This month, I am pleased to inform you about this important project, Mouth Care Matters, and am proud to support the Dental Service within the MaxilloFacial Department as the Executive Lead on this. 1 Bay Governance Blog Improving the Quality of Healthcare for our Patients Issue 21 August 2018 What is Mouth Care Matters? Mouth Care Matters - Led by: Sara Hurley, Chief Dental Officer for NHS England. (Putting the mouth back into the body). Adopting this model of oral healthcare can improve and safeguard the health and wellbeing of elderly patients in hospital. Why do we need this project? Mouth Care Matters an initiative that utilises dental health care professionals to improve the oral health of hospitalised adult patients. Mouth Care Matters - is a simple but highly effective intervention, which is not just about oral health but improving the overall quality of care, which saves a lot of NHS-funded care. Why Does it Matter? Mouth care is sadly neglected in many patients admitted to hospitals, especially in elderly care wards. This lost opportunity for improving quality of care is contributing to extended hospital stays for vulnerable patients and, above all, compromises the compassion and dignity of valued patients. Oral Health Champion Volunteers Thank you! We really appreciate the colleagues that have come forward and volunteered to be Oral Health Champions. We are in the middle of organising an Oral Health Champion day to be held in November 2018 at FGH Education Centre. stephanie.gillies@mbht.nhs.uk sophie.jackson@mbht.nhs.uk Find us on twitter: @ohestephie1 @OheSophie To improve quality of care, hydration and nutrition levels and reduced length of stays. Putting the mouth back in the body Mary
2 This month, the Hub has been working on: Automated WESEE Care Group development reports to ensure that all data comes from the single source of the truth so that the data presented is both cleansed and accurate. CQC preparation, which is integral to the success of the unannounced inspections, and deals with the practicalities of what is required from the Care Groups, and the Trust as a whole. Staff Focus groups are being arranged with an external facilitator who has CQC inspection experience. Staff Focus Groups with the CQC inspectors will follow, once we know the dates, for which you will be notified. A Staff information leaflet has been compiled and reviewed by the Hub. It is planned to be distributed to staff by mid-october. It will be business as usual while the inspections are underway, but the leaflets aim is to provide all staff with an overview of the inspections, give guidance, and alleviate any concerns. Don t forget that you can follow the Hub on Twitter @UHMBGovHub Joe, and the Governance Hub Team Risks and Alerts RISKS Hello. My name is Dot Hemsley and I have taken over from Carl Foulkes to oversee the Trust s Risk Register and Alert system. I work 15 hours a week over 4 days and am contactable via email: dot.hemsley@mbht.nhs.uk or by mobile: 07870 881823. You can also leave messages for me at either RLI: 49425 or WGH: 46704 The Trust currently has 307 risks on its risk register which are made up of issues identified by care groups and corporate departments. These risks can be found on the intranet (go to incident and risk on favourites log in with your name and password and go to RISK). Risks are usually entered by either your care group Governance Business Partner, or a senior manager. They will initially sit in a pending folder awaiting sign off by your governance and assurance group or by a senior corporate meeting. Risks which have been signed off (assigned) will then be monitored at various trust committees and will inform the Trust Board of issues that the care group are concerned about. They will show current controls in place and actions which are being taken to mitigate the risk. The top risks as identified by the Board this year are: ALERTS Risk No. 2100 Robust Sustainable Safe Staffing Levels Risk No. 2101: Patient Flow Risk No. 2124: Quality of Environment and fabric of our estate and its implications for patient safety and experience Risk No. 2445: Bullying & Harassment The MHRA currently publish alerts which are sent to Trusts which we are required to show compliance on within a short period of time. These are entered onto the Alert system and sent to governance business partners to gain assurance from staff within the care group that staff are aware of the alert. NHS Improvement and the CQC monitor our assurances and it is therefore essential that these are dealt with in a timely manner. If you would like further information on risks or alerts, please do not hesitate to contact me. I am happy to come to department meetings to inform staff, and happy to work with staff on a one-to-one basis to allow them to enter risks, or complete alerts. Nicky, and the Patient Safety Team
3 For patients and families who have received sub-standard care, communication sometimes falls short of both the ideal and what evidence of good practice shows is possible. Building a culture of openness across the healthcare system: From transparency through learning to improvement? The Trust is supporting the University of Leicester to undertake independent research commissioned and funded by the Department of Health Policy Research Programme Efforts to learn from high-profile failings have led to recommendations for improving transparency openness and candour in the NHS. In recent years, following wide-ranging consultation with stakeholders inside and outside the NHS, specific policies have been developed to cultivate openness. The result is a series of strategies intended to provide a foundation for culture change, including the statutory duty of candour, the introduction of Freedom to Speak Up Guardians, changes to the relationships between regulators and the scope, focus and reporting of CQC inspections, a revised Serious Incident Framework, among other initiatives. Evidence suggests that change is hard won and healthcare cultures (in the NHS and other systems) have often struggled with openness. For instance, the available evidence suggests that the issues of poor care, faulty systems, or inappropriate conduct are often known to or suspected by personnel at the sharp end of care, yet problems of silence (where employees do not speak) and deafness (where organisations do not hear or act) persist. Change is challenging, and pressures on the NHS, including meeting targets and organisational turbulence, may impede efforts to improve openness. Moreover, some have questioned whether some aspects of certain strategies may bring about unintended consequences. For example, the introduction of legal and disciplinary sanctions for a failure to uphold the duty of candour might create a culture characterised by superficial compliance. The research is seeking to identify the impacts of such strategies - including intended and unintended consequences, positive and negative - across different levels and settings within the NHS. By identifying what works - and what doesn t the evaluation will offer clear, practical and actionable findings that will improve the experiences of patients, their families, and staff. UHMB has been chosen as a case study site to support the research alongside an acute, ambulance, and community and mental health trust, as well as one private provider. We are pleased that we are able to support this work. The study as a whole will give rise to a report to the funder (Department of Health Policy Research Programme), to papers to be submitted to peer reviewed academic journals, and to practiceoriented outputs for managers and clinicians in the health service. We feedback to participating sites on our findings on their work, and we will share this when it is published. Paul, Olivia & Nicola Company Secretary Team
4 It s been a very busy first quarter for the Programme Management Team whose aim is to support staff across the Trust to improve standards of care and patient experience. The PMO work with staff across the whole of the Trust. Using a structured approach, the PMO help increase your chances of success in delivering your improvements. More than that, we will advise and support you throughout your project. At the time of writing, the Care Groups between them have some 293 projects and initiatives that they are working on. These projects range from transactional contract negotiations, service re-design, skill mix reviews, and service relocation, to name but a few. The CIP target for quarter one was 2.33 million with the Care Groups actually delivering 2.65 million in savings. An excellent achievement, and certainly heading in the right direction of achieving their full year target of 14 million. Quarter one savings were due to theatre efficiencies, an increase of the number of patients meeting Fractured Neck of Femur Best Practice Tariff, renegotiation of the Pathology Managed Service Contract within Core Clinical Services, more accurate coding of A&E admissions, a review of bed watch arrangements and a drive to improve staff attendance. There were also significant savings made by less use of Agency staff and recruitment to substantive posts. Some of the other projects we are currently working on are: Procurement Schemes Reduced Histopathology Outsourcing Keogh 7 day Service Maintenance Contracts Reviews Orthotics Contract Electronic Profiling Beds Cemented Hips Repatriation of Activity Centralisation of Medical Records Vacancy Factor Take Home Analgesia Drug Efficiencies Community Paediatric Services Catheters Standardisation Core Clinical Services are well on the way to relocating the Medical Records Department to Barrow in Furness. The project is on time with a completion date of the end of August. The Medical Records service has continued without interruption despite the complexities of the relocation, and the hundreds of thousands of paper notes that have been transferred to their new library building.
All of the Care Groups have been focusing on how to drive down the cost of consumables and a good example of this would be Pathology. There are two products that UHMBT purchase to test for MRSA, these being plates and swabs. Just through a change of supplier, and without compromising the quality of the product, a further 20k of savings a year has been achieved. QSIR Training The PMO Team have now also had a number of their staff complete their QSIR (Quality, service improvement and redesign) courses. The QSIR programmes are delivered in a variety of formats to suit different levels of improvement experience and are supported by publications that guide participants in the use of tried and tested improvement tools, and featured approaches, as well as encouraging reflective learning. The QSIR College programme offers NHS organisations and health systems a unique opportunity to develop quality and efficiency improvement capability within their organization or across their system, enabling them to rapidly build up a sustainable local skills base. Participants in QSIR College will learn how to train clinical and non-clinical colleagues in the QSIR practitioner programme, providing them with the know-how to design and implement more efficient patient-centred services. Based on tried and tested tools and approaches, QSIR covers the breadth of service improvement skills. 5 Forward look Quarter 2 The monthly CIP plan increases at quarter 2 with another step change at quarter 3 and 4. The graphs below illustrate this. Graph 1 shows the CIP 18/19 plan and forecast outturn on a month-by-month basis, whilst Graph 2 shows the plan and forecast outturn on a cumulative basis. Graph 1 Graph 2 The Care Groups have achieved excellent CIP savings in quarter 1 and it s really important that we continue to achieve our savings targets. At the moment the forecast is telling us that we are likely to be short of our overall 14 million CIP target by 252k. If you have any service improvement or service CIP initiatives that you need project support with please contact the PMO who will help and support you throughout the life of your project. Martin, and the PMO team