Delivering Improvement in Practice

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1 v Delivering Improvement in Practice NHS Providers Governance Conference 7 July 2016 Sir Mike Aaronson Chairman, Frimley Health NHS Foundation Trust

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3 Frimley Health FT Comprises: Frimley Park Hospital Heatherwood Hospital Wexham Park Hospital Ministry of Defence Unit Provides specialist services: Vascular Heart Attack Stroke Plastics Cystic Fibrosis Activity: 230k A&E 4 th largest activity in England 80k Emergency Admissions 20k Inpatient - elective 78k Day Cases 800k Outpatients 10k Births Turnover 600m 8,200 staff: 410 consultants 400 junior doctors 3,500 nurses & midwives CQC Rating: Frimley Outstanding (Sept 14) Heatherwood Good (Feb 14) Wexham Inadequate (Feb 14)

4 FPHFT Acquisition of HWPFT 1 October 2014 (18 month process) Substantial financial support from DH (capital and revenue) Regulatory encouragement and political support Willing partner in HWP Board No major competition issues FPH Board in strong position to insist on terms

5 Wexham Park Hospital: CQC Inspection Feb 2014

6 Wexham Park Hospital CQC Inspection Oct 2015

7 Critical Success Factors Leadership (executive and clinical) Emphasis on Values No compromise on bad behaviour Recognition of Staff Communication Honesty Hard work

8 Frimley Health Leadership Wexham Park Director of Operations Deputy Director of Nursing Deputy Medical Director Chief Executive (and Execs) Chiefs of Service Frimley Park Director of Operations Deputy Director of Nursing Deputy Medical Director Associate Director Associate Director Associate Director WPH Associate Director FPH Associate Director Associate Director Orthopaedics & Plastics General Surgery & Urology Specialist Surgery Emergency Department Medicine Obstetrics & Gynaecology Paediatrics Anaesthetics, ITU, Theatres Radiology Pathology & SPS Head of Nursing Head of Nursing Head of Nursing Head of Nursing Head of Nursing Head of Midwifery Head of Nursing Head of Nursing

9 Frimley Health Wexham Park - Objectives Raise and sustain performance Get the culture right Improve the infrastructure Improve governance, quality and safety Financial recovery

10 Getting the culture right Positive values and behaviours We are committed to excellence in everything we do, striving to be one of the best acute trusts in the country. We are facing the future, continuously improving our performance and adapting services to meet demand We are working together as one team dedicated to meeting patient needs.

11 Getting the culture right Frimley Health - Values Committed To Excellence We make safety and quality a priority for ourselves and others We go the extra mile We set ambitious goals for ourselves We strive to achieve our goals consistently to the highest possible quality standard, getting the basics right every time We have a positive attitude We deliver what we promise We work hard to solve problems if things go wrong and make them right We take responsibility for our own performance and for bringing our values to life We are committed to excellence in everything we do, striving to be one of the best acute trusts in the country. Working Together We are friendly, welcoming, courteous and caring We act fairly and compassionately We are open, honest and candid with others We treat other people as individuals and respond to their needs We respect others privacy and dignity We listen and ensure we understand We encourage and support colleagues We work as part of one team with colleagues within and outside the Trust in support of patient needs We are working together as one team dedicated to meeting patient needs. Facing The Future We challenge poor performance in others and expect to be challenged if our own performance is poor We are open to developing ourselves and to constructive feedback We change things for the better We make best use of public money by being as efficient as possible We engage with others to improve how things are done We speak up if things could be done in a better way We see change as an opportunity not as a problem All appraisals including living the values We are facing the future, continuously improving our performance and adapting services to meet demand.

12 Getting the culture right What are we proud of? Living the values Leadership development and team approach Listening Into Action Long service and recognition awards Intolerance of dysfunctional behaviour Ward staffing: 1:8 days 85% Compliant 1.10 nights 95% 31 students recruited for WPH last year 2 Less bullying FFT scores as place to work 40% to 57% FFT scores as place to be treated 45% to 69% Welcoming a speaking up approach No agency staff in maternity since April Public engagement & encouraging feedback What can we do better? Supporting the junior doctors Focus on retention initiatives 7 day consultant service for emergencies & very sick patients Turnover 14% (20% nursing) Reduce reliance on agency staff nursing 270 vacancies 1250 wte (100 nurses pre employment checks), therapy and radiography vacancies We want staff to work FOR Wexham not AT Wexham

13 Bringing good governance at the heart of patient care What have we done so far Quality Assurance Committee Board Committee Wexham Quality Committee CQC Requirement notices Pan Trust Clinical Governance Committee spread good practice Patient Safety Committee Mortality and Morbidity Committee Speciality dashboards Audit Cancer steering group Trust wide Control of Infection and Drugs and Therapeutics committees What has improved? Monitor targets delivered Q1 & Q2 15/16 Identification of SIRIs MDTs more effective Stronger focus on outcomes (CRAB - cardiac arrest, pneumonia, AKI - hydration) Consultant delivered services weekends and new medical and plastics models 16 new consultants More transparency with consultant job plans Radiology out of hours and open access for GP referrals Duty of candour openness and transparency

14 Keeping our patients safe New serious incident process WHO checklist Safeguarding and DOLS Falls & pressure sores DNA CPR Control of infection Sepsis Acute kidney injury Deteriorating patient Mandatory training MDT working Structured handover Creating a learning environment Structured approach to audit Learning from incidents, especially SIRI and never events Encourage more incident reporting Supporting staff when things go wrong Impact Better than average mortality SHMI 86 Harm reduced Surgical complication rate better than expected

15 Getting the quality right for patients What are we proud of? Strengthening the culture- getting the basics right Values based customer care programme leaders Improved access times Released more time to care Being more proactive and open Cleanliness Valuing unregistered staff Support at mealtimes Patient Friends and Family test improving 93% What can we do better? Noise at night Dementia Discharge process Involving patients and carers Antibiotic policy Learning disabilities Patient moves

16 Frimley Health performance top quartile 2014/ /16 Q3 Q4 Q1 Q2 4 Hours X X 18 Weeks X X C.Diff Cancer 2 week rule Cancer 31 day standard Cancer 62 day treatment X X

17 Estates improving the infrastructure What have we done so far? Roof and floor repairs 2 nd Cath lab - Wexham Improved security of Wexham at night Improved way finding all sites Improved the responsiveness of estates department toolbox meeting 50% of urgent requests done on the day Approved 500 additional car parking spaces Point of care - ED

18 Estates improving the infrastructure Wexham Paediatric Critical Care Unit 5 inpatient beds Separate parents room with en-suite 1.25m New Teenage Unit Second CT scanner and replace existing New X-Ray rooms 2.5m C arm

19 Estates improving the infrastructure What we are working on development control plan Wexham 45m investment Short stay beds 72 hours Ambulatory care assessment unit multi speciality 12 hours New emergency department 4 hours

20 Estates improving the infrastructure Redevelopment of maternity - 10m En suites in all delivery rooms including Midwifery Led Unit New bereavement suite with discreet access. Separate maternity and gynaecology outpatient waiting areas Improved outpatient consulting and waiting area in outpatients Fully equipped Gynaecology procedure rooms for Colposcopy/ early pregnancy and urodynamic

21 Estates improving the infrastructure New Heatherwood Hospital 6 operating theatres 48 beds 63m 16 day case beds Outpatients Diagnostics Will move some additional activity from Frimley Need to sell part of the site to generate the funding

22 Securing financial balance 600m turnover 2015/16-14m deficit Need to save 26m per annum How? Reduction in agency cost Productivity output per head needs to improve New Heatherwood needs to make a surplus Better purchasing Improved discharge process

23 CQC Requirement Notices February 2014 inspection Notice Governance process Staffing vacancies Access times Patient safety Culture Deteriorating patient Cancer pathways and MDT working Critical care capacity WHO checklist Bookings and cancellations Responsiveness of complaints and patient feedback Patient environment Action New governance structure. Quality Committee, M&M Committee and CRAB, speciality dashboards 270 vacancies of 1250 ward establishment, 100 nurses going through pre-employment checks Delivered Monitor standards for Q1 and Q2 Embedding key standards Can do attitude - Frimley Health values and behaviours Outreach consultant 8am 6pm 24/7 Outreach nurse plus resus team 8am to 8pm Mon - Fri MDTs functional and improved pathways Transfers out - 2 for Q1 and 0 for Q2 Establish Medical HDU 96.7% compliant No capacity list reduced from 10k to one week beyond target follow up date 200 Complaints backlog eliminated. Wexham Park complaints have reduced from 50 per month to m of investment secured Improved maintenance turnaround times

24 Wexham Park FHFT Key priorities Provide HDU capacity for medicine Top performing District General Hospital Children HDU teenage unit 7 day consultant delivered service Secure additional elective activity Slough +16% Chiltern +20% Windsor +9% Building a reputation for quality 130m investment in estate. New ED and assessment area, upgrade maternity, radiology Heart attack centre New models of care for frail elderly Cancer onsite radiotherapy Eliminate the deficit

25 Wexham Park Hospital Today Better place to receive care Inspiring staff to care and lead Bedding in the new governance arrangements Stronger focus on clinical outcomes Reduced harm events Strengthened culture - Alignment of purpose - Rebuilding confidence and self belief Working with Commissioners to redesign and improve care Better place to work Improved and sustained performance Deficit support package has resulted in more focus on quality Learning from complaints and incidents Clean

26 Reflections as Chairman Put patients at the centre of thinking and decision-making only tick the box after this, not the other way round Understand and support the role of the chief executive leave the long screwdriver at home Assert the independence of the Board innovation and improvement takes courage; risk needs to be rewarded

27 v Delivering Improvement in Practice NHS Providers Governance Conference 7 July 2016 Sir Mike Aaronson Chairman, Frimley Health NHS Foundation Trust

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