This Annual Report is available in other languages and in large print. Please contact the Trust Offices for further details.

With grateful thanks to PKL Healthcare, leading specialist in fast-track healthcare facilities.

Leading the movement in excellence The Robert Jones & Agnes Hunt RESEARCH Orthopaedic & District Hospital NHS TRUST , SY10 7AG TRAINING Tel: 01691 404000 Fax: 01691 404050 Email: [email protected] CLINICAL EXCELLENCE Website: www.rjah.nhs.uk The Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust.

Best practice..

Annual Report 2004/5 Contents

Introduction 3 Our history, background, mission and vision Best placed 4 The Chairman and Chief Executive give their views. Best management structure 6 Board membership; how we are organised. Best achievements 8 Review of another record-breaking year. Best partnerships 10 Working together to make this hospital thrive. Best performance 12 Meeting targets through innovation, excellence and hard work. Best management 14 A tight, efficient framework for running an excellent Trust. Best patient experience 16 How we protect patients’ interest, and how they see us. Best innovation 18 Modernisation and quality initiatives, from the ground up. Best use of investment 20 Targeting funds for maximum effect.. Best employment practice 21 Helping our people fulfil their potential for everyone’s benefit.. Best today, best tomorrow 22 The strategic review confirms a clear vision of the future.

Operating and Financial Review An eight-page summary booklet.

16 of the best..

Just a few of the 1,000-plus clinicians, managers, staff and volunteers who work tirelessly to make the RJAH an internationally reknowned centre of excellence.

Back, L-R: Judy Lloyd, Matron; Angela Hughes, Health Care Assistant; Pauline Cream, Radiographer; Lee Hayden, Maintenance Team; Ray Salisbury, Gardener; Preston Fletcher, Patient Access Manager; Linda Pugh, Physiotherapist; Richard Spencer-Jones, Consultant; Michelle Watson, Occupational Therapist. Front, L-R: Kate Haining, Registered General Nurse; Helen Hughes, League of Friends; Atty Hemming, Personal Assistant; Brenda Mates, Housekeeper; Pam Campbell, Catering; Sue Pugh, Matron; Chris Austin, Appointments Supervisor.

2 Introduction

The Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust is an NHS hospital specialising primarily in bone and joint disorders, with specific additional areas of expertise including spinal disorders and metabolic disorders affecting muscular development.

It was founded by a visionary nurse and an eminent orthopaedic surgeon early in the last century. Dame Agnes and Sir Robert pioneered concepts commonplace today, but unheard-of in the first half of the 20th century. They established traditions of innovative treatment, care, dedication and professionalism which still guide the Trust.

Their legacy has been a hospital which continually raises standards, one which pushes boundaries in areas like community-based care, holistic approaches to treatment and multi-disciplinary working between clinicians, physiotherapists and other professionals.

The hospital achieved Trust status in 1994. It strives for continual, improving excellence in clinical care, research and training; all three areas are strengthened by a culture of cross-fertilisation and co-operation. The Trust is ideally placed to serve orthopaedic and musculo-skeletal professionals in the UK and abroad.

The Trust is well placed near Oswestry in north-west Shropshire to serve Welsh and English patients, also offering care and employment to the local population. Around 1,000 people work on the site. Patients’ written comments and external auditors repeatedly comment on their enthusiasm and dedication.

Mission and Vision Statement

The RJAH is a specialist elective orthopaedic hospital, committed to providing the best possible clinical care, training and research in its field, benefiting the people of England, Wales and beyond.

The Trust manages its business through a culture of continual improvement. Governance and monitoring frameworks are appropriately developed to minimize risk, maximize efficiency and above all, to deliver the best possible outcomes for patients.

The Trust seeks to develop partnerships and clinical networks to enhance these objectives.

3 Best placed

I arrived at the Trust in January, aware of its excellent reputation. Everything I had heard has been borne out by the professionalism and dedication of the people I have met here.

The high-powered National Orthopaedic Project commented that this was a well-run, efficient Trust, and I heartily endorse that. I took over just as the positive benefits of tighter financial control, efficiency initiatives and more effective and open governance arrangements began to show.

Continual improvement on all of these fronts is crucial if we are to meet the challenges highlighted in the Strategic Review. Happily, the whole workforce has demonstrated its ability to innovate and change. The willingness of staff to initiate improvements is particularly encouraging.

Also vital is the development of new and existing partnerships and alliances. These bring out the best in our organisation, enhance our value and ultimately benefit our patients.

Patients are clearly at the centre of all that we do at the RJAH, and that philosophy has led to a fund of goodwill towards our Trust among local people and stakeholders.

The scale and generosity of the Trust’s voluntary supporters also bear this out – just look at the new pool, for example! – and we are very grateful for the funding and hard work they provide on a daily basis.

All of the factors I have outlined combine to make our hospital a very special and unique institution. Building on them will underpin our future success.

David Sear Chairman

From left: Consultant Stuart Hay with Chairman David Sear, Chief Executive Jackie Daniel and Pre-operative Assessment Unit Manager Elizabeth Reece. 4 Best placed

The watchdog Healthcare Commission awarded the RJAH a maximum three stars in its annual ratings for 2004/05, with our Trust hitting the top performance band in both clinical and patient focus.

This was a magnificent achievement, particularly in a year of difficult circumstances. I am delighted to be able to introduce my annual thank-you to everyone at the hospital with such a ringing endorsement of their efforts.

We broke even financially, helped by an extraordinary response to requests for continuing cost reductions. As NHS Trusts nationwide wrestle growing deficits, we see real signs that the RJAH has turned the corner.

We met all waiting list demands, coping with the phasing-in of the tighter English and Welsh targets. Activity records were smashed again, with absolutely no compromises in patient care.

The new modular theatre, with capacity for 1,000 procedures annually, was a key factor. It took around 14 weeks from approval to receiving the first patient – a breathtaking achievement.

Meanwhile, we carried out our Strategic Review. Such deep analysis naturally causes anxiety among the workforce and local population. I hope that the results bring confidence and comfort.

We now have a rigorously tested, clear picture of where we stand; we recognise our strengths and weaknesses; understand exactly what we really are…and what we really are not. This insight puts us in a much stronger position to negotiate a sound, thriving future for the Trust.

The Review’s high estimation of our people’s hard work, skill and dedication came as no surprise. I am proud of everyone here, and grateful for their accomplishments. New challenges keep piling up, but I know they have what it takes to overcome them.

Jackie Daniel Chief Executive

5 Best management structure

Non-Executive Directors Effective management of risk and performance runs through the Trust’s Board Assurance framework. This integrated approach allows the Trust to monitor, evaluate and enhance performance efficiently. Duplication is avoided, priorities and goals are clearly defined. The Board Assurance Identification of how risk Michael David Sear Jennifer Framework covers every is measured. Bolderstone Chairman Bayliss area of activity within a Chairman (From 1.1.05) Non-executive standardised format which The committee reviews and (Until 31.12.04) Runs a management Director (Until 1.9.04) Chairman for over four consultancy advising local Involved in various training, sets deadlines and identifies manages the Risk Register, years, after eight years as authorities, housing education and staff projects vice-chair of the Princess associations and other in the NHS, including a lead personnel for action. reporting significant risks to Royal in Telford, public sector bodies spell as training manager The framework ensures the Trust Board via the Shropshire’s first NHS nationally. His background at the Royal Trust. Built up own dairy is in accountancy, mostly Hospital. Member of delivery of objectives. Key Management Board. business and served in the public sector. Spent Shropshire Community groups are: nationally as President of five years as a non- Health Council until the National Dairyman’s executive director on the appointment. Takes a keen Estates and Facilities, Association and Chairman Board of the Shrewsbury interest in local community of the National Dairy Council. and Telford Hospitals Trust. activities. The Trust Board – sets Human Resources, MTBVM ACRCVM MTBVM ACRCVM MTBVM ACRCVM strategic aims and reviews Operations, Research management performance. and Finance Committees – responsible for delivering The Audit Committee – Trust objectives and for ensures effective internal effective management of controls, enabling the human, capital and Board to have confidence financial resources. Also in its financial and risk identify, manage and report Nick Croft Mervyn Dean Peter Jones Non-executive Non-executive Non-executive management systems corporate risks and Director Director/Audit Director through scrutiny and reports. controls through the Took early retirement from Committee Chair Dean of Natural Sciences career as chartered Principal Auditor at and Professor of Statistics Governance Committee. management accountant Wrexham County Borough at Keele University. Author The Management Board – in policy positions within Council. His father, an or co-author of over 200 Civil Service including instructor at Derwen papers, some with RJAH brings together managerial The Operational Risk Cabinet Office and College on the hospital clinicians. His research and clinical perspectives, Customs and Excise. Now campus, was one of the interests lie in statistical Management Committee teaches in local colleges RJAH’s first patients, modelling in medicine and delivers strategic aims, – monitors and improves and is trustee and moving with Dame Agnes clinical trial design. Peter treasurer of Nightingale Hunt from . is Vice-chair of the Trust provides operational standards of patient, visitor House Hospice, Wrexham. Board. leadership and helps to and staff safety. MTBVM ACRCVM MTBVM ACRCVM MTBVM ACRCVM shape strategy. The Clinical Governance The Governance Unit – oversees, operates Committee – delivers and reports on Clinical clinical governance and risk Governance arrangements, management systems. including maintaining Trust Scrutinises and reviews Risk Register, incident Helen Rogers James Turner Angela Vint systems in place to ensure, reporting and management, Non-executive Non-executive Non-executive monitor and improve quality claims and complaints Director Director Director (from 1.12.04) (from 1.12.04) (Until 31.7.04) and safety of healthcare management, patient A Senior Research Fellow Company director with Managing Director of The services and delivery of experience, clinical audit, at Birmingham University, wide experience in Amargo Consultancy, Department of Primary Executive Director and which specialises in trust objectives. Ensures health and safety, clinical Care and General Non-Executive Director change management, that Trust has a strategy risk management and Practice. Has a roles in both the public organisation development background in mental and private sectors. and board/senior team allowing for: clinical effectiveness. health and social services, MTBVM ACRCVM development for clients Continuing identification and expertise in policy including the Department development and User of Health. Angela is a and prioritisation of risks and Carer Involvement in skilled facilitator and service planning and executive coach. Description of action delivery. MTBVM ACRCVM taken to manage each MTBVM ACRCVM key risk and

6 Executive Directors TRUST BOARD

AUDIT COMMITTEE

MANAGEMENT Jackie Daniel Sarah Byrom Marion BOARD Chief Executive Director of Killington In post since 2002. A & Quality Director of Finance Registered General Nurse, Clinical Governance Information has worked in NHS clinical Quality Computer Services and managerial roles. Professional Leadership Internal Audit GOVERNANCE Director of Operations and Library Services Commissioning COMMITTEE Service Improvement in Risk Management Finance large District General Patient/Public involvement Hospital. Has led national Management consultant

RISK REGISTER NHS staff development Qualified nurse with 11 then Deputy Director of Estates & Facilities initiatives. Leads NPfIT years’ clinical practice, six Finance at Liverpool Committee across Shropshire and years as Senior Nurse Women’s Hospital. Similar Staffordshire. Manager. Asst Director post at RJAH before Building Land & Plant MTBVM Service Development and promotion to Director. Catering & Food Hygiene Pathology Directorate Member of National Finance Manager Wirral Hospital. Staff Development Board. Environmental Management MTBVM MTBVM Fire & Security Medical Devices Decontamination Transport Waste

Finance Committee Finance Purchase & Supply Andrew Ron Wilkins Jane Cox Professional & Product Liability Roberts Director of Estates Director of & Facilities Strategy and Informatics Medical Director Estates Performance Clinical Governance Hotel Services/Fire/ Strategic Planning Lead Human Resources Security/Accommodation Marketing Audit & Research Commercial activities Performance Committee Research & Development Private finance Management Staff and Staff Management Consultant orthopaedic Partnership Training & Development surgeon specialising in Chartered Engineer with Communications children’s orthopaedics extensive public and private sector experience. Operations Committee and gait analysis. At RJAH for 12 years, joined the Was technical adviser to Trauma & Orthopaedics Trust Board early 2004. At large NHS hospital Trust Physical Medicine forefront of developing redevelopment project hospital's Electronic involving public and Emergency Planning Patient Record System. private finance. MTBVM MTBVM Research Committee Research Management Research Governance

Clinical Governance Unit Risk Management Committee Mandy Edwards David James Aidan Wafer Director of Service Director of Director of Human Clinical Audit & Outcomes Improvement Operations Resources Complaints & Incidents Lead Director for Overall Responsibility Human Resources Patient & Public Involvement Modernisation for Operational Training & Development Programme Delivery Post Graduate Education Health & Safety Implmentation of 10 Infection Control high impact changes Medicines Management MTBVM Main Trust Board – voting members Information Governance ACRCVM Audit Committee and Remuneration Committee – voting members. Chairman also on Remuneration Committee.

7 Best achievements

The number of patients seen and treated at the Trust has reached record levels, up 16% since 2002/03, equivalent to 1,000 patients.

This achievement owed therefore it would not be much to staff working very possible to treat more hard and smart; initiatives patients using existing to maximise efficiency resources." continued throughout the year (see Best Innovation, P18).

Extra activity was necessary to meet tighter waiting list targets from English and Welsh commissioners. However, with theatres already operating at up to 98% capacity, the Board bidded successfully for Strategic Health Authority funding to build an additional theatre. Seeing building taking place Provided by PKL has been good for morale Healthcare, specialist in in a Trust suffering from fast-track healthcare decaying bricks-and-mortar facilities, this modular for many years. The new structure was built off-site therapeutic pool came to to Trust specifications, completion at year-end, built installed and operational after a £1.4 million appeal within 14 weeks. It was a by the League of Friends. major factor in coping with increased demand and in A new pre-operative attracting enough income assessment unit and for the Trust to break even admissions department financially. were opened. Both provide better facilities for services The National Orthopaedic to improve patient Project worked with RJAH experience, reduce surgery managers and backed the cancellations and increase business plan for the new hospital efficiency and theatre. The Project was a activity levels. high-powered NHS trouble- shooting initiative to A grant from the charitable address the potential risk King’s Fund has been used to six-month English wait to develop a work of art to targets in the pressured give the main hospital orthopaedic sector. Its task corridor a much-needed force reported that the focal point. RJAH "was already running efficiently and managing its Staff and patient groups existing capacity effectively, have worked with local The new modular operating theatre, installed and commissioned by PKL Healthcare in just 14 weeks, increases capacity by 1,000 operations a year. 8 Best achievements

artists on devising a striking An in depth analysis of the three-dimensional piece Trust was carried out with which reflects the values the support of health and ethos of the hospital. It management consultants is scheduled for completion Finnamores. This strategic in summer 2005. review involved the Trust, its stakeholders, patient groups and fellow management and clinical professionals locally and regionally.

Its central conclusions were that the future of the Trust should be designed around services, and that this future can be secured on Glenys Davies Hotel Services Manager, Sally Leppanen Senior the present site, subject to Physio and Chris Morris General Manager and project leader with certain measures. These draft ideas for the art project. include continued strengthening of financial As the Trust’s pioneering and budgetary controls Modern Matron took up a and an estates strategy to more senior managerial post, maximise current facilities two new matrons were without incurring significant appointed; both successful extra spending. candidates were internal applicants. They work to a nationally agreed Matrons’ Charter, providing a focus for patients and spearheading nursing and quality issues. Their remit is divided between orthopaedics and physical medicine, but the matrons share responsibility for cleanliness and hygiene, helping to maintain the hospital’s historically low infection rates. The Midlands Centre for Spinal Injuries pioneers multi-disciplinary approaches to patient care.

Clinical services on offer should be mixed, rather than specialised in highly complex work or simple "low specification" activity. To concentrate on one or other would have severe adverse clinical and

New matrons Judy Lloyd, left and financial consequences to Sue Pugh right with Mary Powell the local health economy. who retired as the hospital’s last traditional matron in 1974.

9 Best partnerships

Partnerships are key to the Trust. They provide opportunities to add value to Trust services, to share expertise and to initiate clinical and organisational improvements.

The Strategic Review looking at new ways to process involved diagnose and treat professionals from the orthopaedics to reduce Shropshire and Staffordshire hospital stays. The Trust is health economy and from working with the PCT to Wales, reflecting the joint develop a system that working and multi-disciplinary produces the best patient projects the Trust enjoys outcomes. with institutions such as the Wrexham Maelor Hospital, Patient focus is also at the Shrewsbury and Telford heart of the Trust’s Hospitals and others. partnerships with Welsh commissioners, and we The review also involved worked with them on the representatives of local Second Offer scheme, communities, the Primary aimed at reducing Welsh Care organisations and the waiting times from 18 local authorities. The Trust months to 12 months. has been closely involved with these groups in the Health4Oswestry programme, debating and planning delivery of health services locally. Some non-orthopaedic services, such as minor injuries and maternity, are currently provided at the RJAH, and local partnerships have been essential in working towards the best local healthcare solutions.

Annabelle Simpson, League of Oswestry Borough Council Friends Chair, with Olympic swimming gold medallist Jane has also been exploring Stidever, who opened the pool. initiatives to boost quality jobs locally. The council The League of Friends has involved the Trust, and other voluntary and Advantage West Midlands, fund-raising groups are business interests and others long-standing and invaluable in exploring the feasibility of partners. The League a Medipark in the town completed its biggest which could form a mutually single appeal to build the beneficial link with clinical new £1.4 million therapeutic research at the RJAH. Pennill Pool. It also raised £11,000 in its summer fete, Shropshire County Primary and funded items including Care Trust has been a training manikin for

10 Best partnerships

theatres (£2,600), wheelchairs cells used in joint repair, led for children on Alice Ward by the RJAH Arthritis (£1,055), children’s Research Centre. For more entertainment, a garden information on research, bench for the day case unit, contact the Trust Offices Christmas gifts for patients for a copy of the Institute and Samaritan grants. Annual Report.

Other voluntary services The Trust has enjoyed a continue to provide invaluable growing relationship with support to the Hospital’s representative bodies for patients and staff. RJAH patients, the Community Health As the pool campaign drew Councils in Wales and the to a satisfactory conclusion, PPI Forum in England. the TORCH appeal to Members have actively improve facilities for children participated in patient has gathered momentum. environment action teams It will fund a new building (PEAT), have visited specific housing a state-of-the-art areas within the hospital gait laboratory and a and attended Trust Board research laboratory. At meetings. year-end, the fund stood at around £1.5 million, with a Smarter purchasing and further £1 million in pledges procurement policies, and grants anticipated including increasingly during summer 2005. formalised joint initiatives across the Shropshire- Staffordshire health economy, have saved money and encouraged suppliers themselves to foster a partnership relationship with the Trust.

Internally, a close partnership between management and staff side has helped smooth the complex Agenda for Change process of reforming NHS pay structures. Health Research is a major area of Service unions nationally activity at the Trust, which backed the programme in has an international the autumn, and RJAH reputation and welcomes staff are being assimilated clinicians and scientists into the new structure from around the world. throughout 2005. Regular One of the key research meetings, newsletters and partnerships is with Keele intranet bulletins have University, which is taking a helped to keep the major role in an international workforce in touch with trial of lab-grown cartilage the process.

11 Best performance

The number of patients treated at the RJAH rose to a new record level of 63,516 outpatients and 11,169 inpatients, rises of 8% and 16% over the past two years.

The achievement is all the Activity and income levels more impressive against a started to rise. national background of phased, tighter waiting Infection rates continued to targets and a local imperative be low at the hospital. to break even financially, National average rates for after the previous year’s hip replacement are 2.99%; deficit of £2.3 million. the RJAH recorded 0.52%. Despite these pressures, all For knee replacement English and Welsh waiting surgery, the national targets were met – crucially, average is 1.55%, and the without any compromise in RJAH recorded 0.41%. quality of patient care. Bloodstream MRSA was detected in just two patients during 2004/05. Rates are kept low through constant vigilance by the matrons, infection control team, clinical and nursing staff plus hard work by dedicated and well-trained

Part of the sophisticated “barn” domestic and housekeeping suite of operating theatres staff, rigorous procedures and sophisticated air-cleaning All staff and clinicians started and theatre equipment. the year at a furious pace, working at near-maximum The Trust had worked hard capacity. A high degree of in 2003/04 to improve teamwork and flexibility analysis of its activity and from theatre staff, costs. With this better- combined with initiatives quality information, the such as those outlined RJAH was able to work below, had removed any with commissioners to slack from the system. avoid being financially disadvantaged by over- The only way to meet performance, as had waiting targets and happened a year earlier. generate the necessary Better management led income was to increase directly to sounder finances, surgical facilities. a point picked up during the Trust’s involvement in The resulting new operating the National Orthopaedic theatre (see P8) was up Project and the Strategic and running in November. Review process. The installation process was achieved with minimal Improved bookings and disruption and no interruption admissions procedures, to surgical schedules. helped by the opening of

12 Best performance

the new admissions office, patient information systems. ensured that "no shows" These have resulted in and cancelled operations better managed surgeons’ were kept to a minimum. operating timetables and Day case bookings were at tighter controls on waiting 100% all year and inpatient lists, always subject to bookings were above 92% patient confidentiality – peaking at 98% – from protection. September onwards, above national targets. Another factor in keeping the theatres busy was the development of pre- operative assessment. A new dedicated unit opened close to the operating theatres, and by the year- end, over 400 patients per month were having their suitability for surgery checked. Some had to have operations postponed One of two new training suites through ill-health, dental installed for NPfIT. decay or other factors, and some had simply got These systems and others better. Discovering these are due to be superseded factors on the scheduled by the giant National day of an operation wastes Programme for IT (NPfIT). time and money. Pre-op The NHS’ 10-year project assessment contributed to to introduce a comprehensive the low cancellation rates computer system will outlined on P18. eventually cover all aspects of healthcare, including GP referrals, bookings and waiting lists, bed allocations, storage and transfer of patient records, X-rays, lab results and other information.

The Trust is on schedule in putting training and deployment measures in place for NPfIT, with the Patient Administration System first to come on

Elizabeth Reece, Pre-operative stream in 2005/06. Assessment Manager, with patient Existing Trust systems will Carol Corbett. run in parallel until NPfIT The Trust has in recent equivalents are established. years improved speed and accuracy of its procedures through introducing highly effective computerised

13 Best management

The Trust has reformed its governance and performance framework in order to streamline decision making and clarify objectives and targets.

The bases for the In addition, the process of framework are the Trust’s bringing risk management own strategic aims and elements into a standardised the Health Commission’s format has been completed. star ratings criteria. The Throughout the hospital, strategic aims are: managers and staff have effectively a "checklist" Patient focus and high which makes priorities, quality care progress and responsibilities Best value clear. Not only does the Organised to deliver risk register cover every Partnership foundations aspect of running a busy Estate development hospital, but it also has risks itemised very The Star Ratings cover specifically. every aspect of running an NHS trust, from financial The Trust began the year management to patient with an Audit Commission waiting times to cleanliness review of its financial health issues. Trust managers use and performance. The the ratings criteria as a Commission produced a basis for comprehensive 35-point action list of performance monitoring recommendations, including and improvement. Regular better communications and progress reports are information procedures, presented to the Trust plus tighter control on Board. contracts with commissioners. The actions were in place in The committee structure the first half of the year, and has been reorganised with management workshops clearer lines of accountability held to ensure the issues and responsibility (see P6-7). were understood and embedded. Clinical functions are now organised into two divisions, The independent Healthcare orthopaedics and physical Commission annual staff medicine, with a general survey, carried out throughout manager heading each. A the NHS, gave the Trust a matron is assigned to each 3.4 out of five rating for division, ensuring a strong staff satisfaction, a slight link between patients, wards dip compared to 2003/04. and management. As a part of the Improving Working Lives (IWL) Built into the new framework programme, a focus is a system of executive- group has been set up level quarterly reviews, to look into staff issues offering an opportunity for and improve satisfaction an in-depth look at levels. successes and challenges. Training is a key area of Trust activity. 14 Best management

The previous survey had of developments in musculo- identified communications skeletal medicine. Similarly, as a weaker area, so the the research work at the Trust tightened up its core RJAH involves consultants briefing procedures. On the and patients on a day-to- day after each Board day basis. meeting, a bulletin outlining decisions is produced and The HR department worked circulated and briefing closely with staff side in sessions held, hosted by at preparing a submission for least one executive team Practice Plus standard in member. A monthly Improving Working Lives. electronic newsletter for All grades and departments staff, containing more were represented as 20% informal content, is also of employees took part in planned. Improved health focus groups. The standard and safety training is being is self-assessed, with pursued, also in response validation scheduled for to survey results. autumn 2005.

The Human Resources Staff were involved in Department has appointed competitions and roadshows a Training and Development as part of Work-Life Balance Manager to oversee and Month in November 2004 organise training for staff across the local health and ensure compliance economy. Financial planning with all statutory and and pre-retirement seminars mandatory training required were held for employees, for clinical and non-clinical and the second annual staff groups. The Trust award ceremony was supports staff in professional another big success. development, and 49 nursing staff accessed post- Reducing management registration courses. A further and administrative costs is 33 staff are on diploma/ a central objective of the degree and masters courses. Trust’s on-going service improvement work, including Training of doctors is a electronic bookings, improved highly successful area for patient information systems the Trust, which has never and other elements of the recorded a failure among National Programme for IT. registrars. Consultant David Jaffrey won the Chief At the same time, the Trust Medical Officer's Silver is pro-active in attracting Scalpel Award as the best income to the Trust. The surgical trainer in the UK OSCELL project is a and Ireland in any discipline. marketing initiative to supply lab-grown cartilage cells for Consultants' close transplant. Other revenue involvement does not benefit earners include Ludlow just trainees; it keeps the Ward, the Sports Injuries hospital's clinicians Unit and the orthotics themselves at the forefront department.

15 Best patient experience

Trust staff aim to make every patient as comfortable, well cared-for and free of anxiety as possible.

The Department of Health’s who can pursue issues and national out-patient survey ask questions on patients’ suggested that the Trust and carers’ behalf. If it remains highly regarded by becomes necessary, the patients. Ir reported high PALS can advise on levels of satisfaction with pursuing formal complaints. patient care, privacy and dignity, cleanliness, A PALS volunteer has been organisation and outcome recruited and trained, the of out-patient appointment. patient comment card has been redesigned for launch during 2005/06, the RJAH PALS leaflet, bookmark and poster designed, and the intranet and internet site written. The service is integrated into a Shropshire-Staffordshire PALS network.

During the second half of the year, the PALS officer started to collate thank-you cards, gifts and donations, all of which are acknowledged with a card to the patient/carer. In six Wendy Brookes-Jones with some months, 285 were recorded. healthy options displayed in Denbighs Restaurant Patient comment cards are Communication with usually complimentary to all patients, identified as an staff. The PALS takes up area of weakness, is being any issues or suggested addressed through the improvements. Trust’s Patient Information Committee, which is The Trust received 61 written rationalising and clarifying complaints, only eight more all leaflets and information. than in the previous year, Improvements to the even though an extra 1,115 RJAH website are also more patients were seen. under way. Of the complaints, 24 were upheld, leading to a The two matrons seek to change of practice or address patient concerns acknowledgement of a and complaints, ensuring Trust error. (Figures do not changes in practice where include private patients, appropriate. They liaise whose complaints are closely with the Trust’s investigated but are exempt Patient Advice and Advice from NHS regulations.) Service – PALS – officer,

16 Best patient experience

Some changes in practice with the final formal written in response to complaints: response. They received two requests for independent Patients can now park review relating to the RJAH. outside the OT Department to collect or drop off The first, in August 2004, equipment and put a related to nursing and note in their car stating medical care and has now they are visiting OT. been completed. The Commission said the Trust New cannulas have been had done everything introduced to reduce possible to resolve the discomfort and improve complaint and its handling the administration of of the complaint was good; intravenous drip treatments. the Trust’s response may never be fully reconciled To help patients ringing with the complainant’s to change appointments, point of view and the a telephone answering complainant could have machine is checked and the complaint referred to switched on after 4.00 pm the Health Service on a Friday and two Ombudsman. telephonists are now on duty until 4.30 pm. The second, in March 2005, related to hospital’s The Head of Clinical standards and infection Governance acknowledged prevention facilities. The every complaint within Commission is considering two working days. Of the complaint. complainants receiving a full written response from For more information on the Chief Executive, 87% how the Trust is working to arrived within the 20-working improve its partnership with -day national standard. The patients and the public, see rest received progress P10. The detailed Clinical updates or explanations for Governance Group annual any delay. report is available through the Trust offices. Appointments, delays and cancellations were the biggest source of complaint – 20 out of 61 – followed by 12 on aspects of treatment, 11 on aids, appliance, equipment, premises (including access) and 10 on staff attitude.

Since July 2004, the Healthcare Commission has been responsible for independent review for Ambulanceman Brian Peart with complainants unhappy patient Dorothy Warrell.

17 Best innovation

The profile of innovation in the shape of service development has risen at the Trust. The Strategic Health Authority has supported funding and training for initiatives generated in close liaison with staff on wards and in departments.

One of the NHS "10 high- Department quality initiative impact changes" requires sets standards of care in day surgery to become the specific areas. Trust norm for elective procedures, progress so far includes: and the day surgery service development team’s approach exemplifies work carried out throughout the Trust.

Roles have been extended, multi-tasking developed and self-directed team working encouraged. The result has been an empowered group of people with the confidence to come up with ideas and to carry them through in order to increase efficiency. Job satisfaction has Older people – steps to increased, with patient eliminate age discrimination satisfaction a welcome and to promote older additional benefit. people’s health and independence, including Dedicated health screening, work on fair access, care pre-op assessment and pathways, intermediate full/partial booking care and falls. A hospital procedures for day surgery senior nurse and "champions" patients have reduced have been appointed to cancellations from around look out for older people’s 10% to under 2%, no-shows needs. from 9.58% to 0.7%.

Other efficiency improvements have sprung from closer liaison with X-ray and other departments, work with consultants to maximise use of available sessions and redesigned clinic layout to increase trolley space.

Patient focus is at the heart of this work, as is the Children – steps to Trust’s work on National safeguard and respect Service Frameworks younger patients, adopting (NSFs). This Health the Kennedy and Laming

18 Best innovation

recommendations and disease. Partnership working, providing age-appropriate plus multi-disciplinary care facilities. Trust achievements pathways and management include play, recreation and also enhance patient care. education enhancements, a child protection policy The excellence of the RJAH and practice, better access cancer unit’s specialised and facilities for children work on bone tumours was with disabilities and recognised when it was informed consent. selected as one of only six regional units under an Diabetes and heart NHS initiative to boost disease – both NSFs call specialist cancer care. for better identification, care and management of Work is under way on the these conditions. The Trust latest NSF, covering long has improved pre-operative term conditions. screening procedures and raised staff awareness and In other areas of the hospital, training related to both. quality enhancements are increasing efficiency and value for money. The central sterile supplies unit won ISO 9001 accreditation, underlining the consistency of its procedures to ensure that all theatre supplies undergo rigorous sterilisation and are traceable and trackable.

The Francis Costello Library, Shropshire’s lead NHS Consultant Paul Cool, director the tumour unit, with specialist cancer library based at the RJAH, nurse Caroline Pemberton. succeeded in getting Stage 3 accreditation, the top Cancer – The NSF urges grade, at the end of the year. better prevention, action on health inequalities, earlier Imaging services have detection, faster diagnosis been improved throughout and treatment, consistent the year, with a new CT high quality services and scanner installed and improved quality of life accommodation refurbished. through better care. The Two new X-ray rooms were Trust response has been to opened – one a replacement provide quick and easy for facilities closed down in access, continued 2003/04 – and more new development of diagnostic equipment is planned for services for primary bone 2005/06, including a further tumours, surgical treatment MRI scanner. of bone tumours and palliative care for metastatic

19 Best use of investment

Ageing, unsuitable and decaying buildings and a massive backlog of maintenance have been historic problems at the RJAH.

However, the year saw Work is on-going in records morale-boosting new build storage and in the on site and refurbishment pharmacy, which has taking place in various air-conditioning, increased departments. The new space and a new waiting therapeutic swimming pool area. Imaging services and modular operating have had the benefit of theatre are the most visible substantial investment projects on the site, but which continues into changes off the main corridor 2005/06 (see P18). have also made a big impact, including the Outside, CCTV cameras, pre-operative assessment better signage, waste unit and the admissions handling facilities, roads department. refurbishment and car park improvements have Improvements to the lighting contributed to safety and and décor along the corridor security. Car parking has itself have significantly been a particular and brightened up the increasing headache, but environment for staff, this year’s work reversed a patients and visitors. The downward spiral. The Art in the Healing introduction of a £1 Environment project, pay-and-display scheme in financed through a the main car park was ring-fenced £35,000 grant unpopular, but has helped from the charitable Kings to eliminate unauthorised Fund, will round off the parking – on verges or in corridor work (see P8-9 for front of ambulance access more on the pool, theatre points, for example – and and art projects). rationalise use of smaller car parks by staff.

The Strategic Review conclusions highlighted the need for capital investment in the RJAH, but recognised its limited availability. The continuing strategy will be to identify areas for capital schemes based on two criteria: where can the cash make the most difference? and where does the Risk Register indicate that refurbishment and maintenance are most urgently needed?

The physiotherapy gym was among areas to benefit from refurbishment funds during the year. 20 Best employment practices

The quality and dedication of the RJAH’s employees is repeatedly cited as a jewel in the hospital’s crown.

A central NHS aim is to get Such involvement and all non-professional staff empowerment contribute through NVQ and other to staff satisfaction. The qualifications. The Trust National Staff Survey (see helped 123 support staff to P15) suggests that RJAH achieve professional training employees are among the and qualifications. Many of 20% most satisfied in the these higher successes NHS. were by people who had gone on from their first - Health and safety training, ever qualification. Seven seen as a shortcoming in members of staff took up the survey, is under way, nurse training. Staff also with a framework in place underwent Basic Skills, the to cover all relevant areas European Computer of the Trust. Driving Licence and other training. (see also P14) Shropshire County Primary Care Trust hosts occupational The Trust also supplies health through a Service clinical placements for Level Agreement with the nursing and allied health RJAH. In addition, staff professional courses from have access to independent several universities – 105 counselling from Network of pre-registration nurse Staff Supporters specialists. places and 91 allied health professional placements The Trust holds the two during the year. ticks disability symbol showing its commitment to Increasing confidence, employing disabled people. responsibility and decision It also has an equal -making among middle opportunities policy and managers continues to drive equality statement, plus a Clinical Leadership, training diversity strategy and action and coaching schemes at plan, including training and the RJAH. This policy has development at all levels in helped to free up senior diversity awareness. The managers for more strategic Improving Working Lives roles, and has encouraged working group explores moves to initiate service patient and staff diversity improvements from issues bi-monthly. department/ward level up.

We’ve done it! Some of the happy NVQ recipients

21 Best today, best tomorrow

The RJAH’s three-star status for 2004/05 is a welcome endorsement of the Trust’s operations and a tribute to the quality of all of its staff.

Maintaining and developing where capital injections will a high level of performance produce maximum benefit is at the heart of the to patients and staff. These 2005/06 RJAH Business include a new MRI scanner, Plan. It combines The NHS refurbished day case Plan, National Service facilities, improved records Frameworks and the NHS storage, fire and health and Improvement Plan with safety improvements. directions highlighted in the Trust’s recent Strategic The Trust is pursuing Review. strategic planning with its academic partners with the It also includes a performance aim of enhancing a reputation framework based on the for training and research new Health Care Standards, that is already world-class. which next year replace the current Star Ratings system. Other partnerships to be The framework covers explored and developed every aspect of the include those with patient organisation, with clear groups, NHS colleagues, milestones, each the local communities, responsibility of a named stakeholders and councils. executive. Such partnerships were cited in the Strategic Financially, the Trust has to Review as a key way go beyond the 2004/05 feat forward for the Trust. of breaking even to close an historic £5m budget gap, Another lay in the mixed with still more cost activity profile of the RJAH, improvements to be identified. encompassing a range of work from basic arthroplasty Agenda for Change, the to highly complex musculo- major reorganisation of skeletal procedures, with the NHS pay and career special expertise in areas development structure, such as metabolic disorders, continues. All staff must be bone tumours, spinal injuries assimilated by September and mobility problems. 2005, and must have a Knowledge Skills Framework The Trust has made outline by December 2005. significant progress in continuous improvement of The ageing bricks-and- clinical and governance mortar of the hospital are a standards over the 12 continuing problem. While months covered in this the Trust cannot tackle its report. Much groundwork massive maintenance has been laid to secure the backlog and dilapidated institution as a unique, buildings in one go, it has valuable specialist health targeted £2.6m at areas resource for years to come.

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