Our Passion, Your Care. Quality Account 2017/18 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Contents
Part 1 - Statement on quality Chief Executive’s commentary ...... 3 Who was involved in the Trust services ………...…………………………………………………………4 development of our Quality Account? Part 2 - Priorities for improvement and statements of assurance The Trust consulted with the 2017/18 quality improvement priorities ...... 6 following in the development of Patient Safety Priority: To continue to develop services to support its Quality Account and the patients who are elderly and frail ...... 6 content within: Clinical Effectiveness Priority: To continue to improve our care to our commissioners, Ipswich those at the end of their life and support patients who have limited and East Suffolk Clinical treatment options ...... 7 Commissioning Group; Patient Experience Priority: To avoid delays in transfers of care of a patient from hospital or community beds to other care environments ... .8 Suffolk Health & Wellbeing Patient Experience Priority: To continue to expand our dementia- Board; friendly environment ...... 9 Healthwatch Suffolk; and Patient Experience Priority: Work with clinical partners to identify staff, volunteers, carers and the most appropriate service for children and young people needing members of the public. unplanned medical advice or care ...... 10 Quality improvement priorities for 2018/19 ...... 11 The Ipswich Hospital NHS Trust Provided and sub-contracted services ...... 14 would like to thank those who Participation in clinical audit ...... 15 contributed to the development Participation in clinical research ...... 21 and publication of this Quality Account. Monitoring quality ...... 23 How healthcare is regulated ...... 25 Statements relating to the quality of relevant health services provided .. 27 NHS number and General Medical Practice Code validity ...... 27 Information Governance Toolkit attainment levels ...... 27 Clinical coding ...... 27 Data quality ...... 27 Core Quality Indicators ...... 28
Part 3 - Other information Patient safety ...... 35 Infection prevention and control ...... 35 Prevention and treatment of pressure ulcers ...... 38 Learning from Incidents, SIRIs and Never Events ...... 40 Prevention of patient falls ...... 42 Clinical effectiveness ...... 44 Emergency Care ...... 44 Summary Hospital-level Mortality Indicator (SHMI) ...... 45 Review of Hospital deaths ...... 48 Patient experience ...... 49 Improving the patient and carer experience ...... 49 Measuring and reporting the patient experience ...... 56 Patient and public involvement, community engagement and patient feedback ...... 62 Learning from complaints ...... 67 Patient-Led Assessment of the Care Environment (PLACE) ...... 70 Workforce ...... 74 Education and training for staff ...... 83 Statements from key stakeholders ...... 88 Our front cover shows team Statement of assurance from the Board of Directors ...... 90 members from the Reactive Glossary ...... 91 Emergency Assessment Appendix A - Limited Assurance Report ...... 92 Community Team (REACT). How to provide feedback on the Quality Account ...... 95
2 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Part 1 - Statement on quality Chief Executive’s commentary
This is our account to you about the quality of services provided by The Ipswich Hospital NHS Trust in 2017/18. It looks back at our performance over the last year and gives details of our priorities for improvement in 2018/19.
What matters to patients is the care provide seamless services giving Improvement, the new Trust will be and compassion they receive in professionals opportunities to work called the East Suffolk and North those moments when they most collaboratively while sharing good Essex NHS Foundation Trust. need it. There are hundreds of practice and avoiding duplication. Further information about our people who work behind the partnership with Colchester can be scenes to make sure that happens I continue to lead the local found at every day, making sure our Sustainability and Transformation www.colchesteripswich.org buildings are safe and warm, and Plan (STP) for Suffolk and North that care is delivered in the right East Essex. Over time, this will The Trust is registered without place at the right time. People deliver the significant changes conditions by the Care Quality making sure our systems and needed to allow the system to Commission (CQC) from 1 April processes work, and that patients manage the increasing demand. 2010 when the current system of are kept informed about their The ambition of the STP process is regulation became law. The CQC care. People who often go to align services and resources so visited the Trust between August unnoticed but who are as important that by working differently, we will and October 2017, and awarded to the patients as the clinician in find a way to manage the the Trust an overall rating of front of them. increasing demand on health and ‘Good’. More details on our care services. We will work inspection can be found on pages This year has been one in which together to improve safety and 25 and 26. we have seen the organisation quality of care, and use technology continue to deliver good to save patients and carers I remain grateful to our many performance despite some journeys to hospital when they can partners for their contributions to significant challenges. Our staff be seen more conveniently closer the services we manage. We have once again demonstrated to home. could not deliver the high quality of tremendous effort, motivation and care of which we are rightly proud energy to ensure we achieve our After many months of work we without the support of health, ambitions, and I thank them all for developed a business case which social care and voluntary their hard work. reviewed the various options organisations throughout the town available to Ipswich and and county. We remain an innovative forward- Colchester hospitals in the thinking organisation, always future. The recommendation was To the best of my knowledge, looking for ways to improve our that we form a single combined the information contained in this services. In October 2017 we organisation with fully integrated Quality Account is accurate. commenced a seven-year contract clinical services. In August 2017 for NHS community services, which we held a meeting in public of the means we can continue to focus on boards of The Ipswich Hospital patients in their home areas and at NHS Trust and Colchester Hospital the same time tackle rising University NHS Foundation Trust demands on doctors, nurses and to discuss how to take forward our health professionals’ time. We partnership and hear the views of have established an alliance in our community. Since then, we Nick Hulme Ipswich and east Suffolk have held a number of meetings Chief Executive comprising Ipswich Hospital NHS with local communities and staff Trust, Norfolk and Suffolk NHS giving people the opportunity to Foundation Trust, Suffolk County ask questions and raise any Council and the GP concerns about the merger they Federation. The community may have. The full business case services contract is the first (FBC) was considered by both important step for our health and Trust Boards at a joint Board social care system towards meeting held in public in March providing local people with simpler, 2018, where the FBC was seamless services and brings to life approved to be taken forward. We the vision detailed in the local are working towards a merger of Sustainability and Transformation the two organisations in July 2018. Plan. The alliance enables us to Subject to approval by NHS 3 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Trust Services
We are an organisation with a proud history and one that has long adapted and responded to changes in health needs and circumstances. We are recognised by our patients and peers as a provider of good quality healthcare with a reputation for delivering caring and compassionate services. We provide a full range of acute services to the people of Ipswich and East Suffolk, and manage a range of community services including three local community hospitals. Background Admission Prevention They also assess patients in the hospital’s emergency department Every day over 3,000 patients rely Services and emergency assessment unit on us to improve their lives. Our before putting appropriate support services include accident and Reactive Emergency Assessment Community Team in place to allow them to be emergency; critical care; planned discharged, wherever possible. medical and surgical care; (REACT) REACT is a new team dedicated This includes up to five days of consultant and midwifery-led ongoing crisis management maternity, neonatal and paediatric to avoiding unnecessary admissions to Ipswich Hospital by support, which will be provided by care; diagnostic and therapy REACT to ensure continuity and services; community hospitals and making sure patients receive the right treatment to meet their needs the best possible patient specialist community services. experience. in their own homes. REACT brings Ipswich Hospital has formed an together staff based at the hospital alliance with Suffolk County and colleagues working within The launch of this new team is Council, the Suffolk GP Federation community healthcare with the another really good example of and Norfolk and Suffolk NHS aim of improving continuity of care health and social care services, Foundation Trust to deliver for patients and reducing alongside the voluntary sector, community services from October duplication. working more closely together to 2017. further improve care for patients Operating 24/7, they work and their families. Two alliances have been set up to together to put the right care in drive this work, which are made up place to prevent an admission to Crisis Action Team (CAT) of Ipswich Hospital in the east and hospital, in turn helping to manage Nurses and therapists work jointly West Suffolk Hospital in the west, growing demand for health with social care and the voluntary with Suffolk County Council, services. The team receives sector to avoid unnecessary Suffolk GP Federation and Norfolk referrals from GPs and ambulance hospital admission by supporting and Suffolk NHS Foundation Trust staff for patients who have patients in the community in crisis spanning the whole county. These reached crisis point. Staff then to remain at home with multi- providers are working closely carry out a comprehensive disciplinary team support, or together to place the patient at the assessment in the patient’s own supporting patients being centre of care, share good practice home with the aim of preventing discharged from the Emergency and improve quality while making them needing to be admitted to Department to go home with a the best use of limited resources. hospital. range of health and social support to meet their needs. The older population in Suffolk continues to grow. This means it is Community Hospitals managed by Ipswich Hospital vital to ensure patients receive the right care, at the right time and in the right place. Supporting people to remain at home rather than spend unnecessary time in hospital also makes them far more likely to maintain their independence, in turn reducing their reliance on health services in the future.
There are a number of examples of initiatives taking place across Suffolk to join up care more closely, support prevention work and tackle rising demand for healthcare services.
4 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Trust Services
Frailty Assessment Base (FAB) Outpatient Parenteral Suffolk GP Federation Patients who are referred by GPs, Antimicrobial Therapy (OPAT) Suffolk GP Federation is a or identified in the Emergency service Community Interest Company (not- Department, are brought to the The OPAT team consists of an for-profit). It is a member of the FAB as a “one-stop shop” and antimicrobial pharmacist, nursing alliance delivering community they will spend 3-4 hours having staff, OPAT consultant and a services to the people of Ipswich their complex needs addressed. microbiologist. Inpatients who and East Suffolk. The GP Patients will have a heart tracing, are felt to be able to be treated at Federation and Ipswich Hospital blood tests performed and blood home with intravenous antibiotics NHS Trust are providers of pressure taken lying and standing are referred to the OPAT service services, with the other partners as part of the assessment. If and assessed by the team as to influencing strategy development needed, X-rays and scans may their suitability to have their to improve access to services and also be performed. Patients will intravenous antibiotics at deliver these services more receive a review from a consultant home. Patients are followed up efficiently. geriatrician, a therapist, a once a week by the OPAT nurses specialist nurse, a pharmacist and to check progress. This service Suffolk GP Federation services are dietitian who will work together has been very successful, helping sub-contracted through Ipswich and look at each patient patients to go home from hospital Hospital and as well as the holistically in order to keep them earlier, and saving around 2,500 community services recently active, healthy and at home. It is bed days per year. The team can awarded, they have provided similar to a 'health MOT' for the currently treat a maximum of 10- services in North East Essex and older person. 15 patients, most of whom are across the whole of Suffolk. capable and willing to self- FAB is a service unique to administer. OPAT covers all Under the banner of Suffolk Ipswich Hospital, which has specialities, the only exclusion Community Alliance, all won a number of national being where high risk antibiotics organisations involved are awards: are required. Self-administration committed to working together to winner of the “Value and allows more patients to go home maximise the partnership and work on either the 24 hour infusion together to break down the existing Improvement in Acute devices or once daily antibiotics. organisational barriers and Service Redesign” award at boundaries to improve the quality the Health Service Journal When patients are referred to the of the patient experience and Value and Healthcare service by their Consultant, they meeting the challenges of rising Awards, 2016; are seen on the ward by a member demand and financial challenge. winner in the category “FFT of the OPAT team. They are risk and Patient Insight for assessed and consented as being The services provided by the Improvement - Accessibility” willing to take responsibility for self- Suffolk GP Federation are: at the Patient Experience administration. Patients are taught Bladder and Bowel Service Network National Awards, how to self-administer on three Falls Fracture Liaison (west 2016; and separate occasions by a registered Suffolk only) winner in the category nurse before their competency is assessed. Patients have access to Minor Injuries Unit in “Continuity of Care” at the nurse support once they have been Felixstowe Patient Experience Network discharged, and are reviewed face- Podiatry National Awards, 2016. to-face every week to ensure all is Stoma Service. on track and that patients are happy to continue self- administration.
“My family and I would like to say a huge thank you to every staff member whatever their status who work on Sproughton ward. Our brother has very recently had a long stay on this ward and his care could not have been more exemplified. A great team retaining patient dignity, quality of care and compassion.”
Patient comment posted on NHS Choices, June 2017
5 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Part 2 - Priorities for improvement and statements of assurance 2017/18 quality improvement priorities Progress against the priorities agreed
Patient safety priority: What did we do to improve our How and where was progress reported? To continue to develop performance? Reports and updates to: Portfolio Board, services to support patients Emergency Care Programme Board, Quality Increased capacity of current FAB. Committee, Trust Board, system-wide Integrated who are elderly and frail. Increased links with ED to enable Care Network.
Why was this a priority? more patients to benefit from a comprehensive geriatric assessment. Older patients who require health Our key achievements services are often physically, Extended hours of cover for the Extended Therapy team cover, increasing the cognitively or socially frail. By emergency therapy team in ED and number of hours covered each day. Service expanding services already in place emergency assessment unit to 7 days also expanded to cover 7 days per week. we aim to keep patients well and a week, 8am - 8pm. Further continual improvements to the Frailty reduce their dependency on health Minimised deconditioning in hospital Assessment Base service including access to services by supporting them to via re-ablement programme across the service by the Emergency Department. maintain their independence and the Trust, training over 500 staff. Changes to internal ED processes, internal functional ability and so reduce the streaming and implementation of external incidence of hospital-based How did we measure and monitor review recommendations to improve patient deconditioning (the process of our performance? flow through department. physiological or functional change as Changed the stroke patient pathway so that a result of inactivity or bedrest). The Monitored the number of patients referred to FAB and CAT services, patients now go straight to CT Scan, aim is to eliminate assessment waits bypassing the Emergency Department. to shorten hospital admissions and and of those seen, monitored how reduce the consequences of many patients subsequently avoided Reduced the length of stay for patients aged prolonged admission. Patients at risk admission to hospital. 65 years and over on Lavenham ward. By of deconditioning need to be Monitored the length of stay of those using bedside ‘huddles’ to focus and agree identified on admission, and expect patients who required admission individualised reablement goals, we have zero tolerance of unnecessary delays following assessment by the FAB. reduced the average length of stay from 9.1 days to 7 days, ensuring patients spend more to prevent deconditioning along with Emergency admission levels. very proactive management, early time at their usual place of residence. mobilisation and prevention of Patients in hospital over 7 and 14 ‘Get up and Go’ reablement project launched. unnecessary ‘bed rest’. days. CAT Plus and HomeFirst teams’ expansion % of patients discharged via Pathway and integration between health and social Lead Director Zero and Pathway One via Discharge care, working to jointly support patients’ Director of Operations. to Assess model. earlier discharge from hospital (Pathway 1 Number of beds occupied in acute and Discharge to Assess programme). 2017/18 performance community hospitals in accordance Launch of REACT integrated service; a joint Number of emergency admissions with detailed bed model. service amalgamating all teams involved in for patients aged 75 years and admission prevention. over = 12, 286 patients (12,840 Did we achieve our intended target? Launch and embedding of the Short Term patients in 2016/17, showing a Assessment, Reablement and Rehabilitation decrease across the full year of CAT and FAB services achieved 6 avoided admissions per day across the Centre (STARR Centre) at Bluebird Lodge 4.3%, bucking the national trend and community hospital. despite increasing ED attendances). year, achieving the targets set. DToC numbers = 9,689 total acute We achieved our target of reducing the Delirium patient pathway launched, enabling bed days occupied by patients who number of emergency admissions patients with delirium to be cared for at are medically stable but delayed required, with 3.2% reduction below Barking Hall nursing home, rather than having either home with care or to another plan for 2017/18. to stay in hospital. care setting. Patients in the hospital >7 & >14 days First in Midlands & East region for ED 4 hour showed improvement over the 12 performance across 2017/18, achieving What was our target? month period, but not quite sustaining 91.1%. To achieve patients with a length the target of 105 patients over 14 days Emergency admissions growth reduced; the of stay over 14 days, sustained at (see Stranded patient metrics in Key admissions for the first nine months were 105 patients. Achievements). lower than last year, and were 3.2% below plan at month 11. To reduce the number of We achieved our bed model admissions required. predictions for 9 out of the 12 Emergency average length of stay for months. The 3 months where we Medicine at 5.3 days, the lowest seen across To expand service to become exceeded bed occupancy against an 18 month period. available seven days a week. expected numbers was mainly due to Stranded patient metrics dropped from 278 To further integrate with the significant impact of flu, D&V and >7 days in February 2017 to 199 in February community services and social severe snow weather conditions 2018; and 178 >14 days in February 2017 to services. causing complete disruption to patient 120 in February 2018. discharges, from affected beds both in DToCs continue to reduce, from 1,050 bed the hospital and care homes. days in February 2017 to 620 in February 2018.
6 The Ipswich Hospital NHS Trust—Quality Account 2017/18
2017/18 quality improvement priorities Progress against the priorities agreed
Clinical effectiveness Recognised individual's needs and SPICT tool (identifies patients likely to priority: To continue to wishes to ensure they lived well be in the last year of life, with support improve our care to those at until they died. to start discussions regarding 'My Care Wishes' and communicate this to Used national and locally the end of their life and GPs, and appropriate health care recognised tools, ie the regional support patients who have teams) piloted on Lavenham ward DNACPR form, the yellow folder, limited treatment options. then rolled out across the Trust. treatment options form and the individualised end of life care plan. ‘Just in case’ medicines community Why was this a priority? prescription chart now available on There is only one chance to get end Promoted co-ordinated care for Evolve to ensure patients having end of life care right. In the final stages discharge planning, enabling of life care outside of hospital have the of illness, care priorities shift with patients to die in their preferred correct paperwork to enable symptom the focus often changing to surroundings, be that at home, control medicine to be given quickly. hospital or hospice. palliative care for the relief of pain, Dying Matters week, held in May symptoms, and emotional distress. Facilitated palliative and end of life 2017, was well received throughout Compassionate high quality care care training and education for staff the Trust. enables us to make a loved one’s using innovative and creative All refurbished wards have a side final weeks or days as comfortable approaches to learning. room to be used for end of life care as possible by offering the person at Provided access to specialist with bespoke furniture and lighting to end of life, and those identified as palliative care assessments, seven ensure a calming environment, with important to them, choice around days a week. relatives able to stay with the patient decisions concerning treatment and Improved bereavement support for overnight. care wanted, and an individual plan families of patients who have died. 24hr chaplaincy service available. of care tailored to the needs, wishes Trust involvement with the One Voice and preferences of the dying How did we measure and monitor for Travellers Health Project to person; agreed, coordinated and our performance? delivered with compassion. understand the needs of patients and Monitored themes from complaints family from the travelling community at Lead Director relating to end of life care. end of life, and how healthcare Director of Nursing. Monitored results from DNACPR professionals can support and work and national end of life audits to together to provide end of life care 2017/18 performance highlight themes for improvement. which meets the needs of the individual and their family. We achieved our target of Audited use of individualised care Refurbishment of the mortuary waiting improving end of life care for plans to ensure best possible and viewing rooms. patients and their families, as practice. Commencement of a relatives’ evidenced by the results from the Expanded post bereavement national end of life care audit. bereavement survey to enable the follow up service with families. Trust to learn from relatives’ and
What was our target? carers’ experiences of bereavement How and where was progress and support services. To deliver high quality, reported? Funding for the Hospice and Trust to compassionate and dignified Regular reports and updates to: end of life care for all patients. End of Life Care Steering Group. run a pilot whereby patients are assessed when they come into ED to Patients will receive the right Our key achievements support them to reach their preferred care in the right place. place of death. The 2017 CQC inspection rated To increase the number of The palliative care team, and the end of care service as 'Good'. patients dying in the place of mortuary team hosted a study day their choice. End of Life Care Strategy launched, which included simulation training for with 4 workstreams of the End of caring for patients after death. Life Care Programme Board What did we do to improve our Involvement of the end of life care performance? delivering key objectives. team with the Trust’s Schwartz rounds Recognised timely identification All complaints mentioning end of life continues. care are reviewed by the End of of patients in the last year of life. Funding of consultant and nursing Life Care Programme Board to Facilitated patients and their posts to support the Palliative Care families with making advance enable service improvements and influence future education & training team to achieve 7 day working, decisions and prioritising levels supported by Macmillan. of care. plans. DNACPR audits ongoing; audit of Worked with system partners to the use of the ICP in July 2017 improve end of life care at home showed 75% compliance (relates to provision. ICP in place and completed appropriately). 7 The Ipswich Hospital NHS Trust—Quality Account 2017/18
2017/18 quality improvement priorities Progress against the priorities agreed
Patient experience priority: detailed review and proposal aiming to keep the number of To avoid delays in transfers of around evidenced usage, DToC patients in hospital below care of a patient from hospital forecasted growth and 20 at any time. or community beds to other incorporation of impacts from: New patient pathway for patients care environments. reviewing the delirium/ requiring end of life care to enable them to spend their final dementia best practice days in their preferred place. Why was this a priority? pathways; and The service is run by St Delayed transfers, where patients delivering the Discharge to Elizabeth Hospice, supporting are ready to return home or transfer Assess model, including domiciliary care needs for our to another form of care but still revised pathways for patients patients to go home earlier. occupy a bed, are a symptom of a with delirium and non-weight- system failing to provide the right bearing patients. Introduced intravenous care, in the right place, at the right antibiotics self-administration time. By ensuring patients are How did we measure and monitor programme, supporting patients transferred from the ward our performance? going home, rather than having environment as soon as they are Progress against this priority was their antibiotics in hospital. medically stable to be discharged, measured by: Embedding ‘Peer to Peer improves wellbeing and gives them reporting DToCs; challenge’ when a consultant, matron and senior therapist work back their independence. reporting readmission rates; together to independently visit a Lead Director reporting the number of patients different ward to that where they Director of Operations. in the hospital with length of stay normally manage, constructively over 7 and 14 days; and challenging their peers on plans 2017/18 performance reporting the % emergency and next steps for every patient Number of delayed transfers of care admission rate for patients over who has been in the hospital for from Ipswich Hospital wards = 9,689 75 years. more than 7 days. bed days. Continued planned and ad hoc Did we achieve our intended ‘Red to Green’ periods. What was our target? target? Warmer Homes project started, To reduce the number of patients Readmission rates are at 9% trust- with weekly visits from Warmer who have to stay in hospital wide and will require additional focus Homes representatives, to beyond the date when they are and scrutiny in 2018/19. support patients returning home medically stable for discharge. with additional equipment/ This is a high priority ‘system- How and where was progress support. wide’ urgent care project. reported? Patient discharge workshop Regular reports and updates to: held, to share all of the schemes To achieve and sustain DToC Patient & Carer Experience rate of 3.5%. and tools relating to effective Committee, Quality Committee, management of discharge Fully implement the system-wide Trust Board, Accountability planning. Discharge to Assess model. Framework Oversight and Additional consultant presence To achieve and sustain number Performance, Sustainability and each weekend, performing of patients with a length of stay Transformation Programme, further patient reviews to enable over 14 days at 105. Portfolio Board and Emergency Care discharges across the weekend, Programme Board. with discharge co-ordinator What did we do to improve our support. Our key achievements performance? Launch of ‘Home Tomorrow, Working with our commissioners, Launch and embedding of TTA’s today’ programme, Social Services and other partners, ‘discharge to assess’ bringing forward the preparation we planned to improve our programme, redesigning care of medications to ensure they performance by: pathways to support early and are ready in time for the patient’s improving the current discharge safe discharge including higher expected discharge. model, with Ipswich Hospital and numbers going home without social services staff working care, integration of health and together to provide multi- social care to support patients at disciplinary team ‘early supported home, short term reablement discharge’ to support patients to and rehabilitation at Bluebird safely return to their home Lodge. setting; Embedded twice-weekly focus on system-wide DToC reduction Optimised utilisation of and clarity on escalation triggers, community beds, following 8 The Ipswich Hospital NHS Trust—Quality Account 2017/18
2017/18 quality improvement priorities Progress against the priorities agreed
Patient experience priority: How and where was progress reported? To continue to expand our Regular reports and updates to: dementia-friendly Patient & Carer Experience environment. Committee, Quality Committee and Trust Board. Why was this a priority? Each year the number of people Our key achievements living with dementia is growing and Stradbroke ward (colorectal ward) this number is expected to double refurbished and is now a during the next 30 years. It is dementia-friendly environment. estimated that over 40% of people Key performance indicators to aged over 65 in general hospitals measure and monitor have a dementia diagnosis or a improvements in the patient, carer cognitive impairment. Being in an and staff experience following the unfamiliar environment such as a refurbishment such as complaints, hospital can be very frightening and incidents and general feedback. distressing, and can reduce the person’s level of independence. Brantham ward and emergency assessment unit both refurbished Lead Director and now have dementia-friendly Director of Nursing. environments. Reconfiguration of Brantham ward 2017/18 performance and assessment area which has Creatively refurbished two adult enabled the following: acute wards, designed to be Creation of a safer, accessible dementia-friendly. Continued to area for people who may create a dementia-friendly require a calm, quiet space for environment in community inpatient their clinical assessments. areas. Quiet rooms available for private discussions with What was our target? patients and their families. We achieved our target to increase Improvements to the the number of dementia-friendly ambulance entrance to the wards in the hospitals managed by assessment unit. The Ipswich Hospital NHS Trust. Additional consultation rooms. Direct access corridor from What did we do to improve our Emergency Department to performance? Brantham assessment unit to Creatively refurbished two further improve patient transfers, wards to provide a shared clinical reducing the noise and and social environment using throughput of patients through The Kings Fund’s Enhancing the Brantham ward. Healing Environment and other Created additional chair existing research in the design spaces for patients who do not process. require a bed maintaining Shared the learning from creative independence, privacy and refurbishments with other areas. dignity. #fit2sit Creation of a bay on Brantham How did we measure and monitor ward for those patients our performance? requiring more intensive short- Tracked progress of works to term monitoring and improve ward environments to assessment. ensure all work was completed within the agreed timescale. Measured the numbers of incidents of violence and aggression in these areas. The new dementia-friendly Patient, carer and staff Stradbroke and Brantham wards which opened in the autumn. experience findings.
9 The Ipswich Hospital NHS Trust—Quality Account 2017/18
2017/18 quality improvement priorities Progress against the priorities agreed
Patient experience to a more appropriate Dedicated paediatric nursing priority: environment. We believe this is team based in the Emergency indicative of more appropriate Department, which enables Work with all clinical attendance to the Emergency partners to identify the most the ED team to better manage Department. those children attending ED, appropriate service for and to signpost them to children and young people What was our target? alternative services if needing unplanned medical To reduce the number of under appropriate. advice or care. 18s attending ED by 5% by 2022, GP streaming service against a growing population. adjacent to the Emergency Why was this a priority? This target was achieved. Department has enabled a The local population is rising at number of patients attending around 1% per annum, with a What did we do to improve our the Emergency Department to large rise in the number of performance? be seen by a more children aged 5-9 years. An Education of parents/ appropriate service. increasing challenge is the rising guardians/carers by health Promotion of self- number of patients coming to the visitors on managing minor management for certain Emergency Department (ED) with childhood illness. conditions such as respiratory medical conditions, some of whom Work in partnership to produce illness. attend because they feel unable to information leaflets for parents Piloting of a community access other forms of advice. The about minor childhood illness. mental health crisis action challenge is to ensure they can team service for under 18s. access the right care in the right Work with the Alliance to better Condition-specific audits (eg place. meet the needs of this patient group. bronchiolitis, feverish illness) This age group is the only patient of attendances to ED and cohort which showed an increased How did we measure and admissions have taken place admission rate in 2016/17 monitor our performance? and resulting actions compared with 2015/16, (having Monitor the number of addressed. taken into account the ED attendances in ED by children Collaborative work with Public attendance growth). In and young people. Health to better understand comparison, all other age groups the reasons patients have showed significant decreases in Did we achieve our intended attended ED, where patients admission rates when comparing target? live and time of their arrival to the same period, hence why a We achieved our target to reduce enable a focus on key focus on children and young the number of patients aged 18 themes. people admission rates is a key and under attending ED, however priority for 2017/18. the number emergency admissions for patients aged 18 Lead Director and under increased slightly when Director of Nursing. compared to 2016/17.
2017/18 performance How and where was progress Number of attendees to ED reported? aged 18 and under = 18,419 Regular reports and updates to: Children’s Services Project Board. Number of emergency admissions of patients aged 18 Our key achievements and under = 5,448 (of which ‘Common illnesses’ booklet 2,946 were aged 16 and under) given to new parents/
guardians/carers by health This highlights that whilst we have visitors and on attendance at seen a reduction in ED the Emergency Department if attendances over the previous felt to be appropriate. year, there has been an increase in admissions to the Paediatric Any baby aged under 28 days Assessment Unit (PAU) from who attends the Emergency 2,765 in 2016/17, in part due to Department, is now referred the pressure to move people on directly to the Paediatric from the Emergency Department Assessment Unit.
10 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Quality improvement priorities for 2018/19 Qualitative information from a number of sources including patient surveys, staff surveys, complaints, compliments and the views of users and user groups has helped inform the Trust’s priorities for 2018/19.
Patient safety priority: What is our target? Clinical effectiveness To improve compliance with Commence treatment of sepsis priority: the Sepsis Six care bundle. according to Sepsis Six pathway; complete all within 60 mins = 90% To improve access to Why is this a priority? psychiatric liaison services The Sepsis Six is the name given To increase the number of clinical for hospital inpatients. to a bundle of medical therapies staff having received sepsis designed to reduce the mortality of training: Why is this a priority? patients with sepsis. It was Q1 = 50% of clinical staff trained The mental health five year developed in 2006 by a group of Q2 = 75% of clinical staff trained forward view ensures patients physicians and nurses working on Q3 = 80% of clinical staff trained receive equitable and prompt an educational programme to raise Q4 = maintain 80% of clinical staff access to both mental and awareness and improve the trained. physical health care. treatment of patients with sepsis. What will we do to improve our Nationally, there is evidence that The management of sepsis after performance? 25-33% of people admitted to admission to hospital usually Implement clinical Sepsis Six acute hospitals also have a mental involves three treatments and three tool to guide screening and health condition; with 5% of all tests, known as the ‘Sepsis Six’. treatment Emergency Department (ED) These should be initiated by the Implement mandatory training admissions having a primary medical team within an hour of (e-learning programme) for all mental health concern. diagnosis. clinical staff Working in partnership and Enable the prescribing of Treatment involves: providing effective mental health intravenous fluids by nursing giving intravenous antibiotics support to patients, and expertise staff to manage the early to staff, we can provide rapid giving fluids intravenously if treatment of sepsis clinically required assessment, care planning and Increase awareness of the intervention, and can minimise the giving oxygen if levels are low signs and symptoms of sepsis time a patient needs to stay in an for healthcare professionals acute hospital environment. Tests will include: and the public through taking blood to identify the type education Training and guidance to help of bacteria causing sepsis Bespoke training sessions for identify, support and refer when taking a different type of blood ward-based staff. needed, patients who have mental sample to assess the severity of health or psychological needs. sepsis monitoring urine output to How will we measure and assess severity and kidney monitor our performance? Lead Director function Audit timely identification and Director of Operations. treatment of sepsis
Many centres throughout the world Monitor compliance with staff 2017/18 performance have adopted the Sepsis Six, training for doctors, registered Level of ED breaches attributed to which has been associated with nurses, and healthcare Psychiatric Liaison for the hours decreased mortality, decreased assistants the Psychiatric Liaison service length of stay in hospital, and fewer Compliance with CQUIN for intensive care bed days. operates (0700 to 2100) = 5.17%. identification and treatment of suspected sepsis Lead Directors What is our target? To meet the 95% target for Medical Director and Director of How and where will progress be Nursing. patients attending ED needing reported? psychiatric intervention (review Regular reports and updates to: 2017/18 performance within one hour). Quality Committee, Trust Board, Timely treatment of sepsis in ED Deteriorating Patient Group. and Acute inpatient settings: To provide patients with access to Q1 = 71% mental health review during their Q2 = 70% admission in the acute hospital Q3 = 66% (review within same day or 24 Q4 = 67% hours).
11 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Quality improvement priorities for 2018/19
What will we do to improve our Patient experience Facilitate patients and their performance? priority: families with making advance In partnership with the Ipswich & To continue to improve our care decisions and prioritising levels of East Suffolk Clinical to those at the end of their life care. Commissioning Group and the and support patients who have Work with system partners to Norfolk & Suffolk NHS Foundation limited treatment options. improve end of life care at home Trust, we have co-written and co- provision. commissioned an enhanced Why is this a priority? Recognise individual's needs and psychiatric liaison service. There is only one chance to get wishes to ensure they live well end of life care right. In the final until they die. Within the enhanced psychiatric stages of illness, care priorities Promote better use of national liaison service we have also shift with the focus often changing included training and education for to palliative care for the relief of and locally recognised tools, eg healthcare providers to support pain, symptoms, and emotional the regional DNACPR form, the increased awareness and referral distress. Compassionate high yellow folder, Supportive and when required. quality care enables us to make a Palliative Indicators Tool (SPICT), loved one’s final weeks or days as treatment options form and the To monitor our key performance comfortable as possible by individualised end of life care indicators against the criteria set to offering the person at end of life, plan. ensure we are consistently and those identified as important Promote co-ordinated care for achieving a sustainable service. to them, choice around decisions discharge planning, enabling concerning treatment and care patients to die in their preferred How will we measure and wanted, and an individual plan of surroundings, be that at home, monitor our performance? care tailored to the needs, wishes hospital or hospice. Review and regular monitoring of and preferences of the dying Facilitate palliative and end of life KPIs. person; agreed, coordinated and care training and education for
delivered with compassion. staff using innovative and Development of a dashboard to creative approaches to learning. capture and collate information and Lead Directors performance. Provide access to specialist Director of Nursing and Medical palliative care assessments, Director. How and where will progress be seven days a week. reported? 2017/18 performance Regular reports and updates to: How will we measure and monitor DNACPR compliance: our performance? Trust Performance Boards; Joint January 2017 = 78% Monitored themes from Operational Board (Ipswich June 2017 = 94% Hospital, Norfolk & Suffolk NHS September 2017 = 92% complaints relating to end of life Foundation Trust and our February 2018 = 94% care. Commissioners); and Quality Monitored results from DNACPR Committee. Number of complaints relating to and national end of life audits to end of life care = 14 highlight themes for Reporting by exception to: improvement. Mentally Healthy Communities What is our target? Audited use of individualised care Board; Integrated Care Network; plans to ensure best possible and East Alliance Partnership To deliver high quality, practice. Board. compassionate and dignified end of life care for all patients. Assessment of surveys of Patients will receive the right bereaved relatives. care in the right place. Service assessment reviews of To increase the number of new initiatives. patients dying in the place of Review of processes and policy their choice. for end of life care.
What will we do to improve our How and where will progress be performance? reported? Pilot processes to promote Regular reports and updates to early/prompt recognition of Quality Committee, Trust Board. patients in the last year of life.
12 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Quality improvement priorities for 2018/19
Patient experience What is our target? priority: To reduce the number of under Work with all clinical partners to 18s attending ED by 5% by 2022, identify the most appropriate against a growing population. service for children and young people needing unplanned What will we do to improve our medical advice or care. This is performance? the second year of a two year Education of parents/ priority. guardians/carers by health visitors on managing minor Why is this a priority? childhood illness. The local population is rising at Work with the Alliance to better around 1% per annum, with a meet the needs of this patient large rise in the number of group. children aged 5-9 years. An increasing challenge is the rising Development of a Children’s number of patients coming to the Board to drive improved Emergency Department (ED) with performance by auditing medical conditions, some of whom patterns of attendance to ED, attend because they feel unable to allowing a focus on the key access other forms of advice, and issues highlighted to take young adolescents requiring targeted actions to improve mental health care. The challenge performance further. is to ensure they can access the Collaborative working with right care in the right place at the Norfolk & Suffolk NHS right time. Foundation Trust to ensure consistent patient pathways for This age group is the only patient all children who attend in crisis. cohort which showed an increased Work in partnership with Public admission rate in 2016/17 Health and Primary Care to compared with 2015/16, (having produce further information taken into account the ED leaflets for parents about minor attendance growth). In childhood illness. comparison, all other age groups Continue our multi-agency showed significant decreases in approach. admission rates when comparing the same period, hence why a How will we measure and focus on children and young monitor our performance? people admission rates is a key Monitor the number of priority for 2017/18 and 2018/19. attendances in ED and admissions from ED by children Lead Directors and young people. Director of Community Services and Director of Nursing. Review of audit data to shape key priorities. 2017/18 performance Number of attendees to ED How and where was progress aged 18 and under = 18,419 (a reported? 1.4% decrease when compared Regular reports and updates to: with 2016/17) Children’s Board. Number of emergency admissions of patients aged 18 and under = 5,448 (of which 2,946 were aged 16 and under)
13 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Provided and sub-contracted services
Provided and sub- Commendation winners contracted services Ipswich Commendation is a staff recognition scheme which says During 2017/18 The Ipswich thank you to colleagues who live the hospital values. The Hospital NHS Trust provided and/ nominations are judged by a panel of colleagues and patients. or sub-contracted 110 relevant health services. Two physiotherapists who organised a 24-hour specialist physio rota to The Ipswich Hospital NHS Trust help a very ill baby won a Commendation for the care they provided. has reviewed all the data available Charlie Martin and Ali Angell were part of a multidisciplinary paediatric to them on the quality of care in team caring for a young baby with a dangerous chest infection. 110 of these relevant health services. Determined to help the child, Ali and Charlie thought quickly, rallied their small team and set up a 24/7 physiotherapy service, making sure the The income generated by the baby received a complex chest physio treatment every four hours. This relevant health services reviewed was on top of their daily jobs and for some of the team meant balancing in 2017/18 represents 100% of the caring for their own small children at home. This dedicated care went on total income generated from the for a week and a half, night and day, until the baby’s illness improved. provision of relevant health services by The Ipswich Hospital NHS Trust for 2017/18.
The data reviewed covers the three dimensions of quality: patient safety, clinical effectiveness and patient experience. All relevant data has been reviewed and a number of contract monitoring systems are in place.
Ali and Charlie were presented with their commendations by Managing Director Neill Moloney, watched by team members on the children’s ward.
14 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Participation in clinical audit
During 2017/18, 33 national clinical Clinical Audits audits and 3 national confidential enquiries covered relevant health Heart and Circulatory System services that The Ipswich Hospital 1 Acute Coronary Syndrome or Acute Myocardial Infarction (MINAP) NHS Trust provides. 2 Cardiac Rhythm Management (CRM) 3 Coronary Angioplasty/National Audit of Percutaneous Coronary Interventions During 2017/18 The Ipswich 4 National Cardiac Arrest Audit (NCAA) Hospital NHS Trust participated in 5 National Heart Failure Audit 96.97% of the national clinical audits and 100% of the national Acute confidential enquiries of the 6 Case Mix Programme (CMP) - Intensive Care national clinical audits and national 7 Falls and Fragility Fractures Audit Programme (FFFAP) confidential enquiries which it was 8 Fractured Neck of Femur (care in emergency departments) eligible to participate in. 9 Major Trauma Audit (TARN)
The national clinical audits and 10 National Emergency Laparotomy Audit (NELA) national confidential enquiries that 11 National Joint Registry (NJR) The Ipswich Hospital NHS Trust 12 Pain in Children (care in emergency departments) was eligible to participate in during 13 Procedural Sedation in Adults (care in emergency departments) 2017/18 are as follows: Women and Children 14 Diabetes (Paediatric) (NPDA) 15 National Maternity and Perinatal Audit (NMPA) 16 National Neonatal Audit Programme - Neonatal Intensive and Special Care Older People 17 National Audit of Dementia 18 Sentinel Stroke National Audit programme (SSNAP) Long Term Conditions 19 BAUS Urology Audits - Nephrectomy audit 20 BAUS Urology Audits - Percutaneous Nephrolithotomy (PCNL) 21 Inflammatory Bowel Disease (IBD) Programme/IBD Registry 22 National Chronic Obstructive Pulmonary Disease (COPD) Audit Programme 23 National Diabetes Audit - Adults UK Parkinson’s Audit: (incorporating Occupational Therapy, Speech & 24 Language Therapy, Physiotherapy, Elderly Care and Neurology) Cancer 25 Bowel Cancer (NBOCAP) 26 National Audit of Breast Cancer in Older People (NABCOP) 27 National Lung Cancer Audit (NLCA) 28 National Prostate Cancer Audit 29 Oesophago-gastric Cancer (NAOGC) Haematology 30 National Comparative Audit of Blood Transfusion Programme Serious Hazards of Transfusion (SHOT): UK National haemovigilance 31 scheme Other 32 Elective Surgery (National PROMs Programme) 33 National Ophthalmology Audit
National Confidential Enquiries 1 Child Health Clinical Outcome Review Programme (chronic neurodisability) Maternal, Newborn and Infant Clinical Outcome Review Programme 2 (MBRRACE) 3 Medical and Surgical Clinical Outcome Review Programme
15 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Participation in clinical audit
Cases Cases Clinical Audits % The national clinical audits submitted expected and national confidential Heart and Circulatory System enquiries that The Ipswich Acute Coronary Syndrome or Acute Myocardial Infarction 1 370 370 100 Hospital NHS Trust (MINAP) participated in during 2 Cardiac Rhythm Management (CRM) 500 500 100 2017/18 are as follows: Coronary Angioplasty/National Audit of Percutaneous 3 400 399 99.8 Coronary Interventions The national clinical audits 4 National Cardiac Arrest Audit (NCAA) 76 76 100 and national confidential 5 National Heart Failure Audit 633 633 100 enquiries that The Ipswich Acute Hospital NHS Trust 6 Case Mix Programme (CMP) - Intensive Care 812 812 100 participated in, and for 7 Falls and Fragility Fractures Audit programme (FFFAP) 493 493 100 which data collection was Fractured Neck of Femur (care in emergency 8 50 50 100 completed during 2017/18, departments) are listed below alongside 9 Major Trauma Audit (TARN) 396 396 100 the number of cases 10 National Emergency Laparotomy Audit (NELA) 204 204 100 submitted to each audit or 11 National Joint Registry (NJR) 719 719 100 enquiry as a percentage of 12 Pain in Children (care in emergency departments) 100 100 100 the number of registered Procedural Sedation in Adults (care in emergency 13 58 58 100 cases required by the terms departments) of that audit or enquiry: Women and Children 14 Diabetes (Paediatric) (NPDA) 195 195 100 15 National Maternity and Perinatal Audit (NMPA) 3,585 3,585 100 * Inflammatory Bowel National Neonatal Audit Programme - Neonatal Intensive 16 34 34 100 Disease (IBD) Programme and Special Care Registry Older People Unfortunately the Trust did not have internal resources. 17 National Audit of Dementia 89 89 100 18 Sentinel Stroke National Audit programme (SSNAP) 622 622 100 Long Term Conditions 19 BAUS Urology Audits - Nephrectomy audit 54 54 100 20 BAUS Urology Audits - Percutaneous Nephrolithotomy 19 19 100 21 Inflammatory Bowel Disease (IBD) Programme Registry 0* 0* 0* 22 National Chronic Obstructive Pulmonary Disease (COPD) 466 466 100 23 National Diabetes Audit - Adults 3,715 3,715 100 UK Parkinson’s Audit: (incorporating Occupational 24 Therapy, Speech & Language Therapy, Physiotherapy, 40 40 100 Elderly Care and Neurology) Cancer 25 Bowel Cancer 238 238 100 26 National Audit of Breast Cancer in Older People 350 350 100 27 National Lung Cancer Audit 202 202 100 28 National Prostate Cancer Audit 341 341 100 29 Oesophago-gastric Cancer 144 144 100 Haematology 30 National Comparative Audit of Blood Transfusion 43 43 100 Serious Hazards of Transfusion (SHOT): UK National 31 15 15 100 haemovigilance scheme Other 32 Elective Surgery (National PROMs Programme) 1,292 1,845 70 33 National Ophthalmology Audit 2,788 2,788 100
Cases Cases National Confidential Enquiries % submitted expected Child Health Clinical Outcome Review Programme 1 7 7 100 (chronic neurodisability) Maternal, Newborn and Infant Clinical Outcome Review 2 22 22 100 Programme (MBRRACE) Medical and Surgical Clinical Outcome Review 3 12 12 100 Programme 16 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Participation in clinical audit
The reports of 33 national clinical National Breast Cancer in Older Findings audits were reviewed by the Patients (NBCOP) 2017 Annual 90% of women aged 50 to 74 years provider in 2017/18 and The Report diagnosed with invasive breast Ipswich Hospital NHS Trust The National Audit of Breast cancer had surgical resection. intends to take the following Cancer in Older Patients was The proportion of women actions to improve the quality of commissioned to evaluate the undergoing surgery decreases with healthcare provided: quality of care provided to women age, with 50% of women aged 90+ aged 70 years or older by breast years having surgery for invasive BTS Adult Asthma Audit cancer services in England and breast cancer. There is regional (British Thoracic Society) Wales. It was established to variation in treatment patterns for The audit has been carried out in explore why older women with older women in types of breast and 2011, 2012 and 2016, and focuses breast cancer appear to have axillary surgery; in duration of post on hospital admissions with acute worse outcomes than younger breast cancer surgical hospital stay; asthma, specifically looking at initial women, and to investigate and in tools/methods of formal assessment, management and apparent differences in the patterns assessment of older patients. follow-up. Ipswich Hospital results of care delivered to older women. Teams caring for the older patients are generally above the national The audit started on 1 April 2016. were rarely involved in the formal average. This is due to management of breast cancer implementation of the Asthma Care The results of the audit’s work patients. Bundle. Nonetheless, there are during its first year are described in areas for improvement including the annual report. The main National recommendations writing a written action plan and components have been: relevant to Ipswich Hospital arranging hospital follow-up. An analysis of existing national Breast cancer units should review hospital datasets to provide the results for their organisation to Sample and data collection comparative background ensure care is consistent with the method information on patterns of recommendations in clinical Cases admitted with acute asthma breast cancer treatment in guidelines on the management of to the adult acute medicine service England and Wales. older patients with breast cancer, between 1 September and 31 such as those published by the December 2016 were included. International Society of Geriatric An organisational audit to Ipswich submitted 28 cases; a Oncology (SIOG) and European examine the structures of minimum of 20 cases was Society of Breast Cancer Specialists breast cancer services in requested from each participating (EUSOMA). Units should review England and Wales. unit. whether patients and carers feel
they are involved adequately in National Recommendations A series of case vignettes to decision making and receive The comparative report currently explore which patient factors sufficient information on treatment available on the BTS website does are most important for breast options. not include national cancer clinicians in determining recommendations. It is anticipated treatment options for older Local protocols should be developed that a report will be made available patients. and implemented: on the website within the next few 1. to improve the formal months containing general Developing a set of process assessment of older patients’ recommendations. and outcome indicators for the health in order to guide decision prospective patient-level audit. making about treatment, and Local recommendations 2. to improve the identification of Provide education to doctors to Sample and data collection patients who could benefit from ensure follow-up is arranged. method access to Teams Caring for the All NHS breast cancer units in Older Person. Provide education to junior England and in Wales were invited to participate in and to evaluate the doctors to ensure all Clinicians and hospital managers structure and range of breast assessments are conducted, should review their hospital length of cancer services available, with findings acted upon within the stay figures. The variation described particular emphasis on those action plan, with counselling and in this report suggests there is scope services with greatest relevance for education to patients. for greater consistency and older patients. efficiency among hospitals. A discharge checklist sticker is Providers should regularly monitor the completeness and accuracy of introduced for asthma patients. data submitted to the national cancer registration services.
17 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Participation in clinical audit
Actions taken Myocardial Ischaemia National Audit Project (MINAP) Ipswich Hospital has led the MINAP measures the processes and outcomes of care of every patient diagnosed Elderly Breast Cancer Care with heart attack, from their call to the emergency services or self-presentation to programme in East Anglia, an Emergency Department, to the prescription of preventative medications on has reported to SIOG and discharge from hospital. Largely this reflects hospital care, but often includes presented a paper covering diagnosis and treatments before arrival at hospital. The audit describes aspects our care and outcomes. The (process measures) of the quality of care of hospitals and of ambulance trusts, Trust is compliant with all and is based on analyses of data that has been directly submitted by the participating organisations. measures. The MINAP audit assesses care against the Quality Standards and Clinical All patients are offered all Guidelines issued by NICE: QS68 Acute coronary syndrome in adults, CG172 treatments, and patients and Myocardial infarction: cardiac rehabilitation and prevention of further cardio- carers are involved in vascular disease, CG167 Myocardial infarction with ST-segment elevation: acute treatment planning. Ipswich management. The audit findings were published in June 2017. has the highest surgical Sample and data collection method intervention rate in the region Data was routinely collected by designated Trust staff. 370 cases were submitted >75%. during 2015/16.
When needed we access Audit findings other care providers for Ipswich Hospital does not currently provide primary Percutaneous Coronary advice and management both Interventions. Local patients with STEMI suitable for immediate reperfusion are in Primary care and taken directly by ambulance to other centres. Secondary care. Management of patients admitted to hospital with nSTEMI
We have excellent day case Had nSTEMI Admitted figures for all. Longer-stay angiography seen by to cardiac Out of Out of before care ie overnight is only Cardiologist ward indicated for those who live discharge alone and is pre-planned from 2015/16 - England 96.2 55.8 47,039 83.6 39,082 clinic. 2015/16 - Ipswich 98.4 64.3 370 99.2 240 2014/15 - England 94.3 55.6 45,910 77.9 38,676 Areas of good practice 2014/15 - Ipswich 9.7 60.7 440 61.2 387 We provide an excellent service with no age discrimination. Treatment planning is Performance of hospitals with respect to prescription of secondary prevention individualised and patients are medication at time of discharge home to patients with either STEMI or nSTEMI. always involved in decision Performance is not reported when there are fewer than 20 eligible patients. making. There is complete data Patients are excluded if they were transferred to another hospital or if they died in for a cohort of patients >70 hospital. years of age from 2009-2011 Patients received all secondary Number of with all outcomes recorded. medication for which they were eligible patients eligible This is a group of >700 patients. 2015/16 - England 91.1 58,993 Areas for improvement/local 2015/16 - Ipswich 95.6 320 recommendations 2014/15 - England 88.3 57,301 2014/15 - Ipswich 93.9 325 The service is compliant in all areas and exceeds the National recommendations recommendations. Continue to ensure the data provided to MINAP is high quality, accurate and The breast team continues to timely, as outlined in the MINAP Minimum Data Standard. work on the 5 year+ survival Interrogate the data on a regular basis (quarterly), and use the data to facilitate data and can demonstrate that quality improvement initiatives aimed at targeting MINAP identified limitations surgery has a huge impact on in the care provision of people with STEMI and nSTEMI. survival and cancer free survival compared to those who do not Findings for the Trust: Areas of good practice and comment proceed with surgery. Ipswich performed very well in 2015/16. For each criteria for management of nSTEMI and secondary prevention, Ipswich results were better than the national average/median. Ipswich’s length of stay has increased slightly since last year, but compares well to other local trusts receiving few STEMI cases (West Suffolk Hospital and Colchester Hospital). Audit results were presented at the Divisional audit/governance meeting in December 2017. 18 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Participation in clinical audit
The reports of the 162 local investigations. Another reason Oxycodone prescribing and clinical audits were reviewed by may be related to education; administration the provider in 2017/18 and The 93.11% of the requests identified Oxycodone is a potent opioid, Ipswich Hospital NHS Trust as unnecessary according to useful in the treatment of chronic intends to take the following agreed guidelines were placed by and acute pain. The British actions to improve the quality of ENT trainees and grades more National Formulary notes that it healthcare provided: junior than Consultant. has an efficacy and safety profile similar to that of morphine. In the Last but not least, the findings can Trust, it is often used as an MRI scan of Internal auditory be due to the lack of unanimity in adjunct in the treatment of meatus (IAM) - Request for agreeing upon a single guideline palliative patients, but its use is Screening of Vestibular or standard to be followed when broad and can be used in many Schwannoma requesting MRI IAMs for the different types of nociceptive Although vestibular schwannoma screening of vestibular cases. (acoustic neuroma) is a rare finding schwannoma. (approx. 1 per 100,000 person- The aim of this audit is to review years), a large number of MRI scans Action Plan and optimise the use of are requested to screen for this. The following actions were taken: oxycodone at Ipswich Hospital Over-investigation leads to wasting NHS Trust. This includes of resources and can increase Incorporate British Academy of identifying why errors are made patient anxiety. Audiology guidelines into local when prescribing or administering guidelines as the standard for different forms of oxycodone, and The aim of the audit was to ensure MRI IAM requests to rule out potential ways to minimise such that requests for MRI IAM for vestibular schwannoma. errors. This audit differs from its screening of vestibular schwannoma predecessors in that it targets a follow agreed current guidelines. An particular opioid (oxycodone) as Hearing threshold values are additional objective of collecting the opposed to the whole class. entered for each frequency data was to conclude which staff separately in a table format groups should be targeted for Such errors are not exclusive to below the graphic audiogram for education, to reduce unnecessarily Ipswich Hospital NHS Trust, with quicker and more accurate requested MRI scans. patient safety incidents involving calculation of interaural oral oxycodone (both standard difference in hearing sensitivity Conclusions and modified release) previously by the clinician. In the absence Between 1 August 2017 and 9 reported to the National Reporting of recordable bone conduction October 2017 there were 177 MRI and Learning System (NRLS). thresholds, air conduction IAM scans requested for the While the majority of incidents thresholds should be considered screening of vestibular schwannoma. reported were ‘near misses’ 801 instead. Only 2 (1.12%) scans had a positive (10.8%) incidents reported a finding for this pathology. degree of harm to the patient. Re-audit in 12 months to ensure Of the 67 selected audiograms which that the changes have improved Recommendations were made in represented the basis for imaging the results and that the a Rapid Response Report issued investigations requested, 29 did not improvements are sustained. by the NPSA in 2008 highlighting comply with the agreed standard. opioid prescribing errors nation- wide, and a 6-point checklist The majority of wrongly requested produced which aimed to reduce scans were made by a Locum errors. Specialty Doctor or Middle Grade Doctor (11, 37.93%), followed by training Specialist Registrars (10, 34.48%). GPs with special interest in ENT requested 4 (13.79%) and Consultants and Specialty Doctors 2 (6.89%) each.
One of the reasons that led to the findings may be the fear of the clinician not to miss a diagnosis; hence the cautious approach of requesting a large number of
19 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Participation in clinical audit
The following recommendations Commendation winner were made: Assistant practitioner Kim Swan received a surprise when she was To instil the importance of using awarded a Commendation. reference sources in prescribing, administering and dispensing Kim, who works for the Crisis Action team (CAT), was presented with oxycodone by issuing a the award from managing director Neill Moloney. newsletter detailing the resources available and how to use them. She joined the team when it was formed last year and works above Increase awareness of patient and beyond regularly to make sure patients are able to leave hospital factors by noting them in a on the day they are scheduled to, giving those patients their lives newsletter detailing what back at home and freeing up bed space. symptoms to look out for. Kim has also been instrumental in training and inducting no fewer Monitoring and managing the than 13 CAT generic workers, supporting them as they all completed side effects of oxycodone (and their Care Certificate. naloxone), to be detailed a
medication safety update Line manager Hannah Beardmore said: “I can honestly say that Kim newsletter. has been my rock through some very difficult and trying times we To heighten awareness of have had in developing this new service and, as an assistant appropriate dosage regimen and practitioner, I truly know that she has gone well beyond what is active ingredients in oxycodone expected of her at this level.” brands by including this in a medication safety update. Awareness of which preparations are long acting and short acting by including this in a medication safety update. Presentation of results to the Medication Safety Committee. Presentation of results to Nursing and Midwifery Board. Inclusion in junior doctor induction. Kim Swan was presented with Further medicine safety updates her Commendation by Managing Director Neill would be beneficial and more Moloney information given informally at multidisciplinary team ward meetings is considered a suitable method of disseminating this kind of information. Future audits will further aim to develop and enhance the ability of healthcare professionals to prescribe and administer oxycodone with greater ease and skill.
Actions: Prepare a suitable drug safety newsletter which follows the recommendations made in the Rapid Response Report.
Present results to the Medication Safety Committee.
Present results to the Nursing and Midwifery Board. 20 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Participation in clinical research
Commitment to research as The question the research hopes During the course of the following to answer is “if a woman has ICP, 15-month recruitment period, a driver for improving the what are the consequences for the Ipswich Hospital was one of the quality of care and patient baby if she is treated with UDCA top-three recruiting sites on the experience. or placebo?” study. Recruitment to the study closed on 31 January 2018, by The number of patients receiving Professor Lucy Chappell, which time Ipswich had recruited relevant health services provided PITCHES Chief Investigator, and 68 study participants, consisting of or sub-contracted by The Ipswich the PITCHES Trial Team in 34 patients and 34 suitable Hospital NHS Trust in 2017/18 that Oxford have praised Ipswich informants - who provided were recruited during that period to Hospital for their consistent essential proxy information about participate in research approved recruitment to the trial over the each patient. The study team at by a research ethics committee past 24 months with 26 the University of East Anglia was 2,526. Of the 2,526, 1,216 participants already randomised to (UEA) commended the quality of were involved in industry date. the Ipswich team quoting sponsored studies. We were “throughout the recruitment successful in recruiting the first window, Ipswich Hospital was patient globally into a complex constantly one of the most cancer commercial study. consistent recruiters and it is a testament to their hard work and The Department of Health is PERFECTED - Enhancing dedication to the study that they committed to offering patients the recovery of patients admitted to managed to achieve such an opportunity to take part in robust, acute settings with hip fracture impressive overall total on what is peer-reviewed research. The who are identified as experiencing a very difficult to recruit to organisation remains dedicated to confusion. complex interventional study”. supporting clinical research in order to improve the quality of care Hip fracture has a significant we offer and to making our impact on the health and contribution to wider health independence of patients and their improvement. We actively seek to families. Older people who fracture their hip can become attract high quality research to help develop our research portfolio. confused whilst in hospital. For 65 Trial - Recent evidence people with prior memory suggests that aiming for a lower The Ipswich Hospital NHS Trust difficulties, the risk of confusion is blood pressure may be beneficial was involved in conducting 79 greater, and can have a more for patients, particularly those clinical research studies during serious impact on their daily life. aged 65 years or older. 2017/18, across 19 clinical units, The PERFECTED study aims to examples of which include: see if care of patients who fracture Ipswich Hospital is one of 65 UK their hip and who experience Centres running this multicentre confusion can be delivered more trial comparing treatment using a effectively. To do this we are lower target for blood pressure comparing acute care wards using (Group one: aiming for a blood an intervention enhanced recovery pressure in the range of 60 to 65 pathway against wards delivering mmHg), with treatment that is PITCHES is a Phase III trial in standard care, across 11 Hospital IntrahepaTic CHolestasis (ICP) currently used in the NHS (Group sites in England and Scotland. two: usual care). We have this of pregnancy to Evaluate Ipswich Hospital was randomised urSodeoxycholic acid (UDCA) in year recruited 29 patients (at a to the trial as an active site, high rate of 4.2 patients per improving perinatal outcomes. meaning that it was charged with ICP or obstetric cholestasis (OC) is month). Ipswich has been implementing the PERFECTED congratulated by the sponsor for a liver disorder which occurs Enhanced Recovery Pathway during pregnancy. It affects 1 in this great achievement of Intervention on a designated recruitment and ensuring 150 pregnancies each year in the orthopaedic care ward. UK, but the causes of ICP are not screening and recruitment have Following a 3-month lead-in been incorporated into usual fully understood. It can cause period, where key members of the itching, mainly on the hands and practice within the critical care site staff ensured that the study unit, helping to ensure a high feet and may lead to marks on the ward’s intervention adherence skin from scratching. ICP can be number of eligible patients are score was achieved, Ipswich picked up each month. very uncomfortable. Hospital officially began recruiting to the study in November 2016.
21 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Participation in clinical research
Leading Consultants appointed to professorships
Two of our senior Consultants have been appointed as honorary professors.
Professor Gerry Rayman, a consultant at Ipswich since 1993, took up his role with the University of East Anglia (UEA) in VESPA - Variations in the August, in recognition of the major contribution he has made organisation of Early pregnancy to diabetes research and education, for the support he has assessment units in the UK and given to the UEA’s medical school for the past decade and their effect on clinical, Service and his role supervising doctors completing higher degrees. PAtient-centred outcomes. At the same time, he has become the diabetes clinical lead for Ipswich Hospital has been one of a national project called Get It Right First Time (GIRFT). In the participating UK Centres for this role, Professor Rayman will visit trusts across the country this multicentre trial to collect to identify and share best practice while making suggestions information from women and staff which will improve efficiency and the care people with diabetes receive. from early pregnancy units. The aim is to better understand how to Professor Rayman, who leads the hospital’s Diabetes Research Team and is improve the ways in which early also a visiting professor with the University of Suffolk said, “I decided to pregnancy care is delivered and specialise in diabetes after I started helping people to understand and manage how to make sure that women’s the condition, which I found very empowering. I also developed a particular needs and expectations are met. interest in diabetes education and research, both of which can make a real We collected data for 150 women difference to people with diabetes. The professorship is an endorsement of and recruited 112 women to the not only my research work, but also of the excellent clinical and research team questionnaire arm of this study, we have in place at Ipswich, without who this would not have been achieved. It which collected information is nice to receive that recognition.” about the journey of women through our early pregnancy unit, “I am excited by the GIRFT project, which will focus on improving the quality of what investigations they had and diabetes services across the country. We have done tremendous things in the number of women admitted to East Suffolk for diabetes care. Sharing this best practice, learning from other hospital because of early teams across the country and finding ways to support others to implement pregnancy complications. In service changes and innovations in their own trusts will be a stimulating and addition, we asked women to rewarding challenge. I also hope to bring back ideas from elsewhere which share their thoughts about the could improve the services we provide locally still further.” care they received and the impact
on their health and sense of Professor Richard Watts has been awarded an honorary wellbeing, as well as feedback professorship for his work in the Trust, as well as his academic from staff. The Trust was the achievements at UEA. Professor Watts joined Ipswich as a largest recruiting site in the East of consultant rheumatologist in 1994 and was appointed a clinical England. senior lecturer at the Norwich Medical School in 2005. He was Research & Development director at the Trust between 2004 The Trust’s employees have and 2016, and chaired the Norfolk and Suffolk Clinical demonstrated the vibrancy and Research Network. innovative practice of a research active organisation in the last Having written and edited several text books and lectured to twelve months by producing thousands, Professor Watts remains as committed as ever to conference abstracts and the continuous development of treatment for patients with various types of publications in high quality arthritis, and explained that the long-term care of his patients was his key academic journals. 141 articles motivation. “I have an inherent curiosity of my field and want to develop, improve and abstracts were produced. and gain new knowledge. There is still plenty of scope for research of rheumatic diseases over the next 20 to 30 years. My key motivation is the continuous long- These examples demonstrate term follow-up of patients, as it is a chronic disease speciality. I see patients that a commitment to clinical over a very long time and patient care is the fun part of my job.” research leads to better treatments for patients. He served as Editor-In-Chief of Rheumatology between 2002 and 2008 and added: “I have been working academically most of my career and I think this award reflects the academic work I have done over many years, both within the Trust and UEA. Ninety-five per cent of my role is looking after outpatients though and that reflects a dramatic improvement in the treatment of patients with rheumatoid disease over the last 20 to 30 years.”
22 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Monitoring quality
When we talk about quality (sub-committees of the Trust Board), through the Commissioning for and our user groups including the Quality and Innovation payment care we mean care that is over-arching user group, Ipswich framework because the agreed safe, responsive to people’s Hospital User Group (IHUG). Close goals formed part of a block needs and contributes to a monitoring of quality enables us to contract agreement. positive patient experience. take action to make improvements if this is required. Monitoring of Further details of the agreed goals community-based services is for 2017/18 and for the following Our vision reflects our position as managed via a joint board with West 12 month period are available a provider of healthcare for both Suffolk Hospital. electronically at: local people and the wider https://www.england.nhs.uk/wp- population and we provide care in content/uploads/2016/11/cquin-2017- many ways and locations. To Quality Metrics 19-guidance.pdf deliver this ambition we know that Our approach to quality monitoring we will always seek to improve the With regards to compliance with in clinical areas links to the Trust healthcare we provide and we will CQUIN 2b (timely treatment of accountability framework providing be flexible and responsive to future sepsis in ED and Acute inpatient a view of quality and performance demands so that we can make settings), we have not fully met at both Trust and clinical area level. sure patients get great care when our target, achieving 71% in Q1, Review of existing, and the addition and where they need it. 70% in Q2 and 66% in Q3. This of more relevant specialised quality CQUIN is linked to a patient safety metrics, takes place annually. In order to ensure we consistently quality priority for 2018/19 (see deliver high quality care, we page 11). monitor and regularly report on a wide range of quality indicators at Use of the Commissioning for We did not achieve CQUIN 4a all levels within the organisation. Quality and Innovation (CQUIN) (improving services for people This information is displayed for payment framework with mental health needs who the public on noticeboards in ward The CQUIN payment framework present to ED), but did improve and clinic areas, on the website enables our commissioners to from 10% in Q1 to 50% in Q3. We and on the staff intranet site. Our reward excellence and innovation now have an established system- performance on quality is of national and locally-agreed wide forum which is developing discussed at staff meetings and at quality improvement goals reported system-wide care plans. each meeting of the Trust Board, to NHS England and our local as well as being reported to a Clinical Commissioning Group. Table 1 overleaf demonstrates number of groups and assurance the actual performance for the committees, such as the Quality The Ipswich Hospital NHS Trust’s CQUIN indicators for 2017/18 Committee, Finance & Performance income in 2017/18 was not for The Ipswich Hospital NHS Committee and Audit Committee conditional on achieving quality Trust. improvement and innovation goals
Commendation winner We said thank you to trainee doctor Foyzur for being an NHS hero. Foyzur is currently caring for our Obstetrics and Gynaecology patients and was surprised with an award while working on the Stour Centre.
Foyzur was singled out for the brilliant care he gave an emergency patient and their family. The family was distressed and anxious and Foyzur showed ‘over and above’ levels of professionalism and kindness to support them.
Foyzur Miah was presented with his Commendation by Managing Director Neill Moloney
23 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Monitoring quality
Table 1 – Actual performance for the CQUIN indicators for 2017/18
CCG Scheme Sub-scheme Q1 Q2 Q3 Q4 1 Improving Staff Health and Wellbeing a Improving staff health and wellbeing b Healthy food for staff, visitors and patients c Flu vaccination uptake for frontline staff 2 Reducing the impact of serious a Timely identification of sepsis in ED and Acute inpatient settings infections (Antimicrobial resistance and sepsis) b Timely treatment of sepsis in ED and Acute inpatient settings
c Antibiotic review Not d Reduction in antibiotic consumption for 1,000 admissions available 4 Improving services for people with Improving services for people with mental health needs who present mental health needs who present to ED a to ED 6 Offering advice and guidance a Offering advice and guidance 7 NHS e-referrals a NHS e-referrals Supporting proactive and safe Supporting proactive and safe discharge 8 discharge a
Specialist Commissioning Scheme Scheme Sub-scheme Q1 Q2 Q3 Q4 Hospital Adoption of best value generic/biologic products in 90% of new patients within one quarter of 1 Medicines guidance being made available. Optimisation Improving drugs MDS data quality to include dm+d as drug code in line with ISB0052 by June 2017 or 2 in line with agreed pharmacy system upgrade as well as all other mandatory fields. 3 Increase use of cost effective dispensing routes for outpatient medicines. 4 Improving the turnaround time for infection testing within NICU to meet NICE CG149 Improving data quality associated with outcome databases in agreed format fully, accurately 5 populated in agreed timescales. Nationally Local Drugs and Therapeutics committee have agreed and approved principles of dose 2 Standardised standardisation and dose adjustments required. Dose Banding 3 for Adults Targets to be agreed for end of year achievement in relation to the % of doses standardised per drug (number of SACT doses given of selected drugs that match to the standardised doses/number of (SACT) SACT doses given of selected drug); including confirmation of transition from local previously agreed QIPP arrangements (if any) such as legacy gain share.
4 Trust agreement and adoption of standard product descriptions (where these are available) for individual chemotherapy drugs. Palliative Review of current practice in relation to 30 day mortality reviews ensuring that monthly 30 day Chemotherapy 2 mortality review meetings are in place to review all deaths within 30 days of chemotherapy and that consultant specific 30 day mortality data is feedback on a regular basis to individual consultants. Documented improvement plan against all aspects of triggers 1 and 2 agreed and shared. Including % targets set for improvement in relation to number of cases where a documented peer discussion 3 takes place prior to commencement of continuation of treatment within the patient cohorts defined above. Spinal Surgery Continued working of the Regional Spinal Network on a 4-6 monthly rota. Minutes to be available and 1a must follow the National template. Continued working of the Sub-Network Clinical Governance Group with meetings every 2-4 months. 1b Minutes to be available and must follow the National template. 1c Update the Regional Policy to manage spinal emergencies including transfer if required 1d Update the Regional Policy for emergency imaging if required. Key
Green Amber Red Grey
Standard achieved Standard partially achieved Standard not achieved Development, implementation or not deliverable for this Quarter
24 The Ipswich Hospital NHS Trust—Quality Account 2017/18
How healthcare is regulated
The Ipswich Hospital NHS Trust is required to register with the Care Quality Commission (CQC) and its current registration status is full registration.
The Ipswich Hospital NHS Trust has the following conditions on registration - no conditions. are assessed during an inspection: The CQC found areas for The Care Quality Commission has Urgent & emergency services; improvement including two breaches not taken enforcement action against Medical care, including older of legal requirements the Trust must address. There were 22 The Ipswich Hospital NHS Trust people’s care; recommendations that the Trust during 2017/18. Surgery; should improve to comply with a Critical Care; The Ipswich Hospital NHS Trust has minor breach that did not justify not participated in any special Maternity; regulatory action, to prevent reviews or investigations by the Care Services for Children & Young breaching a legal requirement, or to improve service quality. The CQC Quality Commission during the People; issued two requirement notices to reporting period. End of Life Care; the Trust, which means the Trust Outpatients; and The CQC undertook unannounced has to send the CQC a report saying inspections of the Trust’s acute and Community health inpatient what action would be taken to meet community services on 30 & 31 services. these requirements. This action August 2017, 19-21 September 2017 related to breaches of legal and announced inspections on In addition there were inspections of requirements at a trust-wide level 12 & 13 October 2017 for the Well- the Well-led domain and Use of and in a number of core services. led domain, and 18 October 2017 for Resources. The CQC will ensure the Trust takes Use of Resources. the necessary action to improve its Inspections by the Care services. The CQC will monitor the safety and quality of services CQC monitoring and inspection Quality Commission (CQC) through its continuing relationship process The CQC regulates and regularly with the Trust and the regular The CQC‘s surveillance model is built inspects healthcare service providers inspections. The full report can be on a suite of indicators which relate in England. Where there is a legal viewed on the CQC website at http:// to the five key questions - are duty to do so, the CQC rates the www.cqc.org.uk/provider/RGQ services safe, effective, caring, quality of services against each key responsive, and well-led? question as outstanding, good Areas for improvement from requires improvement or inadequate. The indicators are used to raise Healthcare service providers can be the Trust’s inspection by the questions about the quality of care re-inspected at any time if services CQC but are not used on their own to fail to meet the Fundamental Action the Trust must take to make final judgements. Judgements Standards of Quality and Safety, or if improve: will always be based on a any concerns are raised. The CQC issued the Trust with two combination of what is found at requirement notices. For further inspection, national surveillance data Following the unannounced information see page 42 of CQC and local information from the Trust inspections of the Trust’s acute and report detailing what action the Trust and other organisations. The community services in August and must take. judgement is based on a ratings September 2017, and announced approach using the following inspections in October 2017, the Actions the Trust must take to categories: Trust received a rating of ‘Good’. comply with a minor breach that did Outstanding not justify regulatory action, to Good The report of this inspection, prevent it failing to comply with legal Requires Improvement published on 18 January 2018, details requirements in future, or to improve Inadequate a number of recommendations for services. This action related to two improvement. The Trust has services (urgent & emergency care, Inspections are carried out using an developed an action plan to address and children & young people’s expert team of inspectors over these recommendations, with services), and the Trust overall. several days. The following areas progress monitored monthly by the Quality Committee. 25 The Ipswich Hospital NHS Trust—Quality Account 2017/18
How healthcare is regulated
For the overall Trust: assessment base to identify Within the children’s service there ensure staff are up to date with patients with frailty needs. These is innovative use of various mandatory training in accordance with patients are moved to a specialist techniques, such as sensory their role, specifically basic, assessment ward within the Trust. equipment and animal handling for intermediate and advanced life The 2016 National Diabetes stimulation, distraction and comfort support. Inpatient Audit measured the for children with differing needs. ensure all staff are up to date with quality of diabetes care provided The chaplaincy team provide a safeguarding training to a level in to people with diabetes when they responsive supportive role accordance with their role and that are admitted to hospital whatever throughout the Trust. They carry a safeguarding documentation/ the cause, and aims to support trauma bleep to enable them to be flowcharts make reference to the quality improvement. The audit available to offer emotional different aspects of potential abuse. identified 86 inpatients with support to relatives of critically ill ensure there are effective processes in diabetes at the Trust. The overall patients. They also offer results indicate the Trust is in the place for equipment maintenance and emotional support to staff and best performing 25% of trusts in servicing. Oversight of action plans for have developed a resilience England. Electrical & Biomedical Engineering training programme. department should continue to ensure The frailty assessment base The Trust has a ‘carers cabin’ the environment is fit for purpose. provides an alternative to acute which is run in partnership with admission and enables instant ensure the recently established senior Suffolk Family Carers, a local advice for GPs or community management oversight of the charity. The cabin is situated teams and same or next day discharge lounge continues. outside the main hospital building, assessment by a dedicated MDT. and is open from Monday to Urgent & emergency services: The children and young people’s Friday, offering carers free service achieved recognition in refreshments and the chance to undertake a formalised assessment nominations for national awards drop in for emotional support and process to ensure that the area in with Voice4Change young signposting to services. majors used for mental health people’s group and the research assessments is safe and suitable for and development team. use. ensure staff are competent and documentation is accurate in relation to the modified early warning score (MEWS) within the emergency department. ensure there are effective processes in place to manage the electrical safety testing for all electrical equipment. ensure there are processes in place to manage effective equipment checks for example all resuscitation equipment is checked daily. ensure staff complete the required mandatory training.
Children & young people’s services: ensure all relevant staff are up to date with safeguarding children level three training. ensure the first hour of care documentation is completed by medical staff for all babies admitted to the neonatal unit.
The CQC found examples of outstanding practice in medical care, end of life care, children & young people’s services and urgent & emergency care:
The emergency department works collaboratively with the frailty 26 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Statements relating to the quality of relevant health services provided
NHS number and General Data Quality Medical Practice Code validity The Ipswich Hospital NHS Trust will be taking the following actions to improve The Ipswich Hospital NHS Trust data quality: submitted records during 2017/18 to the Secondary Uses Service for inclusion in the Hospital Episode Data Quality Indicator Update Statistics which are included in the latest published data. Consolidation and Co-ordinating 20/6/17 IHT - Awaiting feedback The percentage of records in the Commissioner sign off of the from CCG. published data which included the reporting into the Provider’s 15/8/17 CCG - Part of overall review patient’s valid NHS number was: Accountability Framework including of reporting requirements - CCG the source data file. Internal review - Ongoing. 99.69% for admitted patient care; 99.85% for outpatient care; and Joint review of accuracy of dataflow 20/6/17 IHT - Awaiting feedback 98.8% for accident and following implementation of NHS from CCG with regards to emergency care. Digital national data services. timeframe. 15/8/17 CCG - a) Move to non-sus The percentage of records in the to Data Landing Portal & b) ECDS published data which included the Progress IHT currently report will patient’s valid General Medical meet 1/10 start date - Ongoing. Practice Code was: 99.63% for admitted patient care; Child safeguarding - revised 20/6/17 IHT - Currently under review 94.07% for outpatient care; and template to be agreed by the by IHT, but Child Safeguarding Lead 98.32% for accident and Provider and Co-ordinating has expressed concerns that need emergency care. Commissioner and submitted. to be addressed. 15/8/17 CCG - Request for Child safeguarding template escalated Information Governance Toolkit within CCG - Ongoing. attainment levels The Provider shall publish median 20/6/17 IHT - Requires further The Ipswich Hospital NHS Trust waiting times for first and follow up discussion. - Ongoing. Information Governance Assessment outpatient appointments by specialty 15/8/17 CCG - CCG request. Report overall score for 2017/18 was on their website and to inform the Co 04/10/17 IHT - the August Median 84% and was graded satisfactory -ordinating Commissioner. OP Waiting Times were published (Green). on the Ipswich Hospital internet website at the end of September. This will be updated on Clinical coding a monthly basis. The Ipswich Hospital NHS Trust was not subject to the Payment by SEND Reporting. 20/6/17 IHT - Requires further Results clinical coding audit during discussion. - Ongoing. the reporting period by the Audit Commission*. However, an external clinical coding audit was carried out Data Sharing Requirements to 20/6/17 IHT - Trust IG Manager in January 2018 to satisfy the support development of Urgent and agreed a Data Sharing Agreement requirements of the Information Emergency Care Dashboards. with I&ES CCG and this wasn't Governance Toolkit. included at the time, so CCG should engage with Trust IG Manager to take this forward.
* The clinical coding functions noted above and previously undertaken by the Audit Commission are now under the guidance of NHS Improvement.
27 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Core Quality Indicators The data given within the Core Quality Indicators is taken from the Health and Social Care Information Centre Indicator Portal (HSCIC), unless otherwise indicated. Please note that HSCIC is now known as NHS Digital.
Indicator: Summary Hospital-Level Mortality Indicator (SHMI)
SHMI is a hospital-level indicator which measures whether mortality associated with a stay in hospital was in line with expectations. SHMI is the ratio of observed deaths in a Trust over a period of time divided by the expected number given the characteristics of patients treated by the Trust. SHMI is not an absolute measure of quality, however, it is a useful indicator to help Trusts understand mortality rates across every service provided during the reporting period.
The data made available to the Trust by Reporting Ipswich National Highest Lowest Banding the HSCIC with regard to: period score average score score
The value and banding of the SHMI for the Oct 14 - Sept 15 0.983 1 1.177 0.652 2 Trust for the reporting period Oct 15 - Sept 16 0.983 1 1.164 0.692 2
Oct 16 - Sept 17 1.044 4 1.247 0.727 2
The percentage of patient deaths with Oct 14 - Sept 15 11.7 26.5 53.5 0.2 - palliative care coded at either diagnosis or speciality level for the Trust for the reporting period Oct 15 - Sept 16 14.6 29.7 56.3 0.4 - (the palliative care indicator is a contextual indicator) Oct 16 - Sept 17 21.5 31.5 59.8 11.5 -
The Ipswich Hospital NHS Trust considers that this data is as described for the following reason: The Trust is banded as a ’2’ which is ‘as expected’ mortality. This correlates with the information gained from local morbidity & mortality meetings.
The Ipswich Hospital NHS Trust is taking the following actions to improve this score, and so the quality of its services, by: The Trust now follows the national mortality review programme and is prospectively reviewing any patient groups flagged through Dr Foster via the structured judgement review process.
Ongoing surgical improvement audit to reduce mortality associated with emergency and elective surgical care.
Ongoing learning is occurring through newly established regular divisional ‘learning from death’ meetings, feeding back to the Mortality Review Group.
Commendation winners
Lavenham ward sisters Fiona and Naomi have won a staff award after their staff described them as ‘hard working and professional’ and said they ‘would love them to know how grateful we are’. Here they are pictured with matron Lindsey and Director of Nursing Lisa.
Fiona Rawson and Naomi Gunton pictured with matron Lindsey Mazur (left) and Director of Nursing Lisa Nobes (right).
28 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Core Quality Indicators
Indicator: Patient Reported Outcome Measures (PROMs) scores PROMs measures a patient’s health-related quality of life from the patient’s perspective using a questionnaire completed by patients before and after four particular surgical procedures. These questionnaires are important as they capture the extent of the patient’s improvement following surgery.
The data made available to the Trust by the Ipswich National Highest Lowest Reporting period HSCIC with regard to: score average score score
2015/16 0.491 0.573 8.0 0.02 The Trust’s patient reported outcome measures scores for groin hernia surgery during the 2016/17 0.636 0.575 7.58 0.01 reporting period 2017/18 Data expected to be published summer 2018. 2015/16 0.335 0.327 1.918 0.020 The Trust’s patient reported outcome measures scores for varicose vein surgery during the 2016/17 0.258 0.349 3.366 0.21 reporting period 2017/18 Data expected to be published summer 2018. 2015/16 0.646 0.869 12.87 0.153 The Trust’s patient reported outcome measures scores for hip replacement surgery during the 2016/17 1.00 0.85 4.66 0.164 reporting period 2017/18 Data expected to be published summer 2018. 2015/16 0.736 0.963 7.730 0.035 The Trust’s patient reported outcome measures scores for knee replacement surgery during the 2016/17 0.947 0.944 5.54 0.18 reporting period 2017/18 Data expected to be published summer 2018. The Ipswich Hospital NHS Trust considers that this data is as described for the following reason: The scores show significant improvement from earlier scores. One reason would be a higher incidence of laparoscopic surgery for varicose vein and groin hernia surgery.
The PROMs score for knee replacement is 0.003 below the national average for the first time. We can find no reason for this change.
The Ipswich Hospital NHS Trust has taken the following actions to improve this score, and so the quality of its services, by: More recently, a greater number (>50%) of varicose vein and groin hernia surgery has been carried out laparoscopically by Consultant grade clinicians.
The data will be reviewed in the next round of scores being published summer 2018 and if scores unchanged or worse we will attempt to review the raw data.
29 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Core Quality Indicators
Indicator: Readmission rates
The percentage of patients readmitted to a hospital which forms part of the Trust within 28 days of being discharged from a hospital which forms part of the Trust during the reporting period.
In the absence of national data being made Ipswich National Highest Lowest available by NHS Digital, the Trust has Reporting period score average score score presented locally calculated metrics: % of patients aged 0-15 years readmitted 2015/16 10.7% within 30 days 2016/17 10.8% No data available. NOTE: Data runs from 1 February 2017 - 31 January 2018 2017/18 10.8% % of patients aged 16 years or over 2015/16 7.8% readmitted within 30 days 2016/17 7.4% No data available. NOTE: Data runs from 1 February 2017 - 31 January 2018 2017/18 7.9%
The Ipswich Hospital NHS Trust considers that this data is as described for the following reason: As national data for readmissions within 28 days has not been made available through NHS Digital, the Trust has provided the local metric for readmission rates within 30 days. This is monitored at both a divisional level and Trust level through the Accountability Framework. The Ipswich Hospital NHS Trust has taken the following actions to improve this score, and so the quality of its services, by: Ensuring every child and their parents/carers are given both written and verbal information on their condition, with self-management instructions. Children with chronic conditions such as Cystic Fibrosis, oncology or respiratory conditions are able to attend under ‘open access’ arrangements, and these patients are counted in our readmission figures. Enhanced admission prevention services in place to prevent patients reaching crisis point before needing admission. From 1 April 2018 we will be bringing historically separate services together to deliver a more integrated approach across acute and community services.
Indicator: Responsiveness to the personal needs of patients during the reporting period The data made available to the Trust by the Ipswich National Highest Lowest Reporting period HSCIC with regard to: score average score score
The Trust’s responsiveness to the personal needs 2015/16 68.1 69.6 86.2 58.9 of its patients during the reporting period 2016/17 66.9 68.1 85.2 60.0
2017/18 Publication due August 2018. The Ipswich Hospital NHS Trust considers that this data is as described for the following reason: Care rounding is used in all appropriate clinical areas. It is regularly audited to ensure practice is embedded.
The Ipswich Hospital NHS Trust has taken the following actions to improve this score, and so the quality of its services, by: The nurse in charge on each ward is identifiable with a large red ‘Nurse in Charge’ badge. Plan to further develop the HELP line, helping to empower loved ones and patients to raise and resolve concerns at ward level. Improving recruitment and retention of all care staff using the learning from the NHS Improvement Retention Collaborative.
30 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Core Quality Indicators
Indicator: Staff recommendation (Friends and Family Test) Taken from Question 21d of the NHS staff survey The data made available to the Trust by the Ipswich National Highest Lowest HSCIC with regard to: Reporting period score average score score (best) (worst) The % of staff employed by or under contract to 2015 76% 69% 89% 46% the Trust during the reporting period who would recommend the Trust as a provider of care to 2016 75% 69% 91% 48% their family and friends. 2017 77% 71% 93% 42% The Ipswich Hospital NHS Trust considers that this data is as described for the following reason: Responses to the NHS Staff Survey are independently reviewed. The 2017 survey was a census rather than responses from a random sample of staff. The Ipswich Hospital NHS Trust is taking the following actions to improve this score, and so the quality of its services, by: In collaboration with staff and external stakeholders, we have developed and will be delivering our People, Organisation and Development Strategy. Further development of our Staff Experience Group and our Equality, Diversity and Inclusion Group. Improving the experience for appraisals and personal development conversations by delivering a number of appraisal training sessions entitled High quality workplace conversations. Improved communication by launching a new weekly staff briefing.
Indicator: Patient recommendation (Friends and Family Test) The data made available to the Trust by the HSCIC with Reporting Ipswich National Highest Lowest regard to: period score average score score (best) (worst) All acute providers of adult NHS funded care, covering services for inpatients and patients discharged from A&E (types 1 and 2) Inpatients 2015/16 95.82% 95.4% 100% 83.3% 2016/17 95.87% 95.39% 100% 75.55% 2017/18* 97.22% 95.75% 100% 71.88% A&E 2015/16 79.04% 87.69% 98.9% 49.3% 2016/17 74.56% 86.16% 100% 47.8% 2017/18* 77.26% 88.27% 98.6% 53.3% The Ipswich Hospital NHS Trust considers that this data is as described for the following reasons: Results are monitored by the Information Department, Divisions, Patient & Carer Experience Committee and Trust Board using the Integrated Performance Report; and any outlying scores trigger a review.
The Ipswich Hospital NHS Trust has taken the following actions to improve this score, and so the quality of its services, by: Reviewing results within the relevant CDG and Divisional meetings and at Patient & Carer Experience Committee meetings, and any actions required to improve responses are taken. Teams working with wards and clinics to review feedback to make improvements - see ‘You said, we did’ on page 64. Emphasising the importance of submission of good returns and the satisfactory outcome scores achieved in multidisciplinary team meetings.
*Data relates to the period April 2017 - February 2018 (the latest published data) 31 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Core Quality Indicators
Indicator: Risk assessment for venous thromboembolism (VTE) The data made available to the Trust by the Reporting period Ipswich National Highest Lowest HSCIC with regard to: score average score score (best) (worst)
% of patients who were admitted to hospital and 2015/16 94.1% 95.7% 100% 75% who were risk assessed for venous thromboembolism during the reporting period 2016/17 81.5% 95.5% 100% 73%
2017/18 Q1 - Q3 (most recent data 88.1% 95.2% 100% 66.4% available at time of publishing) The Ipswich Hospital NHS Trust considers that this data is as described for the following reason: The Ipswich Hospital NHS Trust switched to electronic VTE risk assessment in 2016. Although we have largely maintained our performance in the appropriate prescription of thrombo-prophylactic medication, we have performed less well in our risk stratification assessment of VTE risk. The move to the electronic Nervecentre system for risk stratification brought an additional task to perform in the VTE risk stratification. We have tried hard to improve performance, but after discussion with clinicians and nursing staff, have now moved to a paper based risk stratification as part of a new drug chart. We intend in the longer term to look to an e-prescribing solution whereby VTE risk assessment will be a gateway to the inpatient prescription pathway. The Ipswich Hospital NHS Trust is taking the following actions to improve this score, and so the quality of its services, by: The thrombosis group and medical director have decided to revert to using the paper VTE assessment on the drug chart from 1st May 2018. The overall plan is to include VTE risk assessment with e-prescribing when this is implemented. We would expect compliance to improve, since rates of assessment were high on previous paper VTE risk assessments prior to switching to electronic assessment.
Indicator: Clostridium difficile infection rate The data made available to the Trust by the HSCIC Reporting Ipswich National Highest Lowest with regard to: period score average score score (worst) (best)
The rate for 100,000 bed days of cases of Clostridium 2015/16* 20.1 14.9 66.0 0 difficile infection reported within the Trust amongst patients aged 2 or over during the reporting period 2016/17** 18.6 29.9 62.0 0 2017/18** 10.4 13.9 95.1 0 The Ipswich Hospital NHS Trust considers that this data is as described for the following reasons: The accuracy of the data is checked thoroughly before submission. Data is cross-checked with laboratory data and is subject to external assurance by the Ipswich & East Suffolk Clinical Commissioning Group. Post infection reviews now carried out at a local level, ensuring more robust investigation to highlight areas of learning to share with all clinical areas. The Ipswich Hospital NHS Trust has taken the following actions to improve this score, and so the quality of its services, by: Purchased a Vaporised Hydrogen Peroxide decontamination system for environmental decontamination of single rooms including equipment, and the Trust is planning to review how this equipment could be utilised more widely across all clinical areas.
* Includes Clostridium difficile cases at community hospitals managed by The Ipswich Hospital NHS Trust from 1 October 2015 to 31 March 2016. ** Includes Clostridium difficile cases as community hospitals managed by The Ipswich Hospital NHS Trust.
32 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Core Quality Indicators
Indicator: Patient safety incident rate
The data made Reporting Ipswich National Highest Lowest available to the Trust period Score average score score by the HSCIC with regard to: Number Rate Number Rate Number Rate Number Rate the number and rate of October 14 - 2,664 26.67 4,538 37.1 12,784 82.21 443 3.57 patient safety incidents March 15 reported within the April 15 - Trust during the 2,954 32.90 4,125 38.25 12,080 74.67 1,559 18.07 reporting period September 15
October 15- 3,331 38.68 4,817 39.6 3,426 75.91 2,394 18.19 March 16 (please note that the reporting period April 16- 3,486 35.44 4,955 40.76 3,620 71.81 2,305 21.15 changed to ‘per 1,000 September 16 bed days’ in April 2014) October 16- 4,049 36.77 5,122 41.1 3,300 68.97 3,227 26.29 March 17
April 17- 4,630 44.44 5,226 42.84 10,016 111.69 3,085 23.47 September 17
October 17- Data not available at time of publishing. March 18 the number and Reporting Ipswich National Highest Lowest percentage of such period Score average score score patient safety incidents that resulted in severe Number % Number % Number % Number % harm or death during October 14 - the reporting period 12 0.4 22.5 0.5 128 1.53 2 0.02 March 15
April 15 - 21 0.7 17 0.14 89 1.12 0 0.03 September 15
October 15- 19 0.5 19.4 0.4 94 1.3 1 0 March 16
April 16- 27 0.77 18.5 0.37 98 1.73 1 0.02 September 16
October 16- 22 0.5 19.2 0.4 92 1.1 1 0 March 17
April 17- 24 0.5 18.38 0.4 121 2.0 0 0 September 17
October 17- Data not available at time of publishing. March 18
Continued...
33 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Core Quality Indicators
Indicator: Patient safety incident rate
The Ipswich Hospital NHS Trust considers that this data is as described for the following reasons: Our ambition for 2017/18 was to increase our incident reporting rate and we have achieved a 20 percent increase; particularly of ‘no harm’ and ‘low harm’ categories. This proactive and open reporting ensures that all patient safety incidents are reviewed and investigated to ensure lessons are learned to safeguard future patient care. Patient safety incidents (irrespective of the level of harm) are uploaded to the NRLS, to enable NHS-wide learning.
We have reported performance of 0.5 percent in respect of the ‘percentage of patient safety incidents that resulted in ‘severe harm or death’ indicator which benchmarks similar to our peer group. The nature of the process for investigating patient safety incidents and assessing the severity means that the severity of a case may be amended following the initial upload of the details to the national database. The national database has data freeze points during the year which prevents any amendments post these points in time being reflected in the published data. Five of the reported severe harm or death patient safety incidents were subsequently re-graded to lower harm levels following investigation which is not reflected in the published data. As a result, the published figure of 24 has subsequently changed and using most up to date data would give a percentage of patient safety incidents resulting in severe harm or death for April-September 2017 as 0.37 percent which is consistent with peer organisations.
41% of our patient safety incidents resulting in severe harm or death were related to patient falls leading to injuries requiring medical interventions. The Trust continues to focus on the prevention of falls and will continue to work with health and social care colleagues locally to support the elderly and frail members of our community. See pages 42 and 43 for the improvements we intend to make.
The Ipswich Hospital NHS Trust is taking the following actions to improve this score, and so the quality of its services, by: The Trust Board has stated a commitment to improving our reporting rate, with the ambition stated within our strategy to be in the top 25% of reporters on the NRLS database by 2022.
We will continue to engage our staff to report all types of incidents to enable learning and changes to our service models to reduce the risk of adverse events for our service users.
Commendation winner
Critical Care Outreach nurse Sue Chatterton Sue is part of our Critical Care Outreach team and supports very unwell patients on the wards, often before or after a stay in the Critical Care Unit.
Alongside her day job caring for patients, Sue has been leading a project to collect and analyse useful data for her team’s patients. It means the team can provide a safer service.
Sue Chatterton with her commendation certificate
34 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Part 3 - Other information Patient safety Infection prevention and control
Infection prevention and control is a high priority for the Trust, our patients and visitors. Limiting the spread of infection can be as simple as making sure everyone washes their hands, uses the antibacterial hand gel, does not visit hospital when feeling unwell and everything is clean, to caring for patients who need complex clinical care.
What is MRSA bacteraemia? MRSA stands for meticillin resistant Staphylococcus aureus. It is a strain of the Staphylococcus aureus family of bacteria, which cause a number of infections, some of which are serious. The reason that MRSA is such a problem for hospitals, and why it has become known as a superbug, is that it is resistant to common antibiotics.
Bacteraemia is when there is bacteria present in the bloodstream such as MRSA. MRSA can enter the normally sterile bloodstream either from a local site of infection (wound, ulcer, abscess) or, for example, via an intravenous catheter (placed there for the patient’s medical care).
MRSA screening MRSA bacteraemia Number of cases of As per the Department of Health Year Target Chart 1 shows our performance in MRSA paper Implementation of modified rates of MRSA bacteraemia bacteraemia admission MRSA screening compared with the other hospitals guidance for NHS, published in Zero in the East of England. The last 2015/16 0 2014, the Trust screens patients in case of MRSA bacteraemia cases high risk areas such as Critical assigned to the Trust was May Zero Care, Oncology, Orthopaedics and 2016/17 0 2017. cases Neonates, and screens high risk patients such as renal patients and The rates are calculated using the Zero past MRSA-positive patients, but 2017/18 1 total number of cases from 1 April cases does not routinely screen medical 2017 to 31 March 2018, the patients, emergency admissions or average daily number of available day cases. This targeted approach and occupied beds and expressed to screening is national practice. as rates per 100,000 bed days.
Patients identified as colonised with MRSA will be offered Chart 1 – The performance of Ipswich Hospital in rates of decolonisation treatment as MRSA bacteraemia, compared with the other hospitals in the appropriate. East of England region for 2017/18 Patients currently colonised with MRSA will be cared for using MRSA bed days (monthly figures by average) per 100,000 EOE all cases: precautions to stop Data 1/4/17 to 31/03/18 transmission. 8 7 6 5 Learning from MRSA 4 bacteraemia cases 3 2 Improved recording of insertion 1 and removal of peripheral 0 intravenous catheters.
35 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Patient safety Infection prevention and control
Clostridium difficile Chart 2 shows our performance in rates of Clostridium difficile compared What is C.difficile? with the other hospitals in the East of England. The rates are calculated C.difficile is an abbreviation of using the total number of cases from 1 April 2017 to 31 March 2018, the Clostridium difficile and it is the average daily number of available and occupied beds and expressed as rates per 100,000 bed days. major cause of antibiotic- associated diarrhoea and colitis, Each case of Clostridium difficile is subject to a post-infection review. If all an infection of the intestines. It care is in place and appropriate, the Infection Prevention and Control lead is part of the Clostridium family for the commissioners may designate a case as ‘non-trajectory’. of bacteria, which also includes
the bacteria that cause tetanus, 14 of the 23 cases were identified as non-trajectory by commissioners. The table below shows the total number of cases, both apportioned to The botulism and gas gangrene. It is Ipswich Hospital NHS Trust (trajectory) and those where all care had been an anaerobic bacterium (it does appropriate and there was nothing further that could have been done to not grow in the presence of prevent the infection (non-trajectory), such as the patient’s need for oxygen) and produces spores antibiotics being greater than the risk of developing a Clostridium difficile that can survive for a long time infection. in the environment. It most
Two themes have emerged as learning from Clostridium difficile infections: commonly affects elderly the benefits of both timely isolation and sampling lead to reduced risk of patients with other underlying transmission and more prompt giving of treatment. diseases.
Total number of cases of Year Target Clostridium difficile 32+5 cases from the three 2015/16 No more than 18 cases community hospitals (October 2015 onwards)
No more than 18 (trajectory) 9 trajectory 2016/17 cases 20 non-trajectory
No more than 18 (trajectory) 9 trajectory 2017/18 cases 14 non-trajectory
C.diff bed days (monthly figure by average) per 100,000 bed days EOE year to date: Trust apportioned - Data 1/4/17 - 31/03/18 90 80 70 60 50 40 Chart 2 – The 30 performance of Ipswich 20 10 Hospital in rates of 0 Clostridium difficile, compared with the other hospitals in the East of England region for 2017/18 (reference: Public Health England, 2018)
36 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Patient safety Infection prevention and control
Norovirus Influenza Norovirus is measured in number There were 3 outbreaks of of outbreaks rather than the Influenza A in the Trust during number of cases. This is because 2017/18. One ward was of its ability to affect the optimal completely closed as a management of a hospital consequence, and two wards (outbreaks may cause ward or were partially closed. hospital closures). Preventing healthcare There were 10 outbreaks of associated Gram-negative Norovirus during 2017/18, which bloodstream infections resulted in two complete ward closures and eight partial ward There is an NHS-wide ambition to closures to minimise transmission reduce the number of healthcare to other patients and visitors. associated Gram-negative blood Visitors can help to stop the stream infections by 50% by 2021, spread of norovirus by not visiting and reduce inappropriate the hospital if they feel unwell or antimicrobial prescribing by 50% by have vomiting and/or diarrhoea. 2021.
Number of outbreaks of As an organisation, we will be focussing across our acute and Norovirus at Ipswich community services on reducing Hospital NHS Trust the number of e-coli bloodstream infections as this represents 55% 2015/16 (includes community services 6 of all Gram-negative bloodstream from October 2015) infections.
Appropriate use of antibiotics for 2016/17 8 (includes community services) possible urinary tract infections and keeping patients hydrated may contribute to a reduction in e-coli 2017/18 10 (includes community services) bloodstream infections.
Commendation winners
The IT team The NHS Cyber Attack brought IT systems in hospitals up and down the country to a halt back in May. While our hospital’s computers systems weren’t infected, our IT and Information teams had to work extraordinarily hard behind the scenes. Not only did they pull out all the stops to protect our hospital’s systems and ensure patient care could continue as normal, they also travelled in numbers down the A12 to Colchester Hospital to help out where they were more heavily affected.
Members of the Trust’s IT Team, receiving their commendation certificate from Managing Director Neill Moloney and Chief Executive Nick Hulme
37 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Patient safety Prevention and treatment of pressure ulcers
What is a pressure ulcer? How do you recognise a pressure ulcer? A pressure ulcer is damage that occurs on the skin and The first sign that a pressure ulcer may be forming is underlying tissue. usually discoloured skin, which may get progressively worse and eventually lead to an open wound. Pressure ulcers are caused by three main things: Where do you get a pressure ulcer? pressure - the weight of the body pressing down on the skin; The most common places for pressure ulcers to occur are over bony prominences (bones close to the skin) like shear - the layers of the skin are forced to slide over the bottom, heel, hip, elbow, ankle, shoulder, back and one another or over deeper tissues, for example when the back of the head. you slide down, or are pulled up, a bed or chair or when transferring to and from a wheelchair; and friction - rubbing the skin.
The development of a pressure recommend use of correct Thematic review of pressure ulcer is usually the result of a equipment for individual needs; ulcers has provided a number of factors including health framework for key actions to conditions which make it difficult to develop the wound care product formulary; and reduce the occurrence of move, especially those confined to avoidable pressure ulcers. ensure the Trust is providing lying in a bed or sitting for The Quality Committee prolonged periods of time, sensory current, evidence-based care. continues to provide support to impairment, poor nutrition, the tissue viability service to dehydration and incontinence. Our key achievements drive improvements in patient safety. We have a clinical specialist team Expansion of the senior tissue Increasing use of vacuum whose remit is to: viability team to provide dressings which enable patients encourage ‘gold standard’ enhanced support to all clinical to be discharged from hospital practice across the hospital to areas. sooner and receive further reduce the number of pressure Led the development of the treatment at home. ulcers that occur during Tissue Viability Alliance for Continue to trial new and hospital inpatient stays; Suffolk. innovative equipment to meet support community staff who Purchased additional bariatric the individual needs of our regularly visit patients in their equipment such as pressure- patients and encourage own home to assess, educate relieving cushions and reablement. and offer pressure relieving wheelchairs. equipment and guidance to Responded to the increasing patients to reduce the high requirement for enhanced Aims for 2018/19 occurrence of pressure ulcers levels of tissue viability that develop in this patient prevention equipment, as part Review the provision of group; of the organisation’s seasonal equipment available for use on provide education and training planning. wards, reducing the delay of to multidisciplinary staff to Tissue viability links with the essential equipment being improve and standardise University of Suffolk to improve available. practice across all areas levels of knowledge for pre- Strengthen local leadership for including community staff and registration healthcare tissue viability to include other support services; students. pressure ulcer management. support education opportunities Focussed training provided Develop the provision of an to care home staff to tailored to individual enhanced service to include encourage ‘gold standard’ departmental needs. outpatients. practice in all care Provision of support to ward Standardise a wound care environments in the managers and clinical teams formulary Suffolk-wide. community. when undertaking root cause Provide training days for care develop policies and pathways analysis of pressure ulcer home staff. in line with national guidance development to ensure lessons and best practice; are learnt and disseminated 38 widely. The Ipswich Hospital NHS Trust—Quality Account 2017/18
Patient safety Prevention and treatment of pressure ulcers
How pressure ulcers are Commendation winner graded Anna Kruczek has been awarded a Commendation for acting European Pressure compassionately and quickly to help two end of life patients get home to die. Anna is the discharge coordinator for Washbrook and Woodbridge Advisory Panel (EPUAP) wards but was on a night duty overtime shift as a healthcare assistant Classifications when she stepped in to help the patients and their families.
Grade 1 There is only one chance to get end of life care right and Anna acted Non-blanchable erythema of intact skin. Discolouration of the skin, with kindness, respect and professionalism to get both patients safely warmth, oedema, induration or discharged, with care arranged at home, the following morning. One of hardness may also be used as the patients died in the comfort of her own home, as was her wish, the indicators, particularly on day after. Without Anna voluntarily using her discharge skills while on individuals with darker skin. an HCA shift the lady would have died in hospital. Anna was also applauded for the rapport she built with the patients’ families and the Grade 2 arrangements she made with the day staff to make sure the discharges Partial thickness skin loss involving went ahead. epidermis, dermis, or both. The ulcer is superficial and presents Anna was surprised with the award at a ward Board Round by Managing clinically as an abrasion or blister. Director Neill Moloney. Grade 3 Full thickness of skin involving damage to, or necrosis of, subcutaneous tissue that may extend down to but not underlying fascia - the skin may be unbroken.
Grade 4 Extensive damage, tissue necrosis or damage to muscle, bone or supporting structures with or without full thickness skin loss.
Anna Kruczek, pictured with colleagues and Managing Director Neill Moloney
Chart 3 – Our performance over the last three years: Avoidable pressure ulcers per 1,000 bed days
39 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Patient safety Learning from Incidents, SIRIs and Never Events
Reporting incidents helps us to learn from them and decide whether we need to change the way we do things to improve patient safety, as well as identifying areas where we need to focus resources, such as training. We report our patient safety incidents to the National Reporting and Learning System (NRLS) so that information can be reviewed nationally for trends or problems.
Learning from incidents Changes we have made as a Duty of Candour All reported incidents are result of lessons learnt: Open and honest communication investigated and lessons that can Removal of non radio-opaque with patients is at the heart of be learnt are shared by Clinical small cotton swabs from use healthcare. Delivery Group governance within theatres. meetings, at Divisional Board Introduction of the national Regulation 20 of the Health and Social Care Act 2008 (Regulated meetings, at morbidity & mortality Invasive Procedure Policy which Activities) Regulations 2014 sets meetings and discussed at the sets out the standards for out some specific requirements Trust’s Risk Oversight Committee. checking of patients undergoing which providers must follow when invasive procedures outside the things go wrong with care and It is important that when serious operating theatre, such lumbar treatment, including informing incidents occur, they are reported punctures. people about the incident, and investigated in a timely Anaesthetic Pre-operative manner, not only to ensure that the providing reasonable support, Investigations in Adults guideline providing truthful information and correct action can be taken, but to updated and incorporated into a enable the Trust to learn from the an apology when things go wrong. comprehensive overarching incident to prevent it happening guideline to ensure patients with again and to reassure the patient As part of the Trust’s process, suspected acute kidney injury patients or their relatives are involved that such incidents are are managed correctly. taken seriously and thoroughly informed of any such incidents. investigated. Sepsis e-learning programme for The Trust continues to work to new FY1, FY2 and registered improve the timeliness of follow up The higher level incidents are nurses launched to highlight the letters to patients, their families or categorised as Serious Incidents signs and symptoms of sepsis carers and to work with the Requiring Investigation (SIRIs) and (Sepsis Six). families to individualise the level of are reported to the Ipswich & East Formalised process introduced engagement. Suffolk Clinical Commissioning so that patients being Group. These incidents are transferred between Failure to meet this regulatory investigated, a comprehensive departments now require formal standard may result in financial report written and actions identification between staff penalty. The Trust has not been implemented, and the learning undertaking the transfer. subject to any penalties relating to shared both within the organisation Modification to the incident Duty of Candour. and with the patient and/or their reporting system to ensure fields family. relating to whether a patient safety incident has safeguarding What have we done to make The number of pressure ulcers implications are now mandatory. improvements? recorded during 2017/18 has Introduction of new processes increased due to reporting changes around the management of Availability of an information to now include the reporting as patients with glaucoma, leaflet to be given to patients or SIRIs of all avoidable and particularly patients with raised their relatives who have been unavoidable pressure ulcers. intraocular pressure. the subject of a serious incident Updated protocols in place to (SIRI). The leaflet explains the agree referral criteria and process for investigating a SIRI required response times (such and how patients and their as ‘urgent’, ‘soon’, ‘routine’) for families can get involved. appointments within Diagnostic Formalisation of a family liaison Imaging. officer role to support those patients and their relatives during the SIRI investigation process.
40 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Patient safety Learning from Incidents, SIRIs and Never Events
Table 2 – Adverse events and SIRIs reported Never Events For the year 2017/18, there have been the following adverse events Never Events are serious, (categorised as no harm to severe harm) reported on the Datix risk largely preventable patient management computer system. The adverse events recorded below are all safety incidents that should not adverse events, not only those related to patients. occur if the available preventative measures have No. of been implemented. Type of adverse event adverse events The list of Never Events for 2017/18, as defined by NHS Abusive, violent, disruptive or self-harming behaviour 222 Improvement (Revised Never Access, Appointment, Admission, Transfer, Discharge 1,860 Events Policy and Framework, 2015), are: Accident that may result in personal injury 2,246 Anaesthesia 19 1 Wrong site surgery Clinical assessment (investigations, images and lab tests) 1,105 2 Wrong implant/prosthesis 3 Retained foreign object Consent, Confidentiality or Communication 435 post-procedure Diagnosis, failed or delayed 85 4 Mis-selection of a strong Financial loss 3 potassium containing solution 5 Wrong route administration of Implementation of care or ongoing monitoring/review 2,636 medication Infrastructure or resources (staffing, facilities, environment) 550 6 Overdose of insulin due to Labour or Delivery 442 abbreviations or incorrect device Medical device/equipment 405 7 Overdose of Methotrexate for Medication 1,299 non-cancer treatment Other - please specify in description 309 8 Mis-selection of high strength midazolam during conscious Patient Information (records, documents, test results, scans) 438 sedation Security 63 9 Failure to install functional collapsible shower or curtain Treatment, procedure 264 rails Totals: 12,381 10 Falls from poorly restricted windows 11 Chest or neck entrapment in Of these adverse events, 162 were reported during 2017/18 as Serious Incidents bedrails Requiring Investigation (SIRIs) on the national Strategic Executive Information 12 Transfusion or transplantation System (StEIS): of ABO-incompatible blood components or organs No. of Type of adverse event 13 Misplaced naso- or oro-gastric SIRIs tubes Adverse media coverage or public concern 0 14 Scalding of patients Allegation against staff 4 Diagnostic incident including delay meeting SI criteria 14 There are exclusions to each Never Infection control incident meeting SI criteria 5 Event. Information Governance breach 2 Never Events at The Ipswich Maternity/Obstetric incident meeting SI criteria (mother/baby) 3 Hospital NHS Trust Medication incident meeting SI criteria 3 Pressure ulcers Grade 3 or 4 meeting SI criteria 91 2015/16 2016/17 2017/18 Screening issues meeting SI criteria 0 5 4 1 18 Slip/trip/fall meeting SI criteria Regrettably there was one Never Suboptimal care of the deteriorating patient meeting SI criteria 5 Event during 2017/18 when a Surgical/Invasive procedure incident meeting SI criteria 6 foreign object was retained post Treatment delay meeting SI criteria 11 procedure. The patient has suffered no ill effects. Totals: 162
41 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Patient safety Prevention of patient falls
What are patient slips, trips and falls? What can contribute to the cause of patient There will always be a risk of falls in hospital given slips, trips and falls? the nature of the patients that are admitted, and badly fitting or no footwear; the injuries they may sustain could be serious. not using the correct walking aids, if needed; cluttered areas; However, there is much that can be done to problems with vision, hearing or balance; reduce the risk of falls and minimise harm, whilst loss of muscle strength; at the same time properly allowing patients dehydration; freedom, mobilisation and rehabilitation during medication; their stay in hospital and beyond discharge. not calling for assistance; confusion; acute medical illness.
Prevention of patient falls What are we doing to make Our key achievements Preventing falls must be balanced improvements? Supporting patients to help with patients’ rights to dignity, Our focus has been on themselves so that they do not privacy, independence, reablement and giving patients the lose confidence in mobilising. rehabilitation and their choice confidence to move safely, which Launched an enhanced about the risks they are prepared stops their muscles deconditioning reablement training programme to take. A ward where no patient (wasting) giving them strength to for all nursing, therapy and falls is likely to be a ward where mobilise and not lose their support staff, with 2-3 no patient can regain their balance. Loss of strength can reablement champions on each independence and return home. make the difference between ward. Led by therapists, the This does not stop the Trust from dependence and independence. training helps staff to recognise wanting to provide the best quality those patients most likely to fall. and safest care for our patients. For patients who have acute Launch of ‘Get up and Go’ confusion or delirium, evidence of initiative (see page 43). There has been a changing frailty and are at risk of falling, we Participation in the national demand on community hospitals, have implemented a delirium care #EndPJparalysis campaign with an ever increasing cohort of plan and continence care plan to Launch of the Short Term frail patients. There is a concerted optimise these parts of their care. Assessment, Reablement and effort to tackle these challenges Delirium and continence are often Rehabilitation (STARR) Centre whilst continuing to maintain major pre-cursors for falling. at Bluebird Lodge community patient safety. Ward staff continue hospital. The facility helps to assess falls risk and manage patients who are not safe to patients who repeatedly fall using return home immediately after a individualised care plans. We stay in hospital to go back to continue to investigate innovative their own homes within two and collaborative ways of working weeks, thanks to a course of with other organisations to intensive rehabilitation and streamline resources. reablement. Patients will be able to plan their recovery while being helped by staff with everyday tasks such as walking, dressing and cooking to help them regain their independence and increase their strength.
Chart 4 – Our performance over the last three years: Falls per 1,000 bed days 42 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Patient safety Prevention of patient falls
Participated as one of 20 The “Get Up and Go” initiative as they did before their admission Trusts invited to be part of an reminds staff of the importance of when they do return home. East of England 100 day keeping all patients, especially challenge to get all of our those who are frail and elderly, “Where clinically possible, we want appropriate patients up and active so they do not lose strength, every single patient to stay as close dressed on the wards to balance and mobility. By doing so, to their usual routine as they can by promote their independence they can retain a good quality of life getting up and dressed, staying and prevent deconditioning. and live as independently as hydrated, eating their meals in a We accepted the challenge as possible after discharge from chair and walking to the toilet so it links with our Get Up and Go hospital. that they can enjoy a good quality campaign and the reablement of life when they are discharged.” training programme. In 100 Evidence shows spending 10 days days, the 20 trusts together in a hospital bed causes the Staff training is taking place, while a aimed to get 100,000 patient equivalent of 10 years’ ageing in patient booklet is also being days where patients are up, the muscles of people aged 80 and produced which includes exercises dressed and moving in their over. In addition, prolonged bed people can do in their chairs as well own clothes, rather than rest can also lead to depression, as space to note down their daily wearing hospitals gowns or reduced appetite, urinary tract goals, such as walking to the toilet. pyjamas. infections, incontinence, confusion and pressure ulcers. Implemented the continence A variety of initiatives are already in assessment and the delirium place at the hospital to encourage Penny Cason, professional lead activity, such as static cycles on care plan. occupational therapist, said: “This Reducing our length of stay Lavenham ward to reduce the risk campaign reminds our staff to keep of muscle wastage. where possible for frail life as normal as possible for patients, who are the group of patients by empowering them to get patients most likely to fall, to up, get dressed and carry on with attempt to keep patients as many of their usual activities as independent. they can. By doing so, they will reduce the risk of developing pressure ulcers and other complications while also retaining the strength in their muscles so that they can return home and be as independent as possible.
“Hospitals across the country tend to inadvertently over-prescribe care by bringing everything to the patient’s bedside and not encouraging them to be active. Although we may think we are being helpful, this can actually have a negative impact and could mean they cannot fulfil as many activities
Commendation winner Senior occupational therapist Clare Cunnell
Patients who spend a week in bed will lose 10% of their strength. Team leader Clare has been instrumental in the hospital’s ‘Get Up and Go’ campaign which focuses on getting patients out of bed, dressed and active so they do not lose strength, balance and mobility. Clare is on a mission to make sure as many staff as possible get specialist training, showing a real passion for patient care.
43 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Clinical effectiveness Emergency care
Waiting a long time for treatment Chart 5 – Our performance over the last three years: 4 hours may impact on clinical outcomes to discharge from Emergency Department and does not result in a good patient experience. Since 2002, the measure for successful and timely treatment of patients who need emergency care has been the 4 hour target. This can only be achieved if Emergency Department (ED) capacity matches demand; beds and length of stay are sufficient; and patients are not delayed leaving hospital when they no longer need acute hospital care. Achievement of this standard is a barometer for how the hospital is functioning across all services.
National achievement of this target has consistently fallen below 95% since 2012. The NHS in England has been set a target to again achieve 95% by March 2018. It is recognised that the whole system needs to be well resourced and organised to achieve safe and timely care for our Chart 6 – Our performance over the last three years: patients. These same national Emergency Department activity pressures are felt in Ipswich Hospital, and since 2016 achievement of this standard has fallen below 95%.
To address this, a number of changes have been made to improve our processes so that we can once again achieve this target. These changes have started to improve care for patients in ED, elsewhere in the hospital and in the local community, helping patients to avoid or delay the need for acute care.
This work is reported through the Emergency Care Programme Board Integrated Care Network who coordinate the actions needed to make improvements. Those involved in this work include Ipswich Hospital, Ipswich & East Suffolk CCG, Adult Community Services, Norfolk & Suffolk NHS Foundation Trust, East of England Ambulance Service and At Ipswich, we increased the number Elsewhere in the hospital, teams voluntary groups. of trolleys in ED and created more have increased capacity for direct
triage areas. There are also new referrals from GPs to specialty In February, a new handover screens to be able to divide bigger teams in an attempt to avoid ED procedure was introduced in the bays when necessary. A ‘Fit to Sit’ being used for inappropriate region’s hospitals to help ambulance area has been created for patients attendances where the patients crews hand over patients within 15 who do not need to be lying down. should be going straight to minutes, enabling the crews to be The ‘Majors’ area has 24/7 reception specialty clinics. available for new emergency calls as cover and a dedicated handover quickly as possible, without putting nurse in place to cover peak times. patient safety at risk. 44
The Ipswich Hospital NHS Trust—Quality Account 2017/18
Clinical effectiveness Summary Hospital-level Mortality Indicator (SHMI)
What is SHMI? How does SHMI work? The Summary Hospital-level Mortality Indicator is a ratio SHMI, like the HSMR, is a ratio of the observed number of the observed number of deaths to the expected of deaths to the expected number of deaths. The number of deaths for a trust. The SHMI differs from calculation is the total number of patient admissions to some other measures of mortality by including both in- hospital which result in a death either in-hospital or hospital deaths and deaths of patients occurring within within 30 days of discharge. Like all mortality indicators, 30 days of discharge from hospital. the SHMI shows whether the number of deaths linked to a particular hospital is more or less than expected, and Why is SHMI important? whether that difference is statistically significant. We need to know what our ratio of actual deaths against What is HSMR? expected deaths is, in order to assess and measure how good the care and treatment is. The Hospital Standardised Mortality Ratio is the ratio of observed deaths to expected deaths for a basket of 56 diagnosis groups, which represent approximately 80% of in-hospital deaths.
Chart 7 - Crude mortality: March 2017 - March 2018 Crude mortality continues to show an expected seasonal variation with winter months higher than the summer in line with the national picture. The crude mortality rate continues to remain one of the lowest in the region. For more information about our performance with regard to SHMI, please see the SHMI Core Quality Indicator on page 28.
The Ipswich Hospital NHS Trust Crude Mortality Rate: April 2017 - March 2018
2.50%
2.00%
1.92% 1.93% 1.86% 1.74% 1.50% 1.59% 1.51% 1.42% 1.30% 1.25% 1.24% 1.20% 1.00% 1.13%
0.50%
0.00% Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18
45 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Clinical effectiveness Summary Hospital-level Mortality Indicator (SHMI)
The monitoring of in-hospital and Table 3 - Results summary for December 2016 - November post-discharge mortality is a key component of safe and effective 2017 health care. By using a range of In-hospital mortality, for all in-patient admissions to The Ipswich Hospital indicators, the Trust can be NHS Trust for the period December 2016 - November 2017 has been assured there are no significant reviewed. The SHMI is updated and rebased quarterly. areas of unexpectedly high mortality and continue to provide care to a high standard. Metric Result
The Mortality Review Group has HSMR 111.6 ‘higher than expected’ range. overseen the establishment of the national mortality review HSMR position vs. programme as laid out by NHS The Trust is 1 of 5 within the peer group of 16 that England. East of England sit within the ‘higher than expected’ range. peers The Mortality Review Group meets every month to review the mortality Other gastrointestinal disorders statistics and oversee the review HSMR outlying Acute cerebro-vascular accident of patient deaths. groups Fractured Neck of femur Pneumonia
HSMR analysis: Rolling 12 There is now a significant difference between the months (December 2016 - HSMR Weekday/ weekday and weekend HSMR for emergency Weekend Analysis admissions. Weekday admissions are no longer November 2017) ‘higher than expected’. The Trust’s HSMR is 111.6 and is within the ‘higher than expected’ range. SHMI (July 2016 to 102.01 ‘as expected’ (band 2). June 2017) Other gastrointestinal disorders This is a varied group of patients and flagged as a risk in January, May and June 2017. On review of a sample of these cases, this was a very heterogeneous group with Fractured Neck of femur reviewed with further ongoing no thematic learning. Due to the Flagged in January and again in prospective review occurring. No nature of data, this will continue to October 2017. Overall mortality significant thematic issues have flag until June 2018. rate remains within expected been identified at present with the limits. Prospective review of a care of these patients being Acute cerebro-vascular accident sample group of these patients judged to be good. Issues within Flagged in April and July 2017. has been commenced. the coding of pneumonia have Our relative risk remains higher been identified which may go than expected as does our long Pneumonia some way to identify the higher term crude mortality rate. Rolling 12 month relative risk than expected mortality as Prospective review of these remains higher than expected. A reported by Dr Foster. patients has been commenced. sample of these cases has been
References SHMI The SHMI is like the HSMR, a ratio post discharge. Like all mortality HSMR of the observed number of deaths indicators, the SHMI shows The Hospital Standardised Mortality to the expected number of deaths. whether the number of deaths Ratio is the ratio of observed deaths However, this is only applied to linked to a particular hospital is to expected deaths for a basket of non-specialist acute providers. more or less than expected, and 56 diagnosis groups, which The calculation is the total number whether that difference is represent approximately 80% of in of patient admissions to the statistically significant. hospital deaths. It is a subset of all hospital which resulted in a death and represents about 35% of either in-hospital or within 30 days admitted patient activity.
46 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Clinical effectiveness Summary Hospital-level Mortality Indicator (SHMI)
Weekday vs Weekend mortality for emergency Chart 8 - Weekday vs Weekend admissions, emergency only admissions 12 months rolling trend, December 2016 - November 2017
Weekday HSMR (Emergency Weekday HSMR (Emergency Admissions) = 107.1 ‘as expected’ Admissions) = 107.1 (99.9 - Weekend HSMR (Emergency Admissions) = 123.5 ‘higher than expected’ 114.6) ‘as expected’
Weekend HSMR (Emergency Admissions) = 123.5 (110.9 - 137.1) ‘higher than expected’
The difference between the two has led the Board to focus on development of an integrated ‘hospital at night’ service and to move towards meeting the NHS England key criteria for 7 day working in order to ensure safe and sustainable patient care at all times.
Chart 9 – HSMR peer comparison
47 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Clinical effectiveness Summary Hospital-level Mortality Indicator (SHMI): Review of hospital deaths
Review of Hospital deaths The reviews have shown a very low We now have clinical The Ipswich Hospital NHS Trust is number of deaths that have been felt to involvement in coding of committed to ensuring robust processes have been preventable due to care. This treatment and diagnosis, and are in place and working effectively, so may well be a reflection of the low crude improvement in that we continuously identify areas for rate of mortality within the trust. Reviews documentation which now improvement in the care and treatment we have highlighted the need for earlier allows the diagnosis on provide to our local population. recognition of patients who are dying and admission to be reconfirmed the need for palliative care, along with 48 hours after admission and There is a trust-wide approach to the discussions around DNACPR. Significant also retrospectively as part of implementation of the national learning efforts have been made to improve the the mortality review process, from deaths guidance, which is awareness of and need for specialist all with approval of the coding communicated and available to all staff. It palliative care. This has seen our rates auditors. This will improve the sets out the procedures for identifying, palliative care increase from 2.5% in quality and accuracy of our recording, reviewing and investigating the 2016/17 to 4.1% in 2017/18 to now be in coding, enabling us to be deaths of people who die in hospital by line with the national average. more confident in how we are providing a framework for clinical staff who performing with different participate in mortality reviews. The Trust Coding of the admitting diagnosis has patient groups. supports those who have been bereaved sometimes reflected the symptoms rather We continue to increase by a death in hospital, and also how they than the overall diagnosis, leading to consultant engagement into should expect to be informed about and sometimes spurious results in mortality involved in any further action taken to the use and meaning of data such as data from Dr Foster. mortality data, which helps to review and/or investigate the death. The Trust also supports staff who may be guide ongoing quality What we are doing to make improvement in services. affected by the death of someone in the improvements Trust’s care. Feedback to clinical groups through the Please note: During 2017/18 the Mortality Review Group and the The Mortality Review Group has overseen method and process of mortality Learning from Deaths/Mortality and the establishment of the national mortality review substantially changed at Morbidity meetings to highlight the review programme as laid out by NHS the end of Q2 to bring the need for proactive referral and process in line with the National England. The Group meets monthly to involvement with the palliative care Learning from Deaths review the mortality statistics and oversee team. Framework. During Q1 and Q2, the review of patient deaths. Divisional reports from Learning from all reviewed patients had a notes The monitoring of in-hospital mortality is a Deaths two-monthly meetings to the review with the reviewer key component of safe and effective health Mortality Review Group and Clinical indicating whether they believed care. By using a range of indicators, the Audit and Effectiveness Committee, the death was more likely than Trust can be assured there are no with identification of departmental and not due to problems in care. If so, significant areas of unexpectedly high corporate areas for system there was a more detailed mortality and continue to provide care to a improvement. These will link with second review if the patient’s high standard. The Trust’s Learning from quality improvement projects wherever care was not already subject to a Deaths policy sets out how the Trust will necessary. serious incident investigation (to avoid duplication of the case learn from the care provided to patients We have already seen a significant who die, as part of its work to continually review). From Q3 the initial improvement in palliative care referral reviewing clinician was no longer improve the quality of care it provides to all rates, which are now in line with the its patients. asked to rate care, but only to national average. allocate cases for review as laid The importance of discussing with Key findings from mortality reviews out in the learning from deaths patients and their families the The mortality reviews have overall policy, which required a SJR. escalation of care, treatment options demonstrated high levels of care in all Hence the significant change in and DNACPR continues to be fed back groups of patients. number of reviews between Q1/ to clinical teams. Whilst we continue to provide high quality Q2 and Q3/Q4. care to patients at the end of their lives Number of Case note Investigation Case note % of deaths judged once in hospital, we are not recognising deaths review or Structured review and to be more likely that some patients are in the last weeks including Judgement investigation than not to have and months of life, and are appropriate for screening Review been due to palliative care prior to the point of acute review (SJR) problems in the admission to hospital, often out of hours. care provided. We should be more proactive in having discussions with patients and their Q1 338 258 2 258 0.8% families/carers in regards to the extent of treatment and escalation of care including Q2 318 187 1 187 0% DNACPR decisions. Our palliative care Q3 363 302 28 302 0.2% coding rates are now in line with the national average. Q4 449 189 10 189 0%
Total 1,468 936 41 936 1% 48 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Patient experience Improving the patient and carer experience
Key achievements Follow up clinics for Critical Care patients Expansion of ‘Kissing it Better’ activities. A follow-up clinic to help former Critical Care patients with their recovery was launched at our hospital this year. Transformation of an
additional two wards, The Critical Care Follow-up Clinic offers patients who were on a Brantham and Stradbroke, ventilator in Critical Care for more than four days, appointments at two, into dementia-friendly wards. six and 12 months after their discharge. Patients can experience any of Launch of the Learning a number of symptoms following their stay on the Critical Care Unit Disability Action Group. (CCU), including post-traumatic stress disorder, mobility issues, or Launch of the Liver Disease problems eating or sleeping. Action Group. Pam Talman, Patient The first monthly clinic was held in September and patient Valerie Experience Coordinator, was Pitchers was the first patient to attend. Each clinic is run by a Critical ‘Highly Commended’ for the Care consultant and an outreach nurse. GPs can also refer appropriate ‘Living the Values’ patients to the clinic. #TeamIpswich staff award. Publication of the Baby Critical Care lead nurse Roz Yale, said: “We are very excited about the Guide, which is available for launch of the new Critical Care Follow-up Clinic and this valuable all parents-to-be. opportunity to meet our patients again and improve their journey of Joined the Patient Experience recovery. Collaborative, working with colleagues from Northumbria “The transition for the patient from CCU to a ward and then, from a ward Healthcare NHS Foundation to home, can be underestimated. It can be very challenging for them Trust, and the Patient emotionally and psychologically and this service is helpful on their road to Experience Network to drive recovery. The clinic can also be very helpful to family members and forward improvements in data people close to the patient.” analysis. Finalists in the PENNA National Institute of Health and Care Excellence (NICE) guidelines awards. recommend that CCU patients should be offered such a service and was Critical Care ran a second highlighted at a service user feedback session. service user engagement event. Changing Places toilet in the main Outpatient Department to give people with multiple learning and physical disabilities, such as spinal injuries, muscular dystrophy and multiple sclerosis, the extra space and equipment they need to ensure their safety and comfort. It includes a hoist, adult-sized changing table and shower, along with space for both the individual and their carer.
Back row: Nikki Benmore (Critical Care Outreach team practice educator), Roz Yale (lead nurse, Critical Care).
Front row: Lynn Bolton (radiographer and Valerie Pitchers’ daughter), Valerie Pitchers, Dr Paul Carroll (consultant intensivist).
49 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Patient experience Improving the patient and carer experience
Strengthening the Foundation relatives and patients, making the Involving patient leaders in impact of the learning far more significant, and comments such as human factors training “Now I understand” and “I had
never considered relatives as a The initiative is believed to be the resource before” were made. first in the country to utilise a patient/
staff collaborative approach to The biggest impact was human factors training. The unexpected, with one staff member simulation suite manager and the discovering through IHUG IHUG Chair have built a solid and feedback that in stressful situations trusting understanding which has such as resuscitation, relatives’ Patient Experience Network enabled them to lead the different overwhelming desire was to stay in aspects of the training. The success National Awards (PENNA) the room and quietly observe what of the project has been tangible, was happening to their loved one, demonstrated by the feedback from The Trust was again a finalist in three whereas the instinct of staff was to participants who appreciated the award categories: remove the relative, believing this value of ‘real’ patient participation, as was kinder. IHUG feedback clearly well as patient feedback measures Measuring, Reporting and Acting showed relatives’ stress levels indicating improvements on the Lavenham Ward Supporting were far higher when they were wards. The training aimed to provide Family Carers & Frailty Initiative taken away and imagining the a sustainable change of behaviour worst. Involving IHUG literally on the wards and in the participants. Support for Caregivers, Friends changed the thought process of and Family staff. At the end of the courses, IHUG identified that they, as patient there was a statistically significant Lavenham Ward Supporting leaders, would have a unique sustained improvement from the Family Carers & Frailty Initiative contribution to make to staff training patient’s perspective. There was by utilising their ‘expert by also huge personal benefit The Trust has created a holistic experience’ insights. By working reported by IHUG members, as frailty-focussed culture with an collaboratively with IHUG as actors they were also learning. emphasis on the identification and for the scenarios planned for the support of family carers as central to sessions, they thought the impact of Before, during, immediately after supporting patients; especially ‘real’ patients/relatives might be and again six weeks after the around a sustainable discharge. increased for those staff attending course, staff and IHUG members Led by nursing teams on Lavenham the training. IHUG members gave were sent questionnaires to identify (an acute surgical ward) this is the unbiased feedback as to how they if the impact of the course could be first initiative of its kind nationally. had felt during the sessions. This is seen on the wards. Staff reported Ward Sisters have striven for something unable to be captured by improvements in their recognition ambitious results. All areas of the other means. of the concepts, of how patients/ multidisciplinary team are involved carers felt and improved team and actively encouraged for their During the training, staff were able to sense. opinion and ideas for innovation. see the IHUG members as real Work to clearly identify initial focus areas enabled a decrease in length of stay for patients; improved satisfaction from patients and carers - better informed, involved, motivated to be mobile and less likely to suffer deconditioning. The ward sisters, ward team and Frail older person nurse consultant are motivated and enthusiastic to strive for excellence, ensuring that all initiatives are achievable and sustainable not only on Lavenham but across the Trust.
The results have been regionally and nationally recognised for the nurse- #TeamIpswich finalists at the PENNA awards (Left to Right) led approach on a surgical ward, as Lavenham ward and Suffolk Family Carers workers supporting family carers, and IHUG and Simulation Suite collaboration opposed to a care of the elderly ward. 50 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Patient experience Improving the patient and carer experience
Kissing it Better (KiB) company. The students not only Partnerships provide a treatment but also a Kissing it Better is recognised Mobilising students from welcome distraction from other nationally and their vision of colleges and universities to worries, and it is a confidence bring in their skills to benefit constantly exceeding a patient’s boost for the students, many of expectation of their care patients, providing professional whom are nervous about working environment - simple ideas, small development alongside kind, in a hospital. Students are always compassionate care; and acts of kindness, harnessing the accompanied by their tutors and energy and goodwill of the increasing joint working with hospital staff. community partners such as community, mirrors the Trust’s own values. the Co-op and Suffolk Artlink. Better patient experience The aim is to provide a range of Addresses patient needs, Who has been involved this compassionate caring services including emotional needs, in a year? over and above traditional holistic way, and responds to Suffolk New College beauty healthcare. For example; music, patient feedback that it is the therapy students visit to art, theatre, reminiscence, social small things which matter and provide hand massage and visiting, hairdressing, manicures, make a difference. Visitors manicures. make-up etc. The services are and family carers can also take Ipswich High School drama provided in partnership with part. and music students sing, act organisations such as local Better staff experience and read poetry. colleges, charities and societies. Improves staff morale by Ipswich Hospital Community Kissing it Better allows the Trust to enabling staff to do something Choir take part in supportive create a programme which sets it with and alongside patients singing on the wards. apart from others - with a focus on over and above the traditional #suppertimesinging the patient as a person and the healthcare interaction which Suffolk New College hospital being truly a part of the facilitates a shared experience; hairdressing students visit to community. enhancing empathy and provide hair treatments.
compassion. Stowupland High School All students conduct themselves Better quality of care with charm, grace and dignity. students visit wards to chat Enhances the whole patient and reminisce. Patients respond and, time and experience. again we see patients that had Applied Science students visit looked withdrawn, open up in their wards to chat and reminisce.
Kissing it Better
51 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Patient experience Improving the patient and carer experience
Carers Week Support for carers Family Carer Support - Carers Week is an annual Debbie Reeve and Mandy King are case study campaign held in June to raise support workers employed by local Suffolk Family Carers Support awareness of caring, highlight the charity Suffolk Family Carers Worker Debbie supported Janet challenges carers face, and (SFC) but are based at Ipswich (not her real name) who is a recognise the contribution they Hospital. They walk the wards family carer and was due to be make to families and communities each day in search of family carers admitted to Ipswich Hospital for a throughout the UK. The campaign or patients themselves who may planned procedure. She was is brought to life by thousands of be family carers, who might need very concerned about her partner individuals and organisations who help. Their message is “Don’t whom she cares for; how would come together to organise struggle alone.” Debbie and they cope whilst she was in activities and events throughout Mandy provide awareness raising hospital? The partner was over the UK, drawing attention to just and education opportunities for 85 and experiencing short term how important caring is. staff both 1:1 and on the wards. memory loss and was at risk of falling. The Trust is committed to SFC also provided a young carers ensuring a partnership approach information stand along with a visit Debbie worked with the multi- to working with family carers is from their bus for Carers’ Rights disciplinary team including the adopted, in which the family Day in November 2017 and for nurse specialist to create a plan carer’s role, expertise and Young Carers Day in January of care with emergency planning understanding of the patient’s 2018. if needed. She ensured the ward needs are recognised and taken was aware that the patient is also into account when planning the 497 family carers have been a family carer and worried about patient’s care, treatment and supported directly by Debbie and her partner. Debbie visited the discharge. The Trust also Mandy during the year. ward when Janet was in to recognises the needs of family provide reassurance and carers to access support, advice 708 people have visited the Carers additional support. Plans were and information. Cabin over the year. put in place to have neighbours go in and help the partner, and the Crisis Action Team and community healthcare team telephone numbers were given to Number of family carers the nurse specialist in case of an supported emergency with Janet’s partner Q1 128 while she was in hospital. A referral was made to the Red Q2 107 Cross for assistance with shopping on discharge from Q3 172 hospital. Q4 90 Outcome/impact Planning prior admission with the assistance of the nurse specialist assisted in a smooth transition, Music around the hospital! enabling Janet to feel reassured ActivLives’ Keep on Rockin’ choir and less anxious about her singing outside the Carers Cabin (above), and PopChorus performing in partner, also knowing that in an our South Wards reception area emergency situation a plan had (below), both during Carers Week been put in place for her partner. The ward was also able to ensure that Janet met all her goals before discharge. Janet said she felt extremely reassured about her partner and was able to concentrate on her recovery after her operation.
Mandy and Debbie provide support and information to family carers as needed.
52 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Patient experience Caring for people with dementia
Helping Aldeburgh patients Sensory garden for Aldeburgh reminisce Community Hospital Aldeburgh Community Hospital has The garden includes an exercise a new interactive touch screen area, pavilion, a listening bench system - packed full of old movies, designed to stimulate TV programmes and songs, as well conversation and interaction as activities, games such as bingo amongst patients with dementia, and exercise routines - aimed at and scented, textured and edible improving the experience of their plants. older patients, including those with dementia. Purchased for £6,000 The Aldeburgh League of Friends- by the Aldeburgh League of funded project has cost over Friends, the digital reminiscence £30,000 and is designed to be an therapy system can reduce a outdoor extension of the hospital’s patient’s stress levels and, as a facilities to aid rehabilitation and result, can reduce the number of recuperation of patients and as a falls they have. resource for the community. It has been transformed into a place to be enjoyed by all, but also Dementia-friendly environment offers areas of privacy for solace Stradbroke ward, specialising in and stimulation. gastroenterology, and Brantham ward (medical admissions ward) One of the garden’s main features were refurbished to dementia- is a horseshoe-shaped listening friendly standards in the autumn seat which has statements and with money from a £1.5m legacy questions designed to spark left to the hospital by former patient conversation. Peter Gibbons. These wards were chosen as patients with a dementia Research indicates that patients are admitted to any of our wards who can enjoy green spaces according to their clinical need. As recover more quickly and can part of the project, social areas and return home more rapidly. They calming artwork were added, also need less pain relief during lighting was improved, bed areas their recovery. Michelle Fletcher, were decluttered and pictorial signs Aldeburgh Community Hospital and colour-coded walls were matron, said: “This project has introduced to help patients find been three years in the making their way. and has finally come to fruition.”
The emergency medical assessment unit adjacent to Brantham ward was also refurbished to create a dementia- friendly environment. Additional building work took place to reconfigure the entire area to create an environment focussed on the needs of the patient. The work carried out included a new entrance from the Emergency Department to reduce the footfall through the ward area enabling the ward to remain calm; a new ambulance entrance for patients who require emergency medical Pictured above, from left, landscape assessment; and provision of gardener Tony Crisp, matron additional fully equipped seated Michelle Fletcher and League of assessment areas, designed Friends volunteer Anne Parsons. around patient and carer needs.
53 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Patient experience Caring for people with a learning disability
Learning Disability Liaison Nurse Familiar carers “The professional approach Research suggests that people with It is sometimes possible for a and collaborative working learning disabilities often have patient with complex needs to be from your team was specialist requirements when funded for a familiar carer to be attending hospital. Ipswich Hospital present during the hospital stay to outstanding.” employs a full-time learning have the assistance they require. (Care Agency 2017) disability liaison nurse to assist Support from known carers can be people with learning disabilities or of benefit to a patient with a autism who visit the hospital. The learning disability as it is a ‘familiar learning disability liaison nurse face’ in unfamiliar surroundings. works directly with family carers and hospital staff to improve the Individualised care pathways experience of being in hospital. All patients with complex medical “The competency of your requirements and learning Staff Training disabilities are given bespoke day team was inspiring. The The learning disability liaison nurse plans for their procedure or visit to work you do is so very trains all Trust staff how to ensure a smooth multidisciplinary important for people with effectively work and care for people approach for the patient. The learning disabilities, and with learning disabilities. All staff plans are produced in work with such dedication receive mandatory learning collaboration with the patient, their and expertise.” disability training and more in-depth family carers, doctors, GP and (Family member 2017) training is available where community staff. requested. Training includes autism, profound and multiple Accessible information learning disabilities, mental health, The Accessible Information and communication training. Standard was introduced by the government in 2016 to ensure Reasonable Adjustments people with a disability or sensory “From start to finish an Reasonable adjustments are loss receive information in a way absolute success, and from changes to the work environment or they can understand. working practices which allow our perspective best practice at its absolute best. Perhaps people with disability to be safely Ipswich Hospital is committed to cared for. Under the Equality Act giving information to people with a your example is something (2010) staff will assess the learning disability in a way they others could learn from in individual reasonable adjustments understand. Where requested, all developing practices that required for all inpatients with a information can be simplified to enhance the quality of care learning disability and use this meet individual requirements. offered to people with assessment to inform the care each learning disabilities and other the patient receives. groups” (Family member 2017) All practicable reasonable adjustments that can be made to facilitate a good stay for a person will be taken.
The learning disability action group (LDAG) consists of people with learning disabilities or autism who use the hospital. LDAG meets regularly to consult on how the hospital can improve services. A user group for parents and carers met for the first time in March 2018. The group has a Chairperson who feeds back to IHUG.
Roger Blake, learning disability liaison nurse, pictured with LDAG members at a recent meeting.
54 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Patient experience Patient Experience Collaborative
Patient Experience have been identified to take the Collaborative project forward on both sites, which will involve eight patient
wards and departments across the What is the Collaborative? sites. 12 trusts across the UK have come together to work with Northumbria The core team members will Healthcare NHS Foundation Trust attend five learning events during and the Patient Experience Network the year and there will be a real (PEN) for 12 months to trial the use time measurement uploaded twice of the Northumbria model for a month giving robust evidence on gathering patient experience impact and change. feedback and applying quality improvement ideas and The core team will have additional methodology. membership to create a ‘steering
group’ to guide and support the The focus of the collaborative is to programme, including the wider identify, develop, share and embed multidisciplinary team ideas and processes for improving patient experience, sustaining that In addition several data collectors improvement and providing a have been identified to undertake measurement framework to the surveys, upload and share the evidence improvement. data with the wards/steering
group. The Northumbria team What is the Northumbria Model? visited both sites in November Real time surveying of at least 50% 2017 to train the data collectors of patients on a ward using a set and core team in the survey covering key aspects of care methodology, with the first data and experience which are being collected the same month. considered to have the strongest relationship to patients’ overall satisfaction (Picker Institute 2009). Wards:
Ipswich Hospital The following are recognised as the Martlesham priority areas for assessing patient Needham experience of acute hospital Saxmundham inpatient care: (all trauma & orthopaedic wards) Consistency and coordination of care; Colchester Hospital Treatment with respect and Aldham (Orthopaedics) dignity; Brightlingsea (ENT, General Involvement in decisions; Surgery) Layer Marney (General Medicine) Doctors;
Nurses; Cleanliness; and Pain control.
Surveys, covering these areas are undertaken and reported on as close to real time as possible enabling immediate action to improve. This is then monitored over time to map and show the improvements.
How are Ipswich and Colchester hospitals involved? Working as one overall team from both Ipswich and Colchester hospitals, six core team members 55 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Patient experience Measuring and reporting the patient experience
National Patient Surveys Patients are asked to answer Table 4 - Based on patients’ responses to the Care Quality questions about different aspects Commission’s National Inpatient Survey, this is how of their care and treatment. Based Ipswich Hospital compared with other Trusts on their responses, each NHS trust is given a score out of 10 for each The Emergency/A&E Department question (the higher the score the 8.7 / 10 (answered by emergency patients only) better). The question scores presented here have been rounded Waiting lists and planned admissions up or down to a whole number. 8.7 / 10 There is no single overall rating for (answered by patients referred to hospital) each NHS trust. This would be misleading as the survey assesses a number of different aspects of Waiting to get to a bed on a ward 7.6 / 10 people’s experiences (such as care received from doctors and nurses, tests, views on the hospital The hospital and ward 7.8 / 10 environment eg cleanliness) and performance varies across these different aspects. Doctors 8.6 / 10 Each trust also receives a rating of ‘Above’, ‘Average’ or ‘Below’. Above (Better): the trust is Nurses 7.7 / 10 better for that particular question than most other trusts that took part in the Care and treatment 7.9 / 10 survey. Average (About the same): the trust is performing about the Operations and procedures same for that particular (answered by patients who had an operation 8.3 / 10 question as most other trusts or procedure) that took part in the survey. Below (Worse): the trust did not perform as well for that Leaving hospital 7.1 / 10 particular question as most other trusts that took part in the survey. Overall views of care and services 4.7 / 10
National Inpatient Survey The results from the CQC survey Overall experience 8.0 / 10 of inpatient experiences of acute trusts 2017 were published on 13 June 2018. People were eligible for the survey if This survey looked at the they were aged 16 years or older, experiences of 72,778 people who had at least one overnight stay in received care at an NHS hospital in hospital as an NHS patient, and July 2017. were not admitted to maternity or psychiatric units. Between August 2017 and January 2018, a questionnaire was sent to The National Inpatient Survey 2017 1,250 recent inpatients at each results for Ipswich Hospital show the trust. Responses were received hospital as being About the same as from 543 patients at The Ipswich all other hospitals overall. Hospital NHS Trust. The national response rate was 41%. The full report can be found at www.cqc.org.uk/provider/RGQ/surveys
56 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Patient experience Measuring and reporting the patient experience
National Emergency Table 5 - Based on patients’ responses to the Care Quality Department Survey Commission’s National Emergency Department The results from the CQC survey Survey, this is how Ipswich Hospital compared with of Emergency Department other Trusts experiences of acute trusts 2017 were published on 17 October 2017. Arrival at the emergency department 8.0 / 10
The survey sought the views of more than 45,000 people aged 16 years and older who attended Waiting times 5.8 / 10 emergency and urgent care departments at 137 acute and Doctors and nurses specialist NHS trusts during 8.5 / 10 September 2016. The (answered by all those who saw a doctor or nurse) questionnaire was sent to 1,250 people who had used emergency department services at Ipswich Care and treatment 8.2 / 10 Hospital, with responses received from 424 people. Tests 8.5 / 10 The following patients were (answered by those who had tests only) excluded from the survey: anyone who had a planned attendance at an outpatient clinic run within the Hospital environment and facilities 8.6 / 10 emergency department (such as a fracture clinic); patients attending primarily to obtain contraception Leaving the emergency department (for example, the morning after (answered by those who went home or went 6.8 / 10 to stay with a friend or relative or went to stay pill), patients who suffered a somewhere else) miscarriage or another form of abortive pregnancy outcome while at the hospital, and patients with a Respect and dignity 9.0 / 10 concealed pregnancy.
Nationally, the survey findings show that 75% of people who had Experience overall 8.1 / 10 attended a major consultant-led accident and emergency department said they ‘definitely’ had confidence and trust in the doctors and nurses treating them; 78% felt they were treated with Actions to address the findings of the survey respect and dignity ‘all of the time’, and that they ‘definitely’ had Waiting times are displayed in Additional touchscreens enough time to discuss their the waiting room, and are available in the Emergency medical problem with staff (73%). regularly updated by reception Department to increase patient However, nationwide, responses to staff. feedback of the service. questions about waiting times, New vending machines for Volunteers speak with patients access to pain relief and discharge snacks and drinks have been to gain ‘soft intelligence’ on the arrangements were less positive. provided in the waiting area. service within the Emergency
Department. The results for Ipswich Hospital Increased involvement by Red show the hospital as being ‘about Cross volunteers, providing the same’ as all other hospitals snacks and drinks for patients, overall. The full report can be and offering support to patients found at and their families as required. www.cqc.org.uk/provider/RGQ/ surveys
57 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Patient experience Measuring and reporting the patient experience
National Children and Young Table 6 - Based on patients’ responses to the Care Quality People’s Survey Commission’s National Children and Young People’s The results from the CQC survey of Survey, this is how Ipswich Hospital compared with Children and Young People’s other Trusts experiences of acute trusts 2016 were published on 28 November 2017. Going to hospital No overall score available Choice of admission date 3.3/10 About the same The survey looked at the Change of admission date 9.6/10 Better experiences of 34,708 children and young people under the age of 16 who received inpatient or day case The hospital ward No overall score available care during October, November Things to do 7.0/10 About the same and December 2016. Between Food 6.5/10 About the same February and June 2017, a Sleep 5.6/10 About the same questionnaire was sent to a Privacy 9.1/10 About the same maximum of 1,250 recent patients Play Not applicable at Ipswich Hospital, with responses Suitability of ward 6.7/10 Worse Play for younger children 7.8/10 About the same received from 283 patients. Enough things for younger children 8.5/10 About the same Food for young children 5.9/10 About the same Children and young people, and Privacy for younger children 8.9/10 About the same their parents and carers were Type of ward stayed on 10/10 Better asked to answer questions about Appropriate equipment or adaptions 9.0/10 About the same different aspects of their care and Cleanliness 8.9/10 About the same treatment. Based on their responses, each NHS Trust has been given a score out of 10 for Hospital staff No overall score available each question (the higher the score Speaking with staff 9.9/10 Better the better). Each trust also Understanding what staff say 8.7/10 About the same Able to ask questions 9.7/10 About the same receives a rating of ‘Better’, ‘About Questions being answered 9.7/10 About the same the same’ or ‘Worse’. Involvement 5.9/10 About the same Better: the trust is better for that Support when worried 9.2/10 Better particular question compared to Talking to a doctor or nurse alone Not applicable Staff introducing themselves 8.8/10 About the same most other trusts that took part Communicating with young children 7.9/10 About the same in the survey. Conflicting information 8.3/10 About the same About the same: the trust is Parents and carers feeling listened to 8.9/10 About the same Explanations parents and carers could understand 9.3/10 About the same performing about the same for Keeping parents and carers informed 8.5/10 About the same that particular question as most Parents and carers able to ask questions 9.1/10 About the same other trusts that took part in the Planning care 9.5/10 About the same survey. Parent and carer involvement 8.4/10 About the same Worse: the trust did not perform Information 9.0/10 About the same Children’s medical history 7.5/10 About the same as well for that particular Individual or special needs 8.5/10 About the same question compared to most Help when needed 8.3/10 About the same other trusts that took part in the Staff working together 9.0/10 About the same survey. Confidence and trust 9.2/10 About the same
Section scores not available: continued Where the number of answers received was too low (less than 30 respondents) the CQC does not report results. If results for children say ‘Not applicable’ this is because too few children answered the question.
58 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Patient experience Measuring and reporting the patient experience
The Trust did better than other organisations in a Facilities for parents and carers No overall score available number of questions such Access to hot drinks 8.5/10 About the same Food preparation 4.0/10 About the same as: Facilities for staying overnight 7.4/10 About the same Not changing the date of admission; Pain management No overall score available Suitability of the ward Pain management 9.2/10 About the same environment; Parent and carer’s views on pain management 8.9/10 About the same Availability of staff to speak with; Support from staff when Operations and procedures No overall score available Information before an operation or procedure 9.5/10 About the same worried; Information after an operation or procedure 8.5/10 About the same Use of distraction Information for parents and carers before techniques during an an operation or procedure 9.4/10 About the same operation or procedure; Answers to questions before an operation or procedure 9.5/10 About the same Availability of information for Distracting a child during an operation or procedure 8.5/10 Better parents/carers after an Information for parents and carers after an operation or procedure; operation or procedure 9.3/10 Better What to do in case of having further concerns Medicines No overall score available abut your child; Information about medicines 9.5/10 About the same Advice on self care; and Information to take home following discharge from Leaving hospital No overall score available hospital. What to do in case of further concerns 8.8/10 Better Information about next steps 8.0/10 About the same Advice on self care 9.1/10 Better What to do if concerned about their child 8.9/10 About the same Actions to address the Parents & carers being given information findings of the survey about next steps 8.2/10 About the same Advice on caring for child 9.0/10 About the same Improve access to food for Information to take home 9.3/10 Better parents and guardians whilst their child is in hospital. Overall experience No overall score available Improve the facilities and Friendliness 9.5/10 About the same suitability of the ward Being well looked after 9.3/10 About the same environment for older Parents and carers feeling staff were friendly 9.2/10 About the same Parents view of child being well looked after 9.3/10 About the same children who are Dignity and respect 9.2/10 About the same transitioning between Parent and carer being well looked after 8.5/10 About the same children’s and adult Parents view of child’s overall experience 8.8/10 About the same services.
The full report can be found at www.cqc.org.uk/provider/RGQ/ surveys
59 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Patient experience Measuring and reporting the patient experience
National Maternity Survey Survey results Actions to address the findings Following the last national The results from the CQC survey of the survey maternity survey, the Maternity Information to be provided to of maternity experiences of acute team completed a comprehensive trusts 2017 was published on 30 women in order to offer action plan which has resulted in choices of where to have their January 2018. key improvements reflected in the baby. ‘green’ (better) status of a number This survey looked at the of the questions within this survey. experiences of 18,426 women who All women to be told how to gave birth in February 2017. contact their midwife Information and explanations (community and ward During the summer of 2017, a telephone numbers). Receiving the information and questionnaire was sent to all explanations they needed after the women who gave birth in February birth Enable women to move around 2017. Responses were received and choose a comfortable from 126 patients at The Ipswich position in labour - active Hospital NHS Trust. 8.7 / 10 birthing equipment ordered.
Exclusions: women whose baby Ensure discharge process is had died during or since delivery; women who had a stillbirth Partner involvement streamlined to avoid delays.
(including where it occurred during Partners being involved as much a multiple delivery); women who as they wanted Women to be given a choice of were in hospital or whose baby where postnatal care can take was in hospital at the time the place, with postnatal clinics to sample was drawn; women who 9.9 / 10 be set up in more community had a concealed pregnancy; locations. women whose baby was taken into care (foster care or adopted); and To provide information about women who gave birth in a Advice at the start of labour emotional changes post- maternity unit managed by another Receiving appropriate advice and natally, and ensure women provider or in a private maternity support know who to contact for advice unit or wing. regarding postnatal emotional 9.3 / 10 changes. The full report can be found at www.cqc.org.uk/provider/RGQ/ surveys
Table 7 - Based on patients’ responses to the Care Quality Commission’s National Maternity Survey, this is how Ipswich Hospital compared with other Trusts
Labour and birth 9.2 / 10
Staff during labour and birth 8.9 / 10
Care in hospital after the birth 8.1 / 10
60 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Patient experience Measuring and reporting the patient experience
Friends and Families Test (FFT)
There is a strategic key Outpatients FFT FFT linked actions performance indicator for The percentage return rate has Linked actions are generated when generally been above 10%. The an ‘unlikely’ or ‘extremely unlikely’ patient experience which is percentage of patients response is reported in a Friends to achieve more than 97% recommending the hospital has and Family Test (FFT) survey. FFT recommenders by stayed circa 96%. They give a ward/department the 2022. ability to rectify issues before they Maternity FFT - antenatal, birth become concerns or complaints ward, post birth ward and post birth and to track any trends that arise. Inpatients FFT (including daycase community Once an ‘unlikely’ or ‘extremely patients) The FFT question is asked at four unlikely’ is reported, it generates a 30% return rate target was agreed ‘touch points’ along the patient linked action alert. as part of our contract with maternity journey - antenatal, birth, commissioners. This was postnatal ward and postnatal Improvements made as a consistently exceeded throughout community. The Trust scores are result of FFT feedback the year. The ‘recommender rate’ on a par with the national FFT % Waiting times in Emergency has been circa 95%. recommending scores for each. Department now displayed on the reception desk for patients to Emergency Department FFT Community hospitals FFT see when they register in ED. 20% return rate target was agreed The community contract has Improved communication in as part of our contract with continued to report on the friends clinics so that patients are aware commissioners. Both the ‘return and family test results and feeds when there are delays in clinic. this back into the community rate’ and ‘recommender rate’ have Now using TV screens to display hospital inpatient units to provide fluctuated throughout the year. some patient information where learning. Analysis shows this is often appropriate.
related to times of peak activity. Staff reminded that special or
FFT results for 2017/18 are given cultural meals (eg Halal meals) below. are available. Magazines now available in Outpatient Department.
April May June July Aug Sept Oct Nov Dec Jan Feb Mar Inpatient FFT return % 42.5 37.5 36.2 34 37.1 38.3 34.7 34 29.2 34.7 47.7 31.9 Inpatient recommenders % 98.07 97.54 97.9 97.19 96.67 97.66 96.86 97.39 97.05 97.4 96.2 97.59 ED FFT return % 17.9 18.8 20 16.9 14.3 9.5 12 9.5 6.1 7 10.2 9.2 ED recommenders % 67.93 77.19 75.2 80 77.18 80.5 78.86 81.44 80.94 84.1 82.6 81.71 Outpatient FFT return % 8.3 11.9 11.6 11.9 16.6 14.6 15.2 16.7 18.61 12.1 12.3 7.9 Outpatient recommenders % 96.9 96.52 97.13 97.97 96.85 97.62 96.82 97.62 98.61 97.2 97.7 96.99 Maternity FFT return % Antenatal return % 25.8 37.1 38.6 27.5 38.7 34.2 41.4 30.9 38.2 41.9 35.5 23.1 Antenatal recommenders % 97.89 99.2 99.25 100 97.99 97.58 98.57 97.9 100 100 97.2 100 Birth return % 36.7 42.5 35.3 30.4 31 27 34.2 23.4 25.5 34.7 32.7 27.8 Trust-wide Birth 98.15 96.18 97.09 95.75 96.97 100 96.61 98.39 98.59 98.7 98.7 98.48 recommenders % Postnatal ward % 35.7 40.6 47.9 33.4 24.5 30.03 31.6 21.97 25.8 34.7 26.7 36.9 Trust-wide Postnatal ward 96.19 94.4 95 93.75 94.87 97.85 98.17 94.83 100 100 95.5 98.75 recommenders % Postnatal community % 32.4 46.6 27.9 25.5 40.2 35.9 38.5 36.7 39.3 33 37.8 27 Trust-wide Postnatal 97.56 100 98.75 98.61 99.08 99.01 98.28 98.28 98.95 98.99 100 96.88 community recommenders % 61 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Patient experience Patient and public involvement, community engagement and patient feedback
Values-based questions The Inpatient questions are refreshed every year to reflect new Trust priorities. In addition, questions have been introduced to Emergency Department and Outpatient surveys. All results are reported via the Trust’s Accountability Framework. These questions provide a fuller picture of patient experience as well as a monitoring tool for key objectives.
The table below illustrates that trust-wide the performance has consistently exceeded the minimum scores required. Performance for Q1 is variable as the new questions bed in.
Target Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Indicator score
Emergency Department questions Did staff introduce themselves to you? 95 0 100 62 * * * * * * * * * Did staff ask about the things that matter to you? 95 0 0 14 * * * * * * * * *
Did you have enough time to discuss your health 0 100 100 100 100 94.3 100 100 100 100 97.2 100 or medical problem with the nurse or doctor? 90 If you had a family carer were they involved in 0 0 50 * * * * * * * * * decisions about your treatment and care? 90 Do you think staff did everything they could to 0 0 100 100 87.1 100 100 100 100 100 100 100 control your pain? 90 Were you informed of how long you would have 0 0 0 33.3 28.3 28.6 14.3 57.6 33 31.6 56.3 50 to wait? 90 Did a member of staff tell you who to contact if 0 100 75 96.2 97.9 96.9 95.2 100 40 80 73.3 75 you were worried after you left? 90
Inpatient questions Did staff introduce themselves to you? 95 97.4 94.5 96.5 97.3 97.7 97.1 96.3 97.1 98.3 98 97.4 97 Did staff ask about the things that matter to you? 95 90.3 87 90.2 90.7 89.3 90.9 88.3 91.5 91.6 90.7 90.2 91 If you had a family carer were they involved in 91.7 92.1 92.1 92.8 91.3 92.5 91.5 93.8 93.9 91.2 91.2 95 decisions about your treatment and care? 90 If you had issues or concerns did you feel able 97.6 97.2 97.7 97.6 97.9 97.9 97.1 98.7 97.8 98 98.2 99 to talk to a member of staff? 90 Call bell answered in 5 minutes? 85 96.6 95.9 95.9 96.2 95.6 95.9 95.4 97.1 97.5 96.6 98.3 97 Did staff keep you informed of discharge plans? 90 93.4 92 94 95.4 92.9 93.5 92.3 95.7 96 93.4 95 95 Did you get enough help from staff to eat your 94 96.4 98 95.7 96.8 96.2 96.2 97.1 96.3 94.3 95.6 96 meals? 95
Outpatient questions Did staff introduce themselves to you? 95 94 97 96 99 98.8 98.4 98.3 99.3 98.4 98.2 97.1 100
Did staff ask about the things that matter to you? 95 86 89 86 91.2 92.2 94.5 94.9 97.8 96.1 90 92 97 Were you involved as much as you wanted to be 98.8 98.5 100 98.6 97.8 99 with decisions about your treatment and care? 80 85 96 96 98.4 99.4 100 If you had a family carer were they involved in * * * * * * * * decisions about your treatment and care? 90 67 76 86 Did the healthcare professional explain the reasons for any treatment or action in a way you 80 0 96 95 99.4 94.8 99.2 98.2 100 100 99.5 97.7 99 could understand? Were you given information on your treatment 98.2 99.2 100 97.7 97.8 96 and how it was likely to progress? 70 0 95 97 97.2 84.8 95 Were you told how long you would have to wait 59.4 61.8 46.6 63.9 73.5 62 once you had arrived? 75 0 68 68 73.2 81.4 61
* No Score recorded 62 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Patient experience Patient and public involvement, community engagement and patient feedback
Compliments are always Social media/online feedback Carers’ feedback welcome and they are passed on Carers are offered a number of ways Feedback left on the NHS Choices to the staff in the areas involved. to give feedback - carers comment and Patient Opinion websites is They are an equally important cards, on-line surveys and phone monitored and responded to with method of identifying trends calls to carers of someone with a prompt, detailed responses and which enable good practice to be dementia. In 2017/18 120 carers are highlighted to the relevant shared widely, as well as a gave feedback via phone calls. ward, clinic or area. Stories from morale boost for staff. 100% were confident to leave their NHS Choices also appear on Many compliments are sent directly loved one with us, and felt always or Patient Opinion. Comments are to the wards, usually in the form of mainly supported whilst at the also recorded from Google, Twitter, cards, chocolates and biscuits. hospital as carers. Iwantgreatcare, Instagram,
Facebook and Healthwatch Suffolk When letters of compliment are sent feedback sites. Community engagement to the Chief Executive, these are Ongoing attendance and always responded to with a letter of The Patient Experience team has engagement continued with: thanks. All compliments are shared been working closely with a Healthwatch Suffolk BME/ with the staff concerned. Over the number of departments who have Diversity Group, working with the course of a year there are many been offering responses online Emergency Department on more compliments received than the directly to comments, queries and information for patients and number of formal complaints. concerns relevant to their area/ carers
ward. Feedback from ‘Comments and The Suffolk Disability Health
Compliment’ cards: Action Group, working to Twitter and Facebook The Trust The feedback stations across the produce the ‘About Me’ passport, has an active presence on Twitter Trust have encouraged further downloadable from the Ipswich and Facebook and receives comments and compliments posted Hospital website: stories/comments via these through the numerous post boxes. www.ipswichhospital.nhs.uk/a- profiles. The completed cards are returned zofservices/Documents/ to the ward/clinic/area for the wards PatientInformation/My%20Health% Healthwatch Suffolk is proactive to display or use for revalidation. 20Passport.pdf in seeking out comments to post
via events and visits to clinics etc. The themes/trends emerging from The Ipswich Mela took place in July In June, they noted three concerns the comments are: and Ipswich Hospital Trust shared a raised via a home care agency table with our commissioners (the related to one particular ward. The Positive comments CCG). Attendance at events such Trust was able to respond swiftly, as the Mela and the One Big Multi- Focus around care, staff take action and reassure those Cultural Festival which takes place kindness and understanding who raised concerns and every August, allow the Trust to
Healthwatch Suffolk. reach out to a wider range of Negative comments: communities as the events are very Waiting times well attended by a diverse mix of Staff attitude Social media and on-line people. Communication feedback, 2017/18 The Patient Experience team is now Car parking, and the anxiety of Total Positive involved with the following groups: worrying about finding number of comments Sickle Cell Health Inequalities somewhere to park to get to their comments appointment, and the price. Action Group, looking at Q1 366 269 producing a patient-held Crisis card. Q2 547 437 Non-Binary and Transgender Q3 431 351 Health Inequalities Task & Finish Group, via Suffolk County Q4 329 297 Council, supporting transgender patients and staff. Comments and compliments Type Q1 Q2 Q3 Q4 Total Cards/gifts direct to wards 84 58 192 772 1,106 Your Views Matter 91 89 75 79 334 Comment/Compliment cards 68 77 67 89 301 Total 243 224 334 940 1,741 63 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Patient experience Patient and public involvement, community engagement and patient feedback
64 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Patient experience Ipswich Hospital User Group (IHUG)
IHUG award winners Outstanding colleagues were honoured at an awards ceremony at Ipswich Town Hall in October.
Fifteen members of staff from several areas of the hospital were recognised for their excellent care over the last year with an Ipswich IHUG is made up of the chairperson Hospital User Group (IHUG) "You Made a Difference" award. or a representative from all the user groups. The winners, who have to be nominated by patients, relatives or carers, were selected by a panel of IHUG members. The Meetings are held every six weeks to award-winning colleagues were congratulated by the Mayor of discuss a wide variety of issues; Ipswich, Cllr Sarah Barber - who works as a recovery nurse at the members of the Trust Board also hospital - and Director of Nursing, Lisa Nobes. attend, with key Trust staff members attending as and when the agenda The presentation ceremony was hosted by IHUG and included requires. When members raise an afternoon tea courtesy of the Mayor. This is the second time the issue at IHUG it is often resolved awards have been held. quickly, as the issues are taken straight to the people who can Roll of honour implement the changes needed, or Andy Page (Porter on the Assessment Ward) who are able to take the issue to the correct department for resolution. All Laura Barham (Midwife) members share the same passion to Lisa Mann (Oncology Macmillan Nurse - Radiology) help improve the lives of all patients, Jennifer Bolt (Gynaecology Nurse, Stour Ward) whether they are outpatients or Fran Vale (Outpatients Nurse) inpatients, children or adults. Ross Harrington (Chief Orthodontic Technician) Our volunteers’ contribution to the life Julia Degutis (Ward Clerk, Stradbroke Ward) of the hospital, helping us to make Anne Oliver (Midwife, Deben Ward) improvements large and small, is so Halty Davis (Therapy Assistant, Sproughton Ward) important and very much appreciated. Leanne Logan-Smith (Senior Nurse, Shotley Ward) We currently have 16 user groups and are always seeking new members. Nikki Williams (Somersham Ward) Cancer Services User Group Petra Claxton (Day Unit, Chemotherapy) Cardiology User Group Satnam Kaur (Ward Clerk, Bergholt Ward) Dr Ben Scoones (Anaesthetics) Diabetes User Group Alex Lingwood (Washbrook Ward). Endoscopy User Group Eye Clinic User Group Hearing Services User Group Hotel Services User Group Inflammatory Bowel Disease (IBD) Patient Panel Musculoskeletal Action Group Maternity Voices Partnership Parents User Group Pain Management User Group Stroke Services User Group Voice 4 change - children and young people involvement group Liver Disease Action Group Learning Disability Action Group
Additional information about IHUG can be found on the notice boards in Some of the IHUG award winners, pictured with Mayor of Ipswich the hospital corridors, or on the Sarah Barber, Managing Director Neill Moloney and Director of Ipswich Hospital website at Nursing Lisa Nobes www.ipswichhospital.nhs.uk/ getinvolved/join-a-user-group.htm 65 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Patient experience Ipswich Hospital User Group (IHUG)
Improvements initiated by First Patient Experience We were then led through various workshops by our facilitator IHUG and user groups Seminar In March we held the first East of Ceinwen Giles who works with Adopt a Ward initiative England Patient Experience many NHS organisations. Along embedded and expanded. Seminar, with the theme of with the patient panel, we Shortlisted for PENNA award ‘Working Together’ co-hosted and showcased some of our work, for joint work on simulation co-produced with the Patient Panel including ‘Adopt a Ward’ and our suite training. at Princess Alexandra Hospital, involvement in the simulation ‘You Made A Difference’ Harlow. This seminar attracted suite. Huge thanks go to Matron awards given to staff by IHUG. over 90 delegates from all corners Sarah Watson and Jo Wesley Organised an end of life of the East of England from around from the simulation suite for helping to present. For me one of workshop for staff and patients. 30 NHS organisations ranging from the best things was later that East of England Patient Patient Participation Groups to Hospitals. The staff/service user evening at home when I read a Experience seminar co- comment on Twitter, where an designed and led by patient ratio was 2:1 and many organisations were attending to attendee had tweeted “I attended leaders. this event today, it was awesome!” Participated in a review of find out more about how to engage with their patients. Neill Moloney Just what you need when you are disabled toilet facilities, from opened the day and welcomed exhausted from running such an the perspective of a person in a everyone to Ipswich. We were event! I’d like to take this wheelchair. very honoured to have Lynne opportunity to say a heartfelt Instigated the now flourishing Wigens attend in her capacity as “thank you” to Sarah Higson, Pam and very positive relationship Regional Chief Nurse NHS East of Talman and Steve Bruce from the with the CHUFT governors. England (Midlands & East). Ipswich Patient Experience Team Presented at NHS for all their assistance in making Improvement conference in Our first speaker, Pete Fleishmann this day such a success. Birmingham on the work IHUG from SCIE (Social Care Institute for does. Excellence) gave what many found Gill Orves, Chair IHUG Presented at the Westminster to be the most comprehensive and Health Forum on effective straightforward guide to what co- service user involvement. production really is. Presented to University of Suffolk service user group on IHUG’s role. 2 IHUG members accepted onto the Q Community and undertook bronze level QI (quality initiative) training. Members have assisted with staff training, particularly with Human Factors, Breaking Bad News, Care of the Deteriorating Patient and Trainee GP training.
Left: Neill Moloney, Managing Director. Middle: Matron Sarah Watson with Gill Orves, Chair IHUG. Right: Lynne Wigens, Regional Chief Nurse NHS East of England (Midlands & East).
66 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Patient experience Learning from complaints
What are complaints? Complaints are written expressions of dissatisfaction from patients and/or relatives who are unhappy regarding an aspect of their interaction with Ipswich Hospital. Complaints are a valuable tool to identify trends which enable us to improve the service where it may be necessary.
The Ipswich Hospital NHS Trust or a revised timescale agreed with All complaints are assigned to a is committed to providing a the complainant, against a Trust complaints co-ordinator who liaises complaints service that is fair, target of 100%. Every effort is with the complainant and ensures effective and accessible to all. made to contact each complainant the department responsible for Complaints are a valuable within 24 hours of the complaint investigating and responding to a source of feedback about our being logged by the complaints complaint does so within the services. We undertake to be team. These calls, known as 24 agreed time limits. open and honest and where hour courtesy calls, are made by a necessary, make changes to senior manager and are seen as Once a complaint investigation has improve our service. an opportunity to: been completed, it is checked by take time to understand the the Associate Director of Nursing Complaints service exact nature of the complaint or their deputy for the appropriate as this will help to ensure a Division to ensure all issues raised Complaints are always taken thorough and meaningful have been answered, before being seriously as they highlight the response; passed to the Managing Director times we let down our patients gain insight to understand the or another Executive Director to and their families. Each complaint review and sign the letter of key issues that need to be is treated as an opportunity to response. resolved; learn and improve the service we provide. The Trust listens and help build relationships with responds to all concerns and the complainant, help them to complaints which are treated feel part of the process and Reopened complaints confidentially and kept separately demonstrate that we take their During 2017/18, 45 (6.9%) of the from the complainant’s medical concerns seriously; and complaints received were records. Making a complaint does explain the 28 working day reopened. One of the main not harm or prejudice the care timeframe for our response reasons for reopening a complaint provided to the complainant. and establish the method in has been identified as poor or which the complainant would inaccurate investigation. In these like to receive our feedback, cases, complaints are returned to How complaints are for example a letter, telephone the investigating team for further managed call or a face to face meeting. explanation and clarification. Analysis of re-opened complaints We aim to respond to complaints This year 96.5% of courtesy calls is being undertaken to ensure that within 28 working days from were made within the 24 hour we understand why first responses receiving the complaint. This year, standard. are not meeting the satisfaction of 100% of complaints received were complainants and to enable the responded to in 28 working days complaints team to offer Divisions appropriate support.
Complaints are categorised in three ways, depending on their severity:
High level Multiple issues relating to a longer period of care including an event resulting in serious harm.
Several issues relating to a short period of care including, for example, failure to meet care Medium level needs, medical errors, incorrect treatment, attitude of staff or communication. Simple, non-complex issues including, for example, delayed or cancelled appointments, lack Low level of cleanliness, transport problems.
67 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Patient experience Learning from complaints
Complaints to the Learning from complaints Parliamentary and Health While information drawn from Service Ombudsman surveys and other forms of patient (PHSO) feedback is important, every During 2017/18, 7 cases were complaint received indicates that investigated by the Ombudsman for that person or their family, they as the complainant was unhappy did not receive the high quality with the response received from care they rightly expected. the Trust. Complaints are an important Of these, 1 investigation has been method by which the Trust completed, with the outcome assesses the quality of the service being the complaint not being it provides. We take all upheld by the PHSO. At the time complaints seriously and have of reporting, six cases remain taken action in response to them under investigation by the PHSO. in various ways to improve the quality of care we provide, as the The Ombudsman now publishes examples on the next page show. data on an annual and quarterly basis. This data is published to We carry out an annual survey of give statistical insight into the 100 complainants to understand complaints the Ombudsman their experience of the complaints receives and investigates to procedure and make changes to encourage discussions and help our processes where appropriate. organisations assess the efficiency of their own complaints handling process.
Chart 10 – Our performance over the last three years: Complaints
68 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Patient experience Learning from complaints
Top three subjects of complaints Patient Advice and Liaison Service (PALS) 2015/16 2016/17 2017/18 The PALS team handles queries and concerns in a practical way, Elements of treatment Elements of treatment Elements of treatment resolving and addressing issues at source to prevent matters escalating. This is seen as a positive step towards taking more Poor communication Aspects of care Attitude of staff responsibility for issues as they arise.
Attitude of staff Attitude of staff Aspects of care PALS offer patients, carers and visitors: advice and signposting - helping to navigate the hospital and its services; Complaint Action taken compliments and comments - PALS can pass on A ‘Safe Discharge’ sheet has been displayed compliments and ideas to Lack of communication with on the ward for all members of staff to read. improve services; and nursing home following The complaint has been discussed at a PALS can address a non- discharge of a patient and recent ward meeting in order that members complex issue informally, antibiotics not given, so these of staff can reflect on the discharge process often preventing the need to had to be obtained from the and ensure that all procedures and protocols raise a formal complaint. GP. are followed to ensure the safe discharge of patients, in particular in regard to medication. PALS contacts are graded as either PALS 1 or PALS 2: Outpatient appointment for a child had been cancelled Urology administration team were reminded PALS 1 are contacts that require without the parent being of the importance of effective communication straightforward information or informed so family had a at all times, New appointment made for signposting, for example, ward wasted journey and the patient. visiting times or how a patient can mother had booked time off apply for a copy of their medical work. records.
PALS 2 are contacts relating to a Poor disabled toilet facilities New toilets at the appropriate height have matter which needs to be resolved in Outpatient Department at been installed. or addressed, for example, lost Ipswich Hospital property, waiting list enquiries or waiting times for appointments.
Typical matters raised with PALS include: For the period April 2017 - March 2018, our PALS team dealt with the Ward-related concerns such following queries as pain management or discharge arrangements; PALS Level 1 Enquiry/Concern Matters that simply require straightforward information or Litter from cigarette ends and 1,217 signposting other service providers such as dentists, mental health staff smoking in groups; services and GPs. Lost property; Car parking concerns; PALS Level 2 Enquiry/Concern Resolving matters where Matters that simply require resolution such as concerns relating to patients are unable to contact the quality of care received, pain management, discharge 1,138 the department of their choice arrangements and difficulties experienced in trying to communicate by telephone. with ward staff, chasing appointments or test results. Total 2,355
69 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Patient experience Patient-Led Assessment of the Care Environment (PLACE)
Good environments matter, and every patient should be cared for with compassion and dignity in a safe and clean environment. PLACE assessments provide a clear message, directly from patients about how the environment or services could improve. Patients must make up at least 50% of the assessment team. Anyone who uses the service can be a patient assessor, including patients, their family, visitors, carers or patient advocates. The assessment teams go into hospitals to assess how the environment supports patients’ privacy and dignity, food, cleanliness and general building maintenance. The assessments take place every year, and results are reported publicly.
Patient-Led Assessment of the to their assessments and develop Each assessment team consists Care Environment (PLACE) is a a plan for improvement. The of at least two patient assessors, self-assessment of a range of PLACE assessment at Ipswich accompanied by other members non-clinical services by local Hospital was undertaken on 16 of staff. Staff members included volunteers (patient assessors) May 2017. members of the Patient which contribute to the Experience team, Estate and environment in which healthcare The assessment has six Facilities team, senior nursing is delivered in both the NHS and categories: staff, infection control, and hotel independent healthcare sector in Cleanliness; services contractors, with one England. member of each team acting as Food and hydration; ‘team leader’. The annual PLACE assessment Privacy, dignity and wellbeing provides a snapshot of how an (how the environment supports Scope of the assessment organisation is performing against delivery of this); A minimum of 25% of wards (or a range of criteria impacting on Condition, appearance and ten, whichever is the greater) and patient experience. Local maintenance of premises; a similar number of non-ward volunteers (patient assessors) go Disability Access; and areas must be assessed. Each into hospitals to assess how the area assessed must be: Dementia friendly environment environment supports delivery of sufficient to allow the PLACE care. The assessments focus It is recognised that hospital team to make informed entirely on the environment and do buildings vary in age and design; judgements about those parts not cover clinical care provision. which may limit their ability to of the hospital it does not meet the criteria. However, it is visit; The role of the assessors is to: important that the assessment is where possible, focus on assess what matters to based on standard criteria and no areas of the hospital not patients/the public; allowances are made for such included in recent PLACE factors. The scores awarded report what matters to assessments so that over a reflect what was seen on the day. period of time all areas will be patients/the public; and assessed; ensure the patient/public voice Support for assessors The term ‘patient assessors’ include all buildings of plays a significant role in different ages and conditions; determining the outcome. covers people whose experience of the hospital is as a user, and include departments/wards Patient assessors must make up including relatives, carers, friends, where a high proportion of more than 50% of the inspection patient advocates and volunteers. patients have dementia or team. At least 25% of inpatient The number of patient assessors delirium. ward areas must be assessed, and should always be at least equal to the complete inpatient meal service the number of hospital staff. Each team makes the final must be observed and patient food PLACE assessors were drawn decision on which patient areas tasted and scored. from the pool of Trust volunteers, they will inspect, but they must
user representatives, Healthwatch ensure that the wards and areas The assessments take place Suffolk and groups already chosen are reflective of the range annually, with Trusts given six actively engaged with the Trust. of services and buildings across weeks’ notice of the specified Training sessions were held for the hospital. Different areas are timeframe during which the PLACE assessors in March 2017. All of selected each year so that all assessment must occur. Results the patient assessors attended for areas are assessed over a period are reported publicly by NHS training, with ‘new’ assessors of time. Digital to drive improvement. The being accompanied by a patient PLACE process requires assessor who had previous organisations to respond formally PLACE experience.
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Scoring Areas assessed in 2017 changed with the ‘Food’ element Scores are based on the The following areas were being scored across three areas conditions seen at the time of the assessed in 2017: (Food overall, Ward food, assessment. It is made clear to Organisation of food) and a new assessors that they must score Wards element of ‘Disability’ compliance the hospital on how it delivers Bramford added. against the defined criteria and Deben guidance. No allowance is made An action plan following the 2017 for infrastructure, age or design of Debenham PLACE survey has been written, the Trust’s buildings. Kirton and below are some key Martlesham comments made by the patient To achieve a pass, all aspects of assessors during the assessment. Needham all items must meet the definition/ guidance as set out in the Orwell Cleaning assessment criteria. There is no Somersham Light dust on some of margin whereby an item can fail to Sproughton the ward equipment. meet the required standard but Woodbridge Light dust on some still achieve a pass. environmental surfaces.
Assessment teams need to Outpatient Clinics Alcohol hand gel not available exercise judgement, and will Antenatal Clinic at every bedside. discuss and agree which score to Child Health Clinic Condition and appearance apply where it is obvious that a Clinics A, B, C & F pass is not appropriate. As an Many areas require example, a small amount of fluff CT Scan Suite redecoration or refurbishment: on a floor would not be deemed as Frailty Assessment Base vinyl flooring, paint scuffed, a fail, but fluff under every bed Heart Centre furniture worn. and/or in every corner would be a Musculoskeletal Department No facilities for patients to fail. lock away valuable property. Neurophysiology Inadequate variety of seating Food audits Ophthalmic Day Case Unit in dayrooms and waiting Teams must base their scoring on Pain Management Unit areas. what is observed and said rather Plastic Surgery than rely on assertions of what Some bathrooms not fitted usually happens. Assessors must: Radiology Department with modesty curtain inside door. undertake the assessment on the ward, from the same food Food audits were conducted on Signage and way-finding inadequate. as provided to patients; Bramford Ward No hearing loops or visual if possible, assess both the Kirton Ward displays at reception areas. lunchtime and evening meal Needham Ward services to obtain a rounded Somersham Ward view and to improve the Dementia accuracy of the assessment; Sproughton Ward Lack of handrails. taste all food on offer to Inappropriate vinyl flooring.
patients; Mirrors not able to be covered General areas (these must be taste food at the end of patient assessed every year) or removed. meal service to ensure that Emergency Department Doors not painted to either temperatures have been emphasise or disguise them. communal areas inside the maintained at an acceptable No displays of calendars, hospital building level for the last patient to be clocks, ward and hospital served; external grounds. name. watch how food is served to
check for the care taken in Disability presentation; and Findings There has been improvements No assistance in reception/ observe how staff are involved and one deterioration in scores clinic areas for visually/hearing in the meal service and how from the 2016 PLACE inspection. impaired. they provide help for those However, it is important to note patients who require it. that from 2015, the criteria have
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Catering Next steps What are we doing to make Temperature of some items. All Trusts are required to formally improvements? respond to the findings of a Main course and dessert not PLACE assessment and develop Old signage has been served separately. an action plan for improvement. removed, updated and Lack of separate dining areas This high level action plan has to replaced. away from bedside on most be published on the Trust’s Foliage around signs cut back wards. website. and signs cleaned. Patients not made ready for Additional seating purchased meals. The Trust’s detailed action plan to provide for the range of Lack of involvement by ward will be shared with each ward and patient needs including chairs staff at meal time on some department that was audited and of different heights, chairs both wards. where appropriate those actions with and without arms and listed will be the responsibility of bariatric chairs. Protected mealtimes not in that ward or department to deliver. All bedside lockers are being universal operation. Where other actions require replaced so they have two
building/decoration works or lockable compartments. Privacy & Dignity capital investment, these will be Large-face clocks now easily No private rooms on wards for managed by the Estates and visible in all patient bedside confidential conversations. Facilities team, under the areas and in day rooms. Patients cannot leave most responsibility of the Director of Ongoing work to ensure there outpatient areas without Estates & Facilities. is clear signage in the passing back through the reception areas, prominently waiting room. displayed showing the Reception desks lacking department name. confidentiality. Replacement and upgrading of Lack of communication aids for flooring where required. hearing/visual impairment. Redecoration where required.
Chart 11 – Ipswich Hospital PLACE audit scores 2017
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The annual PLACE self- Chart 12 – Community Hospital PLACE audit scores 2017 assessments of community hospitals took place on 18 May Aldeburgh Community Hospital 2017 at Bluebird Lodge, on 25 May 2017 at Aldeburgh, and on 8 May 2017 at Felixstowe.
What are we doing to make improvements in the community hospitals? Each community hospital was given an action plan based on the issues noted during the PLACE assessment and the following actions have been completed:
All bedrooms at Bluebird redecorated Shower drains changed at
Bluebird Lodge Provision of extra course for Bluebird Lodge Community Hospital lunch and dinner meals Provision of an extra starter at lunch and dinner Provision of an extra preserve at breakfast Changing the evening meal service time by 30 minutes Extra choice added to the breakfast menu Introduction of dementia- appropriate signage to toilet doors New day-room furniture to be provided in Felixstowe
Felixstowe Community Hospital
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The Trust continues to work towards the achievement of the NHS pledges as outlined in the NHS Constitution to ensure that all staff feel valued, trusted, actively listened to, provided with meaningful feedback, treated with respect at work, have the tools, training and support to deliver compassionate care, and are provided with opportunities to develop and progress.
Our ambition is that our staff will Ability to contribute towards highly recommend Ipswich taff ability to improvements at work; Hospital as: contribute towards improvements Confidence in reporting unsafe at work. a place to work; clinical practice; and
a place to receive treatment; Staff recommendation of the Staff motivation at work. and organisation as a place to work or a place to be trained. receive treatment has improved on prior years (3.80) and is above Areas to address Indeed, this year, this is what our the national average of 3.76. We plan to continue on the great staff have told us in the annual work already achieved, and work staff survey. There are no statistically to improve communication, being significant changes in the scores able to contribute effectively and National NHS Staff Survey from last year. involvement with changes to working. 15 key findings were better than average and 7 are in the top 20%. Feeling valued and looking after the health and wellbeing of our We were below average in only staff have all led to a greater level one key finding - the percentage of motivation and satisfaction. We of staff willing to report will continue to build on that over and was equal to harassment, bullying or abuse. the next year. the response rate as in the 2016 survey. The Trust has 7 scores in the top We will further improve our 20%: communication with staff, and improve the quality and value of Staff agreeing that their role Key Findings appraisals and our training and makes a difference to patients development opportunities for all and service users; staff groups. Experiencing physical (1 being poorly engaged staff to 5 violence; being highly engaged staff). Experiencing discrimination; Ipswich Hospital NHS Trust was in the highest 20% of acute trusts. Reporting errors, near misses and incidents;
Table 8 – Key findings from Staff Survey
Key Finding 1 Key Finding 2 Key Finding 3 Key Finding 4 Key Finding 5 Key Finding 7 Staff Staff Percentage of Staff motivation Recognition and Percentage of staff Questions - recommendation satisfaction with staff agreeing at work value of staff by able to contribute Key Findings of the the quality of that their role managers and towards (weighted by organisation as work and care makes a the organisation improvements at occupational a place to work they are able to difference to work group) or receive deliver patients/service treatment users
2017 score 3.80 3.95 92% 3.98 3.50 74%
Average for 3.76 3.91 90% 3.92 3.45 70% acute trusts
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In December 2016, we appointed a The Trust’s vision and values Freedom to Speak Up Guardian to were developed by staff, patients ensure there was a dedicated ‘go and key stakeholders and apply to to’ person when staff need to all with crucial linkage between speak up and other avenues are good patient and workforce not suitable. We will also be experiences. We plan to have a looking at all ways in which to stronger focus on having improve this score (see page 77). conversations with staff on what matters to them. Taking care of health and wellbeing is a key priority in the The findings from the staff survey challenges we face going forward. will help inform targeted, robust We appointed a specialist partner actions for continuous in 2016 to provide an Employee improvement as essential steps to Assistance Programme for support restore our workforce position and and advice, and we have also ensure the Trust is a good place worked closely with Public Health to work and train. England on ’healthy hospitals.’ In addition, we are working with Recruitment of staff level of BME Suffolk MIND to implement a plan Recruitment initiatives have been representation at senior to train and support staff on undertaken to address difficult to management and board level emotional wellbeing and resilience fill posts and to reduce the number evidence based programmes. of vacancies and the times that action staff are required to work extra hours. We continue with international nurse recruitment campaigns and have taken a The Trust is developing an action Evidence shows that engaged staff number of actions to address our plan and has widely consulted really do deliver better healthcare ‘difficult to recruit to’ posts. with staff. and it is our intention to continue to improve the health, wellbeing and The full and summary survey workplace experience for our staff. reports for Ipswich Hospital are available at We have undertaken an intensive www.nhsstaffsurveys.com 16 week programme called Engage, improve, succeed to listen to our staff and ask them ‘what matters to you’ when they come to work each day.
Table 9 – Our performance over the last two years (unweighted scores)
2016 2017 2016 2017 Key Finding Average for Average for score score acute trusts acute trusts
KF21 Percentage of staff believing that the White 91% 88% 87% 87% organisation provides equal opportunities for career progression or promotion. BME 62% 76% 81% 75%
KF26 Percentage of staff experiencing White 28% 24% 21% 24% harassment, bullying or abuse from staff in the last 12 months BME 26% 27% 31% 27%
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Equality and Diversity NHS Equality Delivery System Like all NHS organisations, the Trust Equality is about fair and uses the Equality Delivery System inclusive treatment. It is protected (EDS2) to implement equality and in law with the aim that we can all diversity strategies and the Public live and work in a society where Sector Equality Duty. There are four everyone can participate, have overarching goals: opportunity to fulfil potential and fair access to services and 1. better health outcomes; Workforce Race Equality Standard employment. 2. improved patient access and (WRES) experience; EDS2 covers all areas of diversity Diversity supports equality, 3. a representative and supported across services and the workforce. recognising and understanding the workforce; and The WRES focuses on workforce broad range of differences which 4. inclusive leadership. and race as a particular NHS need to makes someone unique such as improve performance in this area their culture, belief, gender, age, More details can be found at: where there is potentially less physical or mental abilities, and www.england.nhs.uk/wp-content/ favourable treatment and experience also their experiences, needs, uploads/2013/11/eds-nov131.pdf of BME staff in the NHS. expectations or responsibilities. Engagement and involvement with Workforce Disability Equality Being fair and inclusive means patients, staff and stakeholders Standard (WDES) valuing and respecting a person’s A key part of EDS2 is identification of The WDES is a new development to diverse requirements, thoughts stakeholders from patients, staff, or improve performance. We will also and contribution. Equality and local interest groups to secure be looking to improve services for diversity work in unison to achieve meaningful engagement to help those with a disability. all this. assess and evaluate where we are and how to progress. This partnership Gender Pay Gap Reporting Why this agenda is important approach to engagement and (GPGR) The people we serve and employ involvement with communities helps NHS employers by law are now are becoming increasingly diverse us focus on what matters most for our required to publish statutory with varied needs, but everyone patients, communities and staff. calculations each year showing how needs to feel valued and included large the pay gap is between their and treated fairly and respectfully. Embedding equality and diversity male and female employees. We will The Trust, our patients, staff and EDS2 helps identify, develop and be analysing the information we have stakeholders have all identified implement objectives to continue to and acting upon any gaps identified. and made a commitment to this make real, sustainable improvement within our shared values and our to our services and working Care Quality Commission (CQC)/ expectations of conduct. Everyone conditions whilst delivering better equality diversity and human is responsible for supporting this outcomes and benefits to meet the rights agenda agenda. needs of staff and service users. The Equality and diversity is inspected by equality objectives and priorities are the CQC as part of the Our responsibilities and also aligned to the Trust’s ensuring delivery organisational priorities to ensure Equality, firmly underpinned in the relevance and to realise full benefits Equality Act 2010, ensures people within the Trust’s corporate, do not receive unfair treatment or workforce and patient strategies. be subjected to discrimination or This helps embed the agenda into our harassment due to their age, race, governance structure and into all Our commitment continues gender, belief, sexual orientation, activities for effective implementation. The Trust aims to achieve a diverse transgender, in marriage or civil workforce reflective of and sensitive partnership or in pregnancy or NHS Accessible Information to the needs of the community. We maternity. To ensure we meet Standard (AIS) will work towards eliminating these responsibilities, the Equality Application of the AIS helps to meet discrimination, promoting equal Diversity and Inclusion Steering needs in relation to a disability, opportunity and removing barriers to Group overviews this agenda for impairment or sensory loss which fair and equal treatment of staff and the workforce and patients, affects the ability to communicate. patients. Support from the Trust providing assurance to Trust The AIS applies to patients, carers or Board ensures full ownership and committees and the Trust Board. parents. We try to address any accountability for this agenda. The information/communication support Board is involved in and approves needs to enable better access to equality developments and services and care to give a better understands its role, and legal patient experience. requirements. 76 The Ipswich Hospital NHS Trust—Quality Account 2017/18
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Freedom to Speak Up Guardian of Safe Working Guardian Hours (GSWH) Tom Fleetwood our Freedom to The Guardian of Safe Working Speak Guardian, has now been in Hours (GSWH) has been introduced post for one year. During that to protect patients and doctors by period a significant number of making sure doctors and dentists are changes have been made to our not working unsafe hours. way of doing business and we have embedded Freedom to Dr Mark Garfield, a consultant Speak principles within our anaesthetist, undertakes this role for working practices. We now the Trust. He is responsible for include a session on both raising protecting the safeguards outlined in concerns and freedom to speak the 2016 terms and conditions of up, within our induction process service for doctors and dentists in and Tom also speaks to many training. It is a role intended to be other groups including junior undertaken by a consultant or doctors and those starting out on someone of equivalent seniority. their nursing careers. The guardian reports directly to the Tom Fleetwood, Freedom to Trust Board and is independent of Our policy has been reviewed and Speak Up Guardian. the management structure within the amended and we now reflect organisation. national guidance. We have also launched a poster campaign that To fulfil this role, the GSWH: advertises to all those working acts as the champion of safe within the Trust the various routes working hours; that they can follow to seek advice receives exception reports and and gain support for any concerns records and monitors compliance they might have. This campaign against terms and conditions; was relaunched in the spring with further emphasis on intranet escalates issues to the relevant accessibility and with a executive director, or equivalent recruitment process to encourage for decision and action; other members of staff to become intervenes to reduce any additional Freedom to Speak identified risks to doctors/dentists supporters. or to patient safety; undertakes work schedule Tom reports on a quarterly basis reviews where there are regular through the Workforce or persistent breaches in safe Development and Education working hours; and Committee and to the Trust Board distributes monies received as a once a year. He is also firmly consequence of financial embedded within the National penalties, to improve training and Guardians Network and is part of service experience. the East Of England Freedom to Dr Mark Garfield, Guardian of Safe Working Hours. Speak forum. A number of The GSWH is a member of the individuals from across the Trust regional network and has attended have already contacted Tom and National Guardian events. The he remains available to support network supports the ongoing and offer advice whenever development of the GSWH role and required. the sharing of best practice.
The 2016 contract has been implemented across the Trust for all levels of junior doctors in training.
The Trust uses an electronic exception reporting system (Allocate) which enables doctors to submit exception reports from any IT
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device. The system also supports Our key achievements Looking after our staff the management of exception The Healthy Hospital model reports and work schedule reviews Transition of junior doctors to championed by Public Health so the GSWH can monitor progress the new contract according to England is a concept that brings with resolving issues. A doctor can the national timeline, with together anything additional to submit an exception report if their phased implementation now regular clinical care that improves working pattern varies from the completed. the health of patients, staff or the work schedule or they have missed local community. Longer-term it educational opportunities. A GSWH Quarterly Board reports aims to support the NHS by meeting with the doctor’s submitted and shared with the preventing disease and increasing educational supervisor is then held Junior Doctor Forum and the self-care. It helps to improve staff to discuss the issue and agree any Local Negotiating Committee. wellbeing, productivity and actions. If necessary, a work retention. schedule review can be undertaken Training events and ongoing to formally review the doctor’s ad-hoc training continue to be The project supports a smoke free working pattern. To date, there offered via the medical staffing environment, and supports people have been 67 exception reports team with regards to exception to stop smoking, particularly prior submitted. 65 relate to working reporting and work schedule to having surgery. patterns and 2 relate to education. review processes with junior No work schedule reviews have doctors. Longer term, the project aims to been required. support:
Support and on-line training Health coaching continue to be provided to A workplace wellbeing charter Junior Doctors Forum educational supervisors The GSWH and the Director of regarding their role regarding Direct referrals to lifestyle Medical Education have work schedules and exception support for patients established the Junior Doctor reporting. Suicide prevention training for Forum which is a requirement of staff working in emergency the 2016 contract. In order to Review of the Exception areas increase attendance, the Junior Doctor Forum and Trainee Reporting and Work Schedule Flu vaccination planning Committee have been combined Review Policy. into a single meeting. The meeting In October 2016, the Trust provides the opportunity for junior Implementation of junior doctor launched a wellbeing support doctor representatives to raise any rotas to ensure compliance programme including a new general matters relating to working with the 2016 contract counselling service, joining forces patterns or educational requirements, consequently, with national organisation CiC. opportunities as well as reviewing followed by reviews where The service includes access to the exception reports and necessary to reflect service 24/7 telephone counselling and identifying any trends or concerns needs. This has included aims to help and advise staff so that appropriate actions can be reviews in Obstetrics and requiring emotional and practical taken. Gynaecology, General support. CiC is an external, Surgery, Oral Surgery and independent organisation and staff General Medicine. are assured the service is Rota gaps confidential. There are a number of gaps in Development of a champion of rotas across the Trust mainly due flexible training to provide The Trust runs a number of wellbeing campaigns and activities to vacancies. These are support and advice to less proactively managed and covered than full-time trainees. throughout the year such as in a number of different ways, quitting smoking, Dry January, pre-retirement seminars, yoga including the appointment of Trust Review of the Equality Impact doctors, use of temporary staff classes, running club, and monthly Assessment for the ‘coffee and catch up’ events (bank and locums) and the implementation of the 2016 reassignment of some medical hosted by the Chaplaincy service. contract. roles to nurse specialists, in order to limit the impact on patients.
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Schwartz Rounds Schwartz Rounds are structured, monthly one-hour meetings open to all staff and volunteers in the organisation. The purpose is to reflect on the experience of working in healthcare, rather than to solve problems or look for answers. Evidence shows that staff who attend Rounds feel more supported, valued and connected with others.
We have experienced Rounds with varying degrees of emotional content and audience sharing, and noted how people are becoming more willing to share their personal experiences.
One particular Round held in June 2017 focused on ‘A new country, a new life and new challenges’. We heard from four panellists who talked about their experiences of leaving their homeland and families to come and work in the UK. They delivered their stories with honesty, emotion and good humour and talked about how they had overcome obstacles and barriers with strength of spirit and resilience, reinforcing the importance of an open, supportive working environment.
Their warmth and passion emanated to the room and it was evident from looking at the faces of the audience what a privilege it is to have such kind and caring staff working at Ipswich.
Personal experiences of the audience were recounted; these experiences were respected and ‘held’ by those in the room with connections made between personal stories and experiences and how every day we choose to come to work in a place where ‘all this is going on’ for our staff as well as patients.
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Appraisal & Revalidation The Annual Organisational Audit Nursing staff Medical staff (AOA) Report is a tool used to Every three years nurses and The Trust is required to provide achieve a robust consistent midwives are required to renew assurance to the Board, our system of revalidation compliant their registration with the Nursing regulators and commissioners that with the Responsible Officer and Midwifery Council (NMC) by we have effective systems in Regulations. The mandatory demonstrating they have met place to ensure we meet with audit contained within the AOA certain requirements showing they nationally agreed standards for report provides a process by are keeping up to date and actively medical appraisal and which every Responsible Officer, maintaining their ability to practise revalidation. on behalf of their designated safely and effectively. They are bodies, provides a standardised also required to pay an annual fee Licenced doctors are required to return to the higher-level to remain on the register. have a formal link known as a Responsible Officer. The collated prescribed connection with a audits then form the basis of a Ipswich Hospital currently employs single organisation, identified as report to Ministers and ultimately 1,710 NMC registrants who are the designated body, which will the public, on the overall level of required to undergo revalidation, provide support with their performance of revalidation including central bank staff. All appraisal and ultimately their across England. For the 2017/18 NMC registrants, hospital and revalidation. appraisal year (which runs from 1 community based, are contacted April - 31 March) the Trust is and offered support and all Following the launch of Medical required to submit its AOA return confirmers provided with Revalidation in 2012 the Trust has by 1 June 2018 and the annual training. Registered Nurses (RNs) been committed in strengthening report with a statement of approaching revalidation are sent its processes and ensuring that all compliance by 28 September monthly reminders to their home doctors with a prescribed 2018. address and via email in the 3 connection are in the system of an months preceding their revalidation annual appraisal and revalidation. For the 2017/18 appraisal year, date. Compliance is monitored on the Trust was the Designated a central database with clear policy Revalidation is the process by Body for 307 doctors. During this and escalation processes in place. which a doctor’s licence to period 295 appraisals were practise is renewed and is based completed giving the Trust an Since the inception of NMC on local organisational systems of overall compliance of 96% for Revalidation in April 2016, 797 RNs medical appraisal and clinical medical appraisal. In addition, the have undergone the revalidation governance. The Trust is required RO made 23 recommendations to process successfully. 13 RNs have to provide assurance to the Board, the GMC; 19 of which were for been granted exceptional our regulators and commissioners positive recommendations to circumstances due to maternity and that we have effective systems in revalidate and 4 were for deferral. sick leave and whilst there have place to ensure we meet with The deferrals were made been no unexpected lapses, two nationally agreed standards for following long term sickness and RNs arranged for a lapse of their medical appraisal and to also allow two doctors more registration due to change in their revalidation. time to provide sufficient evidence employment. for revalidation. The NMC Revalidation intranet site has been kept up to date with extra help guides and templates. This will continue to be updated as new information emerges.
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Students say hello to Britain
International nursing students from the Philippines had a taste of British culture when hospital colleagues treated them to a fish and chip supper - for some it was the first time they had ever tasted vinegar.
Education and Training team colleagues Vicki Nunn and Kay Pilkington- Blacker organised the Saturday night event to give the students a break from their OSCE (Objective Structured Clinical Examination) studies. The nurses undertake several weeks’ preparation for their OSCE which the Nursing and Midwifery Council requires them to pass before they can be registered nurses here.
Student nurse Haydee Faeldo said: “Events such as the fish and chips supper give us time out to socialise and relax and to integrate ourselves with the culture in England.” Usual dressings for chips in the Philippines are tomato ketchup and mayonnaise.
But it is not just the food that they have been getting to grips with. Fellow student nurse Pamela Musni said: “It is fun getting to know the area, using the bus, going to the shopping mall near the town. We also enjoy going to car boot sales and bartering.” Kay said: “The students work so hard to become registered nurses, and events such as this give them time to have a break from the classroom.”
Our latest cohort of international nurses, pictured with matron Louie Horne (centre).
“When we were preparing for our OSCE exam, we've received the utmost support of the Trust especially from the Education Centre. Everything that we need was provided to us, we were not only supported in mentally preparing for the test itself, but also they were able to help us emotionally in coping with the stress that we had at that time. Starting our career in a new country where we don't have any idea on how things work is really scary, but because of the support that we received, we were able to manage and cope. We will be forever grateful.”
Mark Besa international nurse, and new member of #teamIpswich
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Volunteers (NAVSM), which provides us with multiple sites to develop the Every one of our volunteers support and guidance on best volunteering offer. If you would like makes a real difference to people practice in NHS volunteering. to join the team, please visit the in hospital. We have started to build volunteering pages of the website at relationships with external www.ipswichhospital.nhs.uk/ This year has been a year of re- organisations with a view towards volunteers/, email establishing voluntary services in growth for the future through visits [email protected] the Trust and beginning to lay to Suffolk New College to present to or phone 01473 704473. foundations for the future. students and working with community litter pick organisers to A number of projects identified and collaborate on a litter pick event at started in 2017 will continue the Heath Road site - the initial Staff Volunteering through to completion in 2018. This event held in October 2017 was a The Staff Volunteering Programme work includes an administrative great success and we look forward remains in place as a back up to our catch up, updating our policy and to another one in April 2018. Our front line staff during the busiest re-introducing a volunteer team of volunteers continue to time of the year. The programme is handbook, an audit of our deliver their support to our patients open to all staff members who can volunteers and data cleanse, and staff whilst also helping to join any of our four teams of bed expanding our database and work shape the future of the service by makers, porters, mealtime on the internal intranet site which providing invaluable feedback supporters or administration will become a one stop shop for all through our volunteer forum. supporters. If you are a colleague information on volunteering for and would like to find out more or anyone working in the Trust. The coming year will see us join the programme please contact continue with all the work we started voluntary services via email to During 2017 we also re-established in 2017, seeing it through to [email protected] links with the National Association completion. We look forward to of Voluntary Services Managers working with our colleagues across
Commendation winners Our Dermatology team has won a staff award after launching clinics for patients with skin lesions which has cut waiting times from 18 weeks to just two weeks. The dermatology screening clinics are for patients with skin lesions sent to see a hospital specialist by their GP. The new innovative, fast-paced clinics see several patients invited to the department for appointments simultaneously. Each patient’s appointment is led by a senior dermatology nurse. The consultant dermatologist then visits each appointment room in turn to spend a short amount of time making a diagnosis and treatment decision. The consultant can see up to 100 patients in one morning and the team runs up to four of the clinics each month.
Sam Fuller, deputy head of Operations, said: “An expert dermatologist will make a decision on the diagnosis and treatment plan for a patient within seconds of seeing a lesion. These new clinics make the best use of the consultants’ time and ensure patients are seen much quicker.”
When patients see their GP with a skin lesion, the GP refers them to one of the specialist screening clinics. Traditionally, appointments with hospital doctors are 20 minutes long but the screening clinics free up the doctor’s time as other members of the Dermatology team help with tasks including handing out and explaining patient information leaflets, and completing the forms and letters which are sent to the GP. The doctors can then use the additional time to see other Dermatology patients (with conditions other than lesions) sooner. The department has 1,000 referrals every month and waiting times have fallen across the department from an average of 24 weeks for a routine first appointment, to 10 weeks.
The screening clinics are based on a clinic model created in South Wales, adapted to suit our hospital. Both patient and staff feedback about the new clinics has been overwhelmingly positive. The screening clinics have replaced a tele-dermatology service previously set up for skin lesion patients. Members of the Dermatology screening clinic team.
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Workforce Education and training of staff
The Trust is committed to additional training tariff. The Trust The future providing a multifaceted learning pays the other 50% of basic salary There will be very major changes in environment for all staff and and any additional payments. The healthcare delivery over the next 5- trainees to ensure it has a high identifiable training tariff is 10 years with a shift to more care quality workforce which is specifically for training such as being delivered in the community. committed, engaged, trained and educational supervisor Planned This will require changes in how supported to deliver safe, Activities, library and support staff and where we deliver education effective, dignified and in the Education Centre. and training, with flexibility and respectful care. adaptation of the education we Trainees are given some choice provide to fit with the new models One of the Trust’s key aims is for as to where they want to go within as they evolve. Overall these are people in training to recommend us the region. More senior trainees exciting times. There are many as a place to train. expect, and would be expected, to changes about to happen; we take posts in teaching hospitals as cannot predict all, and will need to there will be opportunities not adapt and prepare ourselves to Postgraduate medical move with these; ensuring that we education offered in other trusts (for example more specialised surgery), but this promote the highest standards of All our junior doctors in training is not the case for all specialties medical education for the benefit of post are allocated by Health and we do have senior specialist all our patients. Education East of England trainees at Ipswich, however the (HEEoE) (previously known as the majority of senior trainees will go East of England Deanery). They to Cambridge and Norwich. The Physician Associates set how many posts we have in above is one of the reasons for each specialty and at each level Ipswich Hospital works in rota gaps. partnership with the University of (Specialty, Core and Foundation). This process is delegated to East Anglia (UEA) to train a new Trainee perception role of healthcare professional regional specialist training “Ipswich is perceived as a great committees (STC) for each know as Physician Associates. place to train.” Once qualified the Physician specialty. There is evidence that doctors Associates work alongside doctors who have been to Ipswich as providing medical care as part of a There are about 180 trainees at medical students have chosen to multidisciplinary team with a any one time in Ipswich; this return; junior doctors have chosen fluctuates a little, as there may be defined scope of practice and limits to come back as Consultants. of competence. Physician doctors here for an incomplete year The GMC survey is not a good or posts may be unfilled. Associate students will already assessment tool for overall have an undergraduate degree in a satisfaction, but Ipswich scores About one-third of these posts are life science and undertake a two- well in comparison with local year full-time intensive post- Foundation training (the first two peers. years after graduation) and around graduate course in medical science and clinical reasoning. They will be 20 posts are GP specialist training The key to good training is the (18 months of the 3 year GP on placement in a clinical learning environment. If it is a environment for 50% of their training programme is spent in good place to work then it will be a hospitals). In each specialty there course and must pass a national good place to train. Ipswich is a examination at the end of the will be a set overall number of friendly hospital. There is a culture training posts, controlled by HEEoE course in order to qualify and of staff wanting to support and practice as a Physician Associate. and allocated across the different help trainees, and they are Trusts in the region. For example approachable, making trainees in urology we have two Specialty feel valued. Medical staff are and one Core training posts. If keen to teach and enjoy training Undergraduate medical there are less trainees than posts and give up time to do this. The education in the region (eg a doctor on Doctors Mess is popular and maternity leave or taking year out Ipswich Hospital NHS Trust plays always mentioned; it is accessible host to student doctors from the for research), HEEoE cannot and enables development of appoint more trainees and so posts two regional medical schools; community which is an important University of Cambridge School of are not filled. This is also the case component for wellbeing and where there are insufficient Clinical Medicine and Norwich overall satisfaction. This is a large Medical School, and annually will applicants, then there will be busy hospital meaning there is lots unfilled vacant posts. have in excess of 250 student to see and many opportunities for doctors on placement. The two training. Like all Trusts there is a HEEoE fund 50% of the basic medical schools offer very different heavy workload, but no more than styles of learning. Cambridge salary for training posts plus an others. 83 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Workforce Education and training of staff
students are on placement in the Preceptorship Practice-based education Trust from anything between four and six weeks at a time and are A preceptorship programme A coaching methodology for attached to the clinical teams, continues to run for all newly- educating student nurses has now learning whilst working alongside qualified healthcare professionals been rolled out to other clinical the clinicians. Norwich students including nurses, midwives, professional groups such as undertake one of four placements physiotherapists and occupational occupational therapy, physiotherapy offered at Ipswich; urology, renal, therapists with the aim of and diagnostic radiography. This is neurology or obstetrics & supporting them through their first now enabling students to be prepared gynaecology. These placements year as qualified practitioners. It and fit for practice as a newly- vary from two to four weeks in continues to receive positive qualified registrant when they length and involve both classroom feedback from all those attending. complete their course.
based and experiential learning.
Ipswich Hospital is highly Allied Health Professionals Health Care Assistant training regarded by the students that Our AHPs have continued to Number of HCAs 2017/18: come on placement and is thought professionally develop their skills to be the best district general this year. This has enabled them hospital in the region for student to take on advanced roles such as Number of 109 doctor teaching and learning. This non-medical prescribing, working HCAs (65 completed) is due in part to the commitment of as advanced clinical practitioners the staff involved in the teaching in the Emergency Department and but also the warm and friendly running therapist-led clinics such All Health Care Assistants and environment provided by the staff as respiratory physiotherapy Maternity Care Assistants now in general in all departments. One clinics. We successfully recruited undertake the Care Certificate, which of the many rewards of having one Return to Practice Operating is seen as an indicator of quality by such a good reputation is that Department Practitioner. the Care Quality Commission. The many of the students who have Trust has a new group of trainee been on placement return as We now provide acute practice health care assistants commence in junior doctors and later in their placements for paramedic the Trust every month and is careers, as consultants. students studying BSc Paramedic supported by a team of health care Science. assistant trainers who are experienced health care assistants National RCN education forum themselves. Pre-registration nursing international conference and
Number of students, 2017/18: exhibition, 2017 A team of colleagues from Health Support staff Return to Practice 6 Education England, University of Our Trust has signed up to a national Suffolk, West Suffolk Hospital and Child Health 31 pledge which helps widen access to Ipswich Hospital presented at the working in the NHS and then General Nursing 282 above conference and were joined provides support to develop through by two students who shared their apprenticeships and employment Midwifery 24 experience of PEBLs. PEBLs is a opportunities. Ipswich Hospital NHS coaching methodology for Trust is included on the national list of educating student nurses in organisations who have signed the This year has seen the practice, empowering them to pledge which was signed by Chief development from work-based think critically about the care they Executive Nick Hulme and Estates learning programmes to degree- provide, differing from other colleague Trevor Hodgkins, chairman level apprenticeship, with the first models of education which use an of the of the hospital’s Joint Union group starting in February 2018. apprentice methodology. Committee. They will qualify as Registered Nurses in February 2020. These Left to Right: Helen Vickery, Clinical Educator, West Suffolk Hospital, Sue Pettitt, Clinical are all nurses who have already Education and Workforce Development Lead, completed their foundation Ipswich Hospital, Sandra Gover, Clinical degree, and so are entering their Learning Environment Manager, Health apprenticeship at the mid-way Education England, Anna Campbell, Lecturer, point, qualifying in 2020. University of Suffolk, Stephen Warren, Student Nurse, University of Suffolk, Christopher King, Student Nurse, University of Suffolk, Sarah Hunter, Clinical Educator, Ipswich Hospital, Vicki Nunn, Clinical Educator, Ipswich Hospital 84 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Workforce Education and training of staff
We continue to progress with the nurses from the Philippines arriving Quotes from students on Talent for Care programme, which on a monthly basis. We are also placement: looks at widening access to supporting 12 nurses who currently (source: Health Education England, working in the NHS, undertaking work within Ipswich Hospital and December 2017) apprenticeships and education Suffolk Community Health as HCAs whilst working (earn as you learn), but are RNs in their country of origin “Claydon ward was a great and going further into professional to go through the process to register opportunity as a student to qualification (growing your own in the UK. deliver cardiac care. All staff workforce), is now embedded were very friendly and made me within the Trust with a group of staff coming together on a bi- feel welcome and part of the Work experience team, and my two mentors went monthly basis to develop This year we have welcomed a opportunities for support staff above and beyond their role to wide variety of people seeking work provide support for me and the regarding skills acquisition and experience prior to undertaking a patients they looked after.” progression through the clinical training programme such as organisation. Progress is nursing, midwifery, pharmacy, monitored through the Clinical radiography, physiotherapy and Education Group and Workforce medicine. We have also supported Development and Education international students on the Committee. ERASMUS programme, all of “I have found the staff in my whom have evaluated their current placement extremely experience at Ipswich Hospital as a supportive and helpful. It is a Apprenticeships positive learning experience. We great learning experience.” are expanding the opportunities for Number of apprentices, 2017/18: work experience for those in schools and colleges and continue Number of 104 to run workshops such as “So you apprentices want to be a doctor?” to encourage “The staff were welcoming students to take opportunities to and provided numerous work within the NHS. We have a national target to opportunities for learning.” appoint 98 apprentices to the Trust by 31 March 2018. At 31 January 2018, we had 41 apprentices Health Education England working in the Trust. Risk & Quality Governance Framework (RQGF) “Comparing the OSCE We have apprenticeships covering The RQGF aims to measure, preparation in Ipswich Hospital a range of roles such as medical identify and improve quality in to the training of our friends in administration, pharmacy, business education and training other NHS Trusts, Ipswich administration, estates & facilities, environments for all learners in offers the best training in terms IT, degree nurse apprentice, health and care. It demonstrates a of time for practice, materials leadership, team leading, assistant multiprofessional approach to used, educators, and practitioner, hospitality, cleaning managing education provision assistance from previous and support services and medical which is consistent and cohorts who passed the exam. engineering. proportionate. There are six quality Thank you for your unfailing domains and 27 associated support!” standards. Each organisation is International Nurses required to submit a multi- 26 international nurses have joined professional self assessment the Trust, 24 from the Philippines measured against these standards. and two who were previously This was achieved within the “It has been a brilliant working as HCAs elsewhere in required timeframe, and feedback placement, there is a great England (1 Filipino, 1 Indian). 19 is awaited. deal of encouragement and have undertaken their OSCE support given to students by (Objective Structured Clinical The self assessment includes the staff. Feedback is timely Examination), for which we have identification of risks, and how they and appropriate, all persons achieved a 95% pass rate. Before have been mitigated, but also what involved understand the taking their OSCE, the education successes have been achieved student process.” team provide a 6 week preparation over the year which we wish to programme. We continue to have share with others.
85 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Celebrating the #teamIpswich awards 2018
86 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Celebrating the #teamIpswich awards 2018
Supporter of the Year Trainee of the Year Winifred’s Prize for Outstanding Supporter of the Year Trainee of the Year Winifred’s Prize Contribution for Outstanding
Contribution
Winner: Lara Burgess
Trainee therapeutic
radiographer
Highly Commended:
Nick Schindler
Paediatric registrar
Winner: Winner: Joint Winners: Winner: Baby Bereavement Group Lara Burgess Theresa Heath Baby Bereavement Group Trainee therapeutic Senior Hospital Coordinator Somersham Ward Support Group Senior Hospital Coordinator radiographer
Highly Commended: Inge Nijkamp Fundraiser
Highly Commended: Highly Commended: Inge Nijkamp Nick Schindler Fundraiser Paediatric registrar
87 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Statements from key stakeholders
Ipswich and East Suffolk Clinical Commissioning Group, as the commissioning organisation for Ipswich Hospital NHS Trust, confirm that the Trust has consulted and invited comment regarding the Quality Account for 2017/2018. This has occurred within the agreed timeframe and the CCG is satisfied that the Quality Account incorporates all the mandated elements required.
The CCG has reviewed the Quality Account data to assess reliability and validity and to the best of our knowledge consider that the data is accurate. The information contained within the Quality Account is reflective of both the challenges and achievements within the Trust over the previous 12 month period. The priorities identified within the account for the year ahead reflect and support local priorities.
Ipswich and East Suffolk Clinical Commissioning Group is currently working with clinicians and managers from the Trust and with local service users to continue to improve services to ensure quality, safety, clinical effectiveness and good patient/care experience is delivered across the organisation.
This Quality Account demonstrates the commitment of the Trust to improve services. The Clinical Commissioning Group endorses the publication of this account.
Lisa Nobes Chief Nursing Officer
Healthwatch Suffolk thanks the Ipswich NHS Trust for the opportunity to comment on its Quality Account for the year 2017/18. The Quality Account is well set out and should be readable by its intended audience. The Account is honest about adverse events, serious events and never events which have occurred during the year.
The Quality Account (QA) reviews the priorities for the year 2017/18. There were five priorities: Patient Safety, Clinical effectiveness as well as three patient experience priorities. The quality account sets out the Trust's success in achieving its priorities and, where they have not quite achieved the priority, the QA is open and honest about giving the reasons for not fully achieving the priority. However, they are to be congratulated for the number of significant achievements described in this QA. The Trust describes its achievements in dealing with patient slips, trips and falls. The increase in the numbers of patients who are elderly, many of whom are also suffering from confusion or delirium, has made this area of care increasingly important. For the coming year 2018/2019 the Trust has set out the same basic priorities i.e. Patient Safety and Patient Experience. The Trust's priorities are clearly set out describing how they intend to achieve the goals they have set themselves.
Several members of Staff have received Commendations. The Ipswich Commendations are awarded to staff who are living up to and exceeding the Trust's Values. Healthwatch Suffolk congratulates all the recipients of these Commendations.
Patient and Carer Views of the Trust. Healthwatch Suffolk has received 223 comments from patients or carers in the past year. The Trust received an overall rating of four stars out of five. We note that in the case of the following categories, cleanliness, staff attitude and quality of care, the Trust received ratings of 4.5. Some 52 percent of the comments are positive, with 19 percent negative, the remainder being assessed as neutral.
Healthwatch Suffolk looks forward to working with the Trust in future years. As the changes in Health and Social Care begin to mature, we believe the Trust will be a driver of the improvements that these changes will bring about.
88 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Statements from key stakeholders
Suffolk Health Scrutiny Committee
As has been the case in previous years, the Suffolk Health Scrutiny Committee does not intend to comment individually on NHS Quality Accounts for 2018. This should in no way be taken as a negative response. The Committee has, in the main, been content with the engagement of local healthcare providers in its work over the past year. The Committee has taken the view that it would be appropriate for Healthwatch Suffolk to consider the content of the Quality Accounts for this year, and comment accordingly.
County Councillor Michael Ladd Chairman of the Suffolk Health Scrutiny Committee
Response to stakeholder comments
The Ipswich Hospital NHS Trust thanks its stakeholders for their comments on the 2017/18 Quality Account.
The Trust is proud of its staff and all they have achieved in order to deliver high quality, compassionate care for our patients and their families, but accepts there is always more we can do to make consistent, sustainable improvement.
This Quality Account aims not only to provide the regulated requirements, but to share our achievements and we have strived to give a transparent and honest account of our services.
Since the stakeholder comments have been received, typographical errors have been corrected, and where data was unavailable at the time of issuing the draft Quality Account to stakeholders, this has now been added.
89 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Statement of assurance from the Board of Directors
Statement of directors’ responsibilities in respect of the Quality Account
The directors are required under the Health Act 2009 to prepare a Quality Account for each financial year. The Department of Health has issued guidance on the form and content of annual Quality Accounts (in line with requirements set out in Quality Accounts legislation). In preparing the Quality Account, directors should take steps to assure themselves that: the Quality Account presents a balanced picture of the Trust’s performance over the reporting period; the performance information reported in the Quality Account is reliable and accurate; there are proper internal controls over the collection and reporting of the measures of performance included in the Quality Account, and these controls are subject to review to confirm that they are working effectively in practice; the data underpinning the measurement of performance reported in the Quality Account is robust and reliable, conforms to specified data quality standards and prescribed definitions, and is subject to appropriate scrutiny and review. The Quality Account has been prepared in accordance with any Department of Health guidance. The directors confirm to the best of their knowledge and belief that they have complied with the above requirements in preparing the Quality Account.
By order of the Board
David White, Chair Nick Hulme, Chief Executive Date: 29 June 2018 Date: 29 June 2018 90 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Glossary
ACS Adult Community Services. additional division manages corporate should not occur if the available Bed days The measurement of a day that functions (Governance, Operations, preventative measures have been a patient occupies a hospital bed as part Human Resources, Education, Finance & implemented. of their treatment. Performance, and Information). Each PALS Patient Advice and Liaison Service. Care Quality Commission (CQC) The Divisional Board is managed by a For all enquiries to the hospital such as regulatory body for health and social care consultant (Clinical Director), nurse and cost of parking, ward visiting times, how to organisations in England. It regulates operational lead. The Associate Director change an appointment etc. care provided by the NHS, private of Nursing/Midwifery provides senior PLACE Patient-Led Assessment of the companies, local authorities and voluntary nursing and quality of care expertise, with Care Environment. Annual self- organisations, aiming to make sure better the Head of Operations providing expert assessment of a range of non-clinical care is provided for everyone in hospitals, operational advice to the Divisional services by local volunteers. care homes and people’s own homes. Boards. Q1 or Quarter 1 April - June 2017 CHUFT Colchester Hospital University DNACPR Do not attempt cardio- Q2 or Quarter 2 July - September 2017 NHS Foundation Trust. pulmonary resuscitation. A formal Q3 or Quarter 3 October - December 2017 Clinical Coding The translation of decision made when it is not in the best Q4 or Quarter 4 January - March 2018 medical terminology as written in a interests of the patient to be resuscitated Quality Committee The Trust Board sub- patient’s medical records to describe a in certain circumstances. committee responsible for overseeing problem, diagnosis, treatment of a Dr Foster Provider of comparative quality within the Trust. medical problem, into a coded format. information on health and social care RCA Root Cause Analysis. A structured Clinical Commissioning Group (CCG) issues. investigation of an incident to ensure Responsible for commissioning (planning, ED Emergency Department, also known effective learning to prevent a similar event designing and paying for) NHS services. as A&E, Accident & Emergency or from happening. Clinical Delivery Group (CDG) CDGs Casualty. SHMI Summary Hospital-Level Mortality are sub-groups of the Trust’s three clinical Evolve Electronic medical records Indicator. An indicator for mortality. The divisions. Each CDG is accountable to its system. indicator covers all deaths of patients Divisional Governance Board for all GMC General Medical Council. admitted to hospital and those that die up aspects of performance, including patient Gillick competence a term used in to 30 days after discharge from hospital. safety, patient and carer experience, medical law to decide whether a child SIRI Serious Incident Requiring operational standards, financial (under 16 years of age) is able to consent Investigation. performance and staff engagement. to his or her own medical treatment, SLA Service Level Agreement. A contract Clostridium difficile or C.diff A spore- without the need for parental permission to provide or purchase named services. forming bacterium present as one of the or knowledge. STEMI/nonSTEMI ST-Elevation normal bacteria in the gut. Clostridium Harm-free care National patient safety Myocardial Infarction (STEMI) is a very difficile diarrhoea occurs when the normal initiative targeted at high impact areas serious type of heart attack during which gut flora is altered, allowing Clostridium such as pressure ulcers, catheter care, one of the heart’s major arteries (one of the difficile bacteria to flourish and produce a venous thromboembolism (VTE) and falls. arteries that supplies oxygen and nutrient- toxin that causes watery diarrhoea. HealthWatch Champions the views of rich blood to the heart muscle) is blocked. Colonisation The presence of bacteria local people to achieve excellent health Suffolk Family Carers A registered on a body surface (such as the skin, and social care services in Suffolk. charity working with unpaid family carers mouth, intestines or airway) without HSMR Hospital Standardised Mortality across Suffolk, supporting family carers causing disease in the person. Ratio. An indicator of healthcare quality with information, advice and guidance. CQUIN The CQUIN (Commissioning for that measures whether a hospital’s death SUS Secondary Uses Service. Provides Quality and Innovation) framework rate is higher or lower than expected. anonymous patient-based information for enables commissioners to reward Ipswich and East Suffolk Clinical purposes other than direct clinical care excellence by linking a proportion of the Commissioning Group The main such as healthcare planning, public health, Trust’s income to the achievement of local commissioner of services provided by commissioning, clinical audit and quality improvement goals. The Ipswich Hospital NHS Trust. governance, benchmarking, performance Datix A Trust-wide computer system used MDT Multidisciplinary team. improvement, medical research and to record and aid analysis of all incidents, Meticillin Resistant Staphylococcus national policy development. claims, complaints and PALS enquiries. Aureus (MRSA) An antibiotic-resistant Sustainability and Transformation Plan Deconditioning A complex process of form of the common bacterium (STP) Each STP in England, led by a physiological change following a period of Staphylococcus Aureus, which grows named individual, covers a population inactivity, bedrest or sedentary lifestyle. It harmlessly on the skin in the nose of averaging 1.2 million people. The five year is often associated with hospitalisation in around one in three people in the UK. plans cover all aspects of NHS spending, the elderly and has been linked to falls, MRSA bacteraemia is the presence of aiming to improve quality and develop new functional decline, increased frailty, Meticillin Resistant Staphylococcus models of care; improve health and immobility and ability to accomplish Aureus in the blood. wellbeing; and improve efficiency, with a activities of daily living. Morbidity and Mortality (M&M) focus on integration with social care and Delayed Transfer of Care (DToC) meetings M&M meetings are held in other local authority services. Occurs when a patient who is ready to each CDG. The goal of such meetings is The King’s Fund A charity that seeks to leave hospital is still occupying a bed. A to derive knowledge and insight from understand how the health system in patient is ready for transfer when a clinical surgical error adverse incidents. M&M England can be improved and helps to decision has been made that they are meetings look at: What happened? Why shape policy, transform services and bring ready for transfer and it is safe to do so. did it occur? How could the issue have about behaviour change. Dementia A set of symptoms which been prevented or better managed? What UoS University of Suffolk. include loss of memory, mood changes, are the key learning points? WTE/wte Whole-time equivalent staff. and problems with communication and NCEPOD National Confidential Enquiry reasoning. into Patient Outcome and Death. Division The Trust is divided into three Nervecentre A wireless patient distinct clinical divisions: Medicine, observation, escalation and task Therapies & Community Services; management system. Surgery & Gastroenterology; and Cancer, Never Events Serious, largely Pathology, Women & Children. An preventable patient safety incidents which 91 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Appendix A Independent Chartered Accountant’s Limited Assurance Report to the Directors of The Ipswich Hospital NHS Trust on the Annual Quality Account
We have been engaged by The Accounts (which incorporates Our responsibilities Ipswich Hospital NHS Trust to the legal requirements in the Our responsibility is to form a perform an independent Health Act 2009 and the conclusion, based on limited assurance engagement in Regulations). assurance procedures, on respect of The Ipswich whether anything has come to Hospital’s NHS Trust’s Quality In preparing the Quality our attention that causes us to Account for the year ended 31 Account, the Directors are believe that: March 2018 (“the Quality required to take steps to Account”) and certain satisfy themselves that: the Quality Account is not performance indicators prepared in all material contained therein as part of our the Quality Account respects in line with the work. NHS trusts are required presents a balanced picture criteria set out in the by section 8 of the Health Act of the Trust’s performance Regulations; 2009 to publish a quality over the period covered; account which must include the Quality Account is not prescribed information set out in the performance consistent in all material The National Health Service information reported in the respects with the sources (Quality Account) Regulations Quality Account is reliable specified in the NHS 2010, the National Health and accurate; Quality Accounts Auditor Service (Quality Account) Guidance 2014-15 issued Amendment Regulations 2011, there are proper internal by the Department of the National Health Service controls over the collection Health in March 2015 (“the (Quality Account) Amendment and reporting of the Guidance”) as Regulations 2012 and the measures of performance supplemented by the National Health Service (Quality included in the Quality Quality Accounts: Reporting Account) Amendment Account, and these controls Arrangements 2017/18 Regulations 2017 (“the are subject to review to letter dated 26 January Regulations”). confirm that they are 2018; and working effectively in Scope and subject matter practice; the indicators in the Quality The indicators for the year Account identified as ended 31 March 2018 subject to the data underpinning the having been the subject of limited assurance consist of the measures of performance limited assurance in the following indicators: reported in the Quality Quality Account are not
Account is robust and reasonably stated in all Percentage of patients risk- reliable, conforms to material respects in assessed for venous specified data quality accordance with the thromboembolism (VTE); standards and prescribed Regulations and the six definitions, and is subject to dimensions of data quality Rate of clostridium difficile appropriate scrutiny and set out in the Guidance. infections; review; and We read the Quality Account We refer to these two indicators the Quality Account has and conclude whether it is collectively as “the indicators”. been prepared in consistent with the accordance with requirements of the Directors’ responsibilities Department of Health Regulations and to consider The Directors are required guidance. the implications for our report if under the Health Act 2009 to we become aware of any prepare a Quality Account for The Directors are required to material omissions. each financial year. The confirm compliance with these Department of Health has requirements in a statement of issued guidance on the form directors’ responsibilities within and content of annual Quality the Quality Account.
92 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Appendix A Independent Chartered Accountant’s Limited Assurance Report to the Directors of The Ipswich Hospital NHS Trust on the Annual Quality Account
We read the other information We consider the implications Assurance work performed contained in the Quality for our report if we become We conducted this limited Account and consider whether aware of any apparent assurance engagement under it is materially inconsistent misstatements or material the terms of the Guidance. Our with: inconsistencies with these limited assurance procedures documents (collectively the included: Board minutes for the “documents”). Our period April 2017 to May responsibilities do not extend evaluating the design and 2018; to any other information. implementation of the key processes and controls for papers relating to quality This report, including the managing and reporting the reported to the Board over conclusion, is made solely to indicators; the period April 2017 to the Board of Directors of The May 2018; Ipswich Hospital NHS Trust as making enquiries of a body in accordance with the management; feedback from the terms of our engagement letter Commissioners dated May dated 19 May 2017. Our work testing key management 2018; has been undertaken so that controls; we might state to the Directors those matters we have agreed feedback from Local limited testing, on a with them in our engagement Healthwatch dated May selective basis, of the data letter and for no other purpose. 2018; used to calculate the
indicator back to supporting We permit the disclosure of documentation; Latest national and local this report to enable the Board
patient surveys dated of Directors to demonstrate October 2017, November that they have discharged their comparing the content of 2017, January 2018 and governance responsibilities by the Quality Account to the June 2018; commissioning an independent requirements of the assurance report in connection Regulations; and the latest national staff with the indicators. To the survey for 2017; fullest extent permissible by reading the documents. law, we do not accept or the Head of Internal Audit’s assume responsibility to A limited assurance annual opinion over the anyone other than the Board of engagement is narrower in trust’s control environment Directors as a body and The scope than a reasonable for 2017/18; Ipswich Hospital NHS Trust for assurance engagement. The our work or this report or for nature, timing and extent of the annual governance the conclusions we have procedures for gathering statement for 2017/18; formed save where terms are sufficient appropriate evidence expressly agreed and with our are deliberately limited relative the Care Quality prior consent in writing. to a reasonable assurance Commission’s quality and engagement. risk profiles dated January 2018. Limitations Non-financial performance information is subject to more inherent limitations than financial information, given the characteristics of the subject matter and the methods used for determining such information.
93 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Appendix A Independent Chartered Accountant’s Limited Assurance Report to the Directors of The Ipswich Hospital NHS Trust on the Annual Quality Account
The absence of a significant Conclusion body of established practice on Based on the results of our which to draw allows for the procedures, nothing has come selection of different but to our attention that causes us acceptable measurement to believe that, for the year techniques which can result in ended 31 March 2018: materially different measurements and can impact the Quality Account is not comparability. The precision of prepared in all material different measurement respects in line with the techniques may also vary. criteria set out in the Furthermore, the nature and Regulations; methods used to determine such information, as well as the Quality Account is not the measurement criteria and consistent in all material the precision thereof, may respects with the sources change over time. It is specified in the Guidance; important to read the Quality and Account in the context of the criteria set out in the the indicators in the Quality Regulations. Account subject to limited assurance have not been The nature, form and content reasonably stated in all required of Quality Accounts material respects in are determined by the accordance with the Department of Health. This Regulations and the six may result in the omission of dimensions of data quality information relevant to other set out in the Guidance. users, for example for the purpose of comparing the results of different NHS organisations.
In addition, the scope of our assurance work has not included governance over quality or non-mandated BDO LLP indicators which have been Chartered Accountants determined locally by The Ipswich, UK Ipswich Hospital NHS Trust. Date 29 June 2018
94 The Ipswich Hospital NHS Trust—Quality Account 2017/18
Definitions for performance indicators subject to external assurance How to provide feedback Percentage of patients risk-assessed for Rate of Clostridium difficile infections on this Quality Account venous thromboembolism (VTE) Detailed descriptor If you would like to provide Detailed descriptor Rate of Clostridium difficile infections The percentage of patients who were (“CDIs”) per 100,000 bed days for patients feedback on this quality account admitted to hospital and who were risk aged two or over on the date the specimen or would like to make assessed for venous thromboembolism (VTE) was taken during the reporting period. during the reporting period. suggestions for content for future Data definition accounts, please email Data definition Numerator: The number of CDIs identified Numerator: Number of adults admitted to within a trust during the reporting period. [email protected] hospital as inpatients in the reporting period Denominator: The number of bed days or write to: who have been risk assessed for VTE (divided by 100,000) reported by a trust according to the criteria in the national VTE during the reporting period. Governance Directorate risk assessment tool during the reporting period. Details of the indicator (Quality Account) [S618], Denominator: Total number of adults The scope of the indicator includes all cases The Ipswich Hospital NHS Trust, admitted to hospital in the reporting period. where the patient shows clinical symptoms of clostridium difficile infection, and has a Heath Road, Details of the indicator positive laboratory test result for CDI The scope of the indicator includes all adults recognised as a case according to the Ipswich IP4 5PD (those aged 18 or over at the time of trust's diagnostic algorithm. A CDI episode admission) who are admitted to hospital as lasts for 28 days, with day one being the inpatients including: date the first positive specimen was collected. A second positive result for the surgical inpatients; same patient, if collected more than 28 days inpatients with acute medical illness (for after the first positive specimen, should be example, myocardial infarction, stroke, reported as a separate case, irrespective of spinal cord injury, severe infection or the number of specimens taken in the exacerbation of chronic obstructive intervening period, or where they were pulmonary disease); trauma inpatients; taken. Specimens taken from deceased patients are to be included. patients admitted to intensive care units; cancer inpatients; The following cases are excluded from the indicator: people undergoing long-term people under the age of two at the date rehabilitation in hospital; the sample of taken; and patients admitted to a hospital bed for where the sample was taken before the day-case medical or surgical procedures; and fourth day of an admission to the trust (where the day of admission is day private patients attending an NHS one). hospital. Timeframe The following patients are excluded from the Thirteen month data on the number of CDI indicator: cases per trust is produced on a monthly basis. Annual reporting on the number and people under the age of 18 at the time of rates of CDI cases per trust for the financial admission; year. people attending hospital as outpatients; Thank you Detailed guidance people attending emergency More detail about CDIs can be found on the We would like to take this departments who are not admitted to Public Health England website. hospital; and The latest published 13 month data for CDI opportunity to thank all those people who are admitted to hospital cases for each trust and the latest published involved with The Ipswich annual data for the number and rate of CDI because they have a diagnosis or signs cases can be found here. Hospital NHS Trust: our fantastic and symptoms of deep vein thrombosis Source: Public Health England (DVT) or pulmonary embolism. staff and volunteers, all of our
Data relating to the rate of C.difficile patients and visitors, our Timeframe infections can be found on page 32. Data produced monthly for the 2017-18 valuable fundraisers, local media financial year. organisations, our local Members
Detailed guidance of Parliament and health More detail about this indicator can be found colleagues across the East of on the NHS England website. The data collection standard specification can be found England. here. Source: NHS England Thank you for all that you do to make this an organisation Data relating to the percentage of patients risk-assessed for venous thrombo- we can all be proud to be part embolism (VTE) can be found on page 32. of.
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