Stakeholder Brief Autumn 2014 Engage News from ELHT @EastLancsHosp EastLancashireHospitals A UK First Junior Doctors Baby Mia Message from Kevin McGee, Chief Executive Welcome to the autumn issue of Engage, aimed specifically at organisations and individuals with a key interest in who we are and what we do. You are important to us and your support and participation help us to deliver safe, personal and effective care for the people of East Lancashire. I m delighted to have this opportunity to introduce myself to you so soon after taking up my post at East Lancashire Hospitals NHS Trust. In my first few weeks, I have already seen for myself what a great organisation the Trust is, at the heart of our communities, with dedicated staff, who are working day and night, trying to do the right thing for our patients. Highlights in this issue include how we are improving waiting times for both A&E and elective care; meet our new intake of junior doctors, a roundup of news from the summer and service developments and updates. Please get in touch if there are specific topics you d like us to include in forthcoming issues or if you d like to know more about the topics covered in this one. Contact: Jeanette.livings@elht.nhs.uk, Kevin Mc Gee www.elht.nhs.uk
Tackling A&E waiting times We are now seeing some systematic improvements in our Emergency Department (ED) and we now regularly exceed the national standard of treating 95% of all patients within four hours. The year to date position up to August 2014 is 96.16% and the latest figures from NHS England latest NHS England statistics (September 2014) show that ELHT has the best performing ED in our area thanks to close monitoring and specific achievements. We have: re-designed the Emergency Department to provide a better environment for both patients and staff recruited more medical and nursing staff improved triage, with both consultant and GP input ensured that diagnostics and a medical review are carried out as early as possible opened a medical ambulatory care unit, led by a consultant, for patients who do not need admitting. This clinic sees patients from 10am to 5pm five days a week. The service has reduced admissions by approximately 20 a day. On Tuesday 7th October, our Emergency Department, both Urgent Care Centres and Minor Injuries Unit at Accrington treated a total of 435 patients every one of them admitted, transferred or discharged within the four hour national standard. Referral to treatment (18 weeks) Overall, the Trust is meeting the 18 weeks Referral to Treatment (RTT) target though this varies from department to department. Demand in particular clinical specialties, staffing and staff workload can all impact on this target. To ensure delays are minimised, we are improving the way we communicate with patients from the moment they are referred, to make sure that they know about their rights to treatment and their responsibility to take an active part in their care. % of patients Target% 2009/10 2010/11 2011/12 2012/13 2013/14 treated within 90 94 92 92 93 91.8 18 weeks on an admitted pathway treated within 95 99 99 99 99 98.6 18 weeks on a non-admitted pathway on an ongoing 92 96 96 95 96 96.2 pathway under 18 weeks 2
Drs Woodhead, Gavan and Hardy performed a keyhole procedure using an advanced German-made stent to realign a patient s main artery A UK first for hospital team A team of doctors at the Trust has become the first in the UK to perform a keyhole procedure using an advanced German-made stent. Dr Peter Woodhead, Dr Duncan Gavan and Mr Simon Hardy spent a nerve-racking three hours feeding the device into a patient s main artery, where a dangerous swelling had developed. Stentgraft sections Although the trio have performed hundreds of similar procedures, this was the first time they had used stentgraft sections to realign the iliac branch using X-ray technology. Dr Woodhead, also an interventional radiologist, said the devices produce a much better outcome for the patient, who would normally need full surgery, involving a much longer stay in hospital, and intensive care during recovery. First in the country Although the technique has been used before by a handful of major hospitals, this was the first branched iliac graft in the country to use a stent designed by the German firm Jotec. It was incredibly complex and we were all nervous beforehand. We chose this device because it was a good fit for the patient and went through the procedure several times with the company, said Dr Woodhead. The Trust was recently designated as a specialist centre for vascular surgery and interventions. 3
Trust Quality Strategy and Improvement Plan Published In response to the recommendations made by the CQC following the recent inspection, the Trust has produced its Quality Improvement Plan in partnership with local health and social care organisations. Click here to view Quality Improvement Plan The key aims of the plan are to: Reduce harm, improve safety Improve patient flow across our services Reduce mortality Enhance the patient experience Embed a continuous learning process Improve communications and engagement Develop leadership skills Quality Improvement Plan Summary - September 2014 Public Summary 2014/15 Quality Strategy In addition, the Trust has also set out three main goals to achieve for this year detailed in the Quality Strategy for 2014-15 Click here to view the Quality Strategy Reducing harm to our patients by 15% To save an additional 150 lives a year 75% of our staff recommending the Trust to their friends and family www.elht.nhs.uk Trust named as one of Royal College of Physician s Future Hospital Sites ELHT and the wider Pennine Lancs health economy is celebrating being selected as one of four Trusts nationwide to be named a development site for the Royal College of Physicians (RCP) Future Hospitals programme. The Future Hospitals Commission described how care and the systems and staff that deliver care need to change given the aging population and that people are living longer and with multiple conditions. The programme aims to implement the RCP s vision in improving the care of medical patients by bringing medical specialist care closer to the patient wherever they are, in hospital or in the community. East Lancashire Hospitals NHS Trust was one of 20 Trusts who applied to become a development site and its project becomes one of four partners with the RCP in implementing and evaluating the Future Hospital in practice. The Trust s project aims specifically to improve the care of frail older patients - working with local colleagues in primary care, commissioning and social care to coordinate and respond when an older persons health condition or care needs worsen, so that they can rapidly get the care, assessment and treatment they need by the right mix of professionals. This will help prevent some people being admitted to hospital, and means that those who do come to hospital should return home more quickly to complete their care with extra support. This will involve changes in the way that a number of our staff work in hospital and in the community, and improve the way the Trust works together with other organisations to provide the right care quickly. Dr John Dean, Associate Medical Director at the Trust who is leading on the Future Hospitals project, said: Our staff have developed a clear picture of how our current system needs to change for all of this to happen, and we are working together to make these changes now. Becoming a Future Hospitals site will help us to learn with others across the country and locally as we make these changes, as well as carefully evaluating their impact, and share that learning nationally. Being selected is a testament to the commitment of our staff to continually improve the way we deliver care. 4
Meet our new junior doctors In August, 69 new junior doctors started their two-year residencies with ELHT. Officially known as FY1s (Foundation Year Ones), the new junior doctors are joined by 117 speciality trainee doctors as they begin on the job training. Linda Whitfield, Head of Clinical Education, said: Our new doctors receive on-going support from senior staff during their time here to help them in their first jobs so we can pre-empt any problems early on and better nurture their skills. Life as a junior doctor can be a steep learning curve but we offer the right support to ensure they learn from their peers and that patient safety is not compromised in any way. Shadowing Junior doctors stay with the Trust for two years and begin by shadowing the doctors and ward teams they will be working with, as well as training for prescribing, blood transfusion and resuscitation competency. Safety and high quality from Day One Patient safety and providing a high-quality service are at the heart of East Lancashire Hospitals NHS Trust. This shadowing period could save lives, and will equip junior doctors with the local knowledge and skills needed to provide safe, high quality patient care, from their first day as a doctor, says the Trust s Executive Medical Director, Dr. Ian Stanley. The Trust is a major centre for the training and development, of large numbers of doctors, nurses and other health professionals. The Foundation Programme Medical school graduates enter a two-year integrated Foundation Programme based on six four-month posts in the same NHS Trust. This programme enables doctors to acquire the core competencies required today, and includes an understanding of different settings in which medicine is practised. These include the core clinical skills required to care for acutely ill patients as well as communication, team working and IT skills. The Foundation Programmes at East Lancashire have been carefully constructed to provide a wide range of educational opportunities both in the Trust and within the community. 5
3 5 1 2 4 May The Trust s Maternity Service hosted a national conference at The Dunkenhalgh Hotel in Clayton-le-Moors to celebrate good practice in women s experiences of maternity service. Midwives and local service user representatives showcased maternity services in East Lancashire, which this year was awarded Maternity Service of the Year by the Royal College of Midwives. (Picture 1) June Patients and staff moved into the new 7.8 million Clitheroe Community Hospital (opened by Corrie actor Malcolm Hebden pictured above). It s been designed on dementia-friendly principles, with 16 individual rooms and an additional 4x4 bed bays which can be converted into single bedrooms if needed. (Picture 2) July The Trust was officially released from special measures by the TDA in July this year following publication by the CQC of the report of the Chief Inspector of Hospital s visit in April. We were formally been rated as requires improvement with the report recognising that the inspectors were particularly impressed by the hard work and commitment, noting that the staff were kind and caring, and patients generally had a positive experience. However, we are realistic that requires improvement means just that and we are continuing to implement actions that will enable us to continue our progress so that we can soon be rated as good. We will then seek to progress to outstanding. It is now time to draw a line in the sand and look forward, implementing the clinical and quality strategies that will enable us to deliver the best possible safe, personal and effective care to all our patients. The Endoscopy Unit at East Lancashire Hospitals NHS Trust gained national accreditation from the Joint Advisory Group (JAG) on Gastro-intestinal Endoscopy. It s a measure of quality which sees JAG accredited units operating to the highest standards. (Picture 3) Wendy Harrison a Trainee Advanced Practitioner in the Emergency Department at the Royal Blackburn, was awarded Pioneering Community Nurse of the Year award at the Welch Allyn Pioneers of Care Awards 2014. Wendy received a 500 bursary as part of her award. (Picture 5) A new prostate scanner which can diagnose cancers within minutes was officially unveiled at Burnley General Hospital. The scanner, which is the showpiece in the Trust s newly opened Urology Investigation Unit at Burnley, will help detect kidney, prostate and testicular cancers and reduce waits for diagnosis. (Picture 4) 6
6 8 7 9 August A 1 million investment to improve cancer care in the area has begun. The Macmillan Cancer Improvement Partnership in East Lancashire and Blackburn with Darwen is a pioneering three year programme to provide better care and support for cancer patients from the moment of diagnosis to beyond treatment. Kevin McGee joined the Trust from the George Eliot Hospital NHS Trust in Warwickshire, where he had been the Chief Executive Officer since 2011. Kevin led a change management programme at the George Eliot Hospital Trust, improving patient experience and safety. He was also instrumental in working with the management team and staff at the Trust to put in place a number of quality improvements. (Picture 8) September There has been a rise in the number of student nurses choosing to stay and work with the Trust following their graduation. Since the introduction of degree-level nurse training, up to a quarter of student nurses move elsewhere over the three-year course; but this year, every one of the current first year student nurses has chosen to continue their work and studies with ELHT. (Picture 6) The Trust AGM and celebration event showcased the significant improvements in a number of areas and multi-million pound investments in staff and facilities. Over 250 visitors heard about the good work of a number of hospital and community NHS services including dementia, life support, falls team, stroke services and maternity and were able to take part in demonstrations including Tai Chi. (Picture 7) The Trust was awarded excellent marks for standards of cleanliness, food, and privacy and dignity in the 2014 Patient-led Assessment of the care environment (PLACE) report. The Trust s overall food rating rose to 85.74%, a significant increase on the last year s score of 79.97%. Cleanliness of the Trust s hospitals scored highest of all at 91.68%. (Picture 9) 7
Service Updates SPORT Hospital admissions and stays for children with respiratory conditions, including asthma, cystic fibrosis and bronchiectasis could be reduced thanks to a 12-month pilot project now under way at the Trust. The new service, called SPORT Specialist Paediatric Physiotherapy Outreach Respiratory Team has been commissioned in the Paediatric Physiotherapy department. As well as reducing number of admission and length of stay, the project aims to facilitate discharge and improve patient function and outcomes whilst reducing disruption to daily life. The team is led by Natasha Pickering and currently consists of two physiotherapists Kirsty Mckillop and Jo Thornton (??awaiting update on staff numbers). This service is aimed at Paediatric patients with existing respiratory conditions including Asthma, Cystic Fibrosis and Bronchiectasis and also Complex Needs patients with respiratory issues. The team primarily accepts referrals from consultants, respiratory nurses and physiotherapists. SPORT will provide an acute and community service responding to emergency and routine needs. The team is based in the Physiotherapy Department, Level 1, RBH. Baby Mia one in 300 to benefit from tongue tie service Staff in Family Care and Surgery Teams at East Lancashire Hospitals NHS Trust recently marked a milestone in the number of tongue tie divisions carried out at the Trust. Tongue-tie is a problem that occurs in babies who have a tight piece of skin connecting the underside of their tongue and the floor of their mouth. The condition is often spotted by midwives or health visitors. Tongue tie can cause problems with breast feeding and sometimes bottle feeding as the baby has trouble latching on. This in turn can cause problems for both the mother and for the baby who can be slow to gain weight and can suffer from colic and wind.. There is, fortunately, a fairly simple and painless procedure to fix the problem, known as Frenotomy, offered by the Trust s Maxillo- Facial Surgeons in an outpatient clinic. The service, which started at the Trust just over three years ago, has now carried out over 300 procedures; it also treats patients from other areas where their local Trust does not offer this procedure or waiting times are too long. Baby Mia Logan is one the patients to benefit from this service. Mum Jaclyn Logan, from Blackburn, said: After Mia was born she wouldn t latch on and would even struggle with drinking expressed milk from a bottle - which I had done with my younger son who I also struggled to breastfeed. She continued to lose weight and was jaundiced so I was very lucky that my midwife referred me to the infant feeding team at the Trust. They immediately diagnosed posterior tongue tie and I went to see Mr Cousin, the surgeon, who explained the procedure to me and carried it out there and then. Mia didn t cry and immediately went back to sleep. Straight away she started drinking far more milk with little trouble and the infant feeding team helped me to get back to breastfeeding which I didn t think was going to be possible four weeks after I d had to stop as it was very painful and Mia obviously wasn t feeding well. Three months down the line, Mia has put on weight and is thriving, easily drinking the amount of milk needed. Jaclyn added: I d say that if any mum has problems feeding, let your health visitor or midwife know. I d never heard of tongue tie and thinking back, my son had probably suffered from a similar thing though not as severe as he was able to drink from a bottle. Sue Henry, Infant Feeding Co-ordinator at East Lancashire Hospitals NHS Trust, said: Tongue tie is surprisingly common though not very well known and lots of babies with tongue ties will not have any problems feeding and some will resolve over time by themselves. However, a tongue tie division procedure carried out when a baby is very young can be worthwhile as they will not need an anaesthetic and it can help the mother continue breastfeeding. If mums do have problems during breastfeeding, it is certainly worth checking to see if there is a tongue tie before switching over to bottle feeding. 8
Complaints performance The way the Trust deals with complaints was a key feature in the initial Keogh Review and some key changes to the Trust s complaints processes and systems over the past year have resulted in fewer formal complaints and faster resolution times and a 20% drop in complaints over the last three months. These have included: the introduction of a matron on-call bleep so that senior staff can be contacted quickly to meet with and listen to a patients concerns a training programme which has increased staff confidence in responding to patients concerns. This reduces the chance of a concern escalating to a formal complaint. Improvements in data capture and analysis have also provided more accurate information about the nature and source of complaints. The majority of complaints are related to all aspects of clinical care and treatment, while the next biggest category (though far smaller in number) relates to the attitude of medical and nursing staff. Over the coming months, the Trust will assess if this new data capturing mechanism accurately reflects the reasons patients and families log formal complaints. Top 5 Recorded Subjects (Primary Subject) - August 2014 Complaints Closed New Complaints Opened New Complaints opened in August 2014 PALS contacts recieved - August 2014 9
Stakeholders Event On Tuesday 14th October, we held our third Stakeholder Listening Event at the Trust s Learning Centre at the Royal Blackburn Hospital. Representatives of our patients, external partners, voluntary sector and commissioners came together with members of our Trust Board to listen to each other. Chief Executive Kevin McGee met many for the first time, and told of his plans and aspirations for the medium term. Gill Simpson, newly appointed Executive Director of Operations focussed on the challenges of the forthcoming winter and our plans to address them and Dr Ian Stanley (Acting) Medical Director reported on our progress against the Quality Strategy and our commitment to deliver harm free care. Presentations are kept to a minimum so that there is plenty of time for questions and discussion and Tuesday s event, like the two previous ones, was notable for the quality of the debate. It is particularly pleasing that all stakeholders seem to acknowledge that some of the challenges faced by the hospital are in fact the responsibility of the whole health economy and we are all working together to address them. Achievement of the 4 hour target in A&E is seen as crucial, and while this may be viewed by some as a crude target, the Trust feels it is indicative of quality and every effort is made to hit the target, though not always with success. This is one area though where everyone, not just the hospital, has a part to play. Making sure that our population seeks (and receives) the right treatment, at the right place is essential. Vicky Shepherd of Age UK talked of the importance of what she called the softer stuff feeding, personal hygiene, communication and Ian Stanley agreed. He assured Vicky that our Chief Nurse is leading the Trust s drive to get all this right and Director of Corporate Affairs, Nicky O Connor, confirmed that our Quality Improvement Plan (in response to the CQC inspection) includes many actions around this, including the importance of nutritional, tasty food. Ward C5 was highlighted as a leading example of dementia friendly care. Dr Mike Ions, Chief Clinical Officer at East Lancashire Clinical Commissioning Group confirmed that the relationship between the Trust and the CCG was very good, at all levels, not just at the top. The joint commitment and approach to improving quality was particularly beneficial to patients and the community as a whole. Public Health Director, Dr Dominic Harrison talked of the challenges facing the whole county (not just East Lancashire) and the need to reduce reliance on beds. Everyone agreed that this could only be done once community facilities and services were fully in place to cope with increased demand there. Martin Hodgson, Director of Service Development urged stakeholders to look at our five our year plans which detail the expected strategic changes and operational improvements. Dr Ions reiterated that joint working between agencies to keep people out of hospital in the first place, or in for as short a time as is appropriate is beneficial for all, but until that is working well, the hospital beds are needed. Ben Aspinall, Blackburn with Darwen Borough Council, advised that there is a lot of work going on in the community to prevent falls that if increased, and shared, could have a significant impact. Dr Paul Huxley, GP, praised the Trust on its brand Safe, Personal and Effective as it is clear, easy to understand, and the right thing to do. Indeed, he counselled it could be the vision for everyone in the health economy! He was nervous though, about recruitment difficulties, staff sickness in winter, Flu and more. It was agreed a joint communications campaign would be helpful and Gill Simpson confirmed that the Trust was undertaking a Perfect Week exercise starting Monday 20th October which enables the Trust to focus completely on effective patient pathways and flow, to recalibrate the system in preparation for the winter pressures. The next stakeholders listening event will be in January 2015. 10