East Lancashire Hospitals NHS Trust : Our improvement plan & our progress
Personal statement from the Interim Chair of East Lancashire Hospitals NHS Trust:
“I am pleased to share with you our plans to improve the quality of care the Trust provides to our local community. The Board welcomes the
findings of the Keogh review, which was as a result of higher than expected mortality rates at the Trust. We, together with our staff, are
wholeheartedly committed to improving the quality of our services. This plan sets out short-term improvements on the key areas of concern
raised by the Keogh Review Team, however our longer term plans for continuous improvement will go beyond the deadline dates that we have
set out in this plan. This will ensure that we are assessed as a high performing organisation when the Chief Inspector of Hospitals, Professor Sir
Mike Richards inspects our Trust. Once the actions identified within the Keogh action plan have been completed, we will set out a longer-term
plan to maintain progress and ensure that the actions lead to measurable improvements in the quality and safety of care for patients. There will
be regular updates on NHS Choices and subsequent longer term actions will be included as part of a continuous process of improvement.
Our staff were rightly seen by the Keogh review as our biggest asset and we will work together, and support our staff, to ensure we provide
compassionate care that places our patients at the heart of everything we do.
We are committed to improving as an organisation and delivering against our improvement plan is fundamental to helping us on this journey.”
Martin Hill, Interim Chair
East Lancashire Hospitals NHS Trust : Our improvement plan & our progress
What are we doing?
•
The Keogh review made 30 urgent recommendations on the 16th July 2013 which, if implemented, would improve the quality of our services.
Specifically, Keogh said that we need to:
- Improve the way in which the Board seeks to ensure high quality services are delivered every time, all of the time. This is important
because the Board need to be aware of risks to the quality of our services , to promote patient safety and react swiftly to any emerging
issues.
In our individual and collective response to the Keogh review we are emphasising the need to put the delivery of sustainable, safe and high
quality care for our patients at the heart of everything we do. We have therefore simplified our vision for the organisation to set out a clear
ambition for staff, patients, their carers’ and their families: ‘ To provide Safe, Personal and Effective care for every patient, every time’. This
is supported by five clear improvement priorities.
One of our key improvement priorities is to reduce hospital mortality. Following the Keogh review we took immediate action to reduce our
mortality and also ensure we learn from patient deaths. All patient deaths are formally reviewed by a senior clinician and are discussed at
weekly share-2-care meetings by multi disciplinary teams. We have a mortality reduction plan which is overseen by a steering group of
senior clinical staff from a variety of professions.
- Improve the information that the Board receives about savings plans and their impact on the quality of our services. This is important
because, although we have to make savings each year so that we don’t spend more money than we receive, we need to be better at
checking that the savings we make will not have a detrimental effect on the care we give our patients.
The process by which our savings plans are approved has been strengthened to ensure there is no detrimental impact on the quality of care
we provide. All of our savings plans are now reviewed and signed off by our Medical Director and Chief Nurse.
- Improve the way we use our beds across all of our sites. We will also work more closely with other NHS organisations and the Local
Authorities to ensure alternative services can be accessed by patients in a community setting. Both of these points are important because
we need to ensure that we can continue to provide high quality care to the increasing number of patients who need to access emergency
care.
We have developed an ambulatory care service – a patient focussed service where people coming in to hospital as emergency patients can
have investigations, exploratory examinations and receive a treatment plan without the need for an overnight stay. This now avoids
admission for 20 patients a day and will be extended during the winter period.
On Monday the 7th October 2013 we began the ‘Perfect Week’. The Perfect Week was a commitment across the organisation to improve
patient experience and to ensure care was being delivered in the most appropriate setting. We particularly worked with our health economy
partners in a structured way to remove any barriers in discharging patients. A number of quality improvements have been identified
East Lancashire Hospitals NHS Trust : Our improvement plan & our progress
What are we doing?
- Improve our understanding of the reasons why we have a relatively high number of patients who are readmitted to hospital
unnecessarily. This is important because we are now able to move some services into the local community so that they are closer to
home which means patients don’t have to go into hospital. This improves the experience for our patients.
We have undertaken a comprehensive audit of our readmissions to further establish the reasons why they occurred. We are now working
with our partner organisations to address the issues highlighted.
We have doubled the capacity in our virtual ward, which now supports 300 patients, 7 days a week to be cared for in their own home rather
than having to come into hospital.
- Engage more effectively with our patients and their carers and provide an increased opportunity for them to improve our services.
We have launched a new programme of ward/departmental walk rounds by our Board members. This new programme has a more informal
approach with the focus on having conversations with staff, patients, families and friends to ensure our most senior staff understand how
patients feel when they use our services and the issues that staff face when delivering care to our patients. This will promote a culture of
feeling able to report when care is not the best it can be and feel supported in putting it right and learning lessons from those experiences.
- We will listen to patients’ concerns and respond compassionately and quickly and we will listen to what our patients are telling us. It is
important to learn from things which don’t go well so that they don’t happen again. We need to support our staff to continue to learn
and develop in order to provide the best possible care for our patients
We have extensively communicated with staff in a variety of ways on the importance of complaints and concerns raised by patients and
relatives as a mechanism of learning and improving care. We’ve introduced a new education and training programme on how to respond to
and learn from complaints. A new complaints handling process is in place that changes emphasis from investigation and formal response to
understanding complaint/concern, offering an early meeting, responding empathetically and learning to improve care. We are now using
patient stories at a variety of meetings as a learning tool.
- Constantly review our workforce numbers and work hard to meet the changing needs of patients in our care. This is important to ensure
all the needs of our patients are met and that the care that we give is safe and effective.
We have significantly increased the number of nurses on duty at nights on our core medical wards and are continuing to recruit additional
trained nurses, health care assistants and midwives. To ensure we have enough nurses on our wards we have also recruited nurses from
Portugal and Italy. Our sickness absence levels are improving and levels are significantly below the North West average and below the
national average.
East Lancashire Hospitals NHS Trust : Our improvement plan & our progress
What are we doing?
- Strengthen the leadership and support to our nursing staff. This is important so that our nurses and midwives feel valued
and ensures excellent and consistent nursing is provided throughout the Trust.
We have reenergised our organisational development strategy and have cascaded our leadership development programme to
our matrons and specialist nurses. Two cohorts (24 senior nurses) have already completed the programme.
•
This document shows our plan for making these changes and shows how we’re progressing. It builds on the ‘Key findings and
action plan following risk summit’ document which we agreed immediately after the review was published. This can be found
at: http://www.nhs.uk/nhsengland/bruce-keogh-review/pages/published-reports.aspx
•
Whilst we make these changes to address the Keogh recommendations, the Trust is in ‘special measures’. More information
about special measures can be found at http://www.ntda.nhs.uk/blog/2013/07/16/nhs-tda-places-five-trusts-in-specialmeasures . The Trust Development Authority are working with us to ensure we have the right support in place to make these
changes as quickly as possible.
East Lancashire Hospitals NHS Trust : Our improvement plan and our progress
Who is responsible?
Our actions to address the Keogh recommendations have been agreed by the Trust Board.
With the Board our Chief Executive, Mark Brearley, is ultimately responsible for implementing actions in this document. Other key staff are our
Medical Director, Rineke Schram and our interim Chief Nurse, Hayley Citrine, who are tasked with implementing many of the key actions
described below that will help improve the quality of care delivered by our staff and enhance patient experience.
Nicky O’Connor from the Trust Development Authority is helping us to implement our actions by supporting and challenging the process by
which we will ensure we deliver on our action plan.
Ultimately, our success in implementing the recommendations of the Keogh plan will be assessed by the Chief Inspector of Hospitals who is
likely to re-inspect our Trust in the next six to nine months.
If you have any questions about how we’re doing, please ring Lynne Barton our Head of Communications on 01254 732540, or if you want to
contact Nicky O’Connor, as an external expert, you can reach her on nicky.oconnor@nhs.net
How our progress is being monitored and supported
We will update this progress report on the first day of every month while we are in special measures.
• We will work with our Shadow Council of Governors, members and Healthwatch to ensure that the improvements we are putting in place
are effective. We will also hold public meetings and attend listening events, where we will update, face to face, our local community on our
progress. We will also produce monthly press briefings which describe how are delivering against our improvement plan. Further details will
be announced in updates of this progress report.
•
A senior representative will be appointed by the TDA, who will provide expertise to the Trust Board and check that we're meeting our
promises to deliver our improvement plan. (Timescale: By October 2013; Owner: TDA).
•
We will access support from partnership working as appropriate with the Academic Health Science Network, NHS Improving Quality and the
NHS Leadership Academy. (Timescale: By April 2014; Owner: NHS England).
Martin Hill Interim Chair of the Trust (on behalf
of the Board)
Our improvement plan
This table shows the actions we’re taking to address the concerns about the quality of our services which were raised in the Keogh report. It
also shows how we are progressing against our actions.
Summary of Keogh Concerns
Summary of Urgent Actions Required
Agreed
Timescale
External Support/
Assurance
Improve the way in which the Board
seeks to ensure high quality services are
delivered every time, all of the time
The Board will undertake a specific development programme which
focusses on quality and safety.
End Aug 2013
NHS Improving Quality
We will work through the information from the listening events carried out
by the Keogh Review Team to look very carefully at the issues raised and
make sure wherever possible we don’t repeat the same failings. We will
share this learning with our CCG colleagues.
End Aug 2013
We will increase the number of spot checks in clinical areas to ensure that
the care being provided is of the highest standard.
End July 2013
We will work harder to understand the priorities of our patients, their
carers and our staff.
End July 2013
We will target and address specific areas of concern to drive clinical quality
and safety improvements across our organisation.
End Sept 2013
The Board will put in place triggers for all patient safety and quality issues to
make it clear to our staff when they need to notify the Board of issues
which need closer review.
End July 2013
Improve the information that the Board
receives about savings plans and their
impact on the quality of our services
Our Medical Director and Chief Nurse will review all of our savings plans to
ensure there isn’t a detrimental impact on the clinical services we deliver.
End July 2013
Improve the way we use our beds across
all of our sites
Agree our plans for winter and ensure that all of the beds that we use are in
environments which support the privacy and dignity of our patients.
Continued spot checks on escalation areas when in use.
End Aug 2013
Improve our understanding of the
reasons why we have a relatively high
number of patients who are readmitted
to hospital unnecessarily
We will comprehensively analyse the data on patients who have been
readmitted unnecessarily and put in place an action plan to address any
issues identified. Our Board will look at the learning from this work to
ensure our discharge processes are safe and effective.
End Sept 2013
Progress
B/G/R/
narrative
Our improvement plan
This table shows the actions we’re taking to address the concerns about the quality of our services which were raised in the
Keogh report. It also shows how we are progressing against our actions.
Summary of Keogh Concerns
Summary of Urgent Actions Required
Agreed
Timescale
Engage more effectively with our patients
and their carers and provide an increased
opportunity for them to improve our
services
A named Board level lead will oversee patients’ concerns
alongside the newly appointed Complaints Manager.
End July 2013
We will work with our key health partners to share learning
and improve the care we provide for our community.
End Aug 2013
Constantly review our workforce numbers
and work hard to meet the changing needs
of patients in our care
We have obtained support to help us better understand
our nurse staffing levels and how our nursing staff can best
meet the care needs of our patients.
End Sept 2013
Develop a process to constantly review the skills of our
nursing teams and better understand the impact of
vacancies.
End Sept 2013
Review the workforce information which is provided across
our organisation and develop reporting on recruitment
activity levels, by area and staff group.
End Aug 2013
We will place particular emphasis on our senior nurses
and midwives participating in our Leadership Programme.
This programme focusses on the values and behaviours we
want to see shown in our organisation and will help to
ensure we are consistent in how we deliver high quality
care.
End Aug 2013
Strengthen the leadership and support to
our nursing staff.
Key for progress reports
Blue -delivered
Green – on track to deliver
Narrative – disclose delays/risks/plan to recover
Red – not on track to deliver
External Support/
Assurance
External reviewer
Progress B/G/R/
narrative
How we’re checking that our improvement plan is working
This table shows how and when we are checking that the actions we’re taking are making a real difference on our wards, in our
operating theatres and in our community services. It also highlights how we will be communicating our progress to our local
community.
Oversight and improvement action
Timescale
Action owner
Fortnightly accountability meeting with Trust Development Authority
and our Clinical Commissioning Groups to track delivery of action plan.
The Clinical Commissioning Groups are working closely with us to
provide assurance to their governing body that we are delivering
appropriate actions to make a difference.
Aug 2013 to July 2014
Trust Chief Executive/Special
Measures Director
We will use the partnership working with Newcastle Upon Tyne
Hospitals NHS Foundation Trust to learn how we can strengthen our
leadership and make improvements to the quality of services that we
provide.
Aug 2013 to July 2014
Trust Chief Executive
Appointment of an Improvement Director (Marie Noelle Orzel) by TDA,
who will provide expertise to the trust Board on how to improve our
services and check that we’re meeting our promises to deliver our
improvement plan
October 2013
TDA
The monthly meetings of the Trust Board and the Executive
Management Board will review evidence about how the trust action
plan is improving our services and changing the way we work for the
better. There will also be bi-weekly Keogh Action Plan Meetings
attended by our Executive Directors who have lead responsibility for
implementing the action plan.
2 weekly
Sept 2013 to July 2014
Trust Chair
Trust Reporting to the public about how our trust is improving through
Healthwatch, our Shadow Council of Governors, members, our website,
listening events and the local media. We will further develop our
communications plan over time
Monthly
Trust CE
Agreement and regular reporting of quality measures to demonstrate
that the actions are leading to improved quality of care for patients. We
will use the Commissioning for Quality and Innovation scheme with our
commissioners to drive quality up. Our performance will be published
on our website.
Monthly
Trust CE/TDA
Key for progress reports
Blue -delivered
Green – on track to deliver
Narrative – disclose delays/risks/plan to recover
Red – not on track to deliver
Progress
How we’re checking that our improvement plan is working
This table shows how and when we are checking that the actions we’re taking are making a real difference on our
wards, in our operating theatres and in our community services. It also highlights how we will be communicating our
progress to our local community.
Oversight and improvement action
Timescale
Action owner
We aim to complete an
independent review of the quality
and governance systems at the
Trust. We aim to have this
completed within the next six
months .
Sept 2013 to Feb 2014.
Trust Chief Executive
External scrutiny of our new ways of
working and of the quality of our
services by a Quality Surveillance
Group (QSG) composed of the Trust
CE, Trust Medical Director, NHS
England Area Team and CCGs.
Sept 2013 to July 2014.
Trust Chief E/Special Measures
Director/AT/CCGs
Re-inspection.
Early July 2014.
CQC
Progress