EAST AND NORTH HERTFORDSHIRE NHS TRUST CHIEF EXECUTIVE S REPORT

EAST AND NORTH HERTFORDSHIRE NHS TRUST CHIEF EXECUTIVE S REPORT Agenda Item No. 7 23 rd January 2008 1. Christmas Day Visit From Mayor of Stevenage and General Secretary, Royal College of Nursing Alison Murray & I were delighted to welcome Cllr Graham Clark, Mayor of Stevenage to the Lister Hospital on Christmas Day morning. Similarly, at the QEII, Jane McCue and I welcomed Dr Peter Carter, General Secretary of the Royal College of Nursing. Dr Carter found the tour most interesting and has asked for a follow up meeting in the new year. 2. Norovirus Outbreak The Christmas/New Year s Eve period was an especially difficult time for the Trust. Whilst the peak of emergency admissions was predicted and planned for, the seasonal prevalence of winter vomiting disease (or norovirus as it is sometimes known) arose unusually early this year, and affected more patients in both the hospital and the community than for very many years. On 28 th and 30 th December two wards at the Lister Hospital were closed to admissions for 13 and 10 days respectively. On 3 rd January symptoms were detected in patients on a third ward, and that too was closed, on this occasion for six days. This follows earlier outbreaks on two wards at the QEII Hospital in the month of November and at the end of that month another ward at the Lister Hospital. Over the course of the winter 142 beds were closed to admissions for a total of 66 days through a succession of norovirus outbreaks, affecting 67 patients and 3 relatives. In addition 28 members of staff contracted the virus and were prevented from attending work until they were well. In every case patients, relatives and staff made a complete recovery from Norovirus within a few days, and but for the vigilance of ward staff in promptly reporting outbreaks to the Infection Control Team who quickly instituted control measures to prevent further spread the situation would have been much worse. Norovirus is extremely contagious and very difficult to control. Preventing it coming into the hospital is extremely difficult at a time when prevalence in the community is so high. Indeed, in some of the outbreaks index cases were traced to visitors bringing the virus into the hospital where it quickly spread through wards of frail, debilitated and elderly patients. 1 of 6

Nevertheless, the hard work, commitment and attention to detail by clinical staff, who by the nature of the outbreak could not be relieved by colleagues in other areas even when some of their number were excluded from duty, resulted in each and every outbreak being brought under control quickly, and a programme of terminal cleaning being instituted in order to eradicate any traces of the virus before wards were re opened to admissions. Whilst there was some disruption to patients waiting for beds from the emergency wards and accident department, at no time was the hospital closed to admissions, and patients continued to be seen, treated and referred as normal. I would like to recognise both the support of all clinical staff through this time and record the thanks we owe to our colleagues in the Estates department and ISS cleaning sub contractors who worked tremendously hard through enhanced cleaning regimes and exhaustive terminal cleaning to restore normal operations quickly. We are also grateful for the very responsible and helpful reporting of these public health problems by local media which resulted in awareness by the general public becoming much higher, and limiting the likelihood that these infections might be brought into hospital by visitors not feeling well themselves. 3. Award of Level 2 against the NHSLA General Clinical Risk Management Standards The NHSLA i Risk Management Standards for Acute Trusts address central issues concerning clinical care commonly raised during litigation claims handling. The promotion of good risk management and governance are integral components of the NHSLA schemes (NHSLA April 2007). They aim to encourage trusts to ensure that systems of care delivery are well planned and managed so as to reduce the risk of incidents and continuously improve patient safety and patient care. East & North Hertfordshire NHS Trust was awarded level 2 against these standards on January 16, 2008. The Trust had held Level 1 from 2004 to this point. The award of level 2 represents enormous progress in the area of risk management which includes governance arrangements, professional regulation and staff management, training and development, creating a secure and safe environment for staff and patients including vulnerable adults and child protection as well as a number of areas related to clinical care, learning from experience and adherence to best practice guidelines. The fifty standards provide a framework which help hospital services to focus their clinical risk management effectively, thereby improving care for patients. Contributions to the NHSLA premium are reduced if the Trust meets the NHSLA risk management standards. 2 of 6

The potential cost saving to the Trust of achieving level 2 of the NHSLA standards is considerable, with a 20% reduction accruing against the Trust s 3million annual premium (Level 1 attracts a 10% reduction). This should also be considered in the context of improved services for patients and their families with the further potential to reinvest some of that saving in areas where standards have not been met in full. The assessment is the culmination of a year s preparation and a great deal of hard work preparing and auditing policies against clinical practice all over the Trust. The work was led by the Clinical Governance Department but undertaken by every clinical and support department including Human Resources, Training, Nursing, Legal, Complaints, Patient Access, Infection Control, Blood Transfusion, Resuscitation, Child Protection, Protection of Vulnerable Adults, Pathology, EBME, Pharmacy, Occupational Health, Moving & Handling, Safety & Security, Medical Equipment, NHS Professionals, Medical Staffing, Medical Records, Risk Management, Trust Management and Clinical Audit as well as every Clinical Directorate and Department. The NHS Litigation Authority (NHSLA) was established on 20 November 1995 to indemnify NHS bodies against claims for clinical negligence. The NHSLA is a Special Health Authority and, therefore, part of the National Health Service. It is not an insurance company. Initially, its sole function was to administer the Clinical Negligence Scheme for Trusts (CNST), a risk pooling scheme in respect of clinical claims arising from incidents. The CNST standards are now referred to as the NHSLA risk management standards. Its functions include managing and raising the standards of risk management throughout the NHS. All member NHS bodies are assessed at least once every two years against a series of risk management standards. The latest versions of these standards are available on the NHSLA website at www.nhsla.com. 4. Teaching Status The Trust has been designated as an Associated University NHS Provider Trust by the University College London Medical School. Associated University designation is awarded in recognition of training services that a non teaching hospital provides to medical students during their attachments. East and North Herts NHS Trust has a long history of teaching medical students spanning back many years. Over more recent years, we have had a sharp increase in student numbers being received for training in our acute hospitals, a clear indication of our preferred provider status with the Medical School. We provide yearly mock MBBS exams to final year students, simulation training at the University of Hertfordshire, and department based training during most months in the year, which is co ordinated through our Education Centres. Upon acceptance of designation the following conditions would apply: A review at 5 year intervals 3 of 6

Satisfactory performance in UCL quality assurance mechanisms A University nominee must be included as a (voting) non executive director on the Trust Board. The Trust is encouraged to use the term University Hospitals NHS Trust in conjunction with existing logo on letterheads and signs. 5. Healthcare Commission Race Equality Review The Healthcare Commission visited the Trust on 10 th December 2007 to review race equality. The visit included two focus groups one with patients and representatives, and another with staff and interviews with the leads for race equality elements of five of the core Standards for Better Health. The focus groups were well attended and the process overall was constructive and informative. The Commission s draft report was provided to the Trust before Christmas and the final report will be published in a few months. The key recommendations from the draft report are being taken forward through the Trust s Equality and Diversity Committee (EDC) and include: The need to improve the process of carrying out race equality impact assessments To consider providing information about the Trust services in other languages and formats To consider extending the development support provided to BME staff particularly at senior levels To develop ongoing relationships with the patient and public groups in the local community to address race equality issues Action taken will be monitored through the EDC. 6. Delivering Quality Health Care for Hertfordshire On 19 December 2007, the Board of the Trust, together with the Boards of West Hertfordshire Hospitals NHS Trust, West Hertfordshire Primary Care Trust and East & North Hertfordshire Primary Care Trust, met in public to determine the outcome of the Delivering Quality Health Care for Hertfordshire consultation. We were delighted that over 250 staff and community representatives were able to attend this meeting to hear feedback from the consultation and observe the Boards consideration of the outcome of consultation which resulted in unanimous approval of the following recommendations: Centralisation of major acute hospital services in East and North Hertfordshire at the Lister Hospital in Stevenage 4 of 6

Establishment of two local general hospitals in Hemel Hempstead and Welwyn Garden City Establishing a network of urgent care centres in Hertfordshire, which will include urgent care centres at the Lister and Welwyn Garden City. In addition, the PCT will also pilot the feasibility of running urgent care centres at both Hertford County Hospital and Cheshunt Community Hospital Consolidation of children s emergency care and planned care in West Hertfordshire at Watford General Hospital Long term consolidation of planned surgery (surgicentre) services in West Hertfordshire at St Albans City Hospital In reaching their decisions, the Boards recognised the importance for the community of travel and access. In order to respond to this they have agreed to commission work on this issue, headed up by a director from the NHS who will work closely with the County Council on an integrated transport project, building on the good work done previously. The PCT has also agreed to commit up to 2.75million to improving access to care. The County Council s Health Scrutiny Committee has since scrutinised these decisions at a series of meetings held earlier this month. Committee members took evidence from and questioned the local NHS and others who wished to make representations to the Committee, including patient and staff representatives. These meetings were the culmination of extensive scrutiny by committee members of the local NHS s proposals. The Committee decided not to use their power of referral to the Secretary of State. This decision gives the green light for the NHS to commence planning and implementation of this programme of service change across Hertfordshire. 7. Quarterly Reporting on Cleanliness to Trust Board Matrons and Clinical Directors are now required to report quarterly to Trust Boards on cleanliness and infection control 1. These reports will focus on compliance with statutory obligations and will increase the ability of senior clinical staff to raise concerns over cleanliness and infection control with the Board. Clinical Directors and Matrons supported by General Managers will report quarterly in rotation from January 30, 2008. Each directorate will be asked to present an HCAI report to the Board Assurance Committee which focuses upon: Providing a clean environment for care outlining performance for their area in relation to the national cleaning standards over the last quarter (supported by the General Manager, Soft FM) 1 The Health Act 2006, Code of Practice for the Prevention and Control of Healthcare Associated Infections Revised January 2008; PL/CNO/2007/6 IMPROVING CLEANLINESS AND INFECTION CONTROL 5 of 6

Ensuring best practice in infection control including the incidence and prevalence of MRSA, MSSA, MRSA Bacteraemia, Clostridium difficile, GRE and other HCAIs in their area over the last quarter; and the outcomes and learning from root cause analyses into MRSA Bacteraemia and Clostridium difficile over this period Improving clinical care standards including their performance in relation to hand hygiene adherence, compliance with high impact interventions for central renal dialysis and peripheral venous catheters, urinary catheters, prevention of surgical site and Clostridium difficile infections, prevention of ventilator associated pneumonia, compliance with screening and decolonisation protocols for MRSA and adherence to antibiotic protocols. The reporting cycle will be as follows: Emergency Medicine, A&E, Elderly Medicine Medical Specialties Renal Medicine General Surgery, Urology & Gastro enterology Specialist Surgery Trauma & Orthopaedics Anaesthetics, Theatres & Critical care Womens services & Child health Oncology & Mount Vernon Cancer center Radiology & Pathology January, April, July & October February, May, August & November March, June, September & December The Code of Practice for the Prevention and Control of Healthcare Associated Infections will be amended to reflect this new requirement. This will mean that the Healthcare Commission (and, in due course, the new regulator who will be able to impose fines, halt new admissions or cancel a provider s registration entirely) can consider these issues when checking compliance with the standards. If NHS staff have concerns about cleanliness and infection control, they can report these to the regulator. However, in the first instance they should raise their concerns within their organisation. Reporting to Boards and to the regulator should be seen as an escalation process, rather than as two independent initiatives. The Director of Nursing and Director of Operations 2 will prepare and publicise a local system of escalation for all staff. Nick Carver 23 rd January 2008 2 The Director of Operations receives reports from the General Manager, Facilities management which is an operational cf. Strategic estates function at East & North Herts NHS trust. 6 of 6