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Chief Inspector of Hospitals visit 19 January 2015 Our demographics • • • • Focused on Worcestershire (Pop 569,000) Ageing population Urban / rural mix Life expectancy generally higher than average West Midlands Deprivation • Most Deprived: 29% • Least Deprived: 15% Ethnicity - 16.8% • Black: 2.5% • Asian: 8.4% • Other: 5.9% Rurality – 91/9 • Urban: 84.4% • Town: 6.5% • Countryside: 9.1% Worcestershire Deprivation • Most Deprived: 8% • Least Deprived: 28% Ethnicity – 7.3% • Black: 0.8% • Asian: 2.2% • Other: 4.3% Rurality – 56/44 • Urban: 45.2% • Town: 10.6% • Countryside: 44.3% Our Trust Established 1 July 2011 Offering a diverse range of services from over 125 sites 354 inpatient beds 129 Mental health 195 community hospitals 30 respite (2 inpatient units in prisons) 129 Mental h 3085.35 wte staff (3924 head count) £169.2m income 2014/15 Our Partners Patients, families and carers Worcestershire County Council / District Councils 3 CCGs – South Worcestershire, Wyre Forest, Redditch & Bromsgrove Area Teams Arden, Hereford &Worcestershire - West Midlands team from 5th Jan 2015 (Dentistry/ HV’s) Staffordshire – North Midlands team from 5th Jan 2015 (Offender health) 3 emerging GP Federations / 1 practice merger Private partners – Care UK, G4S Active Voluntary & Community Sector and Healthwatch “Well Connected” - Integration Pioneer Our Vision We aspire to be a leading organisation that works effectively in partnership with our stakeholders to deliver high quality, integrated health and care services. Our Values Our Strategic Goals We will always provide an excellent patient experience Our services will always be safe and effective We will work in partnership to improve the integration of health and care Our organisation will be efficient, inclusive and sustainable Our Clinical Strategy Key outcomes for our patients Support people to live healthy lives Promote independence and support people with health care needs and/or disabilities to live well Support people to recover following an episode of ill health or injury Ensure our patients and carers always have a positive experience of our services Always provide safe and harm free care Quality Account Priorities • • • Pressure Ulcers Dementia care Young peoples experiences of sexual health services Delivery Our Service Delivery Units Community Care (£92.5m) Community Services Community Hospitals and Older Adult Mental Health Services * Adult Mental Health Services * (£34m) Inpatients including PICU CMHTs Primary Care Mental Health Specialisms – e.g. perinatal, eating disorders Learning Disability Services * (£5.6m) Respite Units Community teams Children's Services (£18.3m) Community Paediatrics Community Services Child Development Centres CAMHs * Specialist Primary Care Services (£18.6m) Specialist Dental Services Sexual Health Services Offender Health Care Note : 4 SDUs have services that are integrated with social care Strategy Moving Forward Today In 5 years 354 inpatient beds in use Care Closer to home Length of stay variable Effective admission, reduced length of stay Variable Community contacts Increased activity / community contacts that are increasingly meaningful Varied levels of integration Integrated teams wrapped around primary care where appropriate Professionals as leaders of care shifting to partnerships Shift to self care and recovery focused models whilst still supporting complex care Commitment to patient engagement True partnerships Co-production/Co-design Today In 5 years Planned leadership development Comprehensive talent management Large and diverse estate footprint of variable quality Rationalised hub and spoke model of estate. High quality environments Multiple clinical information systems in place with variable access, capability and resilience Small number of integrated clinical information systems in place with strong interfaces. Electronic clinical records Limited use of mobile technology Extensive use of mobile technology Changing workforce model Workforce transformation, generic skill sets, health and social care integration, improved engagement, Staff Governors Ambitions for growth Excellence in Worcestershire with opportunities developed elsewhere informed by market analysis and scenario planning Quality Assurance Local systems, national recognition, external assurance: Patient Safety Walkabouts / 15 Step Challenge Royal College of Psychiatry AIMs accreditation for Mental Health In-Patient and HT/CR teams Royal College of Psychiatry accreditation – ECT and MH Liaison National Awards – e.g. Early Intervention in Dementia, HSJ finalists in 3 categories Benchmarking – MH benchmarks, Community FTs, West Midlands Quality review, Peer reviews External assessments – 52 assessments between April 2013 and December 2014 CQC – 9 HMIP/ CQC – 6 CCGs – 16 ICU – 12 Area Teams – 4 NHSE - 1 WMQRS - 1 S26 visits -1 Speakeasy - 2 Achievements we are proud of and our priorities for action Strengths: Safe staffing work Quality service line reporting analysis to team level Incident reporting processes and Serious Incident Forum Infection Prevention & Control High levels of mandatory training uptake Priorities for action IT & record keeping Recruitment hot spots (Offender Health, CAMHs and inpatients) Supervising Authority delays in authorising DOLs Medical Devices “Your service is excellent and cannot believe how much support we have had in such a short space of time" Early Intervention Dementia, Wyre Forest Achievements we are proud of and our priorities for action Strengths Pledge to care Big recovery Peer support workers and Recovery College Priorities for action Getting it right - “always”/every time Out of hours support “I was so overwhelmed by the care, kindness and helpfulness of the staff " Admission Prevention Team, Kidderminster Achievements we are proud of and our priorities for action Strengths Patient and public engagement Public involvement in Quality action plan – post Francis and beyond Improved complaints procedures Priorities for action Commissioning gaps – MH liaison, Aspergers, CAMHs Tier 4 Out of hours support "Quick response, lovely nurses, great care." MIU, Bromsgrove Achievements we are proud of and our priorities for action Strengths Nursing metrics in Community Hospitals, Mental Health and community services Integrated health and care Progress towards integrated physical and mental health Strength of partnerships Royal College of Psychiatry accreditations Priorities for action Consultant led dashboards still being refined On-going development of medical leadership model in community care Research and Development expansion “We are very pleased with our son’s progress since his introduction with his speech and language therapist" Speech and Language Therapy Team Achievements we are proud of and our priorities for action Strengths Board focus on quality Values Based Recruitment Staff commitment and passion Leadership programmes Staff health and wellbeing programme Quality and Equality Impact Assessments (QEIA) process Priorities for action Embed the LD service management transfer Breadth and complexity of services and associated implications for communication “The professionalism, expertise and engagement offered by staff has enhanced our knowledge, developed collaborative opportunities and ultimately enabled older people to access quality services in a timely and effective manner" Age UK, Herefordshire and Worcestershire Key learning experiences from significant events HMP Oakwood New services opening quickly Dependency on other partners Challenges of metrics Escalation of concerns Patient voice Operation Forge Medical peer scrutiny Consultant performance monitoring Move to locality hub and impact on community nursing in Redditch & Bromsgrove Urgent care system performance Tissue viability Speed of progress Complexity related to care at home Service specific Mental Health Key achievements: Big Recovery project Work in progress: MHA Consent record keeping Mental Health acute wards and PICU Key achievements: Royal College of Psychiatry (RCPsych) accreditation of all areas, mainly at excellent Peer support workers Work in progress: Review of least restrictive practice Health based places of safety Key achievements: Good performance on benchmarking regarding number of patients in S136 suite not held in police cells Work in progress: If a Young Person is seen in the S136 suite it effectively has to be closed to adults Service specific Long stay / rehabilitation Wards Key achievements: RCPsych accreditation Excellent patient outcomes CAMHs Key achievements: Complete redesign of services – increase Tier 2 and 3+. Single Point Access. Substantial reductions in waiting times Work in progress: Lack of local Tier 4 beds Supporting increased GP understanding of CAMHs MH services for older adults Key achievements: Winner of national dementia innovation award for EI Dementia service Work in progress: Review of increased patient acuity at New Haven and staffing impact Service specific Services for people with a Learning Disability or Autism Key achievements: Successful transfer from Local Authority to Trust Management in October 2014 Work in progress: Commissioning gap around services for people with Autism/ Aspergers. Staffing levels in respite units overnight under review Community based MH crisis services Key achievements: Royal College of Psychiatry accreditation Work in progress: Impact of commissioner decision on MH liaison Other adult MH community services Key achievements: International recognition for EI Psychosis SHAPE programme - physical health for young people with psychosis Work in progress: Psychology waiting times and redesign Meridian productivity work. Commissioner discussions on IAPT investment Service specific Specialist eating disorder service Key achievements: Improved pathways with partners e.g. CAMHs Work in progress: Limited local specialist beds Community health services for adults Key achievements: Locality hub development. Tissue viability work Care Home In-reach. Dental Anxiety management service Work in progress: Transition impact and roll out Caseload management – roll out of Warrington tool Tissue Viability Community health services for children, young people and families Key achievements: Young Peoples Board. Redesign of SLT – Talking walk-in Sexual Health move to integrated services. Work in progress: Health Visitor improvements in target delivery Waiting lists for GA Paeds Service specific Community health inpatient services Key achievements: Introduction of Mental Health expertise Reduced length of stay Documentation review Partnership with GP Federation on medical workforce Work in progress: Delayed Transfers of Care / social care impact Bed occupancy during winter. Embedding medical model of care End of Life care at home Key achievements: Whole system approach - partnerships with GPs, CCGs and hospices Wyre Forest CCG - highest rate of deaths of people in their own homes nationally Orchard Service for Children & Young People Work in progress: Review of remaining mortuary facilities (in 2 hospitals) Further work to do on “One chance to get it right” Summary Our key risks 1. The delivery of the Cost Improvement Programme and its impact on quality of care 2. The ability to support the way information is managed and supports clinical care 3. The sustainability of the local health economy and the associated commissioning decisions Our quality priorities in summary Improve core systems - IT and clinical records Embed underpinning enablers – e.g Values Based Recruitment Specific issues / Quality Account - Pressure Ulcers, Dementia Care and young peoples experiences of Sexual Health Services Strengthen use of benchmarking data – Internal and external Nursing metrics, Service Line Reporting, Safe staffing Patient experience – continue to improve data capture and improvement in outcomes across the breadth of services Welcome to the Worcestershire Health and Care NHS Trust We’re here to help!