Transcript Welcome to Brighton and Sussex University Hospitals

Quality Summit Presentation
Matthew Kershaw
Chief Executive
5 August 2014
Presentation agenda
Our journey of improvement
Our vision and approach
What the CQC found
• Ratings
• What we do well
• Challenges highlighted
Actions to address the challenges
Conclusions
Our journey of improvement
Mixed performance re safety, quality and national standards
“increased pace of change and improvement”
Significant and long-standing cultural issues
“the awareness of staff of the work on values and behaviours was almost universal.”
Why the inspection now?
‘Medium Risk’ Trust
Applicant Foundation Trust status
Listening Event – December 2013
“The team noted major strides in the six months since the listening event”
CQC Inspection – May 2014
“The current leadership of the trust are tackling issues that have remained unresolved for
a number of years.”
Our vision
To set the standard for great care, by
• Working together
• Adapting, improving and innovating
• Acting with fairness, kindness and compassion
Our approach
• Be positive and proud about what we do well
• Be open and honest about the things we need
to do better
• Be clear about what we are doing about them
What the CQC found
Overall rating
Requires improvement
Are the services at this trust safe?
Are the services at this trust effective?
Are the services at this trust caring?
Are the services at this trust responsive?
Are the services at this trust well-led?
Requires improvement
Good
Good
Requires improvement
Requires improvement
Overview of ratings
64 Good
 25 Requires Improvement
Our response
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A fair and balanced assessment of where we are
Reflects back the success and challenges we outlined ahead of the inspection
Showcases some good and outstanding services
Realistic about the challenges we still need to overcome
 1 Inadequate
What the CQC said we do well
Open, honest and transparent
“The team felt that the trust was exceptionally open and engaged with the inspection.”
High quality, compassionate care and pride in what we do
“Every service at each location was found to be caring. Staff across the trust described their pride in the services they
were delivering.”
Good outcomes including better than expected mortality
“People were receiving care, treatment and support that achieved good outcomes.”
Foundations for Success – particularly values and behaviours
“With one exception, all the staff we talked to about this had been involved directly in this work, knew a colleague
who had been, or were aware of the opportunities they had to engage with and influence this work.”
Care for patients with dementia
“Staff had been innovative and creative to provide safe and stimulating environments for people (with dementia.)”
Effective infection control team and good hygiene practices
“The trust had an effective infection control team and we observed good hygiene practices by staff.”
Critical care
“The critical care teams … were strong, committed and compassionate.”
Challenges the CQC highlighted
The five categories below are a headline summary of all the “must do’s” and
are all areas for improvement which we highlighted in our original
presentation in May and on which action is therefore already underway.
• Unscheduled care and flow, impacting on patient experience in
the Emergency Department
• The central booking ‘hub’
• Cultural issues – including race equality
• Staffing
• Environment, cleaning and food
We are also working on the “should do’s” many of which link to
overlap with these five categories.
Actions to address the challenges
Unscheduled care, flow and ED performance
Overall aim to achieve and sustain 95% ahead of winter 2014 by:
Internally developing mechanisms to better use our capacity and respond to changes and spikes in
demand. These include:
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creation of a surgical assessment unit
focus on earlier and greater numbers of discharges each day
creation of additional/flexible capacity including for 72 hours stay
‘cohorting’ policy and full capacity protocol
continued work within ED and with downstream wards on all pathway issues and flow
Working with our partners on developing new approaches and tiers of support to address the
changing environment. These include:
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alternatives to ED attendance with primary care and SECAMB
discharge to assess
repatriation to secondary care providers
Better Care Fund and frailty pathway
onward care capacity to help reduce ‘medically fit for discharge’ list
Actions to address the challenges
Central booking ‘hub’
A plan is in place to improve performance over next three months
Headline actions:
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Hub and spoke model in high volume specialties to provide local support and access for clinicians
Patient Access Managers based in the hub
Flexing of staff to answer the phones to ensure times with busiest call volumes are adequately covered
Implementation of version 2 of Choose and Book
Continuation of dedicated email address for raising concerns (checked daily and responded to within
24 hours)
Work with primary care on referral patterns
To highlight and address new and/or ongoing issues weekly activity reports include:
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Referral management – number of new referrals per week and % processed within 48hrs
Clinic management – number of clinics cancelled and number of patients affected (under and over 6
weeks)
2ww referrals – number dated within the 2-week period and challenges encountered
Phone answering – calls per day and response times
Monitoring of formal complaints and concerns raise by PALs
Actions to address the challenges
Cultural issues
Through “Foundations for Success” we are engaging the workforce to address longstanding issues. The programme includes values and behaviours, clinical structure, clinical
strategy and performance management. Has been running since August 2013 and now
into implementation.
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Values and Behaviours blueprint and implementation plan including workstreams on race equality
and empowerment, accountability and performance management now developed
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Appointment of new Director of Strategy and Change
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New clinical structure to remove a layer of middle management and give those closest to the
services more responsibility and authority
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Focus on increased communication, engagement, training and appraisal has started – positive
initial feedback but more to do
Actions to address the challenges
Staffing levels
• £3 million investment in nursing including increased nurse to patient
ratios and supernumerary Ward Sisters/Charge Nurses
• Publication of nurse to patient ratios show that our ratios compare very
favourably to those set within equivalent trusts and we are making
progress towards achieving them
• Improvements to efficiency of recruitment processes and prioritisation of
nursing recruitment in line new recruitment strategy
• Clinical restructure to include lead nurse in each new clinical directorate
with overall responsibility for nurse staffing issues
Actions to address the challenges
Environment, Cleaning and Food
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3Ts redevelopment of Royal Sussex County Hospital
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Ahead of this a capital investment programme to maintain existing
estate/facilities to the highest possible standards and improve where
necessary including, for example, works to support service reconfiguration
and refurbishment of PRH discharge lounge
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Creation of Lead Nurse as link between ward areas and Sodexo to receive and
action issues raised and proactively identify and drive improvement
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Detailed contract negotiations with Sodexo to improve performance in
relation to all ‘soft’ facilities management functions
In conclusion
We take lots of positives from the report in relation to the ratings themselves and the
way that we approached the whole inspection process. However:
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We acknowledge and accept that overall BSUH requires improvement and we are
absolutely committed to continuing the journey of improvement which we are on
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We will continue to be honest about where we get it wrong and what we are doing
to put it right
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We will constantly learn and look at ways we can improve
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We will continue to engage with our patients and staff to achieve all of this
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We will work internally to make the necessary changes and improvements and look
to our partners to do the same in relation to the areas we cannot deliver in isolation,
particularly around unscheduled care, patient flow and the impact this can have on
the experience of patients who use our Emergency Departments