) 18 weeks pathways the Trust are only reporting the acute services patients and excludes the community
services contract patients.
The following explanation is taken from the NHS
England website: A Referral to treatment (RTT)
pathway is the length of time that a patient waited
from referral to start of treatment, or if the patient
has not yet started treatment, the length of time
that the patient has waited so far. The waiting time
standards set the proportion of RTT pathways that
must be within 18 weeks. These proportions leave
an operational tolerance to allow for patients for
who starting treatment within 18 weeks would be
inconvenient or clinically inappropriate.
Admitted pathways are the waiting times for
patients whose treatment started during the month
and involved admission to hospital. These are also
often referred to as inpatient waiting times, but include
the complete time waited from referral until start of
inpatient treatment.
Non-admitted pathways are the waiting times for
patients whose treatment started during the month
and did not involve admission to hospital. These are
also often referred to as outpatient waiting times, but
they include the time waited for patients whose RTT
waiting time clock either stopped for treatment or
other reasons, such as a patient declining treatment.
Incomplete pathways are the waiting times for
patients waiting to start treatment at the end of the
month. These are also often referred to as waiting
list waiting times and the volume of incomplete RTT
pathways as the size of the RTT waiting list.
For information purposes the Referral to treatment
times for incomplete pathways, 28 day emergency
readmissions and surgical site infections were audited
by Deloitte (external auditor) during the 2014/15
financial year. See Appendix D for further information.
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QUALITY ACCOUNT
Surgical Site Infections (SSI) for
Orthopaedics - Knee and Hip
A surgical site infection occurs when germs (microorganisms such as bacteria) enter the incision that the
surgeon makes through your skin in order to carry
out the operation, and multiply in the tissues. Surgical
wound infections are uncommon.
There are three classifications of surgical site infections:
1.‘Superficial incisional infection’ – an SSI involving
skin or subcutaneous tissue of the incision;
2.‘Deep incisional infection’ – and SSI involving deep
tissues (i.e. fascial and muscle layers); and
3.‘Organ/space infection’ – involving any part of
the anatomy (i.e. organ/space), other than the
incision, opened or manipulated during the surgical
procedure.
Where no implant is inserted the surveillance period for
SSI’s is up to 30 days following surgery; whereas if an
implant is inserted, then the surveillance period is up to
one year following surgery.
It is also important to note, that there are several
criterion that must be met in order for an SSI to be
confirmed. Please see the ‘Protocol for surveillance of
surgical site infection – June 2013’ document which
explains in more detail the criteria for identification of
surgical site infections. This document can be viewed or
downloaded from www.gov.uk/surgical-site-infectionsurveillance-service-ssiss .
Due to the fact that the surveillance period after an
implant has been inserted is one year, the SSI data
reported for the 2014/15 financial year is subject to
change. This is because it is possible for an SSI to
be detected after the data has been finalized and
submitted. For example, if a patient had surgery in
December 2014, the surveillance period would run
until November 2015. If the SSI is detected after the
data is published then the information would be added
retrospectively to hospital data by contacting the Public
Health England SSI Team.
There are no targets in relation to Surgical Site
Infections (SSI)* although we do monitor these
regularly. Data from Public Health England indicates
that for the period of January 2010 to December
2014 inclusive, the SSI rate for knee replacements was
3.1% (above the national average of 1.7%) and for
hip replacements the SSI rate was 3.3% (above the
national average of 1.2%). The table below shows the
performance for the 2014/15 financial year compared
to the same period the previous year.
Surgical site infections (SSIs)
Total number of knee
replacements
117
150
3
8
2.6%
5.35
Total number of hip
replacements
81
56
Number of hip SSIs
3
1
3.7%
1.8%
Number knee SSIs
Knee SSI rate
Hip SSI rate
6
2013/14
5
5.3%
4
% SSI rate
2014/15
3.7%
3
2
2.6%
1.8%
1
0
Knee SSI rate
2013/14
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Homerton University Hospital NHS Foundation Trust Quality Account 2014/15
Hip SSI rate
2014/15
2.4 Reporting against core indicators
This section contains data on the nationally set core indicators. The data is available from an unrestricted public
website which means that the data is available to the general public and all other Trusts.
The data presented in the table below shows the most recently available national data for the Trusts performance
against specific core indicators.
This is published through the Health and Social Care Information Centre website: https://indicators.ic.nhs.uk/
webview/index.jsp
No.
1
Reported Activity
NHS Outcomes Framework Domain
Summary Hospital Mortality Indicator (SHMI)*
Preventing people from dying prematurely
Enhancing quality of life for people with long term
conditions
2
Patient Reported Outcome Measure Scores
(PROMS)
Helping people recover from episodes of ill health or
following injury
3
Readmission rate (28 days)**
Helping people recover from episodes of ill health or
following injury
4
Responsiveness to the personal needs
Ensuring the people have a positive experience of care
5
Patients who were admitted to hospital who
were at risk for Venous Thrombo-Embolism
(VTE)
Treating and caring for people in a safe environment and
protecting them from avoidable harm
6
Infection Control – The rate per 100,000 bed
days of cases of Clostridium difficile infection
Treating and caring for people in a safe environment and
protecting them from avoidable harm
7
Patient safety incidents
Treating and caring for people in a safe environment and
protecting them from avoidable harm
8
Staff who would recommend our Trust to
their friends and family
Ensuring the people have a positive experience of care
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57
QUALITY ACCOUNT
1. Summary Hospital level
Mortality Indicator (SHMI)
Prescribed Information from Monitor:
(a) The value and banding of the summary hospitallevel mortality indicator (“SHMI”) for the trust for
the reporting period; and
(b) The percentage of patient deaths with palliative
care coded at either diagnosis or specialty level for
the trust for the reporting period.
Our Response:
This national measure gives an indication of
whether the mortality rate of our patients is above
or below what is expected when compared to a
national baseline. Data published in October 2014
shows that the Trust overall banding has moved
from band 2 to band 3, which is a significant
improvement for the Trust.
Table 6: SHMI data from HSCIC
Reporting Period
SHMI Rate
Homerton
National*
Lowest
Highest
2011/12
0.97
1.00
0.71
1.24
2012/13
0.94
1.00
0.65
1.16
2013/14
0.82
1.00
0.53
1.19
Table 6a: Percentage of deaths with palliative care coding
Reporting Period
Homerton
National
Lowest
Highest
2013/14
23.3%
23.6%
0.0%
48.5%
Oct 13 - Sep 14
26.1%
25.3%
0.0%
49.4%
We consider that this data is as described for the following reasons:
• SHMI has been addressed as a quality account priority for 2014/15 and steps have been taken to continue to
improve coding and the data that is used to calculate the SHMI.
We have maintained our SHMI in the “better than as expected” range and intend to take the following action to
maintain this indicator and so the quality of services by:
• Ensuring that the SHMI is prioritised within our quality improvement goals for 2015/16,
• Identify a clear program of work to support this indicator, and
• Report to our Quality and Patient Safety Board on progress throughout the year.
58
Homerton University Hospital NHS Foundation Trust Quality Account 2014/15
2. Patient Reported Outcome
Measures (PROMS)
Patient Reported Outcome Measures (PROMs) is a tool
used to evaluate quality from the patient’s perspective.
They currently cover four clinical procedures: hip
replacement, knee replacement, groin hernia and
varicose vein operations. PROMs calculate the
improvements to a patient’s health, as the patient
perceives it, after surgical treatment using pre and
post-operative surveys (at least three months after
groin hernia and varicose vein operations, or at least
six months after a hip or knee replacement). Homerton
does not perform varicose vein operations.
The methodology involves postal questionnaires
returned at a specified interval following surgery.
Completion of the pre-operative PROMs questionnaire is
voluntary for the patient and their consent to participate
must be granted for the data to be processed and used.
Prescribed information from Monitor:
The Trust’s patient reported outcome measures scores
for:
• groin hernia surgery
• hip replacement surgery, and
• knee replacement surgery, during the reporting
period.
Our Response:
Table 7: PROMS data from HSCIC
2013/2014
PROMS: Adjusted Average Health Gain
Homerton
National
Lowest
Highest
Groin Hernia
0.086
0.085
0.008
0.139
Hip Replacement (primary)
0.31
0.436
0.31
0.544
Hip Replacement (revision)
*
0.259
0.156
0.367
Knee Replacement (primary)
0.215
0.323
0.215
0.425
Knee Replacement (revision)
*
0.248
0.116
0.318
N/A
0.093
0.022
0.15
Varicose Vein
*denotes a small number of records and therefore figures have been supressed
Table 7a: PROMS data from HSCIC, pre-operative participation and linkage
Pre-operative participation and linkage
Reporting
Period
2013/14
Apr to
Sep 14
Type of
Procedure
Pre-operative
Eligible hospital
questionnaires
procedures
completed
Participation
rate
Pre-operative
questionnaires
linked
Linkage
rate
All Procedures
456
330
72.4%
232
70.3%
Groin Hernia
275
125
45.5%
79
63.2%
Hip Replacement
57
63
110.5%
52
82.5%
Knee
Replacement
124
142
114.5%
101
71.1%
All Procedures
181
110
60.8%
75
68.2%
Groin Hernia
82
38
46.3%
16
42.1%
Hip Replacement
45
27
60.0%
23
85.2%
Knee
Replacement
54
45
83.3%
36
80.0%
www.homerton.nhs.uk
59
QUALITY ACCOUNT
Knee replacement:
There were 456 eligible hospital episodes and 330
pre-operative questionnaires returned - a headline
participation rate of 72.4% (77.2% in England).
Hip replacement:
Of the 299 post-operative questionnaires sent out, 136
have been returned - a response rate of 45.5% (64.4%
in England).
There has been a significant improvement in the
participation rate and the Trust has been able to
retrieve some data on our outcome measures.
Further work is required to encourage patients to
return the post-operative questionnaires. This would
allow both the pre and post questionnaire to be
presented and assessed. This would provide the Trust
with more meaningful data to monitor outcomes.
60
We consider that this data is as described for the
following reasons;
• There is a built in time delay in our patients
responding to the questionnaires and some patients
may choose not to complete it.
We intend to take the following actions to improve our
scores and so the quality of its services by:
• Continuing to monitor our performance through
our Improving Clinical Effectiveness Committee.
• Work with service leads to encourage patients to
return questionnaires - highlighting the benefits for
them.
Homerton University Hospital NHS Foundation Trust Quality Account 2014/15
3. 28 day readmission
The national data on re-admission rates and how we
compare is outlined below. This data is calculated by
identifying:
• The number of inpatient episodes that are
emergency admissions within 0-27 days (inclusive)
of the last, previous discharge from hospital. Table 8
does not include the national exclusions which are
obstetrics, mental health or cancer.
The most recent national data set is only available for
2011/12.
Prescribed Information from Monitor:
The percentage of patients aged:
There are no further updates to the above data. There
has been a delay in the publication of data this year
due to moving the data production from external
contractors to in-house, and we have been advised
from HSCIC that it is highly unlikely that data will be
published this year. Therefore, data for the 2011/12
financial year is latest data available.
We intend to take the following actions to improve this
rate and so the quality of services by:
• Ensuring that this remains a Quality Account priority
for 2015/16,
• Continue to monitor our progress and report any
concerns as required through our Quality and
Patient Safety Board, and
• Build on work undertaken during through our
Discharge Management Group to improve our readmission rate.
i) 0 to 15; and
ii) 16 or over,
who are re-admitted 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.
Our Response:
The data is calculated by identifying the number of
inpatient episodes that are emergency admissions
within 0-27 days of the last previous discharge from
hospital.
Table 8: Readmission rates from HSCIC
Reporting
Period
Readmission Rate (adult 16+)
Homerton
National* Lowest Highest
2009/10
11.45
10.74
7.42
12.46
2010/11
12.36
10.91
7.14
12.69
2011/12
12.53
11.07
8.73
12.9
Reporting
Period
Readmission Rate (child: 0-15)
Homerton
National* Lowest Highest
2009/10
5.42
9.84
5.42
13.80
2010/11
6.19
10.05
6.19
12.61
2011/12
5.74
9.87
5.74
14.87
*average of all ‘small acute trusts’ across England
www.homerton.nhs.uk
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QUALITY ACCOUNT
4. Responsiveness to personal need
Responsiveness to personal needs has been defined by
a composite score of the answers to five questions in
the inpatient survey. The data has been made public so
that comparisons to other organisations can be made.
One of the questions relates to whether the patients
felt they were involved in decisions about care, this
relates directly to patients having correct and accurate
information in order to be involved in care decisions.
The five questions are:
1.Were you involved as much as you wanted to be in
decisions about your care and treatment?
2.Did you find someone on the hospital staff to talk
to about your worries and fears?
3.Were you given enough privacy when discussing
your condition or treatment?
4.Did a member of staff tell you about medication
side effects to watch for when you went home?
5.Did hospital staff tell you who to contact if you
were worried about your condition or treatment
after you left hospital?
Prescribed information from Monitor:
The Trust’s responsiveness to the personal needs of its patients
during the reporting period.
Our response:
Our performance in relation to this composite of five questions,
in England and the highest and lowest scores of other NHS
organisations using the most up to date data is shown in
Table 9 below.
Responsiveness to personal needs has been defined by a
composite score of the answers to five questions in the inpatient
survey.
Table 9: Responsiveness to personal needs
Reporting
Period
Responsiveness to personal needs
(average weighted score)
Homerton
National*
Lowest
Highest
2009/10
62.4
66.7
58.3
81.9
2010/11
64.6
67.3
56.7
82.6
2011/12
62.5
67.4
56.5
85.0
2012/13
64.8
68.1
57.4
84.4
2013/14
61.8
68.7
54.4
84.2
We consider that this data is as described for the following
reasons:
• We are aware that for the national survey results our
scores are lower than we would like, however, through our
Improving Patient Experience Forum and delivery group we
will be exploring measures to improve our results.
We intend to take the following actions to improve this rate and
so the quality of services by the following actions.
• Ensuring that the real time responses to these questions are
built in to our improvement plans.
• Embed our Patient Experience and Engagement Strategy.
• Engage with key stakeholders through our Improving Patient
Experience forum and delivery group to address gaps in our
performance.
• Monitor our overall performance through our Quality and
Patient Safety Board.
62
Homerton University Hospital NHS Foundation Trust Quality Account 2014/15
5. Venous Thromboembolism (VTE)
Prescribed information by Monitor:
The percentage of patients who were admitted to
hospital and who were risk assessed for venous
thromboembolism during the reporting period.
Our response:
This data is calculated from the number of inpatients
admitted during a month and the numbers who were
risk assessed on admission – this is the data for all
patients, not a sample. Comparison with the highest
and lowest rates of VTE risk assessment at other Trusts
is shown in Table 10. This was a successful achievement
for the Trust.
• The Trust has focused on increasing the VTE risk
assessment rate during the last year.
• This rate has been achieved by mandating the
VTE risk assessment as part of our electronic
documentation.
• The rate has remained above 96% in each quarter
for 2014/15.
We have taken the following action to improve the VTE
compliance rate:
• VTE risk assessment compliance is reviewed monthly
by the Medical Director and Board of Directors.
• An investigation is undertaken for all VTEs.
Table 10: VTE Risk Assessment rates
VTE Risk Assessment Rate
Reporting
Period
Homerton
We consider that this data is as described for the
following reasons:
Acute
Trusts
Lowest
Highest
Q1
2013/14
90.7%
95.4%
78.8%
100.0%
Q2
2013/14
91.0%
95.8%
81.7%
100.0%
Q3
2013/14
94.0%
95.7%
74.1%
100.0%
Q4
2013/14
95.1%
95.9%
78.9%
100.0%
Q1
2014/15
97.2%
96.1%
87.2%
100.0%
Q2
2014/15
96.9%
96.1%
86.4%
100.0%
Q3
2014/15
96.5%
95.9%
81.2%
100.0%
January
2015
97.0%
95.9%
74.1%
100.0%
• A requirement for VTE risk assessments to be
undertaken is a mandatory field in our clinical
information system.
• To ensure that during 2015/16 our performance will
be monitored by our Thrombosis Committee and
our Quality fora.
www.homerton.nhs.uk
63
QUALITY ACCOUNT
6. Clostridium Difficile (C.diff)
Our response:
During 2014/15 our national threshold not to be
exceeded for patients developing C.diff at Homerton,
was no more than two cases. Seven patients developed
C.diff this year in the hospital. All of the cases have a
detailed investigation and review to determine if there
were any lapses in care. This process ensures that we
identify areas for improvement and reduce the risk
of C.diff to patients. Although the number of cases
exceeded the threshold, the Trust still has a low number
of cases, and this demonstrates the success of the
on-going work the Trust has been doing in relation to
reducing the number of patients infected.
Table 11: C.diff per 100,000 bed days
Our C.diff rate per 100,000 bed days is available from
national data up to the end of March 2014. The figures
for the preceding years show the improvements that
we have made in reducing the number of patients
developing C.diff in hospital. The Trust only tests the
cases that it is obliged to test under the guidance.
Homerton’s performance compared to other NHS
Trusts with the highest and lowest rates of C.diff in the
country are shown in Table 11 below.
C.diff per 100,000 bed days rate
Reporting
Period
Homerton National Lowest Highest
2009/10
18.5
35.4
0.0
92.0
2010/11
7.9
29.7
0.0
71.2
2011/12
7.2
22.2
0.0
58.2
2012/13
10.2
17.4
0.0
31.2
2013/14
1.6
14.7
0.0
37.1
We consider that this data is as described for the
following reasons:
• The Trust has continued to focus on ensuring
infection rates remain low.
• The Trust has robust processes in place to prevent
infections.
Prescribed information from Monitor:
• The Trust takes appropriate action if any infection is
identified.
The rate per 100,000 bed days of cases of C.diff
infection reported within the Trust amongst patients
aged 2 or over during the reporting period.
We have taken and continue to enforce the following
actions to improve this rate, and so the quality of
services, by the following actions.
• Hand hygiene continues to be a vital part of
combating infection at the Trust. All clinical areas
audit their hand hygiene monthly and the results
are displayed on the Trust intranet. These audits
show that the Trust averages for staff washing/using
alcohol gel on their hands is 90%.
• Good antibiotic prescribing with regular audits to
monitor compliance.
• Education, training and support of staff by the
infection prevention control team.
• Review of care of all practices in line with current
guidance and expert opinion to ensure that our
patients are receiving the safest care possible.
• Regular review of the care environment to ensure
that we are providing care in a clean and fit for
purpose ward/department.
64
Homerton University Hospital NHS Foundation Trust Quality Account 2014/15
7. Rate of patient safety incidents
Incident reporting is encouraged for all adverse events that occurred or had the potential to occur in the Trust. These
can range from a near miss to those where the patient suffered harm. In the last three years our incident reporting
rate has increased. According to the National Patient Safety Agency and the NHS Commissioning Board increased
reporting is considered to be a positive indicator of a healthy safety culture, giving organisations the chance to learn
and improve.
Prescribed information from Monitor:
The number and, where available, rate of patient safety incidents reported within the trust during the reporting
period, and the number and percentage of such patient safety incidents that resulted in severe harm or death.
Our response:
Table 12: Patient Safety Incidents
Patient safety incidents resulting in severe harm/death
Reporting
Period
Homerton
National
Lowest
Highest
No.
Rate
No.
Rate
No.
Rate
No.
Rate
2009/10
6
0.2%
541
0.7%
0
0.0%
103
2.5%
2010/11
38
1.1%
893
1.1%
0
0.0%
121
7.1%
2011/12
51
1.3%
1,048
1.0%
0
0.0%
81
4.6%
2012/13
41
0.9%
896
0.8%
3
0.1%
94
3.1%
2013/14
38
0.6%
845
0.7%
3
0.1%
101
3.9%
*Total ‘small acute trusts’ across England
Reporting
Period
Reported patient safety incidents
Homerton
% change
(on previous)
Lowest
Highest
2009/10
2,900
N/A
1,302
4,735
2010/11
3,401
17.3%
807
5,404
2011/12
4,055
19.2%
1,260
7,058
2012/13
4,663
15.0%
1,865
9,062
2013/14
6,361
36.4%
1,736
8,091
www.homerton.nhs.uk
65
QUALITY ACCOUNT
We consider that this data is as described for the
following reasons.
• Care is taken to ensure that the data exported
to the national reporting and learning system is
accurate.
• Any harm sustained as the result of a patient safety
incident is part of this information. The actual harm
to the patient is reviewed by the individual dealing
with the incident, by divisional governance groups
and at any meeting held to discuss an incident that
is potentially serious – these meetings are chaired by
an Executive Director.
• Data is presented at our Improving Patient Safety
Committee and is monitored through our Quality
and Patient Safety Board.
• It is a priority for all staff to take all measures
possible to reduce the risk of harm to patients
that are in our care. If a patient is harmed, it is
essential that this is reported immediately, so that all
necessary actions to treat the patient can be taken.
66
• Over the past twelve months we have emphasised
the need to increase reporting, improving our
openness and transparency and the opportunity to
learn from sharing near misses. So the increase in
volume of reported incidents is welcomed as can be
seen in Table 14.
We have taken the following actions to improve this
rate, and so the quality of services, by:
• increasing the rate of incident reporting in the last
year
• monitoring and acting quickly on any incidents that
appear to show that a patient has been harmed as
a result
• investigating when things go wrong to ensure that
systems and processes are improved and made safer
as a result,
• continuing to be open and honest with patients and
their relatives if something has gone wrong.
Homerton University Hospital NHS Foundation Trust Quality Account 2014/15
8. Friends and Family
Prescribed information from Monitor:
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.
Our Response:
Table 13: % of staff recommending the Trust to
their friends and family
Reporting
Period
% of staff who would recommend the
Trust to their friends and family
Homerton
Acute
Trusts
2010
75.0
67.0
38.0
89.0
2011
72.0
62.0
33.0
83.0
2012
74.0
63.0
35.0
94.0
2013
76.0
67.0
40.0
94.0
2014
78.0
67.0
38.0
89.0
Lowest Highest
A percentage of 78% means that the Trust is in the 4th
quartile of performance for Trusts. Trusts in the fouth
quartile are the top performers. This is an improvement
on last year.
Table 14 shows our scores with regards to the
percentage of patients who are likely to recommend
the Trust to their friends and family. This is a new
indicator for reporting in the Quality Account for the
Trust.
We consider that this data is as described for the
following reasons as there were actions taken during
2014/15 to improve staff engagement, this included:
• engagement with staff to create our ‘Living our
Values’ strategy
• clear objectives for our Equality and Diversity group
• listening to our staff and using their feedback to
improve services
• ensuring that we have the right staff, with the right
skills caring for each patient, and
• providing continuity of care through good
communication and teamwork.
We have taken the following actions to improve this
rate, and so the quality of our services by:
• ensuring that 90% of staff have had their appraisal,
with clear objectives
• valuing and supporting the health and wellbeing of
all our staff
• providing services that meet the diverse needs of
our communities, and
• treating everyone with dignity and respect.
Table 14: % of patients recommending the Trust to
their friends and family
Reporting Period
2013/14
(Oct 13 - Mar 14)
2014/15
(Apr 14 - Feb 15)
Service
% of staff who would recommend the Trust to their
friends and family
Homerton
England
Lowest
Highest
A&E
94%
87%
61%
97%
Inpatient
92%
94%
71%
100%
Maternity - Antenatal
96%
94%
0%
100%
Maternity - Birth
88%
95%
62%
100%
Maternity - Postnatal Ward
94%
95%
0%
100%
Maternity - Postnatal Community
92%
92%
64%
99%
A&E
94%
87%
67%
99%
Inpatient
91%
94%
67%
100%
Maternity - Antenatal
91%
95%
0%
100%
Maternity - Birth
92%
96%
41%
100%
Maternity - Postnatal Ward
91%
96%
0%
100%
Maternity - Postnatal Community
93%
92%
61%
99%
www.homerton.nhs.uk
67
QUALITY ACCOUNT
Part Three: Our Quality Plans for 2015/16
This section contains an outline of our quality priorities for 2015/16.
As part of our consultation process, external stakeholders, the Council of Governors, patients and staff were
contacted to ascertain their views on ‘quality’. In particular, they were asked specific questions with regards to what
aspects of quality mattered most to them, or to share their views on our strategic document Achieving Together, as
all priorities that would be developed would link directly to our strategic objectives. From January to March 2015,
several consultation events were undertaken in order to determine what the quality priorities should be for 2015/16.
Building on the progress that we have made during 2014/15, our Quality Account priorities and Quality Plan for
2015/16 will form the foundation for the Trust’s strategy to deliver improvements in patient and service user care and
achieving compliance with key performance and regulatory requirements.
This year we have set further ambitious priorities to drive high quality care and respond to the challenge of meeting
the health needs of our diverse community.
Quality Domain: SAFE
No.
Quality Improvement Priorities for 2015/16
1
To further reduce harm to patients caused by pressure ulcers,
falls, urinary catheter infections and Venous Thromboembolism
(VTE) identified within the safety Thermometer/ Harm Free Care
Programme
Data for monitoring progress will be sourced from our locally
held data as well as the national safety thermometer portal.
2a
To improve the response to acutely deteriorating patients and
reduce failure to rescue focusing on Sepsis and Acute Kidney
Injury (AKI)
During 2014/15 we focussed on introducing the National Early
Warning Score (NEWS). This year we are aiming to build on
achievements made and in addition, meet the national CQUIN
targets.
2b
To improve the monitoring and escalation of response to high
risk women using the Maternity Early Obstetric Warning Scoring
System (MEOWS)
Previous
Priority
New
Priority
3
3
(see previous
data in
Section 2.1)
3
3
(see previous
data in
Section 2.1)
3
This is a new priority for the Trust and measures are set to
ensure that additional improvements are also made within our
maternity services. Data will be sourced locally.
2c
Reduction in the number of babies admitted to NICU at term
with evidence of severe acidosis
This is a new priority for the Trust and measures are set to ensure
that additional improvements are also made within our Neonatal
Intensive Care Unit. Data will be sourced locally.
68
Homerton University Hospital NHS Foundation Trust Quality Account 2014/15
Chosen from
feedback
3
Quality Domain: SAFE
No.
Quality Improvement Priorities for 2015/16
3
To enhance adult safeguarding experience:
• Clients involved in determining outcomes
• Actions recorded with clients’ expressed views
Previous
Priority
New
Priority
Chosen from
feedback
3
3
This is a new priority for the Trust and measures are set to ensure
that improvements are made to enhance adult safeguarding.
Data will be sourced locally.
Quality Domain: Effective
No.
Quality Improvement Priorities for 2015/16
4a
To reduce the number of patients who are readmitted within 30
days of discharge
4b
(To include specifics on reducing the number of postnatal
readmissions)
This is a new priority for the Trust and measures are set to
ensure that additional improvements are also made within our
maternity services. Data will be sourced locally.
5a
Health Visiting Element
To improve maternal health by monitoring using a value
scorecard.
5b
District Nursing Element
To improve communication with key stakeholders by
• Attending practice meetings
• Responding to referrals within the set times
6
Keep me well - to improve our integrated pathways between
community and acute care focussing on the RICS, Community
Paediatric and Ambulatory Care services
7
To improve the quality of dementia care for our patients and
carers
• Ensure that the Abbreviated Mental Test is undertaken
• Improve support to Carers
• Show demonstrable engagement from staff
Previous
Priority
New
Priority
Chosen from
feedback
3
3
3
(see previous
data in
Section 2.1)
3
3
(see previous
data in
Section 2.1)
3
3
(see previous
data in
Section 2.1)
3
3
3
(see previous
data in
Section 2.1)
www.homerton.nhs.uk
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QUALITY ACCOUNT
Quality Domain: POSITIVE PATIENT EXPERIENCE
No
Proposed priorities for 2015/16
8
To improve our end of life care and advanced care planning
9
Improve the effectiveness of discharge from our care for both
complex and non-complex discharges
Previous
Priority
New
Priority
Chosen from
feedback
3
3
3
(see previous
data in
Section 2.1)
10
To improve the management and control of pain
3
3
(see previous
data in
Section 2.1)
11
12
70
To improve the way we communicate and ensure that respect,
dignity and compassion – leading by example and taking
responsibility for our actions
To improve the health and wellbeing of Trust staff and to
achieve Excellence (the highest level) in the London Healthy
Workplace Charter
Homerton University Hospital NHS Foundation Trust Quality Account 2014/15
3
3
(see previous
data in
Section 2.1)
3
Part Four: Our CQUINS for 2015/16 The proposed CQUINS for 2015/16 includes the following:
No.
Category
Description
1
Physical Health
Acute Kidney Injury
2
Physical Health
Sepsis
3
Mental Health
Dementia
4
Urgent and Emergency Care
Reducing avoidable emergency admissions to hospital
5
Long term Conditions
• Diabetes
• COPD
• Heart Failure
6
Urgent Care
Consultant Review
7
Planned Care
Irritable Bowel Syndrome (IBS)
8
Planned Care
Medicines Management
9
Maternity
• Normal births
• Supporting mothers to breastfeed
• Improving patient feedback
10
General Pressure Ulcers
Reducing the prevalence of pressure ulcers in the community
11
Improving Patient Experience
Active participation of patients in their care
12
Public Health
Percentage of clinical staff trained to give basic advice (Ask
Advise, Act)
Acute Scheme
Description
Percentage
Monetary Value
Acute Scheme 1
CUR (Clinical Utilisation Review)
0.50%
£149,255
Acute Scheme 2
ODX Oncotype DX
0.30%
£89,553
Acute Scheme 3
Hepatitis C Network
0.40%
£119,404
Acute Scheme 4
Reducing unnecessary CD4 Monitoring
0.40%
£119,403.83
Acute Scheme 5
Management of Oral Formulation of Systemic
Anti-Cancer Therapy
0.10%
£29,851
Acute Scheme 6
Reduce delayed discharge from ICU to Ward Care
0.40%
£119,404
Acute Scheme 7
Neonatal Intensive Care
0.30%
£89,553
2.40%
£716,424
Total Values
NHSE proposed CQUINs for Early Years/Screening services:
• CHIS CQUIN
• Dental Dashboard
• Immunisations
www.homerton.nhs.uk
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QUALITY ACCOUNT
Annex 1: Statements from Commissioners, local
Healthwatch and the Overview and Scrutiny Committees
The following pages contain Statements from
our Commissioners, Healthwatch-Hackney and
Healthwatch-City of London and the Overview and
Scrutiny Committee.
72
Homerton University Hospital NHS Foundation Trust Quality Account 2014/15
Commissioners Statement for Homerton
University Hospital Foundation Trust 2014/15
Quality Accounts
NHS City and Hackney Clinical Commissioning
Group (CCG) is responsible for the commissioning
of health services from the Homerton University
Hospital Foundation Trust on behalf of the
population of the City of London and the London
Borough of Hackney. We are also the lead
commissioner for other CCGs across North and East
London for the Homerton’s services.
NHS City and Hackney CCG welcomes the
opportunity to provide this statement on the Trust’s
2014/15 Quality Account.
We were pleased to be consulted on new quality
priorities and note there are now twelve quality
priorities for 2014/15. We would suggest the Trust
undertake further consultation, particularly with
patients and staff, this year to set longer term
quality priorities for 2016/17.
We are very pleased to see new quality priorities for
some community services and would like to see this
further developed, as well as more reporting about
the quality of our community services, over the next
year.
systems. The CCG is keen to see frequent auditing
of the use of these tools and we strongly support
the Trust focusing on this during 2015/16.
The Trust also reports on the aim to reduce the
number of patients who are readmitted within 30
days of discharge and improve timely discharge.
We expect the work associated with this aim will
deliver the required results in due course.
It is disappointing to see that the Trust has failed
to achieve the priorities relating to district nursing
which is the only community service quality priority.
We hope there will continue to be a focus on
supporting quality improvement in district nursing
as this service is so highly valued by patients, carers
and local GPs and is such an integral part of our
One Hackney initiative for delivering practice based
integrated care and achieving our system wide
metrics. We hope to see progress during 2015/16
on patients having a named nurse and the use of
care plans being documented.
We congratulate the Trust on achieving the
majority of their safety priorities including harm
free care and reduction in pressure ulcers and
medication errors. The Trust’s aim to reduce its
standard hospital mortality indicator to below
80 was ambitious and unfortunately missed but
achievement to date is strong and we hope will
continue.
We note patients reported increased confidence
and trust in nurses last year and there was an
increase in the percentage of patients who felt
they had been treated with respect and dignity and
reported their pain had been adequately controlled.
We warmly welcome these improvements. This
area has been a focus for the Homerton over the
last year and the various initiatives that have been
introduced appear to be producing results. There
is still room to improve patient satisfaction with
inpatient services and we urge the Trust to continue
to focus on this area in 2015/16 and beyond, and
to engage with local patients and the public in this
work.
We welcome the Trust’s participation in quality
collaboratives including the University College
London Partners Deteriorating Patient Programme
and the recent launch and use of the National Early
Warning Score (NEWS) and other early warning
The Trust has a loyal, dedicated workforce who is
committed to high quality patient care and would
recommend the Trust highly as a place to work. The
Trust is to be congratulated on staff satisfaction and
we hope this can be maintained in 2015/16.
The use and presentation of data is generally good
but for some of the quality priorities it is not clear if
the priority was met or not.
www.homerton.nhs.uk
73
QUALITY ACCOUNT
Commissioners Statement for Homerton
University Hospital Foundation Trust 2014/15
Quality Accounts
We congratulate the Trust on the CQC rating of
“good” for services and “outstanding” for A&E
services in February 2014. We note in March 2015
the CQC issued three warning notices to the
Trust in relation to the Maternity and Midwifery
regulated activity. We hope to work with the Trust
over the next year to address areas identified
by the CQC as in need of improvement and to
increase patient feedback in maternity services.
We confirm that we have reviewed the information
contained within the Account and checked this
against data sources where this is available to us as
part of existing quality / performance monitoring
discussions and it is accurate in relation to the
services provided.
Overall we welcome the 2014/15 quality account
and will ensure we continue to support further
quality improvement at the Trust.
Dr Clare Highton
Chair NHS City and Hackney Clinical Commissioning
Group
74
Homerton University Hospital NHS Foundation Trust Quality Account 2014/15
Healthwatch City of London
response to the Homerton University Hospital NHS Foundation Trust
Quality Account 2014-15
Healthwatch City of London is pleased to have
been given the chance to comment on this quality
account and has provided the comments below
following consultation with City residents and
services users of the Homerton. Comments from
City residents have reflected good quality care
from staff at the Homerton and acceptable waiting
time. The bus routes to the hospital have proved to
be a problem for City residents meaning that the
hospital is not used as frequently by residents as it
could be.
City residents have previously raised concerns over
the moving of the district nurses who provided care
for the City residents from the Neaman practice
to the base at Rushden Street. The purpose for
this was to ensure that the nursing team was in
one base and therefore all staff received adequate
supervision and support. The Neaman practice
have agreed that when the nurses are in the City
and require a base between patient visits they will
provide this so that the relationship between the
GP practice and nursing team is main¬tained and
that communication remains a priority between
both service providers in order to ensure the
patients care is seamless and to a high standard.
There is an allocated nurse for the Neaman practice
who liaises daily with the practice both by going
into the practice and telephone conversations.
When that nurse is off duty her caseload is covered
by another nurse who is fully briefed as to all the
patients’ care requirements. We have not received
any adverse feedback from City residents during
the reporting period on these changes.
The Picker Survey mentioned in the report shows
a lack of trust in clinical staff and the action plan
detailed in the report provides reassurance that
these issues are being addressed. Although the
sample size is small and there have been some
movements in results it is encouraging that the
Trust has taken steps to address the issues raised.
Healthwatch City of London will be happy to
assist the Homerton in the follow up to the
focused follow-up inspection of the hospital based
maternity service, and the subsequent warning
notices from the CQC through providing patient
feedback or attending any meetings arranged in
relation to this area. It is reassuring to see that the
Trust has put in place comprehensive action plans
to address these issues.
www.homerton.nhs.uk
75
QUALITY ACCOUNT
Healthwatch Hackney response to the Homerton
University Hospital NHS Foundation Trust Quality
Account 2014-15
Thank you for the opportunity to comment on
your Quality Account. It is good to see so many
initiatives involving the local community.
We confirm that largely the Homerton’s Quality
Objectives reflect the issues that Healthwatch
Hackney hears about from local patients: Quality
of Care, Communication issues – between
departments and between the Homerton and
other services, Staffing Levels, Waiting times and
Hospital Transport.
And we can report that during the year we have
noted that the majority of the comments we have
collected about the Homerton are positive.
However we believe, from our comment
collecting, that the voices of some patients are
under-represented in the data that the Homerton
collects, including through Patient Surveys, and we
recommend to the Homerton that it looks at some
particular areas:
• T he ability of patients who speak English not
well or not at all to access an equal quality of
service from the Homerton
• T he quality of communication with patients
who have a sensory impairment
It is good to hear about the engagement with local
people to carry out the PLACE Assessment about
the cleanliness and general state of the hospital
environment. However the important part is what
has been identified as needing improvement, and
what actions have been taken, and this is missing
from the report.
One of our roles is to report from the perspective
of local residents, and while we understand that
much of the audience for the Quality Account is
health professionals, we are keen to see it become
as accessible as possible for local people. Therefore
we would like to suggest that in the next Quality
Account, the Homerton:
76
1.Explain the purpose of a Quality Account, so
that people reading understand that one aim
is to enable local people see how the quality of
services in their local hospital is being managed
and improved
2.Separate the reporting against last year’s
priorities from the setting of this year’s priorities.
By mixing them up together, it means there is
no reporting against priorities from last year
where they are not carried over to this year.
This is not transparent, and cannot be seen by
a member of the public unless they access last
year’s report as well.
3.Use the exact wording of the priority from last
year in reporting progress this year so that a
member of the public can see what the aim
was, and whether this has been achieved. By
summarising it becomes unclear if some aspects
are being omitted.
4.When setting a priority, identify a very clear
measure. In reporting, indicate to what extent
this has been met. And adopt the same method
for all areas. This would help a member of the
public to have confidence in the process and to
understand what progress has been made.
5.Set fewer priorities so those less involved with
the hospital can understand what is being
addressed and what improvement would look
like.
Yours Sincerely,
Paul Fleming
Chair
Homerton University Hospital NHS Foundation Trust Quality Account 2014/15
Overview & Scrutiny Committee response to
the Homerton University Hospital NHS Foundation Trust
Quality Account 2014-15
Thank you for inviting us to submit comments on
the Quality Account for your Trust for 2014-15. We
are writing to provide our insights arising from the
scrutiny of the Trust’s services over the past year at
the Commission.
The Commission Members take a great interest
in the performance of our key local acute trust
and were pleased to learn that about your key
achievements, awards won and the growing
stature of your clinical research. Just one example
relevant to our recent work which we were pleased
to see, was that you had secured funding to
investigate the feasibility and acceptability of home
sampling kits to increase the uptake of HIV testing
among black Africans in the UK, something we
recommended in our HIV review last year.
Over the past year our good working relationship
with the Trust has continued. In July we discussed
with the Chief Nurse the action plan arising from
the comprehensive CQC inspection carried out
in February 2014. In October the Chief Executive
presented a briefing in response to the maternal
deaths and we discussed the impact on the trust
of the ‘challenged health economies’ work and
the Transforming Services Together programme.
In February the Chief Executive attended again to
present their regular update and we discussed the
maternal deaths and the handling of the ongoing
complaint by the anonymous group calling itself
‘Unhappy Midwives’. Next month we will revisit the
quality of the maternity service following another
recent unannounced CQC inspection of it. Trust
staff contributed to our own review on ‘Preventing
depression and anxiety in working age adults’, in
particular the IAPT team who hosted a site visit.
b) On the issue of reducing the number of
unexpected deaths (p.24), the Trust is to be
congratulated on moving from “as expected” to
“lower than expected” on the Summary Hospital
level Mortality Indicator (SMHI) rating. We hope this
position in the lower quartile of NHS organisations
nationally can now be maintained.
c) On the issue of avoidable hospital re-admissions
(p.35) we note that management of your sickle cell
patients impacts on how you perform here and we
hope that with an increased focus on the needs
of this group will mean that you deliver better
outcomes for them in the coming year.
d) We continue to await the launch of the
Reablement and Intermediate Care Service (RICs)
(p.35), which appears to have been delayed, and
we hope it will deliver on the promise of reducing
re-admissions. We hope to return to this issue at
the Commission during the year.
e) In relation to improving maternal mental health
(p.38) you say you will “continue to refine our
metrics and roll out across the service”, but you
have not specified which metrics and what has
been measured here so far.
f) We note (p.40) that the attendance of Adult
Community Nursing Team at Multi-disciplinary
Team (MDT) meetings with GP Practices remains
well off target and look forward to this issue being
addressed. We note that their full participation in
integrated care planning will also be essential if
integration is to succeed.
We wish to make the following comments on your
report:
g) In relation to improving the effectiveness of
discharge from care (p.48), it would help to see
the statistics here and understand if these have
improved or not in the past year?
a) The 12 Quality Priorities (6 new and 6
continuing), which you have chosen for 2015/6 are
well chosen, responsive, grounded in evidence and
demonstrate a keen focus on where improvement
can be achieved.
h) On the issue of improving trust and confidence
(p.51) we remain concerned that the Picker Survey
shows that 32% of patients (well above the
national average) did not have confidence and
trust in nurses. We will explore this issue further at
www.homerton.nhs.uk
77
QUALITY ACCOUNT
Commission meetings, particularly in relation to the
maternity service.
i) On the issue of managing under-performing
staff who do not have a trusting relationship with
patients (p.52), we would argue that “having
guidelines agreed and in place” is not sufficient
unless there is also culture change and unless
colleagues are free to report concerns and know
that these will be listened to. We note you have
introduced a “staff cultural barometer” (p.55),
which is run on a quarterly basis. We would be
keen to learn more about the results from this and
what learning has taken place.
We look forward to taking up these issues with you
over the next year as the Trust presents its regular
updates.
Yours sincerely
Councillor Ann Munn
Chair of Health in Hackney Scrutiny Commission
j) We note (p.65) that following a focused followup inspection of your hospital based maternity
service, the CQC issued you with three warning
notices on 31 March 2015. The layout in this
section doesn’t make it obvious that there were
two inspections. The understandable prominence
given to the result of the inspection of A&E services
gives the impression that the text below is related.
It would also have helped if you specified precisely
what “Regulations 9, 10 and 12” are, as you were
found to be in breach of them. We await the CQC
report and your response to it in due course.
k) On the issue of 28-day Re-admissons (p.75) we
are concerned that your most recent data relates
to 2011/12. You state the reason is because of the
HSCIC “moving the data production from external
contractors to in-house” and we would enquire
why you couldn’t publish your local data on this in
the interim?
l) In relation to the exporting of data to the national
reporting system on patient safety incidents (p.82),
we would ask if the steady annual % increases
in the number of patient safety incidents is due
to stricter reporting requirements here or to a
deterioration in performance?
m) Finally, the report does not include a table
outlining the number of patients seen during the
year in inpatients, outpatients and A&E settings
and this would be helpful.
78
Homerton University Hospital NHS Foundation Trust Quality Account 2014/15
Annex 2: Statement of Directors’ responsibilities
for the Quality Report
The Directors are required under the Health Act 2009
and the National Health Service (Quality Accounts)
Regulations to prepare Quality Accounts for each
financial year.
Monitor has issued guidance to NHS foundation
trust boards on the form and content of annual
quality reports (which incorporate the above legal
requirements) and on the arrangements that NHS
foundation trust boards should put in place to support
the data quality for the preparation of the quality
report.
In preparing the Quality Report, Directors are required
to take steps to satisfy themselves that:
• the content of the Quality Report meets the
requirements set out in the NHS Foundation Trust
Annual Reporting Manual 2014/15 and supporting
guidance
• the content of the Quality Report is not inconsistent
with internal and external sources of information
including:
• board minutes and papers for the period April 2014
to 27th May 2015
• papers relating to Quality reported to the board
over the period April 2014 to 27th May 2015
• feedback from commissioners dated 21/05/2015
• feedback from governors dated 21/05/2015
• feedback from local Healthwatch organisations
dated 21/05/2015 and 26/05/15
The Quality Report presents a balanced picture of the
NHS foundation trust’s performance over the period
covered
The performance information reported in the Quality
Report is reliable and accurate
There are proper internal controls over the collection
and reporting of the measures of performance included
in the Quality Report, 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 Report is robust and reliable,
conforms to specified data quality standards and
prescribed definitions, is subject to appropriate
scrutiny and review and The Quality Report has
been prepared in accordance with Monitor’s annual
reporting guidance (which incorporates the Quality
Accounts regulations) (published at www.monitor.gov.
uk/annualreportingmanual) as well as the standards
to support data quality for the preparation of the
Quality Report (available at www.monitor.gov.uk/
annualreportingmanual).
The Directors confirm to the best of their knowledge
and belief they have complied with the above
requirements in preparing the Quality Report.
By order of the board
• feedback from Overview and Scrutiny Committee
dated 22/05/2015
• the trust’s complaints report published under
regulation 18 of the Local Authority Social Services
and NHS Complaints Regulations 2009, dated May
2014
Chairman
Date 27 May 2015
• the national patient survey, May 2014- date of
publication- May 2015
• the national staff survey, May 2014- date of
publication- February 2015
• the Head of Internal Audit’s annual opinion over the
trust’s control environment dated 21st May 2015
Chief Executive
Date 27 May 2015
• CQC Intelligent Monitoring Report dated December
2014
www.homerton.nhs.uk
79
QUALITY ACCOUNT
Appendix A: List of CQUINS 2014/2015
Goal
No.
1
80
Goal
Friends and
Family Test
2
NHS Safety
Thermometer
3
Dementia
and Delirium
Indicator
No.
Description
1
1.a. Implementation of staff FFT in acute and community services
2
1.b. Implementation of patient FFT in outpatients and day cases
3
2.a. Response rate in Inpatient 4
2.b. Response rates in A&E
5
3. Further increase to response rates in inpatient services in March 2015
6
Pressure Ulcers: 50% reduction in new grade two cases compared to
2013/14. Payment would occur for a 50% reduction with a partial
payment mechanism for a reduction of 25% or more.
No more than two new grade three and four avoidable pressure ulcer
cases per month. Payment would only be made for each month this
target is met. 50k of the value attached to this indicator payable on receipt by end of
January 2015 of a report on where old pressure ulcers are originating
and a clinical plan and recommendations for the health economy on
how all pressure ulcers could be reduced during 2015/16.
7
FAIR
8
Clinical Leadership
9
Supporting Carers
4
Urgent Care
10
% of all over 18s (excluding surgical cases) admitted as emergencies to
be seen and assessed by a Consultant physician within 12 hours of the
decision to admit, and a management plan agreed - by end of Q2 90%.
5
Integrated
Care 1
11
% of all patients over 75 admitted as emergencies to be seen by a
Consultant geriatrician within 72 hours and a management plan agreed
- by end of Q2 65%.
6
Integrated
Care 2
12
% of patients over 75 known to ACN service who are assessed by the
service within 48hrs of admission in order to develop a discharge plan.
Targets are 30% for Q1 & Q2; 50% for Q3 and 70% for Q4.
7
Integrated
Care 3
13
CQUIN relating to review of care plans and systems for review and
amendment to be developed.
CQUIN to apply for quarter 4.
Description to be developed by end of September by Integrated Care
Board.
Homerton University Hospital NHS Foundation Trust Quality Account 2014/15
Goal
No.
Goal
Indicator
No.
Description
8
Integrated
Care 4
14
% of patients over 75 admitted as an emergency to Homerton to
be contacted by ACN service either via a home visit or a telephone
contact within 48hrs of discharge, and a report to the GP within a time
of 24hrs via the electronic letter system. Targets for both measures are
30% by Q2; 50% in Q3; 70% in Q4.
9
Long Term
Conditions 1
15
Long Term Conditions:
For all patients admitted with a diagnosis of COPD, diabetes or
heart failure to have a face to face and documented assessment by
a specialist nurse within 48hrs of admission (Monday - Friday) and
management plan communicated to the GP. Diabetes: 80% of all patients assessed within 48hrs of admission by
Q2 and maintained for remainder of 2014/15. 16
COPD: at the documented assessment each patient to receive the
following: Referral to smoking cessation service if a current smoker;
Assessment of suitability and/or enrolment into a pulmonary
rehabilitation programme;
Have appropriate education, written information, self-management
plans and rescue packs for future exacerbations;
Ensure that patient understands their medications and have
demonstrated good inhaler technique whilst on the wards;
Ensure that they have appropriate follow up once discharged from
hospital.
This should be documented into a personalised care plan, developed
and agreed with the individual patient and their carers, and shared
with the patient’s GP and to be documented in the care plan agreed
with the patient and shared with the GP. - By end of Q2 60% of
patients assessed and receiving care bundle within 48hrs
17
Heart Failure: by end of Q3 75% of patients to be assessed within
48hrs. 18
Every inpatient with diabetes/diagnosis of diabetes to have received a
Diabetes Patient Information Pack. Consisting of:
1. Letter to the Patient
2. Flyer for “Walking Group”
3. HUHFT “Your feet and Diabetes” leaflet
4. DM clinic reminder
5. Structured Patient Education Leaflets
6. Diabetes UK “15 healthcare essentials” leaflet
7. Folder to keep paperwork in
10
Long Term
Conditions 2
Other content as agreed by the Joint Diabetes Ops. Group
e.g. Care Planning. By end of Q2 100%.
www.homerton.nhs.uk
81
QUALITY ACCOUNT
Goal
No.
Goal
Indicator
No.
11
Maternity
19
% of women to have their antenatal appointments with the same
midwife for low and high risk women - by end of Q4 70%.
12
General
20
This to be negotiated with and reported direct to LBH Public Health
Department.
Description
1a. By Q4 70% of new non-AHP clinical staff trained to provide very
basic advice on smoking.
1b. By Q4 35% of existing non-AHP clinical staff trained to provide
very basic advice on smoking.
2. By Q4 50% of City & Hackney resident patients 16 years old and
above attending acute services with a smoking status recorded.
3. By Q4 50% of patients in 2. identified with a smoking status
offered very brief advice.
4. By Q4 30% of patients in 2. referred to the local stop smoking
service.
13
82
IAPT
21
To support MIND C&H to Provide IAPT compliant Interventions: Support and Training for and submission of HSCIC reporting, training
of MIND staff for IAPT compliance interventions.
22
Monitoring and evaluation of Access for Turkish and Ultra-Orthodox
Patients. Data Capture, analysis and developing improvement plan.
23
Establishing pathways for peri-natal patients and cannabis users.
Develop pathways for these groups.
Homerton University Hospital NHS Foundation Trust Quality Account 2014/15
Appendix B: List of National Clinical Audits and National
Confidential Enquiries that we participated in
Name of audit / Clinical Outcome Review Programme
% of data
submitted
Adult community acquired pneumonia
100%
Case Mix Programme (CMP)
100%
Emergency use of oxygen
100%
National Audit of Seizures in Hospitals (NASH)
100%
National emergency laparotomy audit (NELA)
100%
National Joint Registry (NJR)
100%
Pleural procedures
100%
Severe trauma (Trauma Audit & Research Network, TARN)
100%
National Comparative Audit of Blood Transfusion programme
100%
Bowel cancer (NBOCAP)
100%
Head and neck oncology (DAHNO)
100%
Lung cancer (NLCA)
100%
Oesophago-gastric cancer (NAOGC)
100%
Prostate Cancer
100%
Acute coronary syndrome or Acute myocardial infarction (MINAP)
100%
National Cardiac Arrest Audit (NCAA)
100%
National Heart Failure Audit
100%
Adult Bronchiectasis Audit
100%
Diabetes (Adult) ND(A), includes National Diabetes Inpatient Audit (NADIA)
100%
Inflammatory bowel disease (IBD)
100%
National Chronic Obstructive Pulmonary Disease (COPD) Audit Programme
54%
Rheumatoid and early inflammatory arthritis
100%
Falls and Fragility Fractures Audit Programme (FFFAP)
100%
Parkinson’s disease (National Parkinson’s Audit)
100%
www.homerton.nhs.uk
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QUALITY ACCOUNT
Name of audit / Clinical Outcome Review Programme
84
% of data
submitted
Sentinel Stroke National Audit Programme (SSNAP)
100%
Elective surgery (National PROMs Programme)
100%
National Clinical Audit of Management of Familial hypercholesterolaemia (FH)
100%
Fitting child (care in emergency departments)
100%
Mental health (care in emergency departments)
100%
Older people (care in emergency departments)
100%
Epilepsy 12 audit (Childhood Epilepsy)
100%
Maternal, Newborn and Infant Clinical Outcome Review Programme (MBRRACE-UK)
100%
Neonatal intensive and special care (NNAP)
100%
Paediatric pneumonia (Not required for QA as not officially running)
100%
NCEPOD – Sepsis
66%
NCEPOD - Gastrointestinal Haemorrhage
100%
NCEPOD - Tracheostomy Care
100%
Homerton University Hospital NHS Foundation Trust Quality Account 2014/15
Appendix C: Maternal Mental Health Value Score-card Metrics
Maternal Mental Health Value Score-card Metrics
ANTENATAL
The service consistently assess all woman antenatally for perinatal mental health problems:
Taken together, “I know what is in my care and support plan and I know what to do if things go wrong”.
% of mothers/fathers assessed antenatally who are asked about past history of mental health problems, and a
care history documented in mother’s clinical record
% of mothers assessed antenatally who have maternal mood assessed using relevant tool: Whooley mood
assessment tool/ EPDS/PHQ9 or maternal mood assessment tool
% of mothers assessed antenatally who have moderate to severe perinatal mental health problems and are
referred to GP/psychologists/perinatal mental health services
POSTNATAL
The service identifies all local woman with - moderate perinatal mental health problems: “I was asked how I felt”
% of mothers/fathers assessed postnatally who are asked about past history of mental health problems, and a care
history documented in mother’s clinical record
% of mothers assessed postnatally who have maternal mood assessed using relevant tool: Whooley mood
assessment tool/ EPDS/PHQ9 or maternal mood assessment tool
All women who are HARM negative receive effective intervention from service: “my health visitor helped me to
understand & make use of local services that are relevant to me & my family”
% of women assessed postnatally with EPDS who score over 10, but are deemed to be harm negative
% of women assessed postnatally who receive 6 listening visits of those deemed to require them
% of women who have received listening visits and still score more than 10 on a repeat EPDS assessment
% of women who have received listening visits and still score more than 10 on a repeat EPDS assessment and who
are referred to GP/psychologists/perinatal mental health services
All women with moderate - severe perinatal mental health problems are referred appropriately by the service
% of women assessed postnatally with EPDS who score over 10, but are deemed to be harm positive
% of women assessed postnatally who have moderate to severe perinatal mental health problems are referred to
GP/psychologists/perinatal mental health services
All women assessed along the perinatal mental health pathway who have a wellbeing care plan in place:
Taken together “I have regular reviews of my care & support plan”
% of women assessed throughout the perinatal mental health pathway who have a wellbeing care plan in place
% of women who are deemed to require PNMH supervision, who have their care plans reviewed and updated at
all stages on the perinatal mental health pathway
www.homerton.nhs.uk
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QUALITY ACCOUNT
Maternal Mental Health Value Score-card Metrics
Qualitative PREMS: 5-point Likert scale answer to the following statements
Taken together: This is seen by the end user to consistently support their mental health: “I feel supported and
understood by my health visitor”.
% of women who have received listening visits who complete the questionnaire and agree that they feel
supported and understood by their health visitor
After contact with the health visitor, I feel confident and more knowledgeable about things I need to know:
agree/strongly agree
% of women who complete the questionnaire and agree that after contact with their heath visitor they feel
confident and more knowledgeable about things they need to know
The service effectively assesses for potential issues in the family at every consultation. “I was asked how the
whole family is adjusting to the new baby”
% of women who complete the questionnaire and agreed that they were asked how the whole family is
adjusting to the new baby
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Homerton University Hospital NHS Foundation Trust Quality Account 2014/15
Appendix D: Limited Assurance Statement
from External Auditors
Independant auditor’s report to the council of
governors of Homerton University Hospital
NHS Foundation Trust on the quality report
We have been engaged by the council of governers of
Homerton University Hospital NHS Foundation Trust
to perform an independent assurance engagement
in respect of Homerton University Hospital NHS
Foundation Trust’s quality report for the year ended
31 March 2015 (the ‘Quality Report’) and certain
performance indicators contained therein.
This report, including the conclusion, has been
prepared solely for the council of governors of
Homerton University Hospital NHS Foundation Trust as
a body, to assist the council of governors in reporting
of Homerton University Hospital NHS Foundation
Trust’s quality agenda, performance and activities.
We permit the disclosure of this report within the
Annual Report for the year ended 31 March 2015, to
enable the council of governers to demonstrate they
have discharged their governance responsibilities by
commissioning an independent assurance report in
connection with the indicators. To the fullest extent
permitted by law, we do not accept or assume
responsibility to anyone other than the Council of
Governors as a body and of Homerton University
Hospital NHS Foundation Trust for our work or this
report, except where terms are expressly agreed and
with our prior consent in writing.
Scope and subject matter
The indicators for the year ended 31 March 2015
subject to limited assurance consist of the national
priority indicators as mandated by Monitor:
- 18 Week Referral to treatment incomplete Pathways
as reported in section 2.3 of the Quality Account.
- 28 day emergency re-admissions as reported in
section 2.3 of the Quality Account.
We refer to these national priority indicators collectively
as the ‘indicators’.
Respective responsibilities of the directors
and auditors
The directors are responsible for the content and the
preparation of the quality report in accordance with
the criteria set out in the ‘NHS foundation trust annual
reporting manual’ issued by Monitor.
Our responsibility is to form a conclusion, based on
limited assurance procedures, on whether anything has
come to or attention that causes us to believe that:
• the quality report is not prepared in all material
respects in the line with the criteria set out in the
‘NHS foundation trust annual reporting manual’;
• the quality report is not consistent in all material
respects with the sources specified; and
• the indicators in the quality report identified as
having been the subject of limited assurance in
the quality report are not reasonably stated in all
material respects in accordance with the ‘NHS
foundation trust annual reporting manual’ and
the six dimensions of data quality set out in the
‘Detailed guidance for external assurance on quality
reports’.
We read the quality report and consider whether
it addresses the content requirements of the ‘NHS
foundation trust annual reporting manual, and consider
the implications for our report if we become aware of
any material omissions.
We read the other information contained in the quality
report and consider whether it is materially inconsistent
with the documents specified within the detailed
guidance.
We consider the implications for our report if we
become aware of any apparent misstatements or
material inconsistencies with those documents
(collectively the ‘documents’). Our responsibilities do
not extend to any other information.
We are in compliance with the applicable
independence and competency requirements of the
Institute of Chartered Accountants in England and
Wales (ICAEW) Code of Ethics. Our team comprised
assurance practitioners and relevant subject matter
experts.
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QUALITY ACCOUNT
Assurance work performed
Conclusion
We conducted this limited assurance engagement
in accordance with the International Standard on
Assurance Engagements 3000 (Revised) - ‘Assurance
Engagements other than Audits or Reviews of Historical
Financial Information’ issued by the International
Auditing and Assurance Standards Board (‘ISAE 3000’).
Our limited assurance procedures included:
Based on the results of our procedures, nothing has
come to our attention that causes us to believe that,
for the year ended 31 March 2015:
• evaluating the design and implementation of the
key processes and controls for managing and
reporting the indicators;
• making enquires of management;
• testing key management controls;
• the quality report is not prepared in all material
respects in line with the criteria set out in the ‘NHS
foundation trust annual reporting manual’;
• the quality report is not consistent in all material
respects with the sources specified; and
• the indicators in the quality report subject to limited
assurance have not been reasonably stated in all
material respects in accordance with the ‘NHS
foundation trust annual reporting manual’.
• limited testing, on a selective basis, of the data
used to calculate the indicator back to supporting
documentation;
• comparing the content requirements of the ‘NHS
foundation trust annual reporting manual’ to the
categories reported in the quality report; and
• reading the documents.
Deloitte LLP
A limited assurance engagement is smaller 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.
Chartered Accountants
St Albans
27 May 2015
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 measurement
and can affect 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 of these criteria, may change over time. It
is important to read the quality report in the context of
the criteria set out in the ‘NHS foundation trust annual
reporting manual’.
The scope of our assurance work has not included
testing of indicators other than the two selected
mandated indicators, or consideration of quality
governance.
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Homerton University Hospital NHS Foundation Trust Quality Account 2014/15
Appendix E: Glossary of Terms and Abbreviations
Term
Explanation
Care Quality Commission (CQC)
The independent regulator of all health and social care services in
England.
Children’s Early Warning Score (CEWS)
A scoring system allocated to a patient’s (child) physiological
measurement. There are six simple physiological parameters which
are: respiratory rate, oxygen saturations, temperature, systolic blood
pressure, pulse rate and level of consciousness.
Clinical Nurse Specialist (CNS)
A nurse who has undertaken additional training and developed
advance nursing skills within a defined area of practice.
Clostridium difficile
A type of bacterial infection that can affect the digestive system
Critical Care Outreach Team (CCOT)
A multidisciplinary team comprising senior nurses and doctors with a
background in intensive care/critical care.
CQUIN – Commissioning for Quality
and Innovation (CQUIN)
CQUIN – Commissioning for Quality and Innovation (CQUIN) is a
payment framework which allows commissioners to agree payments to
hospitals based on agreed improvement work.
Health Education North Central and
East London (HENCEL)
A regional organisation with the responsibility of ensuring that high
quality education and training is provided across the sector.
MEOWS - Modified Early Obstetric
Warning Score
Based on a scoring system that triggers deterioration in a patient’s
condition and the need to escalate concerns.
Multi-Disciplinary Team (MDT)
A team consisting of staff from various professional groups i.e. Nurses,
therapist, doctors etc
National Early Warning Score (NEWS)
Based on a scoring system allocated to a patient’s physiological
measurement. There are six simple physiological parameters which
are: respiratory rate, oxygen saturations, temperature, systolic blood
pressure, pulse rate and level of consciousness.
NHS QUEST
A network of Foundations Trusts who focus relentlessly on improving
quality and safety.
NICE- National Institute of Clinical
Excellence
An independent organisation that produces clinical guidelines and
quality standards on specific diseases and the recommended treatment
for our patients. The guidelines are based on evidence and support our
drive to provide effective care.
Patient-led Assessments of the Care
Environment (PLACE)
Assessments undertaken, focusing on the patient’s privacy and dignity,
food, cleanliness and general building maintenance. The aim is to
provide feedback directly from patients, about how the environment or
services might be enhanced
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QUALITY ACCOUNT
90
Term
Explanation
PEWS - Paediatric Early Warning Score
A scoring system allocated to a patient’s (child) physiological
measurement. There are six simple physiological parameters which
are: respiratory rate, oxygen saturations, temperature, systolic blood
pressure, pulse rate and level of consciousness.
Substance And Alcohol Midwife
(SAAM)
A specialist midwife who works with mothers to take control of their
addictions, their futures and the health and well-being of themselves
and, most importantly, that of their unborn baby.
Summary Hospital-level Mortality
Indicator (SHMI)
The SHMI is an indicator which reports on mortality at Trust level across
the NHS in England using a defined methodology. It compares the
expected mortality of patients against actual mortality.
SSI – surgical site infection
Occurs when germs (micro-organisms such as bacteria) enter the
incision that the surgeon makes through your skin in order to carry out
the operation, and multiply in the tissues. Surgical wound infections are
uncommon.
University College London Partners
(UCLP)
UCLP is organised around a partnership approach: developing solutions
with a wide range of partners spanning universities, NHS Trusts,
community care organisations, commissioners, patient groups, industry
and government. (http://www.uclpartners.com).
Urinary Catheter
A catheter is a medical device that can be inserted into the body to
perform the procedure of draining urine
Venous Thromboembolism (VTE)
A blood clot that occurs in the vein
Homerton University Hospital NHS Foundation Trust Quality Account 2014/15
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91
Homerton University Hospital
Homerton Row
London E9 6SR
Tel: 020 8510 5555
www.homerton.nhs.uk