FT Keogh Plans. Northern Lincolnshire and Goole NHS Foundation Trust. 10 April 2014 KEY. Delivered. On Track to deliver

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1 FT Keogh Plans Northern Lincolnshire and Goole NHS Foundation Trust 10 April 2014 KEY Delivered On Track to deliver Some issues narrative disclosures Not on track to deliver

2 Northern Lincolnshire and Goole NHS Foundation Trust - Our improvement plan & our progress What are we doing? The Trust was one of 14 included in the Keogh Review process because of higher than expected mortality rates. The Keogh Review made a number of recommendations. The actions agreed by the Trust in response to those recommendations are captured within the Trust s Keogh Action Plan. The delivery of those actions, and in turn ensuring ongoing improvement to quality of care, remains the Trust s foremost priority. Since the Keogh review: - We continue to take steps to manage activity pressures and improve patient flow including work with other providers. - We continue to strengthen and embed our new clinical leadership structure including a programme of development and support. - We continue to receive acknowledgment of our progress with the implementation of our Keogh Action Plan and improvements to quality of care via a number of mechanisms including since the date of the last report, the achievement in March 2014 of Level 2 Accreditation against the CNST Maternity Standards, achieving a score of 46/50. The Trust was also commended on the quality of care offered to women accessing the Trust s Maternity Services and for the quality of information and communication. - We also continue to explore mechanisms for testing the implementation and embedding of our Keogh Action Plan including most recently discussions with the local Health Watch organisations in respect of areas for joint enter and view visits during As part of this work, Health Watch will also scrutinise the Trust s complaints handling arrangements. - Preparations are continuing for the CQC Chief Inspector of Hospitals (CIoHs) Visit in April 2014, which will provide opportunities for staff and patients to talk to the inspection team. The Trust will also have the opportunity to confirm to the team the many improvements made as well as any remaining areas of work. This plan & progress document shows our plan for making these improvements and demonstrates how we re progressing against the plan. This document builds on the Key findings and action plan following risk summit document which we agreed immediately after the review was published It should be stressed that these actions are short-term improvements on immediate issues and that we envisage the Trust improvement plans going beyond Keogh deadline dates to ensure that the Trust is ready when the CIoHs, Professor Sir Mike Richards, inspects. Once the actions identified have been completed, the Trust has a longer-term plan to maintain progress and ensure that the actions lead to measureable improvements in the quality and safety of care for patients. To this end, Key Performance Indicators (KPIs), each with a clear trajectory and timescale for demonstrating sustained improvements, have been agreed and progress against these is monitored weekly by the Executive Team and monthly by the Trust Board and relevant Board sub-committees. These KPIs inform the weekly operational Keogh meetings. Oversight and improvement arrangements remain in place to support the changes required. Strengthened assurance and performance management arrangements ensure the earlier escalation of risks to delivery and on the ground testing of these arrangements occurs via a variety of mechanisms including Announced and Unannounced Director Visits, Chief Nurse and Medical Director walk arounds and CQC Mock Visits and the outcomes are reported to the Executive Team and Trust Board. The Trust has also sought external assurance on the sufficiency and deliverability of the Trust s action plan. The Trust has commissioned KPMG to undertake this work. The Trust has also agreed a buddying arrangement with Sheffield Teaching Hospital to identify any areas of good practice which can be replicated within the Trust. This work is progressing and an agreed work plan is in place and is monitored by the Executive Team and Trust Board. Support from our Commissioners has also been sought where actions are outside of our control. While we take forward our plans to address the Keogh recommendations, the Trust is in special measures. More information about special measures can be found at There will be regular updates on the NHS Choices website and subsequent longer-term actions may be included as part of a continuous process of improvement.

3 Who is responsible? Northern Lincolnshire and Goole NHS Foundation Trust - Our improvement plan & our progress Our actions to address the Keogh recommendations have been agreed by the Trust Board. The Trust Board and Monitor receive a monthly update report on progress against the plan including evidence of impact. The report submitted to the Trust Board and Monitor is shared internally and with other relevant external stakeholders. Our Chief Executive, Karen Jackson is ultimately responsible for implementing actions in this document, although all members of the Executive Team have a key role in ensuring delivery of the agreed actions. Progress against the action plan is reviewed weekly by all of the Executive Team, informed by written weekly exception reports from all action plan leads and also reporting against the KPIs and, as at the date of preparing this report, actions have been completed and / or are on target for completion by the agreed deadlines. The Trust Board has ultimate oversight of the plan and monitors and scrutinises progress against the plan on a monthly basis. The Improvement Director assigned to Northern Lincolnshire and Goole NHS Foundation Trust is Eric Morton, is acting on behalf of Monitor and in concert with the relevant Regional team of Monitor to ensure delivery of the improvements and oversee the implementation of the action plan overleaf. Should you require anymore information on this role please contact specialmeasures@monitor.gov.uk. Monitor is helping us to take action to implement the required improvements by supporting & challenging. Ultimately, our success in progressing the recommendations of the Keogh plan was assessed by the Keogh Review Team, who undertook a follow-up visit to the Trust on 22 November 2013 and the CIoHs, who will also re-inspect our Trust in April The Keogh Team noted the significant changes made since their previous visit but that there is still further work to do. The CQC during their re-visit in December 2013 also noted the progress made. If you have any questions about how we re doing, contact Wendy Booth, Director of Clinical and Quality Assurance at: w.booth@nhs.net or on telephone How we will communicate our progress to you We will update this progress report monthly while we are in special measures. Note: This update report will be submitted to the NLG Trust Board meeting on Tuesday, 29 April We will continue to update internal and external stakeholders, including patients and the public, on our delivery of the actions within the plan. In respect of patients and the public, information and updates will be shared via the following mechanisms: Council of Governor meetings including the Annual Members Meeting, Governor/Member Clinics, Chief Executive Briefings to Governors, Trust Board meetings held in public, newly convened Patient Forums, monthly meetings between the Chief Executive and MPs, updates from the Chief Executive to Overview and Scrutiny Committees (OSCs) and Health and Wellbeing Boards. Dr James Whittingham, Chairman (on behalf of the Trust Board) Karen Jackson, Chief Executive (on behalf of the Trust Board)

4 Northern Lincolnshire and Goole NHS Foundation Trust - Our improvement plan Summary of Keogh Concerns Summary of Urgent Actions Required Agreed Timescale External Support/ Assurance Progress Board need a clearer focus on quality and to improve it at a greater pace. The Board needs to prioritise actions to improve quality, urgently addressing key areas of mortality (including the treatment of stroke, respiratory diseases and septicaemia) and other concerns. Develop SMART impact measures in relation to the implementation of action plans. Assign responsibilities to named individuals and make them accountable for delivery. The Trust must continue to embed the learning from stroke care improvements in Scunthorpe across the Trust, and facilitate thrombolysis for all stroke patients. The Trust needs to work with the Clinical Commissioning Group to urgently address the provision of stroke services out of hours. National Clinical Director for Stroke (NHS England) Clinical Commissioning Groups KPMG Hull & East Yorkshire NHS Trust. recent Keogh and CQC revisits. The Trust continues to monitor the embedding of these arrangements. These arrangements will be further tested during the CIoHs visit in April Poor patient flow management. Urgently implement adequate triaging at A&E. Ensure that prompt hand-over can be made by ambulance staff. Minimise patient transfers. Discuss proposed moves with clinicians to agree the impact that it would have on clinical care. Best practice would indicate that no more than one additional internal move takes place. Robust performance management processes should be introduced to ensure that key pathways are implemented and used consistently at all sites. Clinicians must be held to account for the implementation of these pathways. Improve handover communications and procedures. Set standards for these. Develop a clinically led approach to managing the acute medical pathway in conjunction with stakeholders. Aug 2013 Emergency Care Intensive Support Team East Midlands Ambulance Service NHS Trust / Yorkshire Ambulance Services. recent Keogh and CQC visits. The Trust continues to monitor the embedding of these arrangements. Observational audit of handover continues to ensure consistency of application. These arrangements will be further tested during the CIoHs visit in April Nursing and medical staffing levels and skill mix. Review medical cover out of hours and provide more senior cover to ensure safe standards. Continue to review nursing staffing levels and skill mix and address areas with inadequate staffing. Ensure staffing and skill mix are appropriate to provide safe patient care in all areas 24/7. Close monitoring of acuity / dependence in all areas, with prompt escalation when appropriate, needs to be put in place urgently until a longer term solution is made by the Board. Fast track discussions with commissioners, and the wider health economy regarding plans to implement a seven day service. Aug 2013 Medical Director NHS North of England and Deputy Medical Director Clinical Commissioning Groups. recent Keogh and CQC revisits, The Trust continues to monitor the embedding of these arrangements. These arrangements will be further tested during the CIoHs visit in April 2014.

5 Northern Lincolnshire and Goole NHS Foundation Trust - Our improvement plan Summary of Keogh Concerns Summary of Urgent Actions Required Agreed Timescale External Support/ Assurance Progress Evidence of poor care and patient experience in some areas. Perform a Trust wide review of the application of the national definitions and reporting of mixed sex accommodation breaches. Review hydration and feeding practices across the Trust. Identify best practice, share information and implement necessary reforms. Ensure that patients with special dietary needs, for medical and other reasons, are adequately catered for and that the correct meals are received. Review processes governing the completion of clinical documentation and establish safe standards of practice. Nov 2013 Aug 2013 Dec 2013 External Peer Review commissioned Health Watch. recent Keogh and CQC revisits. The Trust continues to monitor the embedding of these arrangements. These arrangements will be further tested during the CIoHs visit in April Commissioner colleagues have been involved in reviewing the Trust s compliance with the national requirements in respect of mixed sex accommodation and have confirmed that they are assured regarding the robustness of the Trust s arrangements.

6 Northern Lincolnshire and Goole Hospitals - How we re checking that our improvement plan is working Oversight and improvement action Timescale Action owner Progress Monitor requires the Trust to implement the recommendations from the Keogh review and commission external reviews of quality governance and clinical leadership. Monitor requires the Trust to ensure is has in place an effectively functioning board and board committees and sufficient and effective board, management and clinical leadership capacity and capability. Ongoing - All actions due to be complete by July 2014 Trust/Monitor. External reviews of the Trust s quality governance arrangements and clinical leadership have been completed and action plans are in place and / or completed in response to the recommendations from those reviews. During March 2014, KPMG reviewed the Trust s implementation of the recommendations relating to the Trust s quality governance arrangements and confirmed the progress made. A new Medical Director has been appointed and is due to commence in January To coincide with this appointment, a revised Trust-wide clinical leadership structure is being implemented. Medical director to take up post in January 2014 Introduction of revised clinical leadership structure from January 2014 Trust Chief Executive (C.E.) Delivered Medical Director and Associate Medical Directors commenced in post on 6 January Monthly accountability meeting with Monitor to track delivery of action plan. Aug 2013 to July 2014 Trust C.E./Monitor. Ongoing. Work with the National Clinical Services Director for Stroke Services to make necessary improvements August 2013 Trust C.E. Delivered. Appointment of Improvement Director (by Monitor) September 2013 Monitor. Delivered Eric Morton appointed in September 2013.

7 Northern Lincolnshire and Goole Hospitals - How we re checking that our improvement plan is working Oversight and improvement action Timescale Action owner Progress Meetings of the Trust Board sub-committee on turnaround which will review evidence about how the trust action plan is improving our services in line with the Keogh recommendations. Trust reporting to the public about how our trust is improving via monthly briefings to local media. Sept 2013 to July 2014 Trust Chair. Assurance Framework / Monitoring in place & ongoing. Formal reporting from Trust Board Sub- Committees to the Trust Board occurs monthly. Monthly Trust C.E. Ongoing via mechanisms described above. Local economy level consideration of whether the trust is delivering its action plan and improvements in quality of services by a Quality Surveillance Group (QSG) composed of NHS England Area Team, Clinical Commissioning Groups, Monitor, Trust Development Authority, Care Quality Commission, Local Authority and Healthwatch. Sept 2013 to July 2014 Quality Surveillance Group. Ongoing. Re-inspection: Keogh Review Team and CQC. A re-visit by some of the original Keogh Review Team took place on 22 November Whilst it was acknowledged that not all actions would be complete at that point, the re-visit was used to assess the Trust s progress in implementing the Keogh recommendations ahead of the visit by the CIoHs. The Keogh Team noted the significant changes made since their previous visit but that there is still further work to do. The Trust was also re-inspected by the CQC during 2013 to follow up their planned review visit in February 2013 no concerns identified and good progress noted. Keogh: November 2013 CQC: December 2013 Keogh Review Team CQC Delivered Keogh revisit and CQC re-visit completed and positive feedback received. Re-inspection: CIoHs. CIoHs April 2014 CIoHs. Embedding of actions is ongoing in preparation for this visit.