The Royal Marsden NHS Foundation Trust Quality Account for January and February 2016 presented to the March 2016 Board. Dr. Shelley Dolan, Chief Nurse

Transcription

1 The Royal Marsden NHS Foundation Trust Quality Account for January and February 2016 presented to the March 2016 Board. Dr. Shelley Dolan, Chief Nurse 1.0. Introduction The monthly Quality Account reports the current Trust performance against the targets for 2015/16 described in the Annual Quality Account (2014/15) under the following three nationally agreed categories: Safe care Effective care Improved Patient experience Data Quality Information and data at the Royal Marsden is produced by a centralised expert team separate from the clinical and operational teams. This separation and expertise is critical to ensure that the data is accurate and is not affected by the operational teams who are trying to comply with local and national improvement targets. All healthcare associated incidents, falls, medication incidents and pressure ulcers are reported locally onto the central Datix incident reporting system. The Datix analyst from the risk management team who is completely separate to the clinical care team compiles the reports for the quality account. All falls and medication incidents are also reviewed by subject matter experts to ensure accuracy and learning from themes. Every month a report is generated for each clinical area and if there is a reduction in reporting there is a central and local alert with action taken Safe Care 2.1. Reduction in Healthcare Associated Infections (MRSA bactereamia and C Difficile infections) Target: <31 C Difficile infections and <1 MRSA bactereamia 1

2 Table 2.1 No. Organism RM attributable January 16 RM attributable February 16 YTD Trajectory 1. MRSA * bactereamia 2. C.Difficile *MRSA has a target of zero but Monitor has a de minimus of six cases. Currently only three cases have been deemed attributable to cross infection throughout the year. This number will be finalised by the national team in April / June Rate of patient safety incidents and percentage resulting in severe harm or death To include: Reduction of severe/moderate risk medication errors Reduction of harm from falls Target: Reduction in the rate of patient safety incidents per 100 admissions and the proportion that have resulted in severe harm or death Performance: 2.3. (1) Reduction in Falls Target: < 0.7 moderate and above (resulting in harm) falls per 1000 bed days Year to date - to the end of February 2016 the Trust has met the target. 2

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5 Severity of Patient Fall incidents: 3 - Severity - Current Period Total No Harm Low / Minor (Minimal harm) Moderate (Short term harm) Severe / Major (Permanent or long term harm) Death / Catastrophic (Caused by the incident) Totals: % Harm Patient Fall 20% 33% 14% 52% 16% 58% 38% 41% 40% 38% 25% 31% 35% 2.4. (2) Reduction in medication errors Target: To increase the reporting of near misses and decrease the incidents that cause actual harm (low<2 per 1000 bed days and moderate <0.17 per 1000 bed days). N.B. To place medication errors in perspective, annually 0.7% of all medicines administered result in a medication error. For February 2016, the figure is 0.08%. There has been a 20% increase in medication incidents categorised as near miss in comparison to the same period in 2014/2015. A streamlined near miss reporting method utilising the current IT system is now available for all Trust staff in order to encourage/facilitate an increase in the reporting of near miss incidents. In the current period, 1125 attributable medication incidents have been reported using the IT system Datix, of which 70% caused no harm. 331 incidents have been categorised as low severity and 6 incidents as moderate severity (resulting in harm), this represents 5.43 and 0.10 medication incidents per 1000 bed days respectively. As such, the Trust has missed the target relating to low severity medication incidents, however the target relating to moderate severity incidents has been met. 5

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8 Severity of medication incidents: 3 - Severity - Current Period Total o Harm Low / Minor (Minimal harm) Moderate (Short term harm) Severe / Major (Permanent or long term harm) Death / Catastrophic (Caused by the incident) Totals: % Harm Medication Incidents 17% 30% 24% 40% 29% 40% 35% 25% 27% 37% 30% 24% 30% 2.5 Percentage of admitted patients risk assessed for Venous Thrombo-embolism (VTE) Target: 95% have completed VTE risk assessments Performance: The Trust consistently achieves >90% compliance with risk assessment (CQUIN target is 90%). All patients with confirmed VTE as reported by radiology undergo a Root Cause Analysis (RCAs). The VTE steering board monitor all confirmed VTE and scrutinise the RCAs. 8

9 3.0 Effective Care 3.2 Incidence of Trust acquired pressure ulcers The number and severity of healthcare acquired pressure ulcers are used internationally as a proxy for the effectiveness of care provision. Many people with cancer and or co-morbidity are more vulnerable to tissue damage for the following reasons; multiple hospital admissions, frailty, multiple drugs including high dose steroids (decreases skin elasticity), immobility, malnutrition or susceptibility to infection Data for this report was taken on 4 March (hospital) and on 2 March (SMCS) 2016 from DATIX. Data may have been updated since Total number of patients with the Trust (hospital/community services) attributable pressure ulcers for the month of January 2016: 52 [Hospital=20, Community services=32] February 2016: 47 [Hospital=14, Community services=33] For serious incident reporting to Steis [Strategic Executive Information System] as Hospital/Community Services. Number of patients with Trust attributable pressure ulcers at categories 3 and 4 for the month of January 2016: 10 [Hospital=0, Community services=10] February 2016: 5 [Hospital=0, Community services= 5] 9

10 3.2.5 Number of patients with Trust attributable category 3 and 4 pressure ulcers Number of patients with Trust attributable category 3 and 4 pressure ulcers, April February hospital community services 2 0 Apr Jun Aug Oct Dec Feb Apr Jun Aug Oct Dec Feb 10

11 Number of patients with Trust attributable pressure ulcers, all categories Patients with Trust attributable pressure ulcers, all categories, April February hospital community services 5 0 Apr Jun Aug Oct Dec Feb Apr Jun Aug Oct Dec Feb 11

12 Number of patients with Trust attributable pressure ulcer, monthly and cumulative totals April 2015 to February monthly hospital total hospital Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb monthly community services total community services 12

13 Description of European Pressure Ulcer Advisory Panel (EPUAP) pressure ulcer classification system. EPUAP Description of Stage 1 Non blanching redness of intact skin 2 Partial thickness skin loss or blister 3 Full thickness skin loss (fat visible) 4 Full thickness tissue loss (muscle/bone visible) 3.3. Emergency re-admissions to hospital within 28 days of discharge Target: Reduction in the number of avoidable re-admissions to hospital within 28 days of discharge Some emergency re-admissions following discharge from hospital are an unavoidable consequence of the original treatment, however some can be potentially avoided through ensuring the delivery of optimal treatment according to each patient s needs, careful planning and support for self care. It is important to note that some readmissions will inevitably include patients who are admitted with side effects of treatment therefore it may be difficult to explain any differences between RMH with other acute Trusts. Performance: Within 28 days of original admission there were the following emergency admissions: 13

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15 4.0 Patient Experience 4.1 Reduction in chemotherapy waiting times and improvement in patient experience related to waiting times Target: Reduction in chemotherapy waiting times at Sutton/Chelsea and improvement in the patient experience related to waiting times Performance: Data in the following graphs are for all chemotherapy attendances, for NHS and Private Patients Table 1: Chelsea chemotherapy waiting times 15

16 Table 2: Sutton chemotherapy waiting times 16

17 Table 3: Chelsea and Sutton chemotherapy waiting times 17

18 Figure 1 Pre-prescribing >5days in advance: All Clinical units Figure 1 illustrates pre-prescribing performance >5days in advance. It demonstrates that there is a reduced performance at Chelsea (70-80%) when compared to the Sutton and Kingston units (~90%). The rates at Chelsea can be seen to have increased over the period and can in part be explained by a change in case mix. However, looking at the Breast unit as an example (Fig 2), it can be shown that across a group of patients where the chemotherapy regimens are essentially the same there is still significantly better adherence to pre-prescribing guidance at the Sutton and Kingston sites. It is unclear why there is such a difference in pre-prescribing rates and this now needs a greater focus. With this in mind, a new chemotherapy pharmacist has been employed on the Chelsea site to specifically work with clinical groups and clinicians to identify reasons for the reduced rate of pre-prescribing and improve this metric each month. This will start from March 2016 and will become part of the monthly metrics we share with clinical teams to drive improvement. 18

19 Figure 2 Pre-prescribing >5days in advance: Breast Unit Plans for improving turnaround of manufacturing of chemotherapy As 80% of the chemotherapy is manufactured from a third party partnership with an external company (Hospira ), the pharmacy department has been working with them to introduce a new way of manufacturing which will help speed up the supply of chemotherapy. The new method of manufacturing will also reduce the amount of chemotherapy that is wasted. The new systems will start in April 2016 and the impact of this will be monitored across RM. Improvements in waiting times for discharge and outpatient prescriptions: In quarter two 2015 there has been a significant change in the supply of discharge medication with commencement of a partnership with Boots the chemist. Boots dispense: Out-patient, day-case and discharge medication for patients at the Royal Marsden. We have also introduced prescription tracking technology at commencement of the partnership, this facilitates the monitoring of dispensing times for both outpatient and discharge prescriptions. 19

20 The Boots partnership has now been in place for six months and whilst a steady improvement has been seen in waiting times for patients across both sites, there are still some challenges, particularly on the Sutton site. The waiting times are longer in Sutton and some of this is due to the greater complexity of prescriptions especially from paediatrics and haematology, which need careful screening before being dispensed. Boots have to feedback performance against certain targets of which discharge is a key indicator and Q3 performance can be seen below. 20

21 We are working closely with Boots to ensure a high quality medicines management service is provided to patients. All targets are monitored monthly as part of performance review meetings, quarterly performance meetings will oversee the contract and provide strategic direction for service development. In addition a bi-weekly Quality Improvement group with both Boots and RMH staff has been set up to raise concerns and work jointly through to resolve them and improve the performance particularly on the Sutton site. 6.1 Ensure that we are responding to inpatient s personal needs The Friends and Family Test The NHS Friends and Family Test was announced by the Prime Minister on 25 May The national mandated question asked is: How likely are you to recommend our ward to friends and family if they need similar care or treatment? The patients then select their answer from the following Likert Scale: Extremely likely; Likely; Neither likely nor Unlikely; Unlikely; Extremely unlikely; Don t know. The Royal Marsden has then chosen to add a second question: What was good about your care and what could be improved? Patients answer this question with free text comments. January 887 responses overall: Inpatients 233, Day Care 352, Outpatient (OPD) 302 Inpatient: 26 patients made suggestions for improvement:- further to my last feedback today (over 4 hours ago) I am still waiting to be discharged. Your admin dept needs a serious overhaul. Medical may be your first priority but all areas contribute to the good running of a service! (still her 1 hour later) 21

22 I think there needs to be more evident senior level management of the work of more junior nurses and HCA s. As a patient it would be impossible to know who to call in case of a query. NICE guidelines, not followed for meds the only thing that could be improved was that at the weekend, the staff were over-stretched and perhaps not enough of them, and the night staff were not as particular with the ward or as friendly Due to an error with my drug chat I was waken at 11.30pm for a new canula to be put in and antibiotics given, but it couldn t be helped and everyone was very apologetic. the only thing instead of those flimsy curtains which, actually offer, very little privacy, could you not put frosted prospect curtains which you can push back when not in use and are easily cleaned We also asked all in-patients on discharge the following questions about their care. Score (out of 5) Were you treated with dignity and respect? 4.94 Did you feel involved enough in decisions made about you? 4.79 Did you receive timely information about your care and treatment? 4.76 Was the location clean? 4.88 Were you treated well by the staff looking after you? 4.94 Day care 20 patients made suggestions for improvement: Room for improvement unit was very busy today. There was a 3 hour delay and I was still there at 6.30 after 12:30 appointment. Also I had to spend all the time on the unit i.e. without my husband for company prior to the procedure. Often found the nurses were not rightly informed on what was going on with the patient s e.g unnecessary blood being taken which could have been done when cannulated more staff for the pharmacy 22

23 I did feel anxious on today s visit, as someone in the waiting area appeared to have a cold. As we all have an impaired immune system this is a worry. As a suggestion, maybe all patients and their companions could be asked at reception when looking in, if they have an active infection Score (out of 5) Were you treated with dignity and respect? 4.95 Did you feel involved enough in decisions made about you? 4.86 Did you receive timely information about your care and treatment? 4.84 Was the location clean? 4.91 Were you treated well by the staff looking after you? 4.97 OPD 11 patients made suggestions for improvement: I do have a minor suggestion and that is registration could be more private. Clerk asked questions re personal status in waiting room within hearing of other patients waiting 1 and a half hours for an appointment is not a good introduction to this hospital-seems to be a complete shambles. Signage from outside and within the grounds is none0existing I had no treatment today as my appointment had been cancelled but the letter telling me so had been headed confirmation of appointment like the previous letter which was a confirmation so I assumed it was just that and I didn t read it carefully enough. That was my fault but if only someone had bothered to head the letter change We also asked all out-patients on discharge the following questions about their care. Score (out of 5) Were you treated with dignity and respect? 4.85 Did you feel involved enough in decisions made about you? 4.77 Did you receive timely information about your care and treatment? 4.75 Was the location clean? 4.85 Were you treated well by the staff looking after you?

24 February overall 977 responses: Inpatients 242, Day Care 356, OPD 309 Inpatients 19 patients made suggestions for improvement: I felt hurriedly and prematurely discharged e.g. not shown how to get in/ out of bed. Not accompanied for my first walk after operation along the ward. Might have been help to have nil-by-mouth signs on bed to prevent catering staff offering food and very occasionally bringing meal to bed. There were four comments about the coldness of the ward bed areas and bathrooms. Faulty air con made the bay too cool/cold. Window seals in room 2 need attention-bad draught. We also asked all in-patients on discharge the following questions about their care. Score (out of 5) Were you treated with dignity and respect? 4.91 Did you feel involved enough in decisions made about you? 4.79 Did you receive timely information about your care and treatment? 4.78 Was the location clean? 4.87 Were you treated well by the staff looking after you?

25 Day care 44 patients made suggestions for improvement: Waiting times. one thing that could definitely be improved is the timing of appointments. My appointment was for 9am but as the anaesthetist have ward rounds, there is no chance of them getting to the ward before 1030/11am. So why the need to arrive at 9am? Sometime though, the wait is one hour and a half (drug trial). If it can be a bit less, it would be very helpful. 1) Decrease in waiting times between apt. time and arrival of drugs for the drip infusion. 2) Decrease in waiting time between apt time and seeing a consultant. 3) Conflict between consultant reports for future treatment. Sometimes quite big delays between appointment time and treatment starting. Could be improved: Waiting time. Waiting for chemo makes anxiety increase- 2hrs late is very hard to deal with. Sadly the open wards lack privacy and are loud and a little stressful to stay in an ideal world, rooms would be separate (and there would be more rooms). I realize that space and money is limited. We also asked all day case patients on discharge the following questions about their care. Score (out of 5) Were you treated with dignity and respect? 4.91 Did you feel involved enough in decisions made about you? 4.81 Did you receive timely information about your care and treatment? 4.77 Was the location clean? 4.88 Were you treated well by the staff looking after you?

26 OPD 10 patients made suggestions for improvement: There were three complaints about car parking. Waiting to get into the car park was lengthy, which does not help patient stress levels prior to appointments. Car park capacity does not seem to have increased over the last few decades, but patient numbers surely have. There were several comments about the reception staff. receptionists not always friendly- very stern especially the man. reception staff helpful and friendly. This is hit and miss depending on who you get, but majority of the time positive. There were several comments about waiting times. My husband had to wait an hour after his appointment and when he checked at the desk he was told that he seemed to have slipped through the net. Too long waiting to see doctor s waiting went for 45 mins then 1 hour then one and a half hours in a time of half hour, I get all uptight waiting this long, you expect a little wait. Why do you over book? We also asked all out-patients on discharge the following questions about their care. Score (out of 5) Were you treated with dignity and respect? 4.94 Did you feel involved enough in decisions made about you? 4.87 Did you receive timely information about your care and treatment? 4.82 Was the location clean? 4.93 Were you treated well by the staff looking after you?

27 National FFT inpatient results reporting: From November 2014 NHS England report a percentage of those who would recommend the Trust to friends and family. Inpatient data was collected for 170 Acute NHS trusts and independent sector providers. Nationally, the overall average inpatient percentage for those who would recommend the service to friends and family was 96% in December. The Trust is slightly below this with an average of 95% in December. Outpatient data was collected for 234 Acute NHS trusts and independent sector providers. Nationally the overall average outpatient percentage for those who would recommend outpatients to friends and family was 92% in December. The trust was above this with an average of 98% in December. The tables below shows the results for the Trust each quarter to date. At the time of reporting (9 th March 2016) national figures were available up to December Q2 Q3 Q4 Q1 Apr 2015 May 2015 June 2015 July 2015 Aug 2015 Sep 2015 Oct 2015 Nov 2015 Dec The Royal 94% 97% 99% 97% 96% 97% 97% 95% 97% 98% 95% 98% 95% Marsden percentage of inpatients who would recommend National average 94% 95% 95% 96% 95.5% 95.7% 95.8% 95.9% 96.0% 96% 96% 96% 96% Response number OUTPATIENTS The Royal Marsden percentage of outpatients who would recommend July 2015 Aug Sept 2015 Oct 2015 Nov 2015 Dec % 97% 96% 99% 97% 98% National average 92% 92% 92 % 92% 92% 92% Response number

28 7.1 Complaints by Directorate and Subject January Standard of Care Attitude Delay Diagnosis/Treatment Communication 1 0 Cancer Services Clinical Services Private Care Community Services There were nine complaints in January. There was no complaint for Clinical Services. Communication Communication prior and after surgery Communication around the handling of child protection procedures Communication around patient discharge Diagnosis/Treatment Review of symptoms and scans, and medical records accuracy Lack of referral and treatment offered 28

29 Concern about treatment at another Trust Delay Delay in physiotherapy appointment Attitude Concern with staff attitude at family planning clinic Standard of care Level of care provided by nursing team is below standard 4 Complaints by Directorate and Subject February Attitude Delay Diagnosis/Treatment Communication Environment 1 0 Cancer Services Clinical Services Private Care Community Services Estates 29

30 There were 11 complaints in February. There were no complaints for Private Care. Communication Lack of communication and clear information about test results Breach of confidentiality Poor verbal communication received as an inpatient Communication around health visiting service's decision to halt its intervention Diagnosis/Treatment Lack of care and concerned with risk of delay in treatment Delay in diagnosis of injury and concerns raised about surgical procedure Delay Delay in outpatients department Delay in appointment at clinic, unacceptably long waiting time Attitude Poor attitude of breast care nurse Attitude of physiotherapists and the treatment received at the health centre Environment Concerns with environment on Wilson Ward Safer staffing From June 2014 all Trusts are required by the Department of Health, Monitor and Care Quality Commission to be able to assure their Boards around the provision of nursing care on its wards and units. This new requirement follows the national failings in care at Mid Staffordshire NHS Foundation Trust and other Trusts since put on special measures. The final Francis report recommended that Boards regularly check that levels of nurse staffing are appropriate for good quality care. Therefore from June 2014 the RM Board has received a monthly summary of planned numbers of nurses and Health Care Assistants (HCA) during the day and at night, versus the actual numbers. It is also mandated that the Board receive a six monthly report from the Chief Nurse regarding all issues regarding Safe Nurse staffing across the Trust. Such a report has been presented to the June 2014 and January 2015, June Board and will be presented again in March

31 The following data is the planned and actual nurse staffing for January Overall the percentages are as follows: Average fill rate for night staff 97.7% Average fill rate for day staff 94.2% Average fill rate for Registered staff 94.9% Average fill rate for Care staff 99.0% Average Trust wide fill rate (All staff, night and day) 95.6% February 2016 Average fill rate for night staff 100.7% Average fill rate for day staff 96.6% Average fill rate for Registered staff 97.7% Average fill rate for Care staff 100.5% Average Trust wide fill rate (All staff, night and day) 98.2% 8.1 Nursing Leavers and Starters Report The tables below show the number of nurse starters and leavers over a two year period. In the financial year 2013/14 the number of nurse leavers equated to 12 nurses per month on average. For the current financial year more nurses have been recruited at this point than in the last financial year. In November 2014 the Chief Nurse began a monthly recruitment meeting to address the issues around recruitment and retention of nurses. For the first time in February the meeting was able to review the results of a small exit questionnaire, questionnaires were sent retrospectively to 35 nurses who had left and nine were returned. In all but one case the nurses left for personal or financial reasons. The questionnaires are now reviewed monthly. Board members will note below that the concerted work of nursing and HR, marketing and communications is finally showing positive results from June onwards more nurses were recruited than left the Trust. The Trust is holding national recruitment days on a Saturday which have thus far yielded 15 days and the next event is to be held on Saturday the 19 th March 2016 at Chelsea. The RM is keen to improve recruitment and retention of nurses particularly at bands 5 and 6 (junior and senior Staff Nurses). The new recruitment group is facilitating HR, senior nursing, marketing and communications to work together and look at innovative solutions. The Board will be kept updated on this important issue through regular reports at QAR. 31

32 Band 5-7 Nurses (2014/15) Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Total Starters (wte) Leavers (wte) Variance Band 5-7 Nurses (2015/16) Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Total Starters (wte) Leavers (wte) Variance

33 8.2 Leavers in January 2016 Area Job Title Nursing Leavers Bands 5-7 January 2016 Leaving LOS Band WTE Reason for leaving date Cancer Services Division Bud Flanagan East Staff Nurse 02/01/ y 3 m XR Voluntary Resignation - Health Bud Flanagan East Senior Staff Nurse 24/01/ y 2 m XR Voluntary Resignation - Promotion Bud Flanagan West Senior Staff Nurse 03/01/ y 2 m XR Voluntary Resignation - Promotion Ellis Ward Staff Nurse 24/01/ y 7 m XR Voluntary Resignation - Relocation Ellis Ward Sister/ Charge Nurse 01/01/ y 2 m XR Voluntary Resignation - Relocation Markus Ward Staff Nurse 10/01/ y 9 m XR Voluntary Resignation - Other Medical Day Unit (S) Staff Nurse 07/01/ y 3 m XR Voluntary Resignation - Other Clinical Services Division Horder Ward Staff Nurse 03/01/ y 8 m XR Voluntary Resignation - Promotion Outpatients (L) Senior Staff Nurse 05/01/ y 7 m XR Voluntary Resignation - Promotion Outpatients (L) Sister / Charge Nurse 10/01/ y 7 m XR Voluntary Resignation - Relocation Clinical Research Division Lerner Lung & Mesothelioma Research Research Nurse 30/01/ y 2 m XR Retirement - Age Oak Ward Senior Staff Nurse 24/01/ y 3 m XR Voluntary Resignation - Other Rehabilitation Research Research Nurse 14/01/ y 5 m XR Voluntary Resignation - Adult Dependants Community Services HV Merton Health Visitor 31/01/ y 3 m XR Voluntary Resignation Work Life Balance - Cost of Living (Travel, Accomodation) Respiratory Nursing Specialist Nurse Respiratory Medicine 04/01/ y 10 m XR Voluntary Resignation - Other Private Care GH Day Services Staff Nurse 31/01/ y 0 m XR Voluntary Resignation - Other GH Ward (1 & 2) Senior Staff Nurses 24/01/ y 3 m XR Voluntary Resignation - Relocation Total WTE Leavers

34 Leavers in February 2016 Nursing Leavers Bands 5-7 February 2016 Area Job Title Leaving date LOS Band WTE Reason for leaving Cancer Services Division Ellis Ward Staff Nurse 17/03/ y 5 m XR Voluntary Resig. - Relocation McElwain Ward Staff Nurse 06/03/ y 7 m XR Voluntary Resig. - Child Dependants Wilson Ward Staff Nurse 28/02/ y 10 m XR Voluntary Resig. - Relocation Burdett Coutts Ward Staff Nurse 18/03/ y 5 m XR Voluntary Resignation - Other Lung Unit (S) Clinical Nurse Specialist 29/03/ y 5 m XR Voluntary Resig. - Relocation Clinical Services Division Critical Care Unit (L) Staff Nurse 11/03/ y 2 m XR Voluntary Resig. - Relocation Critical Care Unit (L) Staff Nurse, Critical Care 10/03/ y 8 m XR Retirement - Age Endoscopy Staff Nurse 01/04/ y 6 m XR Voluntary Resign. - To undertake further Education or Training Theatres (L) Staff Nurse 07/02/ y 8 m XR Voluntary Resign. - To undertake further Education or Training Theatres (L) Staff Nurse 26/02/ y 6 m XR Voluntary Resig. - Better Reward Package Theatres (L) Theatre Sister 31/03/ y 8 m XR Volun. Early Retirement - with Actuarial Reduction Clinical Research Division New Cancer Research Networks Research Nurse - Kingston Hospital 01/02/ y 4 m XR Voluntary Resignation - Other Head and Neck Research Research Nurse 15/02/ y 3 m XR Voluntary Resignation - Other Community Services FP Medical Contraception & Sexual Health Nurse 07/02/ y 1 m XR Voluntary Resignation - Other East Merton Community Nurse 21/02/ y 11 m XR Voluntary Resig. - Relocation Rapid Response Rapid Response Nurse 31/03/ y 5 m XR Retirement - Age Raynes Park Community Nurse 14/02/ y 3 m XR Voluntary Resig. - Child Dependants Private Care GH Ward (1 & 2) Staff Nurse 25/05/ y 10 m XR Retirement - Age Total WTE Leavers Board Members are invited to note the performance of the Trust against the agreed national and local quality targets for January and February 2016 and the actions being taken. 34