AGENDA ITEM 4.2

5 November 2014

Title of the Health Board Report

‘TRUSTED TO CARE’ REPORT – HEALTH BOARD PROGRESS

Executive Lead: Director of

Author: Assistant Director of Quality Improvement & Clinical Governance Contact Details for further information: Claire Bevan, 01443 744800 or email Claire.Bevan2@.nhs.uk

Purpose of the Health Board Report

The purpose of this report is to provide a summary of progress the Board has made in response to the findings of the report “Trusted to Care” – the independent review into aspects of care and practice at Princess of Wales and Neath Port Talbot .

Governance Link to Health The Board’s key role is to ensure the Board’s Strategy Board Strategic is being progressed. Objective(s) – To ensure standards of good governance are in place and compliance with the regulatory framework.

Supporting ‘Trusted to Care’ Report, Professor June Andrews and evidence Mark Butler (May 2014) Dignified Care?, Older Peoples Commissioner. Access link to UHB Internet page where all related information is provided. http://www.cwmtafuhb.wales.nhs.uk/news/32912

Engagement – Who has been involved in this work? The Board, lead by work coordinated by the Director of Nursing and the Assistant Director for Quality Improvement and Clinical Governance.

‘Trusted to Care’ Progress Report Page 1 of 9 University Health Board Meeting 5 November 2014 Health Board / Committee Resolution (insert √) To; APPROVE ENDORSE √ DISCUSS NOTE √ Recommendation  NOTE the attached summary of progress in response to the UHBs Action Plan and  ENDORSE the actions going forward.

Summarise the Impact of the Health Board Report Equality and Care Standards should be of a standard and diversity quality for all patients receiving services including those in the protected groups. E.g. frail elderly and cognitively impaired. Legal implications It is essential that the Board has robust arrangements in place to assess, manage and mitigate risks faced by the organisation. Population Health No impact Quality, Safety & Ensuring the Board has robust assurance Patient Experience arrangements in place to minimise the risks of standards of care which falls below the standards reasonable to expect.

Ensuring appropriate application of the Regulations and care standards to provide high quality and safe care. Resources Ensuring the Board commissions and delivers high standards of care within the available resource. Risks and Assurance Ensuring full compliance with Standards for Health Services in Wales that provide assurance relating to safe and effective care is essential. Standards for Health Access to the Standards can be obtained from Services the following link. http://www.wales.nhs.uk/sitesplus/documents/1 064/Doing%20Well%2C%20Doing%20Better.pdf Standard 1. Governance & Accountability. Standard 8, Care Planning Standard 10, Dignity & Respect Workforce There are significant workforce implications to ensure the learning and improvement agenda being followed by the UHB is embedded in practice.

‘Trusted to Care’ Progress Report Page 2 of 9 University Health Board Meeting 5 November 2014 ‘TRUSTED TO CARE’ REPORT – HEALTH BOARD PROGRESS

1. SITUATION / PURPOSE OF REPORT

In March 2013, a cluster of concerns regarding the Princess of Wales was brought to the attention of the Abertawe Bro Morgannwg (ABMUHB) Board. These included a police investigation into allegations of “falsification of records”, two critical Ombudsman’s reports, relatively high (risk adjusted mortality) RAMI rates. A further serious complaint by a member of the public involving care at both Princess of Wales and Neath Port Talbot Hospitals was subsequently escalated to the Board and reported to the police.

As a result the Abertawe Bro Morganwwg Board discussed these concerns at meetings in public and set up a quality and safety programme at Princess of Wales Hospital and commissioned an external review of safety and quality by AQuA.

Following a meeting between the Health Minister and one of the complainants the Minister decided to commission an independent external review. The Review was undertaken between December 2013 and April 2014 by the Dementia Services Development Centre (DSDC) and The People Organisation (TPO). The “Trusted to Care” report published in May 2015, “is about quality and patient safety. It includes a narrative and analysis of what the Review established, identifies a number of areas of concern and makes a series of recommendations for action. These recommendations largely consist of remedies which the Review Team believes are within the grasp of the local NHS leadership”.

The Board considered the findings of the review at its Development meeting in June and received a report into actions taken or being taken by the UHB at its meeting in July. The summary attached to this report outlines progress with the Board’s agreed actions aligned to its quality delivery plan actions.

2. BACKGROUND / INTRODUCTION

The Review Team was led by Professor June Andrews, Director of the DMDC at the and Mark Butler, Director of TPO.

The remit for the Review concentrated on four areas:

 The culture of the care of older patients, particularly in the medical wards;  The administration and recording of medicines, particularly how medicines are administered to patients who are cognitively impaired or have other challenges taking medicines orally;  How professional nursing standards are protected and delivered consistently and how the Health Board responds to lapses in delivery of these standards;

‘Trusted to Care’ Progress Report Page 3 of 9 University Health Board Meeting 5 November 2014  The response to complaints, how they are handled by the Health Board and how professionals are held to account for lapses in care identified through investigation including Protection of Vulnerable Adults (POVA) investigations.

The Review Team focused on the current position in the hospitals and report of previous experiences of older people in the care of ABMU over a three year period.

3. ASSESSMENT / GOVERNANCE AND RISK ISSUES

The published report “Trusted to Care” is attached via the following link to the Cwm Taf internet site. http://www.cwmtafuhb.wales.nhs.uk/news/32912.

The report contains 18 recommendations (14 for action by Health Boards and four by Welsh Government) and on 13 May 2014, Mark Drakeford, Minister for Health & Social Services wrote to all Chairs and Chief Executives of Health Boards and NHS Trusts in Wales to highlight the publication of the Andrews Report “Trusted to Care”. His letter is also accessible via the link to the Board’s internet page. In this he states “The review team’s findings and observations will be for everyone in the NHS. I am determined that nothing of this sort will be tolerated in any hospitals, any Health Board or Trust in NHS Wales in the future”.

The Minister gave each NHS Wales organisation a four week period (by 11th June 2014) to absorb the findings of the report and satisfy themselves that such departures from basic professional standards are not present in their organisations.

In the immediate weeks after this, all district general hospitals were visited, unannounced by a team of senior individuals to undertake a series of Ministerial “spot checks” in the following four areas of care:

 In giving patients their medication;  In ensuring that patients are kept hydrated;  In the overuse of night-time sedation; and  In basic continence care.

The findings of these visits have also been made public and reported in October 2014. The ‘All Wales’ findings are available via the attached link; http://wales.gov.uk/docs/dhss/publications/141016allwalesen.pdf

Reports relating to Cwm Taf hospitals are available via the following links; http://wales.gov.uk/docs/dhss/publications/141016royal-glamorganen.pdf http://wales.gov.uk/docs/dhss/publications/141016prince-charlesen.pdf

‘Trusted to Care’ Progress Report Page 4 of 9 University Health Board Meeting 5 November 2014 Following the publication of the ‘Trusted to Care’ Report, the Chairman and Chief Executive agreed a series of actions with the Executive team, some of which were immediate and others to take place over the four weeks following the report’s publications.

A series of actions led by the Executive Director of Nursing and supported by the Assistant Director of Quality Improvement and Clinical Governance were undertaken. In the Minister’s letter, he asked Health Boards to assure themselves that matters raised within the report are not features of care being provided within their respective organisations. On this basis the Board shared with the Minister the work it was already doing or has planned, along with any supplementary work arising from our review and consideration of the ‘Trusted to Care’ Report.

The Board in informing its response, considered its priority work streams and actions to improve quality, which are already outlined within the following key Health Board documents;

 3 Year Integrated Plan;  Quality Strategy and Quality Delivery Plan and  Patient Experience Plan.

In helping to inform its response, the Board dedicated its planned Board Development session on 4th June 2014, to focus on the ‘Trusted to Care’ report and considered further its response at the public Board meeting in July 2014.

Attached as a summary to this report, is an update on progress against the actions identified and endorsed by the Board.

In addition, the Board noted the progress scrutinised via the Quality & Safety Committee in April 2014 on progress with its actions in response to ‘Dignified Care?’ the report from the Older Peoples Commissioner, which also reflected some of the themes found within the ‘Trusted to Care’ report.

It is important to note that whilst assurance can never be absolute, the Board will continue to focus its business and energy on ensuring the Standards of Care commissioned and provided for its public are of good quality and safe.

4. RECOMMENDATION

Members of the Board are asked to;

 NOTE the attached summary of progress

‘Trusted to Care’ Progress Report Page 5 of 9 University Health Board Meeting 5 November 2014 Cwm Taf University Health Board – progress against actions identified from Trusted to Care report (May 2014)

Cwm Taf University Health Board undertook a detailed review against the 14 recommendations made in the Trusted to Care report following its publication on 19th May 2014. An unannounced Partnership Dignity visit took place on 30th May 2014, 11 unannounced Executive visits were undertaken during the first 2 weeks of June and a 2 year look back exercise of complaints, incidents and trends relating to the 4 aspects of care identified by the Minister: hydration, continence, sedation and medicines administration. This detailed review provided a level of assurance and identified areas in our current plans which required expediting and 4 new actions for improvement as a result of the Trusted to Care report.

The Board is requested to note the progress being made against these actions:

1. Actions already identified within our current plans to accelerate;

 Full implementation of the ward staffing establishment reviews (3 yr plan):

Approval was given to recruit to the vacant support worker posts across the UHB in September, short listing has been undertaken and interview dates set. The redeployment of staff as part of the 3 year Integrated Plan is progressing and this supports the ward nursing establishment implementation plan.

The pilot of the All Wales patient acuity and dependency tool was completed in June 2014 for inpatient wards and the results and analysis is being completed with 1000 lives team.

 Roll out the integration model for Transforming Safe & Effective Care Together (Transforming Care & Improving Quality Together):

Six wards and their multidisciplinary teams commenced the TS&ECT model in June 2014, undertaking IQT bronze and silver training. Quality reports were provided to triangulate the quality measures and information for each ward to inform quality improvement projects. Examples of improvement projects include: focus on reducing omitted medications; redesign patient record folders; review of visiting times; improving information and handover; improving communication with families; improving ward storage and stock control; improving communication between pharmacy and doctors re medicines reconciliation. The next phase of TS&ECT will be with the multidisciplinary team at Ysbyty Cwm Cynon in November 2014.

‘Trusted to Care’ Progress Report Page 6 of 9 University Health Board Meeting 5 November 2014  Implement Psychiatric Liaison service (supported by Welsh Government as Invest to Save bid):

Recruitment has started with Team Leader and Team secretary appointments made and Consultant interview planned for 30 October 2014. The aim is to launch the service early in the New Year 2015.

 Develop policy for drug administration to confused patients:

An all Wales group has been convened to review the issues arising from “Trusted to Care” and will make recommendations to the All Wales Medicines Strategy Group (AWMSG). This includes a range of policies being developed. Covert Medicines Administration Procedure has been developed with the Mental Health Directorate and Pharmacy with regards to drug administration to confused patients. This is going via the approval route.

 Roll out Care Rounding & Visitor Rounding

We are launching care rounding for Cwm Taf UHB “CWTCH ME” on 23rd October 2014 at the Annual Quality Summit. Visitor rounding has been promoted at the Sister/Charge Nurse forums, Senior Nurse Forum and via the Heads of Nursing. As the nursing establishments are being implemented teams are adopting this approach to staff being available and proactively engaging with family members during visiting time.

 Roll out of continence bundle:

A complete review of all the best practice bundles has been undertaken with an overview report to be presented to the January 2015 Quality & Safety Committee. The continence bundle has been implemented at Ysbyty Cwm Cynon and currently at Ysbyty George Thomas. The next phase is to introduce the bundle to the acute wards in the Royal Glamorgan and Prince Charles Hospitals.

 Complete roll out of “This is Me” (patient centred care):

Triggers have been included into the Nursing Assessment documentation and this has increased the compliance with using “this is me” in practice. Additional “this is me” documents have been printed and are available in clinical areas. Promoted at undergraduate teaching for nurses and doctors; promoted at CTUHB new level 1 dementia awareness training being piloted autumn 2014; the role profile for ward based dementia champions has been completed; “this is me” is promoted via the All Wales Aligning Nursing Skills steering group developing a national competency for ward nurses caring for patients with dementia.

‘Trusted to Care’ Progress Report Page 7 of 9 University Health Board Meeting 5 November 2014  Accelerate implementation and roll out of Schwartz Rounding:

CTUHB has arranged the first Schwartz Round on 22nd October at Prince Charles Hospital the title “why I come to work” with a Consultant, HCSW, Housekeeper and Bereavement Officer all sharing their experiences through story telling. The rounds will be held monthly and rotate across sites with lead facilitators trained by the Point of Care Foundation. The focus is on staff well being with Rounds being designed to provide this support, giving staff an opportunity to reflect on their experiences of delivering care, including both rewards and frustrations – on what the Schwartz Center calls the ‘human dimension of care’.

 Accelerate recruitment and deployment of volunteers:

Progress still needs to be made with this action with confirmation of funding to recruit a coordinator and to support volunteering travel expenses.

2. New priorities as a result of Trusted to Care:

 Expand staff skills and competence in undertaking mental capacity assessments:

Focused work is required and identification of work force to deliver skills training for all staff groups to undertake mental capacity assessments.

 Expand staff skills and competence with talking about death and dying and end of life care planning:

Multi disciplinary events are planned during January and February 2015 to focus on skills development with: Breaking bad news; communication and language, end of life pathway, living with a terminal diagnosis; Spiritual needs of the dying and their families; the grieving process, Do Not Resuscitate and Last Offices.

 Design Question & Answer leaflet for staff re medicines management with confused patients

“Caring for the confused” was launched and circulated in June 2014. Pharmacy and Mental Health Directorates are designing the policy for administration of medicines for confused patients and this Q&A booklet will support this policy.

 Develop a new policy for managing hydration in patients who are Nil by Mouth:

The Nutritional Group are leading the development of the CTUHB “Decision to Feed policy” which focuses on early decision making for those patients who cannot maintain their own nutrition. Within the policy a flow chart is being developed to promote early consideration of hydration as well as nutritional needs of patients.

‘Trusted to Care’ Progress Report Page 8 of 9 University Health Board Meeting 5 November 2014 This flow chart will be shared for information at the Quality & Safety Committee on 22nd January 2015, as part of the Therapies exception report. This will be implemented via the Directorate/Locality Quality & Safety meetings.

Cwm Taf UHB is also promoting the “drink a drop” campaign led by Sister Chris Martin. It is a set of 3 simple interventions consistently applied: 1. Offering the patient a drink at every contact point (when undertaking observations, hygiene, and medication times) and encouraging them to drink about 60mls of fluid. 2. Encouraging family members to offer drinks to the patient by making them aware of the scheme via communication from all MDT members and also visual prompts (posters) on the wall behind the patient’s bed and around the ward area. 3. Education to MDT members of the importance of regular hydration and the benefits of maintaining hydration levels.

Themes from the cluster of unannounced Executive Walk Rounds in September 2014:

Recurrent themes included: staffing related issues; high number of elderly frail patients at risk of falls, difficulties with availability of appropriate beds and mattresses and lack of storage space across clinical areas.

Issues identified for improvement:

1. To accelerate roll out of continence bundle to equip staff with skills regarding product selection 2. To ensure full compliance with patients being given opportunity to cleanse their hands pre meals 3. Staff to always introduce themselves before delivering care 4. Patient call bells need to be in easy reach as a core standard 5. Full compliance with medicines management policy – observation of all patients taking medications and accuracy in timeliness of signing for mediations administered 6. Relocation of Y Bwthyn to Royal Glamorgan – staff request adequate storage room for controlled drugs 7. Development of a governance framework for CAMHS to access temporary workforce via ABMU nurse bank to flex at times of high capacity/demand to avoid high cost agency 8. RGH outpatients – redesign fracture clinic needed and provide new seating and address privacy at reception desk. All out patient clinics need painting. 9. PCH outpatients – need quiet rooms to break bad news 10. Explore potential for finger print access to drug and storage rooms

‘Trusted to Care’ Progress Report Page 9 of 9 University Health Board Meeting 5 November 2014