East Lancashire Hospitals NHS Trust : Our improvement plan & our progress

East Lancashire Hospitals NHS Trust : Our improvement plan & our progress Personal statement from the Interim Chair of East Lancashire Hospitals NHS Trust: I am pleased to share with you our plans to improve the quality of care the Trust provides to our local community. The Board welcomes the findings of the Keogh review, which was as a result of higher than expected mortality rates at the Trust. We, together with our staff, are wholeheartedly committed to improving the quality of our services. This plan sets out short-term improvements on the key areas of concern raised by the Keogh Review Team, however our longer term plans for continuous improvement will go beyond the deadline dates that we have set out in this plan. This will ensure that we are assessed as a high performing organisation when the Chief Inspector of Hospitals, Professor Sir Mike Richards inspects our Trust. Once the actions identified within the Keogh action plan have been completed, we will set out a longer-term plan to maintain progress and ensure that the actions lead to measurable improvements in the quality and safety of care for patients. There will be regular updates on NHS Choices and subsequent longer term actions will be included as part of a continuous process of improvement. Our staff were rightly seen by the Keogh review as our biggest asset and we will work together, and support our staff, to ensure we provide compassionate care that places our patients at the heart of everything we do. We are committed to improving as an organisation and delivering against our improvement plan is fundamental to helping us on this journey. Martin Hill, Interim Chair

East Lancashire Hospitals NHS Trust : Our improvement plan & our progress What are we doing? The Keogh review made 30 urgent recommendations on the 16 th July 2013 which, if implemented, would improve the quality of our services. Specifically, Keogh said that we need to: - Improve the way in which the Board seeks to ensure high quality services are delivered every time, all of the time. This is important because the Board need to be aware of risks to the quality of our services, to promote patient safety and react swiftly to any emerging issues. In our individual and collective response to the Keogh review we are emphasising the need to put the delivery of sustainable, safe and high quality care for our patients at the heart of everything we do. We have therefore simplified our vision for the organisation to set out a clear ambition for staff, patients, their carers and their families: To provide Safe, Personal and Effective care for every patient, every time. This is supported by five clear improvement priorities. One of our key improvement priorities is to reduce hospital mortality. Following the Keogh review we took immediate action to reduce our mortality and also ensure we learn from patient deaths. All patient deaths are formally reviewed by a senior clinician and are discussed at weekly share-2-care meetings by multi disciplinary teams. We have a mortality reduction plan which is overseen by a steering group of senior clinical staff from a variety of professions. We monitor actual (crude) mortality on a week by week basis so that any unexpected peaks are identified and investigated immediately. We have introduced a number of clinical care bundles, which are best practice packages of care for specific conditions, for example for pneumonia and acute kidney injury. There is now clear evidence that our actions have reduced mortality for our patients with specific conditions. Our Summary Hospital Mortality Indicator (SHMI) is now within the expected range. A group of senior clinicians have developed a set of professional internal standards to support improvements in our emergency pathway e.g. timeliness of the first assessment, response times for diagnostic procedures. We now have a dedicated email address for our local GPs to feedback any concerns, this information will help us to improve services and provides GPs with a central point to ask questions. - Improve the information that the Board receives about savings plans and their impact on the quality of our services. This is important because, although we have to make savings each year so that we don t spend more money than we receive, we need to be better at checking that the savings we make will not have a detrimental effect on the care we give our patients. The process by which our savings plans are approved has been strengthened to ensure there is no detrimental impact on the quality of care we provide. All of our savings plans are now reviewed and signed off by our Medical Director and Chief Nurse. We are also sharing our savings plans with our Clinical Commissioning Groups who are responsible for planning and commissioning healthcare services for the local population. - Improve the way we use our beds across all of our sites. We will also work more closely with other NHS organisations and the Local Authorities to ensure alternative services can be accessed by patients in a community setting. Both of these points are important because we need to ensure that we can continue to provide high quality care to the increasing number of patients who need to access emergency care. We have developed an ambulatory care service a patient focussed service where people coming in to hospital as emergency patients can have investigations, exploratory examinations and receive a treatment plan without the need for an overnight stay. This now avoids admission for 20 patients a day and will be extended during the winter period. On Monday the 7th October 2013 we began the Perfect Week. The Perfect Week was a commitment across the organisation to improve patient experience and to ensure care was being delivered in the most appropriate setting. We particularly worked with our health economy partners in a structured way to remove any barriers in discharging patients. A number of quality improvements have been implemented. Also 29 additional beds have been opened with more planned, to ensure that we can care for the increase in the number of patients that we will see over the Winter period.

East Lancashire Hospitals NHS Trust : Our improvement plan & our progress What are we doing? - Improve our understanding of the reasons why we have a relatively high number of patients who are readmitted to hospital unnecessarily. This is important because we are now able to move some services into the local community so that they are closer to home which means patients don t have to go into hospital. This improves the experience for our patients. We have undertaken a comprehensive audit of our readmissions to further establish the reasons why they occurred. We are now working with our partner organisations to address the issues highlighted. We have doubled the capacity in our virtual ward, which now supports 300 patients, 7 days a week to be cared for in their own home rather than having to come into hospital. Our readmission rate is showing early signs of improvement. We compared our rates for 2012-13 with other hospitals across the country and our rates are similar. The rate has reduced even further from 1 April 2013. - Engage more effectively with our patients and their carers and provide an increased opportunity for them to improve our services. We have launched a new programme of ward/departmental walk rounds by our Board members. This new programme has a more informal approach with the focus on having conversations with staff, patients, families and friends to ensure our most senior staff understand how patients feel when they use our services and the issues that staff face when delivering care to our patients. This will promote a culture of feeling able to report when care is not the best it can be and feel supported in putting it right and learning lessons from those experiences. Our Board members have already made a number of visits to wards and departments. We have held some listening events, where members of the public can ask questions or raise concerns directly with members of our Board. We are holding regular events with our members and shadow Governors, for example we held a member event on the 15 January 2014 about to share our improvement plans following the Keogh review. - We will listen to patients concerns and respond compassionately and quickly and we will listen to what our patients are telling us. It is important to learn from things which don t go well so that they don t happen again. We need to support our staff to continue to learn and develop in order to provide the best possible care for our patients We have extensively communicated with staff in a variety of ways on the importance of complaints and concerns raised by patients and relatives as a mechanism of learning and improving care. We ve introduced a new education and training programme on how to respond to and learn from complaints. A new complaints handling process is in place that changes emphasis from investigation and formal response to understanding complaint/concern, offering an early meeting, responding empathetically and learning to improve care. We are now using patient stories at a variety of meetings as a learning tool. For example a patient s relative is attending our joint clinical leaders forum in early February to share their experience and describe the impact of staff behaviours. Our Chief Nurse and interim Director of HR and OD have also been back to the floor where they are working alongside staff across the organisation to learn and understand the issues our staff are facing on a day-to-day basis. - Constantly review our workforce numbers and work hard to meet the changing needs of patients in our care. This is important to ensure all the needs of our patients are met and that the care that we give is safe and effective. We have significantly increased the number of nurses on duty at nights on our core medical wards and are continuing to recruit additional trained nurses, health care assistants and midwives. To ensure we have enough nurses on our wards we have also recruited nurses from Portugal and Italy. Our sickness absence levels are improving and levels are significantly below the North West average and below the national average. We now employ 107 more qualified nurses than we did on the 1 April 2013. We have successfully recruited an additional Consultant in our Emergency Department.

East Lancashire Hospitals NHS Trust : Our improvement plan & our progress What are we doing? - Strengthen the leadership and support to our nursing staff. This is important so that our nurses and midwives feel valued and ensures excellent and consistent nursing is provided throughout the Trust. We have reenergised our organisational development strategy and have cascaded our leadership development programme to our matrons and specialist nurses. Four cohorts (48 senior nurses) have already completed the programme. Our Nursing and Midwifery Strategy, which our nurses and midwives from across the organisation contributed to, has been published and sets the direction for our nurses focussing on the 6 nationally recognised nursing values known as the 6Cs; Care, Compassion, Competence, Communication, Courage and Commitment, with patients firmly at the centre of all that we do. This document shows our plan for making these changes and shows how we re progressing. It builds on the Key findings and action plan following risk summit document which we agreed immediately after the review was published. This can be found at: http://www.nhs.uk/nhsengland/bruce-keogh-review/pages/published-reports.aspx Whilst we make these changes to address the Keogh recommendations, the Trust is in special measures. More information about special measures can be found at http://www.ntda.nhs.uk/blog/2013/07/16/nhs-tda-places-five-trusts-in-specialmeasures. The Trust Development Authority are working with us to ensure we have the right support in place to make these changes as quickly as possible.

East Lancashire Hospitals NHS Trust : Our improvement plan and our progress Who is responsible? Our actions to address the Keogh recommendations have been agreed by the Trust Board. With the Board our Interim Chief Executive, Jim Birrell, is ultimately responsible for implementing actions in this document. Other key staff are our Medical Director, Rineke Schram and our Chief Nurse, Christine Pearson, who are tasked with implementing many of the key actions described below that will help improve the quality of care delivered by our staff and enhance patient experience. Nicky O Connor from the Trust Development Authority is helping us to implement our actions by supporting and challenging the process by which we will ensure we deliver on our action plan. Ultimately, our success in implementing the recommendations of the Keogh plan will be assessed by the Chief Inspector of Hospitals who is likely to re-inspect our Trust in the next six to nine months. If you have any questions about how we re doing, please ring Lynne Barton our Head of Communications on 01254 732540, or if you want to contact Nicky O Connor, as an external expert, you can reach her on nicky.oconnor@nhs.net How our progress is being monitored and supported We will update this progress report on the first day of every month while we are in special measures. We will work with our Shadow Council of Governors, members and Healthwatch to ensure that the improvements we are putting in place are effective. We will also hold public meetings and attend listening events, where we will update, face to face, our local community on our progress. We will also produce monthly press briefings which describe how are delivering against our improvement plan. Further details will be announced in updates of this progress report. A senior representative has been appointed by the TDA; Marie-Noelle Orzell, who is providing expertise to the Trust Board and checking that we're meeting our promises to deliver our improvement plan. (Timescale: By October 2013; Owner: TDA). We will access support from partnership working as appropriate with the Academic Health Science Network, NHS Improving Quality and the NHS Leadership Academy. (Timescale: By April 2014; Owner: NHS England). Martin Hill Interim Chair of the Trust (on behalf of the Board)

Our improvement plan This table shows the actions we re taking to address the concerns about the quality of our services which were raised in the Keogh report. It also shows how we are progressing against our actions. Summary of Keogh Concerns Summary of Urgent Actions Required Agreed Timescale External Support/ Assurance Progress B/G/R/ narrative Improve the way in which the Board seeks to ensure high quality services are delivered every time, all of the time The Board will undertake a specific development programme which focusses on quality and safety. We will work through the information from the listening events carried out by the Keogh Review Team to look very carefully at the issues raised and make sure wherever possible we don t repeat the same failings. We will share this learning with our CCG colleagues. NHS Improving Quality We will increase the number of spot checks in clinical areas to ensure that the care being provided is of the highest standard. We will work harder to understand the priorities of our patients, their carers and our staff. We will target and address specific areas of concern to drive clinical quality and safety improvements across our organisation. End Sept 2013 The Board will put in place triggers for all patient safety and quality issues to make it clear to our staff when they need to notify the Board of issues which need closer review. Improve the information that the Board receives about savings plans and their impact on the quality of our services Our Medical Director and Chief Nurse will review all of our savings plans to ensure there isn t a detrimental impact on the clinical services we deliver. Improve the way we use our beds across all of our sites Agree our plans for winter and ensure that all of the beds that we use are in environments which support the privacy and dignity of our patients. Continued spot checks on escalation areas when in use. Improve our understanding of the reasons why we have a relatively high number of patients who are readmitted to hospital unnecessarily We will comprehensively analyse the data on patients who have been readmitted unnecessarily and put in place an action plan to address any issues identified. Our Board will look at the learning from this work to ensure our discharge processes are safe and effective. End Sept 2013

How we re checking that our improvement plan is working This table shows how and when we are checking that the actions we re taking are making a real difference on our wards, in our operating theatres and in our community services. It also highlights how we will be communicating our progress to our local community. Oversight and improvement action Timescale Action owner Progress Fortnightly accountability meeting with Trust Development Authority and our Clinical Commissioning Groups to track delivery of action plan. The Clinical Commissioning Groups are working closely with us to provide assurance to their governing body that we are delivering appropriate actions to make a difference. We will use the partnership working with Newcastle Upon Tyne Hospitals NHS Foundation Trust to learn how we can strengthen our leadership and make improvements to the quality of services that we provide. Appointment of an Improvement Director (Marie-Noelle Orzell) by TDA, who will provide expertise to the trust Board on how to improve our services and check that we re meeting our promises to deliver our improvement plan The monthly meetings of the Trust Board and the Executive Management Board will review evidence about how the trust action plan is improving our services and changing the way we work for the better. There will also be bi-weekly Keogh Action Plan Meetings attended by our Executive Directors who have lead responsibility for implementing the action plan. Trust Reporting to the public about how our trust is improving through Healthwatch, our Shadow Council of Governors, members, our website, listening events and the local media. We will further develop our communications plan over time Agreement and regular reporting of quality measures to demonstrate that the actions are leading to improved quality of care for patients. We will use the Commissioning for Quality and Innovation scheme with our commissioners to drive quality up. Our performance will be published on our website. Aug 2013 to July 2014 Aug 2013 to July 2014 October 2013 2 weekly Sept 2013 to July 2014 Monthly Monthly Trust Interim Chief Executive/Special Measures Director Trust Interim Chief Executive TDA Trust Acting Chair Trust Interim Chief Executive Trust Interim Chief Executive/TDA