Agenda Item: 5.1.1 REPORT TO PUBLIC BOARD MEETING 31 May 2012 Title Lead Director Author(s) Purpose Previously considered by Ratification of the Strategy for the Care of Older People Siobhan Jordan, Director of Nursing and Quality Julie Brache, Mary Unsworth and the Older People s Pathway Group To ratify strategy Older People s Pathway Group (OPPG) Trust Management Team Executive Summary The Board of Directors is requested to ratify the Strategy for the Care of Older People. This strategy has been considered by the Older People s Pathway Group (staff and user members); initial approval given by the Healthcare Governance Committee and approved by the Trust Management Team. Related Trust Objectives 1. To provide nationally recognised care for older people in the hospital; Sub-objectives Risk and Assurance Related Board Assurance Framework Entries Legal Implications/Regulatory Compliance with CQC Essential standards Requirements Action Required by the Board The Board of Directors is asked to ratify this strategy.
BACKGROUND 1. The Ipswich Hospital NHS Trust aims to be recognised as the provider of choice by placing patients at the centre of everything we do. The Trust has three strategic objectives, one of which is to provide nationally recognised care for older people in hospital. 2. The strategy provides a framework of care which takes into account the requirements of: National Institute for Health and Clinical Excellence (NICE) clinical guidelines Department of Health National Service Framework for Older People Living Well with Dementia: a National Dementia Strategy National Confidential Enquiry into Patient Outcome and Death Report. End of Life Strategy 3. This strategy aims to provide a framework to ensure older people in hospital are given the best possible care. KEY ISSUES 4. In order to maintain and improve successful care for older people, we must ensure: 5. Person Centred Care All patients have access to the specialist services they need, whenever and wherever they are under our care. The patient is at the centre of all decision making. 6 Involvement of Carers and Family With patients agreement, we welcome the involvement of family and carers in their ongoing management and support. With the patients consent the sharing of information between carers, family and staff is standard practice. 7 Care, Kindness and Respectful Attitude Staff prioritise time with patients and carers. Staff have the knowledge and skills to treat every patient with care, kindness and respect. 8 Safe Hospital We manage risk by providing high quality staff training, equipment and patient assessment (eg falls, pressure ulcers, nutrition, medication errors) in an environment that is suitable for patient needs. 9 Enabling Hospital We work to promote autonomy and minimise patient functional decline to achieve fitness for timely and safe discharge home. 10 Seamless Service We provide a continuous patient journey through the development of excellent communication pathways between primary, secondary, intermediate and social care services. 11 Leadership Innovation & Staff Empowerment We invest in our staff, providing training and development to ensure we encourage expert practitioners as well as developing our next generation of leaders. Continuous, sustainable service development is embedded in the culture and supported by experts in innovation and service improvement. 2
NEXT STEPS 12. Once the strategy is ratified, the training needs of staff can be developed further, and linked to the mandatory training plan. 13. Regular progress reports will be submitted by OPPG to Trust Management Team. RECOMMENDATIONS 14. The Board of Directors is requested to ratify the strategy. 3
Strategy for Care of Older People Version 1.0 Purpose: For use by: This document is compliant with /supports compliance with: This document supersedes: To advise and inform hospital staff of strategy for care of older people throughout the Trust All staff National Institute for Health and Clinical Excellence (NICE) clinical guidelines (CG 28,29,32, 42,103,124) Department of Health National Service Framework for Older People Living Well with Dementia: a National Dementia Strategy National Confidential Enquiry into Patient Outcome and Death Report. End of Life Strategy New document Approved by: Initial approval by Healthcare Governance Committee Approval by Trust Management Team Approval date: Trust Management Team 12 March 2012 Ratified by Trust Board Date Ratified Implementation date: Review date In case of queries contact: Responsible Officer Director of Nursing & Quality Directorate and Department Business Unit 3 Archive Date ie date document no longer in force Date document to be destroyed: ie 10 years after archive date To be inserted by Information Governance Department when this document is superseded. This will be the same date as the implementation date of the new document. To be inserted Information Governance Department when this document superseded 4
Version and document control: Version Date of Change Description* Author number issue 0.1 12.03.12 1 st draft JB/MU/ & Older Peoples Pathway Group This is a Controlled Document Printed copies of this document may not be up to date. Please check the hospital intranet for the latest version and destroy all previous versions. Hospital documents may be disclosed as required by the Freedom of Information Act 2000. Sharing this document with third parties As part of the hospital s networking arrangements and sharing best practice, the hospital supports the practice of sharing documents with other organisations. However, where the hospital holds copyright to a document, the document or part thereof so shared must not be used by any third party for its own commercial gain unless this hospital has given its express permission and is entitled to charge a fee. Release of any strategy, policy, procedure, guideline or other such material must be agreed with the Lead Director or Deputy/Associate Director (for hospital-wide issues) or Directorate/ Departmental Management Team (for Directorate or Departmental specific issues). Any requests to share this document must be directed in the first instance to the Director of Nursing & Quality. 5
CONTENTS SECTION 1 - INTRODUCTION... 7 1.1 Rationale & Background Information... 7 1.2 Key Objectives... 7 1.3 Definitions... 7 SECTION 2 - DUTIES AND RESPONSIBILITIES... 7 2.1 Older People s Pathway Group... 7 2.2 Chief Executive... 8 2.3 Director of Nursing & Quality... 8 2.4 Clinical Chairs, Business Unit Managers, Head Matrons... 8 2.5 All Staff... 8 2.6 Trust Management Team... 8 2.7 Healthcare Governance Committee... 8 2.8 Trust Board... 8 SECTION 3 - STRATEGY FOR THE CARE OF OLDER PEOPLE... 8 3.2 Seven Key Objectives:... 9 SECTION 4 - TRAINING AND EDUCATION...10 SECTION 5 - DEVELOPMENT AND IMPLEMENTATION INCLUDING DISSEMINATION...10 SECTION 6 - MONITORING COMPLIANCE AND EFFECTIVENESS...11 SECTION 7 - CONTROL OF DOCUMENTS INCLUDING ARCHIVING ARRANGEMENTS...11 SECTION 8 - SUPPORTING COMPLIANCE AND REFERENCES...11 Appendix 1 OPPG Organisational Chart...12 6
SECTION 1 - INTRODUCTION 1.1 Rationale & Background Information Ipswich Hospital has a core catchment population of 356,000 with one of the fastest growing proportion of over 85 year olds in the country. Between 2010 and 2020 there will be a 34% increase in over 65s and 65% increase in the oldest old (over 90) patient group. (Source: Office of National Statistics May 2010). The Trust wants to be recognised as the provider of choice by placing patients at the centre of everything we do. The Trust s strategic objectives are: To provide safe, reliable, personal and responsive emergency care, planned care, maternity and children s care our local acute services To provide a number of more specialised services where they meet defined accreditation standards To provide nationally recognised care for older people in hospital There are many national guidelines, strategies, reports and audits signifying high quality care in specific disease processes and pathways, despite this there are no overarching agreed standards that define nationally recognised care for older people in hospital. As a result of this, we have defined what Nationally Recognised Care means to us: it is not only meeting standards that exist but exceeding in all aspects and leading the way for the care of older people, from admission to discharge regardless of speciality 1.2 Key Objectives Person Centred Care Involvement of Carers and Family Care Kindness & Respectful Attitude Safe Hospital Enabling Hospital Seamless Service Leadership, Innovation and Staff Empowerment 1.3 Definitions CQC: Care Quality Commission NICE: National Institute for Health and Clinical Excellence NCEPOD: National Confidential Enquiry into Patient Outcome and Death NRC: Nationally Recognised Care OPPG: Older Peoples Pathway Group SECTION 2 - DUTIES AND RESPONSIBILITIES 2.1 Older People s Pathway Group This is the Trust s operational group to oversee the development and implementation of the strategy, provide leadership and support innovation to constantly improve and develop services. Work groups for each of the 7 key objectives as defined in 1.2 are led by senior Trust staff with a Trust Board member acting as a champion. Within each work stream, project leads oversee the 7
development and implementation of the action plan for each objective. Progress against agreed timescales will be monitored at the monthly OPPG meetings. 2.2 Chief Executive Overall responsibility for the delivery of the Trusts strategic objectives. 2.3 Director of Nursing & Quality The Executive Lead for ensuring delivery of the strategic objectives. Responsible for overseeing the implementation of the strategy, gaining updates from project leads and ensuring the Action Plans are on target. Monitoring compliance with CQC and providing quarterly reports to the Trust Management Team and Board. The Director of Nursing & Quality is the Designated Responsible Officer for this document 2.4 Clinical Chairs, Business Unit Managers, Head Matrons Responsible for ensuring that all staff are aware of the strategy and their role in achieving the strategic objective Responsible for managing the performance of any staff responsible to them who are integral to the delivery of the strategy. 2.5 All Staff Responsible for ensuring that they are aware of the contents of the strategy. Responsible for reporting any failure to achieve the objectives identified in this strategy to their line manager Responsible for reporting any breaches of the strategy that they witness to their line manager or other senior person 2.6 Trust Management Team Responsible for approval of this strategy. 2.7 Healthcare Governance Committee Responsible for initial approval of this strategy. 2.8 Trust Board Responsible for ratification of this strategy. SECTION 3 - STRATEGY FOR THE CARE OF OLDER PEOPLE 3.1 Introduction To achieve NRC our services must be patient centred and needs related. Older people will have access to the most appropriate services for their clinical problem, irrespective of age, under the principle Right patient - Right place Alongside the provision of best medical and surgical care there are two overarching principles in our strategy for excellence which apply to both inpatient and outpatient episodes of care alike. These are: To optimise Patient and Carer experience within the hospital environment To minimise avoidable disability and maximise independence and access For many older people this means the provision of best evidence-based medical and surgical care in the most appropriate environment for their clinical problem. 8
For people with complex health and social care needs this means the provision of: Individual therapy and care solutions delivered by:- Integrated medical, therapy and social care teams in:- Specialist Complex Care ward environments or:- Through outreach to other specialist environments for those with less complex needs Our strategy recognises the importance of seamless pathway planning with our primary, intermediate and community care partners. We place our patients and carer s needs at the centre of everything we do to achieve the best medical and functional outcomes following an episode of acute hospital care The following key objectives were developed by the OPPG 3.2 Seven Key Objectives: 3.2.1 Person Centred Care - All patients have access to the specialist services they need, whenever and wherever they are under our care. The patient is at the centre of all decision making. 3.2.2 Involvement of Carers and Family - With patients agreement, we welcome the involvement of family and carers in their ongoing management and support. With the patients consent the sharing of information between carers, family and staff is standard practice 3.2.3 Care, Kindness and Respectful Attitude - Staff prioritise time with patients and carers. Staff have the knowledge and skills to treat every patient with care, kindness and respect 3.2.4 Safe Hospital - We manage risk by providing high quality staff training, equipment and patient assessment (eg falls, pressure ulcers, nutrition, medication errors) in an environment that is suitable for patient needs 3.2.5 Enabling Hospital - We work to promote autonomy and minimise patient functional decline to achieve fitness for timely and safe discharge home 3.2.6 Seamless Service - We provide a continuous patient journey through the development of excellent communication pathways between primary, secondary, intermediate and social care services 3.2.7 Leadership Innovation & Staff Empowerment - We invest in our staff, providing training and development to ensure we encourage expert practitioners as well as developing our next generation of leaders. Continuous, sustainable service development is embedded in the culture and supported by experts in innovation and service improvement 3.3 The following policies & guidelines support the strategy but the list is not exhaustive Falls (Adult Inpatient) Guidelines Safeguarding Vulnerable Adults Policy Nutrition Policy Adults Patients Experience Strategy 9
Prevention Treatment and Reporting of Pressure Ulcers Policy Competency training Dignity & Respect Charter for Patients Implementation of National Service Frameworks, High Level Enquiries, National Confidential Enquiries and Nationally Agreed Guidance Policy Mandatory Training Policy Professional Behaviour and Etiquette Guide Capability Policy & Procedures This strategy complies with the Dignity and Respect Charter. An Equality Impact assessment has been completed. SECTION 4 - TRAINING AND EDUCATION 4.1 Training and Education needs will be developed in line with the Training and Education Plan linking with our core Mandatory Training. There may be additional specific training requirements identified within individual projects which will be detailed in the Action Plan as they develop. SECTION 5 - DEVELOPMENT AND IMPLEMENTATION INCLUDING DISSEMINATION 5.1 This strategy was developed by OPPG through a series of workshops where seven key objectives to underpin the strategy for Nationally Recognised Care for Older People in hospital, were identified 5.2 Membership of the OPPG: Executive Sponsor - Director of Nursing & Quality Consultant Elderly Care Physician Head Matrons for Care of Older People, Oncology, Emergency Care, Orthopaedics and Special Surgery Clinical leads in Occupational Therapy and Physiotherapy Nutrition & Dietetics Lead Adult Community Service - Social Worker Senior Nurse Dementia Care & Adult Safeguarding Pharmacist Older People User Group Representatives Associate Directors of Nursing Complaints Manager Patient Experience Manager Representative from Suffolk Mental Health Service Representatives from Business Units 1, 3, 5 5.3 The Strategy will be launched internally following Board Ratification via an email broadcast, Discover magazine and by dissemination through business unit managers, clinical leads, head matrons and ward matrons. 10
SECTION 6 - MONITORING COMPLIANCE AND EFFECTIVENESS 6.1 The Director of Nursing & Quality, Executive Lead for ensuring delivery of the Trust s strategic objectives, is responsible for monitoring compliance via the OPPG and will submit quarterly reports to Trust Management Team and the Trust Board. 6.2 There will be an annual review of the Key Objectives and the structure of implementation. SECTION 7 - CONTROL OF DOCUMENTS INCLUDING ARCHIVING ARRANGEMENTS 7.1 Once ratified by the hospital Trust Board the Responsible Officer will forward this guideline to the Information Governance Department for a document index registration number to be assigned and for the guideline to be recorded onto the central hospital master index and central document library of current documentation 7.2 In order that this document adheres to the hospital s Records Management Policy, the Responsible Officer will arrange for staff to be advised when this document is superseded and for arranging for this version to be removed from the hospital s intranet. The Responsible Officer will also advise the Information Governance Department who will ensure that this document is removed from the current index and library, archived and retained for 10 years from the archive date SECTION 8 - SUPPORTING COMPLIANCE AND REFERENCES This strategy complies with: 1. National Institute for Health and Clinical Excellence (NICE) clinical guidelines: CG124 The management of hip fracture in adults June 2011 CG103 Delirium, diagnosis, prevention and management July 2010 CG29 Pressure Ulcer management September 2005 CG28 Stroke July 2008 CG35 Parkinson s Disease July 2006 CG42 Dementia November 2006 CG32 Nutrition support in adults February 2006 2. Department of Health. National Service Framework for Older People March 2001 3. Department of Health. Living well with dementia: a national dementia strategy. February 2009 4. National Confidential Enquiry into Patient Outcome and Death report. An Age Old Problem: a review of the care received by elderly patients undergoing surgery. 2010 5. Department of Health. End of Life Care Strategy promoting high quality care for all adults at the end of life. July 2008 6. Department of Health. Best Practice Tariff Fragility Hip Fracture 2011/12. 11
Appendix 1 Older People s Pathway Group Organisational Chart Work Stream Lead : Set rationale, standard and measurements, co-ordinate, liaise and support project leads, update Action Plan and report to each OPPG meeting Project Leads: Develop and implement projects, recording progress in Action Plan, report to work stream lead and/ or OPPG, bring successes and difficulties to the OPPG meetings Trust Board Champion:, facilitate, enable and support Work Stream Lead