Pennine Improvement Plan Stakeholder Update 11 October 2017

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1 Pennine Improvement Plan Stakeholder Update 11 October 2017 This briefing is for key external stakeholders. It provides an update on the progress being made on the Improvement Plan to support The Pennine Acute Hospitals NHS Trust (PAT). 1. Background The CQC inspection report of PAT services published in August 2016 gave the Trust an overall Inadequate rating. The CQC inspected all of PAT s hospitals and community services: Rochdale Infirmary rated Good Fairfield General Hospital in Bury rated Requires Improvement North Manchester General & The Royal Oldham Hospitals rated Inadequate All community services rated Good across all CQC domains Outstanding rating given for Caring in the Community End of Life Service Outpatients, x-ray & diagnostic services rated Good across all hospital sites Since April 2016, PAT has benefitted from joint working and support from Salford Royal NHS Foundation Trust under the leadership of Mr Jim Potter, Chairman, and Sir David Dalton, CEO. The CQC will undertake unannounced and announced visits across all PAT sites as part of its reinspection. We expect these visits to take place this month. The CQC will inspect services under a combination of both the old and new regulatory framework. Again, this will involve inspectors speaking with staff, patients and our stakeholders. 2. Pennine Improvement Plan A comprehensive improvement action plan is being delivered in response to both the CQC report and Salford Royal s own diagnostic review and assessment. This Improvement Plan was approved by the CQC and endorsed by the Pennine Improvement Board and PAT s Board of Directors in October The delivery of the Improvement Plan is monitored by the Improvement Board. The Improvement Board is chaired by Jon Rouse, GM HSCP, and is made up of healthcare partners; four local CCGs, Local Authorities, GM HSCP, CQC, NHS Improvement. The CQC s 77 Must Dos and 144 Should Dos in its report have been mapped to the themes contained within the Improvement Plan. The Improvement Plan and updates are publicly available on The Pennine Acute Trust s website click here. 3. Improvement Themes All actions in the PAT Improvement Plan are integrated into six main improvement themes: Improving Fragile Services: stabilise Urgent Care, Maternity, Paediatric, Critical Care; Improving Quality; Improving Safety, Effectiveness, Patient Experience; Improving Risk & Governance: implement new risk & governance arrangements; Improving Operations & Performance: focus on improving data quality, patient flow systems, pathway management, models of care Improving Workforce and Safe Staffing: focus on staff recruitment and retention; Improving Leadership & Strategic Relations: clinical leadership development and strengthening local hospital operational management with new structure for each site. 1

2 4. Improvement Plan Progress Since August 2016, the Trust has focused on stabilising services, addressing and strengthening areas that needed attention and in supporting staff in these areas. Month on month progress on the improvement plan continues to be made and a number of improvements sustained. Key risks continue to be around workforce availability. A&E Services Progress continues across all areas of A&E performance with sites improving against the 4 hour access standard, reduction in medical outliers and improved patient flow. NMGH A&E remains fully open 24/7 seven days a week. A number of measures have been put in place to support staff to stabilise and strengthen the service. This involves enhanced GP and primary care input directly into the department from Manchester GPs, enhanced community services, and increased physiotherapy and pharmacy staff in A&E. Additional temporary A&E consultant cover from neighbouring Trusts has brought stability to consultant rotas. PAT working with Salford Royal & CMFT on joint recruitment and job plans. NMGH has successfully recruited two new permanent A&E consultants. NMGH A&E remains challenged but under the leadership of a new Divisional Clinical Director improvements have been made. This has been demonstrated by a significant reduction in 12 hour DTA waits ahead of the expansion of the acute assessment beds. Fairfield has full consultant medical staff and the four remaining middle grade doctors have been recruited, awaiting start date. At Royal Oldham, investment in 24 WTE nurses and additional band 6 nurse posts in A&E and AMU to strengthen leadership. Maternity and Children s Services These services continue to make progress against their improvement plan and CQC recommendations, with the continued support of CMFT at North Manchester. 1.2m investment in midwives to achieve Birth Rate + staffing levels Thirty-one new midwives started in post across the Trust s two maternity units at NMGH and Royal Oldham in October 2016 (58 new midwives since April 2016). Midwifery recruitment remains on-going with additional staff expected to start Oct Obstetric consultants recruited with clinical directors in post at The Royal Oldham and NMGH, moving away from long term reliance on locum staff. Paediatric teams continue with their improvement delivery plan. New initiative called Tops and Pants rolled out to improve Children & Young People patient engagement in improvement activities and a way to capture what matters most to them whilst in hospital A new matron for paediatrics started in post in August 2016 and three paediatric nurses have been recruited from Salford Royal. PAT recruiting six consultant paediatricians; two have already commenced in post. A clinical educator for NMGH has started in post. Critical Care HDU cover at The Royal Oldham has increased from 5 hours a day of a consultant intensivist and a speciality doctor progressing to 10 hours a day, 7 days a week. Speciality doctors 3 WTE overseas doctors have been recruited, with a further two to join the service by the end of the year. Two of five new middle grade doctors have started in post on a six month induction with a further three started in July. 2

3 Strengthening Nursing Standards - NASS Core nursing standards and ward improvement goals and plans have been developed for all PAT wards and departments, supported by the implementation of a standardised Nursing Assessment and Accreditation System (NASS). This performance assessment framework is being adopted from Salford Royal. The NAAS is designed to support nurses in practice to understand how they deliver care, identify what works well and where further improvements are needed. Medical wards remain a clear focus for improvement on all sites. Quality Improvement (QI) Learning Collaborative - The Deteriorating Patient A major part of PAT s Improvement Plan and longer-term Quality Improvement (QI) Strategy is the involvement of staff in learning collaboratives. The first learning collaborative has focused on the identification, observation, timely escalation and care management of deterioration in patients, particularly elderly frail patients, and what care these patients need. The Deteriorating Patient Collaborative aims to reduce the rate of cardiac arrests per (1000 admissions). End PJ Paralysis initiative In July PAT staff joined in the launch of the Group s first major joint Quality Improvement (QI) staff learning collaborative with colleagues from Salford Royal focusing on our aim to end PJ Paralysis and to consider the importance of care and time given to older patients in hospital. The End PJ Paralysis initiative aims to highlight among staff the impact of patients, particularly those who are elderly, being left in pyjamas or hospital gowns in bed for longer than necessary. This learning collaborative will involve all areas of clinical and nursing care, and help staff work together to generate thinking around the health benefits of getting patients dressed, out of bed and being as active as possible. PAT is also involved in a collaborative around pressure ulcers. End of Life and Bereavement Care In February 2017 PAT adopted the SWAN End of life care model which offers dedicated support to patients in the last days of life and to their families into bereavement and beyond. SWAN is a national scheme which is present in 47 Trusts across the country, set up by Fiona Murphy MBE, Assistant Director of Nursing for Bereavement Services for Salford Royal and PAT. Four new bereavement resource centres have now opened across Pennine Acute s sites one on each hospital site. Our Bereavement centres are staffed by fully trained Bereavement Specialist Nurses accessible 24/7 to provide tailored bereavement support to patients and families when death is expected, as well as when death is unexpected. Care is tailored to different faiths and religions. Mortality Reviews The CQC inspection report made recommendations relating to the Trust s mortality reviews. These focused on sharing lessons from mortality and morbidity care reviews, and using findings to improve practice. Under the leadership of the Medical Director, a combination of independent mortality case reviews, routine mortality and morbidity (M&M) meetings, review of clinical documentation and coding, and speciality mortality reviews progress have taken place. As part of the review of governance around mortality, a Trust Mortality Improvement Lead has been created and a Mortality Surveillance Group which reports to the Executive Clinical Effectiveness Committee has been formed. A programme of staff education and training has been developed, Nursing & Medical Workforce Recruitment Between April and September 2016, PAT successfully recruited 109 new registered nurses and 58 midwives, 36 doctors (consultants & middle grades) and 149 health care support workers. In addition, 60 newly qualified registered nurses started in October registered nurses and 37 midwives started in September. The Trust is in the process of recruiting 70 more health care support workers. More work is being planned and progressed on medical recruitment. 3

4 5. New Local Leadership - Better Care, Locally Delivered Our four Care Organisations for Oldham, Bury/Rochdale, North Manchester and Salford are responsible for delivering safe, high quality and reliable care to the local communities they serve. Each of our Care Organisations now has its leadership teams firmly in place, led by a Chief Officer and consisting of a Medical Director, Director of Nursing, and Finance Director. New teams have been appointed in each Care Organisation with operational responsibilities given to divisional directors and supported by clinical directors and directorate managers. New arrangements are being developed for clinical support, estates, facilities and corporate departments to operate across Group. These new local arrangements place the emphasis for operational management where it matters - in each hospital and locality. They strengthen senior leadership support at hospital-level, enabling better engagement with staff and clinical teams. Compared with the previous, more remote Trust HQ they are closer to the shop floor, understanding the challenges and issues staff are facing. These teams will build strong relationships with each of our local health and social care partners. 6. Introducing the Northern Care Alliance NHS Group Our Care Organisations are designed to operate within a new Group arrangement which brings together Pennine Acute Trust (PAT) and Salford Royal FT. This NHS Group is to be known as the Northern Care Alliance NHS Group. We expect to be known locally as the Alliance. The Northern Care Alliance is one of the largest NHS organisations in the country. Together, we serve a population of over 1 million people across our local communities. We bring together over 17,000 staff, manage over 2,000 hospital beds across our hospitals, and manage a 1.3bn operating budget. The Alliance will use this scale to deliver better patient outcomes and other benefits. 7. Core Purpose of the Alliance Our Mission Statement that binds us all together is: Saving lives, Improving lives. We will deliver highly reliable care and services, at scale, which are trusted, connected and pioneering. The Alliance provides the benefits of scale but delivers this locally through multiple sites. It has 5 key roles which are not undertaken at the Care Organisation level. Develops Service Strategy across the wider population of 1m; Agrees new/replacement buildings and equipment; Agrees annual operational delivery plans with each Care Organisation; Develops a standardised operating model on the basis of evidence of best practice; Organises spread of best care across multiple sites and locations. 8. Governance Arrangements - Committees in Common (CiC) Although Salford Royal has a management agreement to manage the services of Pennine Acute, both Trust Boards have delegated their functions to a Group Committees in Common (CiC) which operates the new Alliance. While the two Trusts remain statutory bodies, the CiC effectively manage both Trusts. The CiC meets monthly in public. It comprises the Chairman and six Non-Executive Directors, along with six Exec Directors responsible for Group leadership roles; Chief Executive, Chief Medical Officer, Chief Nursing Officer, Chief Financial Officer, Chief Strategy/OD Officer and Chief Delivery Officer. These new governance arrangements have enabled rapid handover of responsibilities at virtually no cost to the taxpayer. In contrast, mergers often take considerable time and require significant legal fees and management costs. We will co-operate with any future review of organisational arrangements to provide the most stable, long term arrangements. 4

5 9. Key Priorities of the Alliance 1. To develop world-class Accountable Care Organisations in each Locality; 2. To adopt best clinical practice and standardise this at scale, leading to consolidation of some elements of surgical services; 3. To continue the delivery of high quality specialist services for Greater Manchester and beyond, e.g, neuro services, trauma centre and stroke services; 4. To establish Group-wide shared clinical support services 5. To build strong partnership arrangements with other providers to enable reliable, high quality services to be provided, consistent with changes across Greater Manchester 10. What has already started We continue with the implementation of our Improvement Plan for the Bury/Rochdale, Oldham and North Manchester Care Organisations to meet the requirements of the CQC. We have successfully secured a total of 26m for service improvement for this year and last year. With our local Commissioners we are identifying options for high quality, sustainable service portfolios for each hospital site. We are working with our partners in the City of Manchester to develop a positive, strong and vibrant future for the North Manchester site. We are designing a single shared hospital service across Bury, Rochdale and Oldham associated with Salford Royal and/or where appropriate, with other partner organisations. We are working with commissioners and providers in the City of Manchester to develop a shared vision for the future of North Manchester General Hospital (NMGH), ensuring that the proposed changes create the Manchester Single Hospital Service and the Manchester Local Care Organisation, as well as support the continued provision of services for people in the NE Sector. NMGH has a vital role to play in the City and will continue to provide hospital services, including emergency and maternity care, to the local population. We are planning for NMGH to become integrated as part of the new Manchester University NHS Foundation Trust (MFT) in months time. This will extend the benefits of the new Trust across the whole of Manchester and will enable us to build on the existing expertise at North Manchester in community care, frailty, chronic disease and end-of-life care. With existing, strong links to the local community, the NMGH site also provides us with an opportunity to invest in new facilities and services on the site which can play a role in improving the health and wellbeing of the local population. A new 5m purpose-built Intermediate Care Unit is currently being built on the NMGH site. This will provide patients, particularly older people, with first class care and support to build independence before they return home after a hospital stay. The unit has 24 en suite bedrooms, and will have medical and nursing staff to support those needing on-going medical care during their rehabilitation. Following the successful Vanguard model in Salford, and integrated services in Rochdale, we are working with our local commissioners to develop new integrated health and social care services in each locality. This includes opportunities for new models of care in the community and supporting people at home. We are also building on the digital innovation at Salford Royal - with the Global Digital Centre status and 10m funding we will spread new digital systems across our Care Orgs. We are implementing a number of GM service changes, such as Major Trauma at Salford and High Acuity Centres at Royal Oldham and Salford Royal. We have received confirmation of 48m for a new clinical building at Salford and 25m for a new clinical building at The Royal Oldham Hospital. The Alliance will work with partners in supporting all of the strategies of the GM Health & Social Care Partnership and the priorities of the elected Mayor for Greater Manchester. 5