Fiona Allsop, Chief Nurse Des Holden, Medical Director Sally Brittain, Deputy Chief Nurse Des Holden, Medical Director

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1 TRUST BOARD IN PUBLIC REPORT TITLE: EXECUTIVE SPONSOR: REPORT AUTHOR (s): REPORT DISCUSSED PREVIOUSLY: (name of sub-committee/group & date) Action Required: Date: 29 th January 2015 Agenda Item: 2.2 Chief Nurse & Medical Director Report Fiona Allsop, Chief Nurse Des Holden, Medical Director Sally Brittain, Deputy Chief Nurse Des Holden, Medical Director N/A Approval Discussion Assurance ( ) Purpose of Report: An update of on-going work in relation to safe and quality patient care that sits out with the operational performance reports including Monthly Safer Staffing information and exemption report. Summary of key issues Chief Nurse s Report Safe Staffing Report (January 2015) Sign Up to Safety Medical Director s Report National patient safety collaborative Virginia Mason Interviews Electronic prescribing update KSS Expo Patient Safety Executive Recommendation: The Trust Board is asked to review and gain assurance from the information within the report. Relationship to Trust Strategic Objectives & Assurance Framework: SO1: Safe -Deliver safe services and be in the top 20% against our peers SO2: Effective - Deliver effective and sustainable clinical services within the local health economy SO3: Caring Ensure patients are cared for and feel cared about SO4: Responsive Become the secondary care provider and employer of choice our catchment population SO5: Well led: Become an employer of choice and deliver financial and clinical sustainability around a clinical leadership model

2 Corporate Impact Assessment: Legal and regulatory impact Financial impact Patient Experience/Engagement Risk & Performance Management NHS Constitution/Equality & Diversity/Communication Attachment: Appendix 1 - Surviving Sepsis at East Surrey Hospital 2

3 TRUST BOARD REPORT 29 TH JANUARY 2015 CHIEF NURSE AND MEDICAL DIRECTORS REPORT 1. Introduction This report seeks to provide regular assurance and information to the Trust Board in response to national and local policy and care changes which impact patient safety, experience and clinical outcomes. 2. Safe Staffing Compliance Safe staffing data for the Trust was uploaded to unify as required and is now visible to the public via the NHS Choices and the Trust Website. The data is presented for the Trust Board within the table below. The Board will note that the Trust total score for total staffing compliance 95.09%, with RN compliance at 95.13% during the day and 97.39% at night. This provides assurance that out of hour s compliance, especially of RN s is a priority to ensure safety. During the day the wards have access to a much increased senior nursing team to offer support such as Matrons, Clinical Specialist Nurses and Divisional Chief Nurses for support and guidance. Staffing challenges identified and discussed in month are evidenced within the data below. 3. Data Capture Results Monthly (January 2015) Ward Ward Specialty Entries RN Day RN Night NA Day NA Night Total Day Total Night Abinger Ward 430 GERIATRIC MEDICINE % 100% % 97.61% 99.34% Acute Medical Unit 300 GENERAL MEDICINE % 96.77% 82.78% % 95.59% Birthing Centre 501 OBSTETRICS % 100% N/A N/A 100% 100% Bletchingley Ward 300 GENERAL MEDICINE % 93.71% 88.46% 96.58% 91.82% 9 Brockham Ward 502 GYNAECOLOGY % 100% 100% 94.92% 98.94% 97.52% Brook Ward 100 GENERAL SURGERY % 98.36% 100% N/A 100% 98.36% Buckland Ward 101 UROLOGY % 100% 100% 96.67% % Burstow Ward 501 OBSTETRICS % 100% % 83.87% 95.52% 91.94% Capel Annex l Ward % 97.73% 99.47% 100% 98.48% 98.86% Capel Ward 430 GERIATRIC MEDICINE % 90.48% 99.3% % % Ove rall % % % % % % % % Chaldon Ward 300 GENERAL MEDICINE % 88.24% 95.93% 92.47% 94.64% 90.68%

4 3% Charlwood Ward 301 GASTROENTEROLOGY % 96.77% 94.77% 94.12% 95.8% 95.38% Copthorne Ward 301 GASTROENTEROLOGY % 100% 98.96% 100% % Coronary Care Unit 320 CARDIOLOGY % 98.39% % 94.12% 92.18% 96.88% Delivery Suite 501 OBSTETRICS % 99.46% % % Discharge Lounge 300 GENERAL MEDICINE % 96.3% 96.08% 96.3% 95.12% 96.3% Godstone Ward (Haem) 303 CLINICAL HAEMATOLOGY % 9 N/A N/A 96.09% 96.67% Godstone Ward (Med) 300 GENERAL MEDICINE % % 95.01% 88.46% 93.7% 96% Hazelwood 300 GENERAL MEDICINE 4 100% 100% % 88.26% 100% Holmwood Ward 320 CARDIOLOGY % 100% 97.01% 100% 96.36% 100% ITU/HDU 192 CRITICAL CARE MEDICINE % 96.28% 86.07% 90.32% 93.83% 95.8 Leigh Ward 110 TRAUMA & ORTHOPAEDICS % 96.67% % 95.38% 96.67% Meadvale Ward 430 GERIATRIC MEDICINE % 98.39% 96.49% 100% 93.07% 99.22% Neonatal Unit 420 PAEDIATRICS % % 79.37% 91.48% 89.62% Newdigate Ward 110 TRAUMA & ORTHOPAEDICS % 96.77% 85.64% 91.94% 91.78% 94.3 Nutfield Ward 430 GERIATRIC MEDICINE % 100% 97.47% 98.39% 99.06% 99.19% Outwood Ward 420 PAEDIATRICS % % % 92.56% 96.57% Rusper Ward 501 OBSTETRICS % 100% N/A N/A 100% 100% Surgical Assessment Unit 100 GENERAL SURGERY % 95.16% 83.87% 83.87% % Tandridge Ward 300 GENERAL MEDICINE % 100% 96.19% 98.39% 95.24% 99.19% Tilgate Ward 300 GENERAL MEDICINE % 98.08% 96.87% % 97.12% Woodland Ward 100 GENERAL SURGERY % 81.89% 93.33% 88.52% % % % % % % % % % % % % % 100 % % % % Total 95.13% 97.37% 92.97% 93.83% 94.44% 96.04%

5 9% 4. Sign Up to Safety Campaign Safety Improvement Plan Background Sign up to Safety is a national patient safety campaign that was announced in March 2014 by the Secretary of State for Health and launched at the end of June The campaign underpins the ambition set out of halving avoidable harm in the NHS over the next 3 years, and saving 6,000 lives as a result. NHS organisations who Sign up to Safety are expected to commit to 5 safety pledges; set out the actions they will undertake in response to the pledges; agree to publish this on their website for staff, patients and the public to see; and commit to turn their actions into a safety improvement plan (including a driver diagram) which will show how organisations intend to save lives and reduce harm for patients over the next 3 years. 4.1 The five Sign up to Safety pledges 1. Put safety first. Commit to reduce avoidable harm in the NHS by half and make public the goals and plans developed locally. 2. Continually learn. Make their organisations more resilient to risks, by acting on the feedback from patients and by constantly measuring and monitoring how safe their services are. 3. Honesty. Be transparent with people about their progress to tackle patient safety issues and support staff to be candid with patients and their families if something goes wrong. 4. Collaborate. Take a leading role in supporting local collaborative learning, so that improvements are made across all of the local services that patients use. 5. Support. Help people understand why things go wrong and how to put them right. Give staff the time and support to improve and celebrate the progress. 4.2 Campaign Support and Context A National Co-ordinating and Support Group has been established, chaired by Sir David Dalton who is supported by Dr Suzette Woodward as campaign director. The following national organisations have committed to system wide support of Sign up to Safety: NHS England will provide expert clinical patient safety input to the development of improvement plans and framework for plan assessment. They will also play a key leadership role in the campaign and will ensure all their programmes of work are actively working to support the campaign. Monitor and the NHS Trust Development Authority will offer leadership and advice to trusts and foundation trusts who participate in Sign up to Safety and who will develop and own locally their improvement plans. They will also sign post to partner organisations for specific expertise where required. NHS Litigation Authority which indemnifies NHS organisations against the cost of claims will review trusts plans and if the plans are robust and will reduce claims, they will receive a financial incentive to support implementation of the plan. Any 5

6 savings made in this way will be redirected into frontline care. This is just one way that we can tackle some of the financial costs of poor care. The Care Quality Commission will support trusts signed up by reviewing their improvement plans for safety as part of its inspection programme. CQC will not offer a judgment on the plans themselves but consider them as a key source of evidence for Trusts to demonstrate how they are meeting the expectations of the five domains of safety and quality. The Department of Health will provide Government-level support to the campaign and work with the Sign up to Safety partners to ensure that the policy framework does all it can to support the campaign and the development of a culture of safer care. 4.3 SASH Pledges Surrey and Sussex Healthcare NHS Trust 5 safety pledges 1. Put safety first. Identify, evaluate and implement patient safety systems that look to enhance the quality of our care by increasing the chances of the initial signs of a deteriorating patient being acted on appropriately. It is believed that recent innovations in patient monitoring systems could be of value in improving patient safety related outcomes. We expect that these innovations could also affect the numbers of incidents relating to delays in treatment which are identified by our staff and recorded in our patient safety data. 2. Continually learn. Seek to improve the Trust s systems for identifying and managing pain specifically with patients who have a diagnosis of dementia. We will look to develop a greater understanding of the effectiveness of our pain management systems, develop tools and processes that improve the quality of this element of care, develop further training for staff and then share our findings across the local health provider network. This program will allow significant numbers of staff to be appropriately trained in the assessment of pain, which we anticipate will have considerable benefits for all patients within the Trust. 3. Honesty. Ensure that the Trust is compliant with the statutory responsibility regarding Duty of Candour. The Trust follows the principles of Being Open but will improve the process to ensure compliance with the components of Regulation 20. We will develop a robust system for monitoring compliance and evidence through improved documentation of communications with the relevant person in accordance with the regulation. We will develop training and support for staff in awareness of the duties under the regulation and the principles and how to have the open and honest conversation after an incident resulting in harm, as defined in the regulation, has occurred. 4. Collaborate. Learn from COPD EQ pilot that the Trust has committed to undertake and seek to identify and share learning across South East Coast over the 3 year period of the pilot. This collaborative approach will be extended to acute kidney injury and sepsis. 5. Support. The Trust will ensure that Divisions will; improve the visibility and accessibility of their patient safety data to all staff within the Division; empower their clinical teams to make patient safety improvements; ensure a clear link between patient safety data (incidents, mortality, outcome data) and action plans developed and implemented; ensure that improvements to patient safety are audited to ensure efficacy 6

7 4.4 SASH Progress and Update The Trust has submitted its Safety Improvement Plan and awaits feedback from the NHS Litigation Authority regarding any financial incentive and NHS England approval. The Executive sponsor is the Chief Nurse and the Trust Lead is the Patient Safety and Risk Facilitator. A detailed Safety Improvement Plan Guidance document is currently being worked through and a project lead for each pledge has been identified. The detailed project implementation and communications plan to support the Safety Improvement Plan will be developed during February and March The Trust Sign up to Safety Safety Improvement Plan will be launched in April 2015 and run for 3 years. The Executive Committee for Quality and Risk has been identified as the monitoring committee and a quarterly report will be presented for monitoring, escalation and assurance purposes. Medical Director s Report 5. National patient safety collaborative The Department of Health and NHS England have launched a national safety drive for England, facilitated by the 15 AHSNs. After a collaborative approach, the programme for Kent Surrey and Sussex will include work programmes in the areas of sepsis, pressure damage (across the local health economy), falls, acute kidney injury (AKI) and handover of care between secondary and primary/ community care givers. Of note the last of these topics came from consultation with patient groups while the others are either nationally mandated, or came from consultation with providers. 6. Virginia Mason The Virginia Mason Hospital in Seattle is famous for having achieved game changing gains in patient safety. It has achieved this through the standardisation of many processes, eliminating needless, valueless variation within teams. It describes itself not as a hospital which has a lot of safety projects, but as a hospital with an ethos that seeks to be as safe as possible. The TDA hosted a study day for senior teams from non-fts with a view to fund 5 improvement programmes with 5 providers. While the central funding for this initiative is as yet not finalised, it is the current intention of SaSH to apply to be one of the 5 providers working to implement o VM model. 7. Interviews Since the last trust Board there has been a consultant interview for a paediatrician (0.6wte) to co-lead on safeguarding. The post will also provide support to the general paediatric service. Dr. Katy McGlone was successfully appointed to the post on and will join us after a three month notice period. 8. Electronic prescribing update Electronic prescribing was introduced in the second week of December on Capel annex. Given the risks around cover over the Christmas and new year periods there was extensive discussion and modeling of safeguards but the project has run smoothly to date and has increased to cover 15 beds on the ward. Unofficially, the feedback from the ward is very positive, but a formal project evaluation will take place at the beginning of February after which a decision on roll out across the organisation will be made. 7

8 9. KSS EXPO The KSS AHSN hosted its annual Expo and awards on 13 th January. Key note speeches were given by Dr. Mike Durkin (National patient safety Lead) and Sir Bruce Keogh (NHSE Medical Director) xxx. A number of awards were presented for the Enhancing Quality and Recovery Programme and SaSH did not receive one of these despite strong performance in several of the disease strands. The safety poster prize was judged by Sir Bruce and Dr. Shuab Quraishi won for his work on six steps to safety in sepsis. Sir Bruce commented that he hoped (and expected) this work to be rolled out across KSS. Dr.Quraishi has since presented his work to the Patient Safety Executive 10. Patient safety executive In January we commenced a Patient safety Executive. This stand up meeting is attended by the Exec, the senior corporate staff from E&F, Finance, HR, Procurement, data, and by the matrons and care centre managers. Each session will involve a short presentation on a clinical topic or patient story and the learning that has resulted. So far Dr. Quraishi has presented his sepsis 6 work, and the PII of Cdiff on Godstone ward has been presented. The presentation scheduled for 28 th January is the audit of blood supply and use from SaSH blood bank to the KSS air ambulance. This initiative gives the opportunity for key non-patient facing departments and staff to build up and ground their every day work in the context of the delivery of patient care. 11. Recommendation The Trust Board is asked to review and gain assurance from the information within the report Fiona Allsop Chief Nurse January/ 2015 Des Holden Medical Director 8