Transcript Title

Our improvement plan & our progress
Personal message from the Chair:
At Buckinghamshire Healthcare NHS Trust we are committed to ensuring our patients’ experience of our services is a good one. We take the quality of our care
very seriously and constantly strive to improve and develop. I, on behalf of the Board, unreservedly apologise where our patients have not received the standard
of care we aspire to.
Sir Bruce Keogh carried out a review into the quality of care and treatment at our hospitals as part of a national review. The review was carried out because of
higher than expected mortality rates. Since the review we have been working to reflect and really understand what actions we need to take to further improve
safety and quality, as well as the patient and staff experience. This is a real learning process for all within the organisation.
The action plan developed at the Risk Summit focuses on short-term improvements on immediate issues and we envisage the trust improvement plans going
beyond Keogh deadline dates to ensure that when the Chief Inspector of Hospital, Prof Sir Mike Richards inspects, that the trust is ready. Our actions fall under
four key themes: patient safety; patient experience; workforce; and governance. Some are focussed around our processes, such as how we record and monitor
patient care or the patient experience. Others are about rolling out examples of good clinical practice across all our services so there is one consistent approach.
All of them will support us in our ambition to get it right first time – indeed every time – for our patients. Once the immediate actions identified here have been
completed, the Trust 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.
It is important that we engage our staff, patients and the local public along the way. We want to know, and hear back from you, whether the changes we are
making are having the right impact and learn from what you, the public, have to say.
There will be regular updates on NHS Choices and subsequent longer term actions will be included as part of a continuous process of improvement.
What are we doing?
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Keogh review made 17 recommendations on 11 July 2013 which, if implemented, would improve the quality of our services.
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Specifically, Keogh said that we need to:
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Strengthen leadership at Board level and improve some of the Board processes – this is important because the Board sets the direction for
organisational culture and leads organisational change
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Strengthen processes within our urgent care pathways. This is important because strengthening these processes will improve patient experience
and may have a positive impact on clinical outcomes.
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Strengthen how we learn from patient experience. This is important because patient feedback is an important element of quality and we can
more quickly identify areas for improvement.
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Improve the way data is used to provide intelligent information in relation to clinical effectiveness and operational performance data. This is
important because such information is key to strategic decision making and for understanding our quality and patient experience.
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Formally review staffing levels and skill mix and take action where appropriate. This is important because having the right staff numbers and with
the right skills is central to the delivery of a quality service.
This ‘plan & progress’ document shows our plan for making these improvements and demonstrates how we’re progressing against the plan. This document
builds on the ‘Key findings and action plan following risk summit’ document which we agreed immediately after the review was published:
(http://www.nhs.uk/NHSEngland/bruce-keogh-review/Pages/published-reports.aspx).
While we take forward our plans 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-special-measures/
Oversight and improvement arrangements have been put in place to support changes required. More detail is shown further in the document.
Our improvement plan & our progress
Who is responsible?
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Our actions to address the Keogh recommendations have been agreed by the Trust Board
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Our Chief Executive, Professor Anne Eden is ultimately responsible for implementing actions in this document. Other key staff are the
Medical Director Dr Tina Kenny and the Chief Nurse and Director of Patient Care Standards, Professor Lynne Swiatczak as they provide
clinical leadership within the organisation. The Chief Operating Officer and Director of Human Resources also play key roles in the
delivery of the plan.
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Dr Stephen Dunn is our Trust Development Authority representative and he is helping us to implement our actions by supporting &
performance monitoring the delivery of this plan.
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Ultimately, our success in implementing the recommendations of the Keogh plan will be assessed by the Chief Inspector of Hospitals, who
will re-inspect our Trust by April 2014.
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If you have any questions about how we’re doing, contact us on [email protected] .
How we will communicate our progress to you
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Details of our action group and action plan have been published in a dedicated area on our website http://www.buckshealthcare.nhs.uk/everypatientcounts- we will also publish a summary of our progress against this plan every month
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A report will be presented to and discussed at our Board every month – these meetings are held in public bi-monthly and anyone is welcome to come
along and listen
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We will be using our blog - http://everypatientcounts.wordpress.com/ - to share the work we are doing to improve and develop care, quality and the
patient experience. And we want people to get involved by posting their comments and questions, sharing ideas or participating in discussions
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We will also use twitter to update and engage people – follow us http://twitter.com/BucksHealthcare
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We will be reporting to the Buckinghamshire Health and Adult Social Care Select Committee with regular updates, including the presentation of our
action plan at their September meeting
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Members of the Trust will receive frequent email updates, as will other key stakeholders such as our local Healthwatch, councils, MPs, commissioners
and our patient experience group
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We are working with our local commissioners so that GPs are kept up-to-date with our progress
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We will actively work with our local media – ensuring they are provided with updates and an opportunity to ask questions through our public Board
meetings
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A dedicated section has been set up on our staff intranet, providing regular updates and an opportunity for staff to post comments and ask questions.
As we progress against our action plan, we will continue to use our weekly staff bulletin and monthly team brief to provide updates. Divisional Boards
and professional meetings, for example our Nursing & Midwifery Board, discuss this action plan as a standing item at their monthly meetings.
Signed by the Chair of the Trust – Fred Hucker
(on behalf of the Board)
What have we delivered so far?
• The Trust is now reviewing every patient death in a detailed and systematic way, compared to 50 reviews twice a year previously,
which has helped us to quickly identify if there are clinical improvements we need to make. As a result we have already rolled out a
new system for fluid management
• Made significant improvements in our complaints response time, with 85% of complaints now answered within 25 days compared to
54% in March. All complainants are also being offered an opportunity to meet with the clinicians involved in their care in order to more
fully talk through their concerns
• A dedicated phoneline has been established for healthcare professionals in community services to access GP support more quickly outof-hours
• Additional doctors are working at weekends in Stoke Mandeville Hospital to support emergency medical patients on the wards and
ensuring that each and every patient admitted at the weekend is reviewed on a daily basis
• We have reviewed urgent patient transfers between our two acute sites and confirmed the small number of transfers undertaken (2-3
per day) are safe and clinically effective. We have also determined ongoing monitoring criteria
• We have recruited almost 70 qualified and newly-qualified nurses
• A new process for auditing medical patients taken to ITU within 72hrs of admission has been put in place – allowing doctors to identify
sub-optimal care and learn the lessons in real-time
• The Health & Social Care Information Centre has published the Summary Hospital-Level Mortality Indicator (SHMI) statistics for the
period April 2012 to March 2013, revealing that the mortality rate for Buckinghamshire Healthcare NHS Trust has reduced, placing the
Trust in the ‘as expected’ range. Since 2010 it had recorded ‘higher than expected’ mortality rates.
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
Patient Safety
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We will work with patient and carer group/NHS 111 provider and Clinical Commissioning Groups to
improve functionality of NHS 111 for this healthcare system.
End Dec 13
Support required from Bucks
Urgent Care (BUC) and
Aylesbury Vale Clinical
Commissioning Groups as NHS
111 is the remit of primary care.
Urgent Care
Pathways for
emergency patients
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We will review the way in which patients are transferred between hospital sites to make sure we deliver
high quality of care and ensure clinical effectiveness, positive patient experience and patient safety at all
times.
Our doctors and nurses will continue to focus on identifying and appropriately managing patients at risk of
deterioration admitted as emergencies.
We will perform an audit of medical patients admitted to ITU within 72 hours of admission. This will allow
an assessment of timely identification and management of acutely ill patients, including the response to
deterioration.
We will review the doctor cover for out of hours, including week-ends, for medical patients and put in
place additional cover at these times as soon as possible if required.
We will introduce metrics, presented in Board reports, to measure capacity for care on speciality wards
and the monitoring of patient placement in speciality.
End Sept 2013
Audit of current patient
pathways with BUC.
We will carry out a review of our patient safety culture using the Manchester Patient Safety Framework
(MaPSF).
When we have completed the review of the patient safety culture we will produce a new integrated quality
and patient safety strategy. We will explain how this strategy is going to be implemented and monitored.
We will bring together all improvement projects into this new quality and patient strategy and this will
include consideration of things that are associated with the apparently high mortality. We will use a
recognised improvement methodology such as Intermountain to support these projects.
End Oct 13
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Clinical and
operational
effectiveness:
organisation wide
monitoring
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Key for progress reports
Blue -delivered
Green – on track to deliver
Narrative – disclose delays/risks/plan to recover
Red – not on track to deliver
End Sept 2013
End Sept 2013
Assistance from the Trust
Development Authority in
identifying best practice
examples.
Progress
B/G/R/
narrative
Actions have
been put in
place but will
not be closed
until there is
evidence that
processes are
embedded.
End Oct 2013
End Dec 13
End Nov 13
End Nov 13
External support required to
assist in pulling existing quality
approaches into one combined
strategy. NHS Improving Quality
is a source of support.
Review practice at peer hospital,
Salford Royal NHS Foundation
Trust.
Support from Healthy Bucks
Leaders network.
MaPSF review
has taken
place.
First draft of
quality
improvement
strategy will
come to the
Board on the
27th November.
Our improvement plan continued…
Summary of Keogh
Concerns
Summary of Urgent Actions Required
Agreed
Timescale
Patient Experience
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We will collect and review patient experience information from all wards in the hospitals.
We will make sure that our Divisions have a clear structure and sufficiently skilled individual clinicians to
lead on clinical governance. This includes responding to and learning from patient feedback from
complaints and Patient Advice and Liaison Service (PALS), learning from incidents and claims and clinical
audit.
We will put in place consistently high standards for addressing patient complaints across all divisions with
clear Board level accountability.
We will put in place an effective process for capturing and reviewing the experience of patients presenting
acutely to the Trust
End Dec 13
We will review the staffing levels and skill mix throughout the organisation (including senior support for
Junior doctors), working towards high quality seven day cover arrangements for all services, to address
concerns about weekend and out of hours care. This will include review of services in community hospitals
in relation to their sustainability at the current level of use and include a review of capacity across acute
and community teams to ascertain speciality requirements along the urgent care pathway.
We will develop a recruitment and retention plan based on the staffing levels and skill mix review to
address the difficulties in recruiting nursing staff and the significant variation in the make-up of staffing
levels on individual wards between Trust staff and bank or agency staff.
We will review our current training and development plan against a training needs analysis and implement
changes e.g. Administering intravenous antibiotics or fluids.
We will continue to carry out a variety of two-way communications in the organisation and these will be
included in the safety culture review and development of quality and patient safety strategy.
End Dec 13
We have procured a rapid Board Development review and programme, which will provide a baseline of
Board capacity and capability, including the Board grasp of safety tools and this will focus on all six key
elements of the Rapid Responsiveness Review Report.
We will revise our Board reports, including metrics such as mortality, Friends and Family data, and allowing
improved level of detail to Divisional level.
The Board Development review will assess the Board's approach to risk management in order for the Board
to proactively plan, monitor and manage risks to patient safety, and ensure key risks are identified at all
levels of the organisation and appropriately fed through to the corporate risk register.
We will review our governance structure and processes to ensure that it is fit for purpose
End July 13
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Workforce:
inadequate medical
staffing levels and
skills mix
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Governance
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Key for progress reports
Blue -delivered
Green – on track to deliver
Narrative – disclose delays/risks/plan to recover
Red – not on track to deliver
External Support/ Assurance
Real time
patient
experience
data collection
is improving
with reports
going to ward
managers
weekly.
End Dec 13
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End Dec 13
End Dec 13
End Dec 13
End Dec 13
End Oct 13
End Oct 13
End Oct 13
Progress
B/G/R/
narrative
External reviewer nominated by
Trust Development Authority.
Work with Salford Royal NHS FT
as peer Trust
Clinical Commissioning Group
(CCG)support if more capacity is
required and support around
integrated care pathways with
primary care.
NHS Improving Quality 7 day
working team support
External review
of nurse
staffing has
been
completed and
will be
presented to
the Board.
Support from NHS Leadership
Academy for the procurement
process.
Support from KPMG in
undertaking the review.
KPMG have
completed the
review and
implementatio
n of the
recommendati
ons is due to
commence.
Strengthened
focus on
recruitment.
How our progress is being monitored and supported
This table shows how and when we are checking that the actions we’re taking are making a real difference across our clinical services.
It also highlights how we will be communicating our progress to our local community.
Oversight and improvement action
Timescale
Action owner
TDA has approved the Board development package agreed with external
provider. Leadership is driving turnaround in the trust.
Implemented
Trust
Monthly accountability meeting with TDA to track delivery of action plan.
Jul 2013 to July 2014
Trust Chief Executive/Special
Measures Director
Partnership working with Salford NHS FT as a high performing provider
organisation. This will provide best practice guidance and peer support and
challenge.
Commenced Aug 2013 and
ongoing
Trust Chief Executive
Access support from partnership working as appropriate with the Academic
Health Science Network, NHS Improving Quality and the NHS Leadership
Academy.
April 2014
NHS England
Appointment of an Improvement Director (Marie Noelle Orzel) 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.
October 2013
TDA
Meetings of the Trust Board sub-committee on Every Patient Counts action
plan which will review evidence about how the trust action plan is being
delivered, and embedded to improve services.
weekly
Sept 2013 to July 2014
Trust Chief Executive Officer
Trust Reporting to the public about how our trust is improving via monthly
briefings to local media, use of digital media and bi-monthly public board
meetings.
Monthly
Trust Chief Executive Officer
Agreement and regular reporting of quality measures to demonstrate that the
actions are leading to improved quality of care for patients.
Monthly
Trust Chief Executive Officer
/TDA
Quality governance review refresh being carried out by external provider.
End Dec
Trust Chief Executive Officer
External Scrutiny of our new ways of working/of the quality of our services by a
Quality Surveillance Group (QSG) composed of the trust CE, NHS England Area
Team, CCGs etc…
Sept 2013 to July 2014
Trust Chief Executive Officer
/Special Measures Director/Clinical
Commissioning Groups
Re-inspection
By April 2014
CQC
Key for progress reports
Blue -delivered
Green – on track to deliver
Narrative – disclose delays/risks/plan to recover
Red – not on track to deliver
Progress