EAST AND NORTH HERTFORDSHIRE NHS TRUST CHIEF EXECUTIVE S REPORT. 25 th March 2009

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1 EAST AND NORTH HERTFORDSHIRE NHS TRUST CHIEF EXECUTIVE S REPORT 25 th March Development of PPCI Services across the East of England Approval has been given to the Trust to provide a Primary Percutaneous Coronary Intervention (PPCI) service on a 9am 5pm basis as part of plans to develop cardiac care across Bedfordshire and Hertfordshire. Outside of these times, PPCIs will be undertaken at Harefield and Papworth. I would like to take this opportunity to recognise the work of Dr Diana Gorog and her colleagues in this area. This service will be of enormous clinical benefit to patients and will enable them to receive the best possible care locally, preventing the need to travel out of Hertfordshire during the daytime. 2. Accredited Coders The recent review of clinical coding by the Audit Commission and review of data quality by the Healthcare Commission have highlighted the improvements being made by the Trust in these critical areas. As a Board we are all too aware of the importance of the Clinical Coding function and the significant contribution our coding staff make to the success of the Trust. It is therefore with great pleasure that I can report that two of the Trust s coding staff, Jean Hollis and Wendy Taylor, have recently been awarded Accredited Clinical Coder status by the Institute of Health Record Information and Management, the first such award to members of our staff since Given the high pass mark required, the length of the training and the high demands currently being placed on Clinical Coding, this represents a significant achievement, and I am sure the Board will want to join me in congratulating Jean and Wendy on their success. 3. National Reporting and Learning System Feedback Report April 2008 September 2008 On 6 th March 2009 the National Patient Safety Agency (NPSA) published for the first time the National Reporting and Learning System (NRLS) feedback reports. These reports are compiled from the data analysis of incidents sent to the NPSA via the RLS throughout the NHS, and provide a feedback and benchmarking opportunity for trusts. The feedback report for the six months April September 2008 showed that the Trust is the highest reporting organisation in the cluster (of other large acute trusts) for both general incidents and medication incidents. Just over 11 general incidents were reported per 100 admissions. The NPSA acknowledge in general the higher number of incidents reported, the stronger the reporting culture. In terms of type of incidents, the most common reported by the Trust was patient accident, which includes falls. While always the highest reported category for NHS trusts, the level reported for the Trust at 23% which is over 10% lower than the average for trusts of a similar size. Most of the incidents reported by the Trust have caused no or low harm to the patient. This is about 10% higher than the cluster. Additionally, incidents resulting in moderate and severe harm are significantly lower than the cluster average. The Trust s Medical Director, James Quinn, confirmed that the Trust has been encouraging staff to report every patient safety incident they observe while carrying out their clinical duties. The aim is that through sharing such information openly and without fear of recrimination, we can create a

2 culture that helps lessons to be learnt that benefits all patients. I am pleased to see that our incident reporting is amongst the best in the country Annual Staff Awards This year's annual staff awards, (now in its fifth year), was held at Knebworth Barns on the evening of Friday, 6 March. The awards are one of the ways that the Trust recognises the hard work and significant achievements made by teams and individuals in its many and varied departments and hospitals. As for the last four years, staff were invited to nominate a best team leader, best team and innovation, with the entries judged by a panel made up of staff and management. In addition, I presented awards to those individuals of my choice who have made an outstanding contribution to the organisation; this year four such awards were made. More than 100 staff and their guests attended the event, hosted by me and supported by the Trust s Vice Chair, Alison Murray, who presented the awards to the winners and they were: Best Team Lister Critical Care Best Team Leader Carol Mumford, Matron, Lister Renal Dialysis Unit Best Innovation Rosalind Webb, Cardiology Chief Executive's Award Shuna Kavanagh and Lesley Haskins, Outpatients Supervisors, Dr Richard Dent, Consultant Physician and Andrew Cannon, Waste Porter (posthumous). Full details of the award winners, as well as those shortlisted in each award category, including a brief description as to why they had been selected, has been publicised widely through a special edition of the Trust's electronic staff news letter, Trust Bulletin; see attached Appendix 1 to this report. The awards outcome was also the subject of a special computer screen saver that ran throughout the Trust in the week commencing 9 March, which coincided with press statements being issued to the Trust's local media. 5. New Intestine Mapping Camera Pills Revolutionary new camera pills that can take images of the entire digestive system are now being used at the QEII Hospital in Welwyn Garden City. The Trust is one of just a handful in the UK to introduce the procedure, called wireless capsule endoscopy. Previously, patients experiencing unexplained bleeding in the intestine have had to undergo conventional endoscopy examinations, which involve manually inserting a narrow viewing tube down into the stomach. These could only examine the first 10cm or so of the small intestine. However now patients simply swallow one of the new high tech pills and allow it to pass through their system, meaning the entire five to seven meters of the small intestine can be photographed. Nick Carver 25 th March 2009

3 Appendix 1 Trust Bulletin A weekly round up of operational issues affecting the Hertford County, Lister and QEII hospitals and all staff at the Mount Vernon Cancer Centre 10 th March 2007 special edition: 2009 annual staff awards the results Fifth annual Trust staff awards, Friday, 6 March: the results Last Friday saw the Trust hold its fifth annual Trust staff awards ceremony in the beautiful venue of Knebworth Barns, which is within the grounds of Knebworth House near Stevenage. The annual staff awards is one way that the Trust recognises the hard work and significant achievements made by teams and individuals in its many and varied departments and hospitals. As in the last four years, staff were invited to nominate a best team leader, best team and innovation, with the entries judged by a panel made up of staff and management. In addition, chief executive Nick Carver presents awards to four individuals of his choice who have made an outstanding contribution to the organisation. Well over 100 staff and their guests attended the event, which was hosted this year by Nick. With the able support of the Trust s vice chair, Alison Murray who presented the wards to the winners, it was another good night for all concerned. Best team The winners of the best team award had to show evidence of their working closely together to move towards the team s goals, overcoming obstacles, celebrating success and learning from when things do not go so well. The four shortlisted teams were: Renal technical department (Trust wide) The team comprises: Chris Bates, chief renal technician; Paul Davis, renal technician; Sajiv Sarojam, renal technician; and Peter Warring, health and safety/technician. Between them, the team supports the renal dialysis services dialysis machines and other related equipment provided through the Trust s units at the Lister, Luton & Dunstable and St Albans City hospitals. Chris and his team are described by their colleagues as the unsung heroes of the Trust s dialysis service which quite literally is lifesaving for every patient involved. They offer excellent and responsive support that keeps the service running safely and reliably. Their expertise extends across several fields, supporting wards, intensive care and dialysis units, as well as being involved in teaching. Indeed their actions averted a potential crisis at the St Albans dialysis unit recently, when it developed water plant problems. They work under difficult circumstances, constrained by limited space and constant demand. But their colleagues know that if a problem arises, then any member of the team can be approached because a pleasant and helpful response is guaranteed. Critical care team (Lister) Critical care is one of those services that some may describe as being at the sharp end of acute hospital care. Patients are often extremely unwell and often death is never far away; sadly for some, and despite the best efforts of our staff, that is the outcome too. So critical care staff are Produced by the communications department at East and North Hertfordshire NHS Trust, based on information provided by individual departments and directorates. If you require further details on a particular item, please contact the originating department/directorate. Trust Bulletin is distributed on the first working weekday of each week. Please submit articles, by the preceding Thursday, to trustbulletin.enhtr@nhs.net.

4 coping with patients and their families in times of extreme stress for those involved. The team at the Lister comprises 85 staff, which is led by matron, Wendy Collier. Despite its size, the team works very well together through being divided in to smaller teams. While each of these smaller teams has common patient care responsibilities, they also develop specific interests on which they lead for the overall team as a whole. Over the years, the team has worked hard in developing and implementing care bundles, which mean that every patient receives the same level of high quality care. They have also developed crossworking and co operation with their colleagues at the QEII which has been critical to the Trust providing a high quality service for all of the communities we serve. In January of this year, the team has developed an outreach service at the Lister that takes the skills of critical care out to patients on wards with the aim of identifying early those that need critical care or to prevent them being transferred to the hospital s intensive care or high dependency units. Sterile services team (Trust wide) The whole team was represented by: Lisa Sekaran; Stuart Spillane; Sandra Clarke; Tracey Jackson; Valerie Ross; Louise Esmond; Andrew Fletcher; and Linda Reason. The Trust s sterile services, which previously were provided from failing units at the Lister and QEII, were consolidated in 2006 in an expanded unit at the Lister. All who were with the Trust when that happened will remember that, while the right thing to do, the change resulted in many problems that impacted on the service s reputation both within the Trust and externally with patients, the media and other key individuals with an interest in the NHS. This was probably the most challenging time for the team as it strove to deal with a whole range of problems and challenges many that, perhaps, should have been predicted and some that, quite frankly, were completely unpredictable. Since then, the team has transformed the service. The staff have all worked together to change the processes, culture and work ethic within the department. Today the service they provide, especially to surgical teams at the Lister and QEII is one of which they are very proud. These achievements are reflected in the performance and audit results conducted on the department. But perhaps the biggest seal of approval has come from the service having now received accreditation to several Europe wide standards for such sterile services. It is one of the few such services in the region to have achieved such accreditation, which stands it in good stead for the future. Perhaps of all the teams in the Trust, they delivered one of the hardest challenges ever faced and have rebuilt not just their own reputation, but aided that of the organisation as a whole. Safeguarding children team (Trust wide) Safeguarding children which is the new term for what many might call child protection is an issue that rarely strays far from the media headlines. This has been especially so in the last six months or so, following the sad death of Baby P in north London and the resulting trial. The Trust s safeguarding team, which is supported by colleagues across the wider child health service is based at the Lister, but provides a Trust wide service. It comprises: Dr Jan Reiser, named doctor; Mary Emson, named nurse; Dr Dominic Croft, named consultant; and Bev Morrison, liaison health visitor. Apart from working quietly and effectively on safeguarding children cases with their colleagues across local primary care trusts, Hertfordshire police and the county council one of the team s most recent successes has been the development of a dedicated safeguarding children unit at the Lister. The new unit, which cost 450,000 following a successful bid to the Department of Health, opened in October It enables multidisciplinary teams from across several organisations to work together on cases of children from east and north Hertfordshire who are at risk of, or have been victims of physical, emotional and/or sexual abuse. It is a place of

5 safety, where the needs of some of our most vulnerable children are the focus of the team. The quality of service provided by the Trust s safeguarding children team has been recognised by the multi professional team that uses the new unit including Hertfordshire Police, Hertfordshire County Council s social services team and the county wide safeguarding children board. Increasingly in what is a field of close scrutiny and inspection, the team is seen as providing a comprehensive, high quality service. The winner of the best team award for 2009 was the Lister critical care team. Best team leader A true team leader is one who includes, motivates and develops their team members to meet the team s goals, whatever they may be. They ensure effective communication and give praise and encouragement to their team. The two shortlisted team leaders were: Janis Hall, voluntary services manager Janis manages the Trust s voluntary services team a small, dedicated unit that supports some 450 volunteers at the Hertford County, Lister and QEII hospitals. Her dedication to the Trust s volunteers is second to none. She takes the time to ensure that they are placed in the most appropriate settings for their interests and abilities. Working with her team, Janis checks regularly that they and the staff they are supporting are experiencing no problems. Janis always goes that extra mile. For example in the NHS 60 th year, she invited all our volunteers for tea and cake to celebrate this important event. The feedback that volunteers give of Janis is invariably that of high praise. Carol Mumford, matron, Lister renal unit A member of staff for nearly 20 years, she was one of the first dialysis nurses when the original unit at the Lister opened, Carol s style is typified by a hands on approach despite her considerable management responsibilities. Since being appointed matron, Carol s presence on the unit has helped to ensure a high standard of care; she is often described as being an inspiration to more junior members of the team. Carol maintains an active interest in research currently she is a co investigator in a busy, multi centre national trial and chairs several important committees. She has also played an active role in infection control, as well as vascular access management. Carol s success in these two areas in particular is evident in the team s improving performance. Typically of Carol, she is an articulate voice for dialysis staff and always ensures that her colleagues get the credit they deserve. The winner of the best team leader award for 2009 was Carol Mumford. Innovation award The innovation award is given for an original idea or development of a service or department. Innovation by its very nature needs to be creative, original and have real impact. It also needs to be implemented effectively. The two shortlisted nominations were: Sandeep Bagga, pharmacy Sandeep is a specialist pharmacist working on formulary support for all clinical areas within the Trust. During 2008, he developed an online electronic prescribing guide that is available to staff through the Trust s Intranet service. He developed this important service from scratch, linking the drugs available being prescribed within the Trust to a range of factors for example clinical guidelines, NICE guidance and cost information. It has replaced printed documents, which often were out of date as soon as they were printed. Sandeep s prescribing guide has gone way beyond providing a simple electronic version of these former documents. Rather it is a comprehensive system that uses the same prescribing system as in the British National Formulary better known as the BNF. It also has forms for requesting new drugs and hyperlinks to both internal and external guidance. The guide is updated easily whenever there is a change relating to an existing drug or a new one. The system is user friendly, promoting safe and cost effective prescribing. The establishment of the guide was not without its challenges and setbacks. But Sandeep

6 showed great tenacity and perseverance, investing many hours of his personal time in getting the guide up and running, as well as encouraging its use by his clinical colleagues. The electronic guide has proved such a success that local GPs have expressed an interest. For this to happen, Sandeep is working on a secure version that will be available through the Internet. Rosalind Webb, cardiology Rosalind who is better known to her colleagues as Roz is the Trust s senior chief cardiac physiologist, supporting the cardiology teams based at the Lister and QEII. Since taking on this role, Roz has come up with many innovative ideas to move the department forward. The most effective of these to date has been her work in liaising with the University of Hertfordshire in establishing a link with its gap year programme. A long standing challenge for the Trust has been in recruiting trained physiologists, of which there is a national shortage. By developing links with the university s gap year programme, Roz has enabled the Trust to take on three suitably educated students this year. While solving an immediate problem of having improving levels of staff within the cardiology team, it has also provided the students with an invaluable insight in to the role of becoming a cardiac physiologist. A training programme has also been developed that will allow these students to be fast tracked within the cardiac physiologist degree programme, should they choose this career. Roz s innovative work, therefore, has enabled the cardiology team to raise awareness of this small, but highly important and specialised field within medicine. Perhaps most importantly, it has aided the Trust in recruiting educated and motivated individuals in to junior roles; this in turn has resulted in a positive effect within the team as a whole in reducing waiting times for patients and increasing capacity overall. So successful has this initiative proved, plans are in place already to recruit next year s students. The winner of the best innovation award for 2009 went Rosalind Webb. Chief executive s awards The chief executive s award is presented to an individual or team in recognition of the outstanding contribution he, she or they have made to the Trust, its staff and/or patients. This year four individuals were recognised with a chief executive s award, each proving themselves in very different ways to be completely committed to their work, their colleagues and to the Trust. Shuna Kavanagh and Lesley Haskins, outpatients supervisors (both Lister) During the last four months of 2008, the outpatient contact centre and booking team at the Lister had to move from its base outside the hospital s main outpatients department, initially to the former post graduate centre building before moving finally to the ground floor of the Old School of Nursing. Coinciding with these two, highly disruptive moves, three of the team s senior leaders left the Trust. At the same time, the Trust introduced the new divisional management structure from October 2008, bringing additional change of personnel. Shuna and Lesley, who have both worked for the Trust now for many years, were instrumental in stepping in to the significant leadership gap that appeared at this crucial time. Between them, they led and supported their outpatient team colleagues through a series of changes that were highly complex and challenging to deliver, whilst also keeping this important service running. What is more remarkable is that neither Shuna nor Lesley were asked to take on this role, and nor at the time were they acting up to these roles officially. Quite simply, they saw the need for leadership and stepped in to the roles. For Shuna and Lesley, this involved many extra hours. They were always receptive to all the additional tasks they needed to complete, supporting their colleagues throughout all the changes on which they led. Whatever the pressures and unexpected twists and turns that such moves bring inevitably, Shuna and Lesley behaved professionally and courteously throughout. Most importantly, they were able to keep their sense of humour even during difficult times.

7 When the contact centre moved finally to the old school of nursing, Shuna and Lesley were there all weekend to ensure that the team s work could start as smoothly as possible the following Monday. It is clear that not only do Shuna and Lesley have very high customer service skills, they also have patients best interests at heart. This is alone is clear from the amazing support they generated from their colleagues. Dr Richard Dent, consultant physician, QEII Richard, who is one of the Trust's longest serving consultants, retired from the Trust in February A consultant physician with a special interest in thoracic medicine, whose main base has been at the QEII, Richard has been at the forefront of many developments since the Trust was formed in April His work has included the establishment of a respiratory network with local primary care trusts, which has resulted in the appointment of the first chronic obstructive pulmonary disorder (COPD) specialist in a primary care setting, as well as playing a leading role in the building of the new Hertford County hospital. Richard s respiratory medicine work has resulted in significant improvements in the treatment and care provided to patients through the development of acute admissions units, along with the development of integrated care pathways for those suffering from COPD now one of the most common respiratory conditions in the UK. Similar developments have been delivered for the Trust s tuberculosis service. Between February 2004 and October 2008, Richard was the Trust s associate medical director and cancer lead, chairing the Trust s cancer board. In this role, he had a central lead in the strategic development of cancer services within the Trust and in partnership with the Mount Vernon Cancer Network. Following his retirement, Richard will be returning to the Trust working part time on its Delivering quality health care for Hertfordshire implementation programme, providing clinical leadership and expertise. Andrew Cannon, waste porter, QEII This final chief executive s award was made posthumously to Andrew, who was a waste porter at the QEII until his very sad and untimely death at the end of last year. Anyone who knew Andrew would tell you that he loved his job. It really showed because he was always such a happy person, despite having one of those roles that many would not want to do. Andrew was known by his colleagues and across the hospital as being a truly helpful person, both to patients and staff. Indeed he was held in high esteem by all. Tragically Andrew who was in his late fifties died just before Christmas, leaving his wife Elizabeth on her own. She works in the catering department at the QEII, where she is being well supported by her colleagues. How to purchase prints from the night One of the Trust s medical photographers was on hand throughout the evening to take photographs of the winners. A mounted print will be sent to the category winners but other photographs taken on the night are also available. To order call the medical photography team on extension 4019 (Lister) or e mail him at melvin.bond@nhs.net. Individual mounted A4 photos cost 6.00 each of which 1.00 will go to Comic Relief. Finally a word of thanks The annual staff awards have become a fixture in the Trust s calendar. For those who attend, it is seen as a great evening. But that belies the huge amount of work that goes into organising them. So a word of thanks is due to all the staff involved especially from the human resources department who worked together to put on such a wonderful night. Well done.