Delivering our promise Better health, for life

Annual Review 2016/17

Quality Strategy

Creating a culture of continuous improvement to increase and sustain the quality of our services for our patients, people and stakeholders Contents

Welcome 4 Performance report 5 2016/17 overview 6 About the Trust 8 Performance analysis: introduction 14 Performance against corporate objectives 15 Highlights 2016/17 28 Performance against the five domains of quality 32 Sustainability report 40

Published August 2017

2 Imperial College Healthcare NHS Trust | Annual Review 2016/17 3 Welcome Performance Sir Richard Sykes, chairman report

Imperial College Healthcare is one of the largest NHS trusts in the country, offering a wide range of acute and specialist care for our local communities as well as for patients nationally and internationally. We also play a lead role in healthcare research and education, as part of one of the UK’s nine academic health science centres and 20 National Institute of Health Research biomedical research centres.

With growing challenges and opportunities We also had the unusual experience for health systems across the world – last year of seeing the Trust in action from the increasing volume and complexity weekly on national television in the BBC of care needs to the huge potential of Two documentary series, Hospital. Again, our growing understanding of genomics I was very proud of the values and – it’s more important than ever that the behaviours demonstrated by staff across NHS continues to innovate. And we need our hospitals, on the ‘shop floor’ as well to do this at a time of unprecedented as behind the scenes. Hospital also did financial pressure. a great job of raising awareness and understanding of the challenges and Our approach is to continue to make opportunities we all need to respond to improvements in all aspects of how we if we are to ensure our Trust – and the run our services as well as to develop wider NHS – can deliver its full potential new models of care and ways of over the coming years. working. It’s clear the only sustainable way forward is greater integration This annual report provides a snapshot across the health and care system and of many more developments at the a whole population focus on helping Trust over the past year as well as, everyone to be as healthy as possible. we hope, a clear and balanced account This will require a coming together of of our achievements and challenges. all stakeholders, as well as a genuine It also represents the last full year partnership between health and care under the leadership of our chief services and the patients and local executive Dr Tracey Batten, who is communities we serve, to evolve to returning to Australia. Tracey has been meet changing needs while staying key to very significant improvements true to the values and ethos of the NHS. across all aspects of the Trust and our wider health system over the Those values were highly visible in the past three years. incredible response to those injured in the attack on Westminster Bridge and I hope you find our report of 2016/17 around Parliament in March. As one of interesting and helpful – and I would four major trauma centres in London, really encourage you, in whatever role St Mary’s Hospital received eight patients you have, to find out more through our within minutes of a major incident being website and social media channels, called. Staff across the Trust immediately especially on how you could get more went into action, from the major trauma, involved in shaping and guiding our work intensive care and theatres teams to this year and for the years to come. security and other clinical teams making sure all our patients were getting the care they needed while making room for the casualties. Their behaviour reflected the Richard Sykes many media reports of the astonishing chairman expertise, professionalism and selflessness on display in the NHS that day. 4 Imperial College Healthcare NHS Trust | Annual Review 2016/17 5 Performance report: 2016/17 overview

Dr Tracey Batten, chief executive

Our staff achieved an incredible amount last year, in Innovation overall financial challenge, with the an increasingly challenging and complex environment. NHS facing one of its smallest funding In terms of innovation, we were increases in many years, the Trust delighted to be funded by the National has again needed to set a budget First and foremost, we responded Collaboration Institute of Health Research to run with a planned deficit. to rising demand by providing great our biomedical research centre in I believe our new organisational care to more people than ever before. The past year also saw a step change partnership with Imperial College structure – devolving more authority Compared with the previous year, that in collaboration and coordination across for a further five years. The BRC is to our clinical teams, supported by included 7,500 more patients seen in the NHS and, increasingly, with social supporting 675 active research projects more focused corporate support, and A&E, 7,000 more day surgery patients, care and other partners. Published in across 15 different disease areas. reducing the number of management 11,000 more outpatient contacts and October and setting out a five-year layers – has been an important factor 6,000 more people coming into hospital strategy for tackling shared challenges With funding support from Imperial in our ability to deliver more for patients as inpatients. Overall, we had over in health and care, the North West Health Charity, we also began the this year. Our nearly 11,000 staff are 1.5 million patient contacts last year. London Sustainability and first UK trial to treat patients with really beginning to make the most of Transformation Plan is still a work debilitating tremors using focused We also built on the first year of our new opportunities to initiate and lead in progress in many ways, but it has ultrasound, opening the way for new quality improvement approach, change in their own areas as well as sparked a renewed and very positive a potentially ‘game-changing’ non- with projects underway throughout the invasive alternative to conventional to influence our strategic developments. Trust as well as significant progress on impetus to joint working. brain surgery. We also benefitted hugely from our our strategic improvement programmes There was significant, tangible progress close relationship with Imperial Health and developments. This included from collaboration in a number of areas. We were rewarded for our role as Charity, who are helping to fund many refurbished clinics, more streamlined The Hammersmith & Fulham Integrated a leader in the adoption of digital of our major initiatives as well as processes and better communications Care Programme has expanded to technologies to improve patient care, supporting patients and staff through across all of our outpatient services as include five NHS organisations as well when we were selected by NHS their grants schemes, arts programme well as better urgent and emergency as lay partners, and we are working England to be one of 16 global digital and volunteering. And we have great pathways and improved facilities. closely with social services in the exemplars for acute care. With our support from a number of other borough to design and test out partner Chelsea & Westminster At the end of May 2017, the Care charities too, as well as our hospital genuinely joined up care pathways Hospital NHS Foundation Trust, Quality Commission acknowledged a Friends organisations. We have for local people. Our care information we will receive funding and support real improvement in outpatient services increasingly active patient and public exchange, offering patients and their to drive forward the use of digital and diagnostic imaging at Charing involvement across all aspects of our health and care professionals in north technology and create products and Cross, Hammersmith and St Mary’s work, and I am particularly appreciative west London secure online access to approaches that can also be used hospitals, publishing new ratings for of our strategic lay forum, now in its care records and to sharing information, by other organisations. outpatient services and diagnostic second year. imaging based on its inspection in began its pilot roll out, ending the year Leadership and support November 2016. The ratings are up with 1,000 registered users across As ever, I am extremely grateful to all 13 services and five organisations. of our staff, supporters and volunteers, two levels to ‘good’ overall at St Mary’s All of this was achieved while meeting and our partners in the NHS, local and Hammersmith hospitals, and up Our academic health science centre a ‘stretch’ financial plan which allowed authority and voluntary sectors, for one level to ‘requires improvement’ partnership with Imperial College us to comply with our ‘control total’ all of your hard work and commitment at Charing Cross. expanded to include The Royal for the year set by our regulators in achieving the most that we can for Marsden NHS Foundation Trust and NHS Improvement. Our outturn of However, increasing demand also our patients and local communities. meant that we struggled with the the Royal Brompton & Harefield NHS -£15.3 million, including non-recurrent national operational performance Foundation Trust. This has doubled the sustainability and transformation standards – particularly for waiting pool of clinicians and other healthcare funding of £25.4 million, reflected times for A&E and for some planned staff, researchers and academics the delivery of £54 million of cost who are working together to translate improvements by staff across the whole operations. We have put in place clear Dr Tracey Batten research breakthroughs into better Trust. Our new systems and enhanced action plans, though delivering the chief executive until 30 July 2017 standards consistently is a key patient care as quickly as possible. support mean we start 2017/18 more risk as we go into 2017/18. prepared for further cost improvements Ian Dalton CBE became chief executive than ever before. However, given the on 31 July 2017

6 Imperial College Healthcare NHS Trust | Annual Review 2016/17 7 About the Trust

Imperial College Healthcare • to realise the organisation’s potential Our hospitals and services through excellent leadership, efficient NHS Trust provides acute We provide care from five hospitals use of resources and effective on four sites as well as a range of and specialist health care governance. in north west London for community facilities across the region. around a million and a half Our five hospitals are: Our ethos people every year. Formed in • Charing Cross Hospital, To help everyone to be as healthy as 2007, we are one of the largest Hammersmith – providing a range they can be, we want to look out for of acute and specialist care, it also NHS trusts in the country, the people we serve as well as to hosts the hyper acute stroke unit for look after them. with nearly 11,000 staff. the region and is a growing hub for We seek to ensure our care is not only We look after people by providing care, integrated care in partnership with clinically outstanding but also as kind whenever and however we are needed, local GPs and community providers. and thoughtful as possible. We want listening and responding to individual Charing Cross has a 24/7 A&E to play our full part in helping people needs. We look out for people by being department. their partner at every stage of their life, live their lives to the fullest. • Hammersmith Hospital, Acton – a supporting them to take an active role specialist hospital renowned for its We are part of Imperial College in their own health and wellbeing. academic health science centre, strong research connections. It offers along with Imperial College London, We are one team, working as part of a range of services, including renal, The Royal Marsden NHS Foundation the wider health and care community. haematology, cancer and cardiology Trust and The Royal Brompton & We are committed to continuous care, and provides the regional Harefield NHS Foundation Trust improvement, sharing our knowledge specialist heart attack centre. As well – supporting rapid translation of and learning from others. We draw as being a major base for Imperial research and excellence in education. strength from the breadth and depth College, the Acton site also hosts of our diversity, and build on our rich the clinical sciences centre of heritage of discovery. the Medical Research Council. Our vision and objectives By doing all this, we ensure our care is • Queen Charlotte’s & Chelsea Our vision is to be a world leader in not only clinically outstanding but also Hospital, Acton – a maternity, transforming health through innovation as kind and thoughtful as possible. And women’s and neonatal care hospital, in patient care, education and research. we are able to play our full part in helping also with strong research links. To enable us to achieve this, our people live their lives to the fullest. It has a midwife-led birth centre Increasingly, we offer patient strategic objectives are: Our promise is better health, for life. as well as specialist services for complicated pregnancies, foetal consultations and care in community Our values: • to achieve excellent patient and neonatal care. facilities that would traditionally experience and outcomes, delivered • Kind – we are considerate and have been provided in our hospital Research and education one of NHS England’s 13 genomic • St Mary’s Hospital, Paddington efficiently and with compassion thoughtful, so you feel respected outpatients clinics, and we are working medicine centres – the West London – the major acute hospital for north The Trust with Imperial College hosts and included. closely with GPs and other primary Genomic Medicine Centre – with • to educate and engage skilled west London as well as a maternity one of 20 National Institute for Health and community care organisations to our partners Chelsea & Westminster and diverse people committed to centre with consultant and midwife- Research (NIHR) biomedical research • Expert – we draw on our diverse offer integrated health care services. Hospital NHS Foundation Trust, continual learning and improvement led services. The hospital provides centres (BRC). This designation is skills, knowledge and experience, so The Royal Brompton & Harefield care across a wide range of Imperial Private Healthcare is our given to the most outstanding NHS and • as an academic health science we provide the best possible care. NHS Foundation Trust and The Royal specialties and runs one of four private care division, offering a range university research partnerships in the centre, to generate world leading • Collaborative – we actively seek Marsden NHS Foundation Trust, major trauma centres in London in of services across all of our sites. This country, leaders in scientific translation, research that is translated rapidly others’ views and ideas, so we helping to drive innovation in genomics. addition to its 24/7 A&E department. includes the Lindo Wing at St Mary’s and early adopters of new insights into exceptional clinical care achieve more together. Hospital, the Thames View at Charing in technologies, techniques and We are a major provider of education • Western Eye Hospital, Marylebone • to pioneer integrated models of care • – we are receptive Cross Hospital and the Robert and treatments for improving health. and training for doctors, nurses, Aspirational – a specialist eye hospital with with our partners to improve the and responsive to new thinking, Lisa Sainsbury Wing at Hammersmith midwives and allied health a 24/7 A&E department. The NIHR Imperial BRC supports 675 health of the communities we serve so we never stop learning, Hospital. The income from our private professionals including therapists, active research projects across 15 discovering and improving. care is invested back into supporting pharmacists, radiographers and our NHS services. different disease areas. We also lead

8 Imperial College Healthcare NHS Trust | Annual Review 2016/17 9 About the Trust

healthcare scientists. In 2016/17, • BHH federation: NHS Brent CCG, out of four segments. A rating of three 810 Imperial College medical NHS Harrow CCG and NHS is given to providers who are receiving undergraduates trained with us and we Hillingdon CCG. mandated support for significant are the lead provider for core, specialty concerns. North West London Sustainability and GP medical postgraduate training and Transformation Plan (STP) The Care Quality Commission (CQC) is across north west London. We have the independent regulator of health and around 500 student nurses and In north west London, we are working adult social care in England. The Trust midwives in training annually, together across the NHS, social care received an overall rating of ‘requires many of whom gain their first and voluntary sector to improve improvement’ following the CQC’s job or qualification with us. healthcare services for our two million first, full inspection of our Trust in residents. A Sustainability and September 2014. Transformation Plan (STP) for health Our charities and care in north west London was The CQC returned in November 2016 We work increasingly closely with published in October 2016. One of to inspect our outpatient and diagnostic Imperial Health Charity, which supports 44 such plans across England, it was imaging service, the only core service a wide range of initiatives for patients developed by 28 NHS, local authority to be rated overall by site as and staff. In 2016/17 the Charity and voluntary sector partners, including ‘inadequate’ following the 2014 supported £8.3 million of expenditure our Trust. inspection. The new ratings for this core service were published in May 2017, on the Trust’s capital programme along Its five delivery areas are: with a number of other non-capital and reflected improvements across schemes and initiatives. • radically upgrading prevention and all sites, moving to ‘good’ overall at wellbeing St Mary’s and Hammersmith hospitals During 2016/17 the Trust also received and ‘requires improvement’ overall • eliminating unwarranted variation generous support from COSMIC at Charing Cross Hospital. (Children of St Mary’s Intensive Care), and improving long-term condition the Winnicott Foundation, which raises management In March 2017, the CQC carried out unannounced inspections of two funds to improve care for premature • achieving better outcomes for older core services: maternity at St Mary’s and sick babies at St Mary’s Hospital, people and each of the Friends of St Mary’s, Hospital, currently rated as ‘good’, Charing Cross, and Hammersmith • improving outcomes for children and and medical care at St Mary’s, Charing hospitals. adults with mental health needs Cross and Hammersmith hospitals, with all sites currently rated as ‘requires • ensuring we have safe, high quality, improvement’. We will receive our sustainable acute services. Our commissioners ratings from these inspections during Our own strategies are very much in 2017/18. Almost half of our care is currently line with the objectives of the STP and commissioned by north west London a number of our key initiatives are local clinical commissioning groups being supported by and/or influencing (CCGs), about 40 per cent is specialist the STP’s implementation. care commissioned by NHS England, and about 10 per cent of our care is by other commissioners including CCGs Our regulators beyond our local area. From 1 April 2016, the NHS Trust The CCGs in north west London have Development Authority (TDA) and formed two groupings: Monitor, the regulator for NHS • CWHHE collaborative: NHS Central foundation trusts, merged to form NHS London CCG, NHS Ealing CCG, Improvement, now responsible for NHS Hammersmith & Fulham CCG, overseeing both NHS trusts and NHS Hounslow CCG, and NHS West foundation trusts. Under NHS London CCG Improvement’s Single Oversight Framework, the Trust is rated as a three

10 Imperial College Healthcare NHS Trust | Annual Review 2016/17 11 The Trust in numbers 2016/17 (all rounded)

Our care 1,055,000 210,000 288,500 10,500 109,000 97% outpatient inpatient A&E babies inpatient Inpatients who contacts contacts attendees born operations would recommend us to their friends and family

Our staff

10,970 2,500 4,400 650 950 120 810 500 Staff, Doctors Nurses & Allied health Scientists & Pharmacists Undergraduate Nurses in education, including: midwives professionals technicians doctors in training pre-registration

Our finances

£1,096.6m -£15.3m £54m £47.6m Turnover Deficit at year end Efficiency savings Invested in buildings and infrastructure

12 Imperial College Healthcare NHS Trust | Annual Review 2016/17 13 Performance analysis: Performance against introduction corporate objectives

We regularly review • to achieve excellent patient Assessing performance against Objective: to achieve excellent patient experience May 2017, and reflected improvements information and feedback experience and outcomes, delivered the five domains of quality and outcomes, delivered with care and compassion across all sites, moving to ‘good’ overall with care and compassion at St Mary’s and Hammersmith about our services and The scorecard sets out our indicators hospitals and ‘requires improvement’ • to educate and engage skilled activities at all levels across under the five domains of quality used We also introduced appointment overall at Charing Cross Hospital. and diverse people committed to Improving outpatient services by the Care Quality Commission to reminders by voicemail and expanded the organisation. This helps continual learning and improvement Around a million people come to the Now that we are making good progress assess the quality of NHS organisations text reminders, with more than half us ensure we are on track Trust’s hospitals as outpatients every with our systems and facilities, we are • as an academic health science across England – safe, effective, caring, of patients contacted now confirming year and we have been running a focusing our efforts on transforming our to meet our targets and centre, to generate world leading responsive and well-led. their attendance. All of the improved major programme to improve the model of care to meet changing needs objectives and to deliver research that is translated rapidly communication has meant that fewer These domains also form the quality of their experience. and demand as well as on following into exceptional clinical care people are missing their appointment our strategic plans, as framework for our quality strategy and up on further, recommended actions This includes £3 million of – down from 17 per cent in 2014 to well as to help us spot • to pioneer integrated models of for our annual quality account that sets from our 2016 CQC inspection. refurbishment works, creating a 11 per cent in 2017. care with our partners to improve the out and reports on our annual targets and address problems more patient-friendly environment health of the communities we serve for improving quality. This is all part of our efforts to go digital, as soon as they arise. at our clinics at Charing Cross and helping to make our processes more Milestone in St Mary’s • to realise the organisation’s potential This performance report draws out Hammersmith hospitals, funded by We also contribute to a range of streamlined. Patient records are held redevelopment through excellent leadership, efficient the annual performance against key Imperial Health Charity (known as national monitoring programmes, electronically on a secure system, use of resources and effective indicators under each domain, see Imperial College Healthcare Charity A planning application for a vital which allows our performance which has many benefits for patient governance. pages 32 to 41. A more detailed in 2016/17) who also committed nearly new outpatients building at St Mary’s to be benchmarked against that care. Now, when a doctor sees a assessment of performance against all £300,000 to update the outpatient Hospital was submitted to Westminster of similar NHS trusts. Following our analysis of performance patient in clinic, they have their key of our quality targets for 2016/17 can be department at Western Eye Hospital. City Council in December 2016. against our strategic objectives for details to hand and there aren’t delays Every month, our executive found in our 2016/17 quality account. 2016/17, we look forward and set out And it’s not just about the physical waiting for paper records. Furthermore, The proposal is driven by three main management team reviews a our two-year, business plan objectives Many of our major initiatives in 2016/17 space. We have also been tackling GPs now receive 96 per cent of needs, to: comprehensive set of performance for 2017-19. These objectives take into were intended to support more than one issues with appointment letters, patients documentation, including patient indicators – our ‘scorecard’. • support better care – allowing of our strategic objectives. However, for discharge summaries, electronically. account the following, significant issues being rescheduled at short notice and for more integrated care, tailoring A scorecard with a core set of indicators facing the Trust as we enter 2017/18 ease of reporting, we have set them out long waiting times in some clinics with GPs can also refer patients to our and combining different specialist is also reviewed by the Trust board at (further detail on each issue is provided in this report under the primary objective high demand. hospitals electronically, with a 50 per services to meet individual needs its public meeting. For each indicator, in the governance statement on page 46): to which they relate. From September 2016 patients were cent increase in GP electronic referrals as well as helping patients to recover we look at how we are performing • ability to achieve and maintain able to get their appointment details in the six months to March 2017. quickly and stay well. against national standards and/or our financial sustainability by email if they chose, with 90,000 There is a national requirement for own targets that flow from our various • improve patient experience patients opting in to receive email all referrals to be made via electronic strategies. • ability to achieve required – providing services in ways that will correspondence by March 2017. channels by October 2018. performance targets in the make it as easy and as stress free On our website, we publish an easy-to- For those who prefer having their emergency department and Patient transport is another key issue for patients, their carers and families, understand monthly performance appointments sent by post, we switched for elective surgery for those who are not able to travel to as possible. summary taken from the scorecard to a new postal service in June 2016 outpatient appointments independently. as well as the full scorecard that • ability to recruit and retain required that is faster and more reliable. We • replace ageing buildings – a third We reviewed our patient transport goes to each public board meeting. clinical staff, particularly in relation also made the appointment letters of buildings at St Mary’s are more service, recruited an additional 28 to ward-based nurses, midwives clearer and more informative. than 100 years old and expensive drivers and introduced a new system and radiographers to maintain and run. New and more that can match short notice requests Assessing performance against If patients want to change their efficient buildings will follow best to the earliest available vehicle. our strategic objectives • ability to gain funding approval appointment they will soon be able to practice in design and technology. from key stakeholders for the ring one phone number for all queries. In November 2016, the CQC carried Assessing progress against our redevelopment programme During the year, we created a single The proposed eight-storey building out an inspection of our outpatient and objectives is an important aspect of patient services centre at Charing will replace the existing Salton House, • ability to fund the appropriate level of diagnostic imaging service, provided performance analysis. All developments Cross Hospital with funding from our Dumbell and Victoria and Albert back-log maintenance whilst awaiting at St Mary’s, Charing Cross and within the Trust must aim to achieve Charity. Here, all of the outpatient buildings between Praed Street and redevelopment, and the resulting risk Hammersmith hospitals. This was the one or more of our five strategic administration teams are coming South Wharf Road on the eastern to necessary funding for the medical only core service to be rated overall by objectives: together putting in place new ways side of the hospital estate. equipment replacement programme. site as ‘inadequate’ following our first, of working to make sure we get things full inspection in 2014. The new ratings The new facility will bring together the right for patients and GPs, first time. for this core service were published in majority of St Mary’s outpatient services

14 Imperial College Healthcare NHS Trust | Annual Review 2016/17 15 Performance against corporate objectives

A full refurbishment of Charing Cross • an expansion in resuscitation bays from Hammersmith Hospital as part Hospital’s Riverside theatres has – where seriously ill patients are of planned changes in autumn 2016 enabled us to provide a better stabilised as priorities – from four to six to consolidate acute medicine services experience for patients, expand the at Charing Cross and St Mary’s where • a new four-bed assessment unit range of procedures undertaken there we have our A&E departments. within the children’s A&E department and put in place more efficient ways of to provide dedicated facilities for Mental health working. The four operating theatres in children who need further the unit are tailored for planned surgery Following a change in legislation investigation for short-stay patients. The £1.8 million designating emergency departments upgrade programme was supported • a new adult clinical assessment area as safe places to accommodate by a £1 million grant from Imperial those in crisis, the number of patients • a redesigned reception area to offer Health Charity. attending the emergency departments more privacy and a better patient at St Mary’s and Charing Cross See page 38 for a summary of our experience hospitals with a mental health related performance against the national • a new area where friends and complaint increased and has remained 18-week referral to treatment standard. families can wait. high throughout 2016/17. Waiting times and supporting diagnostics such for this group of patients continue to In addition, the Trust opened a as blood tests, which are currently rise, with patients requiring admission Boosting urgent and 12-space surgical assessment unit at provided from 40 different locations to a mental health bed experiencing emergency care St Mary’s in January 2017 to enable across the hospital site. the longest delays. We saw a three per cent increase in faster access to a specialist surgical The development plans include the A&E attendances and a five per cent opinion where required. We are working with commissioners latest technology, with follow-up and the mental health trusts to improve increase in emergency admissions A&E remained open throughout the consultations via telephone or Skype the pathway for mental health patients. in 2016/17. Like many trusts across refurbishment and staff worked hard where appropriate. And there will We have also established a dedicated the country, we struggled to meet to ensure the works did not affect our be faster, more holistic care with consultant lead for mental health and the national standard for 95 per cent patients’ experience. An expansion co-ordinated, same day appointments added registered mental health nurses of A&E patients to be treated and in consultant numbers in 2015/16 has for patients with multiple needs so that in both emergency departments. discharged or admitted within four enabled us to have more senior staff in people can have their tests, results hours. See page 38 for a summary of the department until later in the evening Ambulatory emergency care and consultation all in one day. the number of planned operations we • improved waiting list management – our performance against the standard. and at the weekends, and a further carry out by 50 per cent over the past better processes, training and on-going We extended the opening hours of There are also plans for fast check-in, expansion of consultants for our four years. audit to make sure all lists are now We have been rolling out a range of our ambulatory emergency care (AEC) a café, children’s play area and easy-to- children’s A&E is planned for 2017/18. managed correctly and consistently improvements to enable a better ‘flow’ service at St Mary’s and Charing follow signage. Space for community We invited NHS Improvement’s Elective of patients through our urgent and Charing Cross Hospital Cross hospitals, which now includes health and wellbeing sessions, research Care Intensive Support Team to review • systematic clinical review – detailed emergency care pathways. We are weekends. The AEC service provides and training is being built into plans. our processes and to provide advice reviews by doctors to ensure patients A £790,000 redevelopment has enabled working to ensure patients receive specialist diagnostics and treatment for Patients and lay partners are involved on improvements. In response, we are not coming to clinical harm as us to expand and co-locate services for care in the right place at the right time patients who have urgent needs but in the design to make sure it will work established a dedicated waiting list a result of their waits patients in our urgent and emergency by the right healthcare professional, are well enough to go home in between well for everyone using the service. improvement programme that has care pathway on the ground floor at • additional clinical activity – including from their first contact with us, through procedures or consultations and, It will serve around half a million focused on: Charing Cross, close to the A&E running more outpatient clinics and assessment, diagnosis and treatment, essentially, to be cared for on patients a year. department. • a data quality clean up – a theatre sessions, both within the to ensuring a safe and timely discharge. an urgent outpatient basis. systematic and detailed audit of all Trust and with the support of Key initiatives in 2016/17 This includes a new acute assessment Reducing waiting times of our waiting lists. This resulted in independent sector providers unit for up to 13 patients and a 35-bed an increase in the number of patients St Mary’s Hospital acute medical unit for patients admitted Improving safety With increasing demand for our • improved theatres – our Riverside reported to be waiting over 18 weeks urgently, through A&E or via their We have achieved a 50 per cent services, keeping waiting times down theatres at Charing Cross Hospital A £3.2 million refurbishment of St from referral to treatment – the GP, who need further short-term reduction in the total number of grade for planned care has been a particular were completely refurbished, see Mary’s A&E began in June, funded national standard is for no more than observation, diagnostics or treatment 3 and 4 pressure ulcers (the most challenge. In early 2016, the Trust also below. A temporary mobile operating by Imperial Health Charity. Due 92 per cent of patients to wait this before being discharged or admitted serious) since 2014 and we have not identified some issues with how we theatre was used to ensure that for completion in summer 2017, long. We also identified a number to the appropriate inpatient ward. had a grade 4 pressure ulcer since were managing our waiting lists as well we were able to maintain our it is providing: of patients who had been waiting 2013. This has been further supported as underlying capacity problems in theatre capacity during the Some of the doctors and nurses on over 52 weeks by an app developed by the tissue some areas. This is despite increasing refurbishment period. the new units have moved across

16 Imperial College Healthcare NHS Trust | Annual Review 2016/17 17 Performance against corporate objectives

viability team in 2015/16 which allows Faster access for chest nurses to record and share vital real pain and urgent renal time data about pressure ulcers enabling and haematology care better management and prevention. Patients with cardiac-related chest pain We continue to focus on preventing or urgent renal or haematology conditions ulcers and are collaborating with our are benefitting from the introduction of partners in the community to adopt a new ‘direct entry’ urgent care pathways whole systems approach to reducing at Hammersmith Hospital in August harm from pressure damage. 2016. Timely treatment in a specialist We have reduced the number of centre has been demonstrated hospital-acquired infections, reporting: to improve outcomes. • three Trust-attributable cases of These patients now see the right clinician MRSA BSI compared to seven and receive the right care in the right the previous year facilities, first time. Previously, patients presenting with urgent chest pain or • 63 Trust-attributable cases of renal or haematology care needs could Clostridium difficile compared be seen by the acute medicine service to 73 the previous year. at Charing Cross, Hammersmith We continue to work to reduce or St Mary’s hospitals before being infections by reducing the inappropriate transferred to the appropriate specialist use of antibiotics, improving hand service. This created an unnecessary hygiene, screening and training. step in a patient’s care journey. Significant improvements were Patients with cardiac-related chest pain implemented in relation to safer attending A&E at St Mary’s or Charing surgery, including training and audit Cross hospitals are now stabilised and programmes. A group was established transferred directly to the heart to review how we were conducting assessment centre at Hammersmith interventional procedures across the Hospital. Trust and to ensure we were providing Patients with suspected heart attack the safest possible care for our patients. are already taken directly by London As a result of this work, we are starting Ambulance Service to one of London’s to see improvements in compliance eight specialist heart attack centres, with the five steps to safer surgery. including the one at Hammersmith Recognising that we have more work Hospital, rather than the nearest A&E. to do to improve our safety culture, in This has been in place since 2010 June 2016 we started a programme of and has been proven to save lives. work to develop and embed a culture Hammersmith Hospital’s heart attack in which all staff can describe their centre layout was changed to improve contribution to patient safety, feel privacy and patient experience as confident in raising safety concerns well as to increase capacity by up and know how to address such issues to 15 beds for patients to recuperate within their place of work. This work after their treatment. will continue into 2017/18. All of the changes followed extensive Further information about the work engagement with patients, carers, described above and our performance local residents and other stakeholders. against the five domains of quality can be found on pages 32 to 41, with full details available in our quality account.

18 Imperial College Healthcare NHS Trust | Annual Review 2016/17 19 Performance against corporate objectives

Objective: to educate and engage skilled and diverse Medical education has continued fellowship programme provides ‘first- engagement score in the national experience and built a transferable skill people committed to continual learning and improvement to develop through a transformation step funding’ for health professionals NHS staff survey in winter 2016. set at the Trust through a supported programme, resulting in improved looking to begin their academic career. internship training programme called We understand that staff engagement feedback from our clinical placements. Project SEARCH. This year, nine projects received grants is essential to excellent organisational Improving use Making quality improvement Case study: We have attracted additional of up to £50,000 to undertake pioneering performance and the delivery of high Project SEARCH is aimed at supporting everyone’s business of orthopaedic theatres placements for undergraduates by research and invest in the training quality patient care, taking a holistic young adults with learning disabilities As part of our 2015-2018 quality Our trauma and orthopaedics team offering innovative new ways of training. and development of our hospital staff. approach. This included in-depth into paid employment. Only seven per Our programme of simulation for engagement with staff in the restructure cent of adults with learning disabilities strategy, the quality improvement (QI) provide the lead spinal service for north The programme allows staff – medical foundation doctors and those in surgical of the organisation, involvement in our were in some form of paid work in 2012 programme was launched and is now west London and perform over 3,500 and non-medical – to undertake 12 training shares unique training facilities work on values, the launch of Pulse according to the Department of Health, into its second year of building a culture planned surgery procedures per year. months of research to develop their with Imperial College, and we run team magazine and the development of this is in contrast to the 65 per cent who of continuous improvement across Data analysis showed that the service research skills for the benefit of training and in-situ multi professional our new people and organisation said they would like a paid job and are the organisation. was not performing as efficiently as it patients. Just under £437,000 was simulation to enhance patient safety development strategy Better health, capable of having one with the right could be. First cases were not always allocated to a range of grants, which The programme: awareness in several specialties. for life, through our people. kind of support and training. starting on time, performance targets include research into improving • engages with staff to ensure for theatre utilisation were not met, The postgraduate medical education ultrasounds to better assess liver We redesigned our internal The students work in different everyone knows about QI and feels and there were too many cancellations department continues to deliver training damage and developing a urine engagement survey Our voice, our trust departments in the hospital, and are empowered to see improving patient on the day of surgery. across our five hospitals, supporting test to diagnose oesophageal to better understand how we can help matched to their placements based care as a key part of their role Members of the multi-disciplinary 790 trainees – junior doctors who and gastric cancers. people have more good days at work. upon their skills, abilities and interests. continue to be developed following We also rolled out a conversation- They rotate placements every three • builds improvement capability team attended a QI training day where through a programme of QI they worked together to identify the graduation. We improved on our based approach to sharing and months in order to gain the maximum Developing our staff at all levels education to enable staff to lead, challenges they wanted to address and performance in the national training articulating staff experience called amount of experience during their time champion and coach improvement plan their first improvements. The team survey. More than 1,000 staff participated in In our shoes which over 700 at the Trust. Our first cohort of students employees have taken part in. graduated in July 2017. work within their teams ran a series of diagnostics in order to We continue to train the nurses and our award-winning staff development understand the issues. This included programmes in 2016/17. • supports teams to deliver focused midwives of the future, and also offer observations of practice, a review of QI projects and programmes aligned the post graduate education they need Courses include the year-long, modular patient experience and development Project SEARCH to our quality strategy to do their jobs and grow professionally. courses for leaders at different stages of a data pack. In 2016/17 we prepared to be an early of their careers – from front line Twelve young adults with learning • embeds rigorous improvement For their first ‘test’ improvement, the implementer site for the new nursing supervisors up to senior leaders. We disabilities began a one year work methods in our organisational team introduced an extra bay with a associate role, with the training also ran an innovative ‘paired-learning’ experience programme at Charing approach to change. dedicated nurse for the patient next programme for these new professionals programme which enables junior doctors Cross Hospital in September 2016. The The method of improvement is to ‘plan’ on the surgery list. This means they beginning in April 2017. and junior managers to learn together. students taking part gain valuable work – make a plan to do something; ‘do’ – are ready the minute the theatre is We are also exploring the graduate Our short-course programme aids try it out; ‘study’ – see what happens available, decreasing the number of nurse apprenticeship programme which specific skills development and using measurement; and ‘act’ – use late starts and minimising turnaround we aim to begin in September 2017. provides career support. And we run the results to tweak things the next time between patients. As a result The apprenticeship programme will an active coaching and mentoring time round. In this way we build up theatre starting time and utilisation allow staff who wish to train as a register and training programme lots of small changes that add has improved and there is an registered nurse to gain their as well as regular sessions on together to make a big difference. increased number of surgical lists. qualifications while being employed people management topics including In 2016/17, the QI team engaged by us. We are also looking at growing performance and development reviews, directly with just under 3,000 staff, Improving education for our our apprenticeship training schemes HR policies and procedures, and for other professionals. initiating a broad ranging education healthcare professionals handling workplace conflict. and coaching programme for over 400. We teach a range of healthcare At March 2017, the QI team was professions and, in 2016/17, this Expanding our research Focus on staff engagement actively supporting 17 strategic Trust- included 810 undergraduate doctors fellowship programme During 2016/17 there was a focused wide initiatives as well as 45 service-led in training, in association with Imperial Imperial Health Charity and our effort to improve employee experience QI projects. They have provided over College London, and 500 nurses and National Institute for Health Research across the organisation and we 112 pieces of internal consultancy midwives, through King’s College Biomedical Research Centre’s research achieved our highest ever staff work to Trust improvement projects. and Bucks New University.

20 Imperial College Healthcare NHS Trust | Annual Review 2016/17 21 Performance against corporate objectives

Objective: as an academic health science centre, to Clinical excellence funding generate world leading research that is translated rapidly for clinical research into exceptional clinical care The National Institute for Health Research (NIHR)/Wellcome Trust Imperial Clinical Research Facility at of biomedical data and samples. In £90 million biomedical Hammersmith Hospital was awarded addition, for the first time, the NIHR research centre award more than £10 million in funding by award to the Imperial BRC will fund the Department of Health for clinical In September 2016 we were awarded research into gut health, with a focus excellence. £90 million, in partnership with Imperial on innovative approaches to disease College, to continue our joint research that consider the microbiome. This specialist research facility provides to develop and improve treatments dedicated bed space for up to 25 Work funded by the Imperial BRC for our patients. patients participating in research is already having an impact on how studies that require stays of up to 10 The biomedical research centre (BRC) patients are diagnosed and treated. days. The research facility is staffed award, from the National Institute for Researchers have: Health Research (NIHR), covers the by a team of 40 dedicated healthcare five years from April 2017. The NIHR is • developed a promising treatment professionals specialising in clinical funded by the UK Department of Health. for the childhood degenerative research. They facilitate ground disease, Friedrich’s ataxia breaking trials that otherwise would not The Imperial BRC was first established be possible due to demand for hospital • created a new test for a form in 2007 and the new funding allows us beds and the expertise required. to continue our world-class research of kidney disease The new award, the largest grant awarded into cancer, heart disease, brain • generated new insights into in London, will fund the clinical research sciences, immunology, infection, cardiovascular disease using facility until March 2022. This will allow surgery and metabolic disorders. imaging technology and genomics the Trust to continue to support It will also support research and • designed a prototype implantable experimental medicine clinical research technology development in areas chip that can help control appetite studies with patients and healthy volunteers that cut across conditions such across a wide range of conditions. as genomics, imaging, molecular • designed an intelligent surgical knife phenotyping and the use and storage called the ‘iKnife’ which identifies if tissue being cut is cancerous. Non-invasive ultrasound for brain surgery We began the first UK trial to treat the trials have concluded and the Building the foundations in the genome. By understanding these patients with debilitating tremors using effectiveness of the treatment has for personalised medicine changes, there is potential to better high-intensity, focused ultrasound been proven. It is anticipated that understand how the disease develops waves, avoiding traditional, invasive new trials will be set up to examine the We are the lead organisation for the and which treatments will be most brain surgery techniques. benefits of the treatment for people with West London Genomic Medicine Centre, effective. Patients may be offered Parkinson’s disease and other types one of 13 NHS centres delivering the a diagnosis where there wasn’t one Around one million people in the UK of tremor, including multiple sclerosis 100,000 Genome Project nationally. before. In time, there is the potential are affected by an essential tremor associated tremor in the near future. of new and more effective treatments. (ET), a brain disorder characterised by The project aims to create a new uncontrollable shaking. Approximately The trial was supported by a £1 million genomic medicine service for the Working alongside our partners 100,000 people also have tremors caused grant from Imperial Health Charity NHS, transforming the way people Chelsea & Westminster Hospital NHS by other movement disorders such as to enable the purchase of special are cared for. It focuses on two main Foundation Trust, Royal Brompton & Parkinson’s disease or multiple sclerosis. equipment to deliver the ultrasound. groups – patients with a rare disease Harefield NHS Foundation Trust and Currently, patients with ET or other and their families and patients living Royal Marsden NHS Foundation Trust, types of tremor are offered treatment with common cancers. the West London Genomic Medicine that can have serious side effects. These areas have been selected Centre had collectively recruited 487 rare disease patients and 387 cancer The Trust hopes that the procedure will because eligible rare diseases and patients to the project as of March 2017. be made available on the NHS once cancer are strongly linked to changes

22 Imperial College Healthcare NHS Trust | Annual Review 2016/17 23 Performance against corporate objectives

Objective: to pioneer integrated models of care with our and to ensure key Trust policies Improving cancer care with North West London Pathology and developments have appropriate partners to improve the health of the communities we serve Macmillan Cancer Support A major hub for pathology services in patient and public input Our partnership with Macmillan Cancer north west London was developed at • recruiting, training and supporting an population. The partnership is also Support is entering its third year. Having Charing Cross Hospital in preparation Hammersmith & Fulham additional 22 lay partners to oversee working closely with Hammersmith successfully improved the experience for the launch of North West London integrated care programme Trust programmes and service & Fulham social care services. of patients in active treatment – as Pathology on 1 April 2017. developments as equal members The Trust is part of a growing evidenced by the latest National Cancer North West London Pathology is a joint of the team collaboration of organisations working Patient Survey – the programme is now venture between the Trust, Chelsea & to develop a radically better way of A step change in patient • creating a patient communications focusing on improving the quality of life Westminster NHS Foundation Trust and providing care for the population and public involvement group to help ensure our materials for the increasing number of people Hillingdon Hospital NHS Foundation of Hammersmith and Fulham. living with and beyond cancer. The first Trust-wide patient and public are clear and effective. Trust to provide a modern and efficient pathology service. The partnership is Along with the Hammersmith & Fulham involvement strategy and action plan, The patient and public involvement Advances in scientific knowledge expected to manage 25 million tests GP Federation (representing GP created through a series of co-design work is supported by Imperial mean that at least 50 per cent of people per year and become one of the practices in the borough), Chelsea & events, was approved by the Trust Health Charity, who also took over diagnosed with cancer can now expect biggest pathology services in Europe. Westminster Hospital NHS Foundation board in July 2016. It builds on many responsibility for volunteering to live for ten years or longer. But we Trust, West London Mental Health NHS great examples of patient and public at the Trust during the year. know that there are side effects, both Most of the routine, specialist and Trust and Central London Community involvement in supporting and developing of the cancer and its treatment, which non-urgent activity will be delivered Healthcare NHS Trust, the partnership specific services across the Trust. can impact on quality of life. at the ‘hub’ at Charing Cross Hospital. aims to: Care Information Exchange At the heart of the strategy is the Phase two of our partnership Pathology required urgently for the • design a practical ‘accountable care’ commitment to ensure patients and the The Trust is leading a major initiative to specifically aims to: immediate treatment of patients will approach – collectively looking after public are able to help shape and input build an online care record for patients be performed in 24/7 essential service • develop a deeper understanding of the holistic needs of local people to every aspect of the Trust’s work, and those providing their care across laboratories based at the other hospital what enables people to live well with and helping them stay as healthy as specifically: north west London. sites in the group. and beyond cancer, or stops them possible, rather than only focusing • maximising individual health and With £3 million funding from Imperial from doing so, by way of an in-depth Major projects to prepare for the launch on treating patients when they wellbeing, for example with patients Health Charity, the goal is to improve research project included the development of a common present with a health problem engaging directly with their health care and help patients be more in IT system, 150 staff moved from West • deliver services which enable • identify and implement immediate and care professionals through the control of their own health. Patients Middlesex and Hillingdon to Charing people to access timely support improvements to ‘join-up’ care, Care Information Exchange can access their information at any Cross in January 2017 and a board and information to help them primarily through a series of tested time, on their computer or smartphone, was appointed in March 2017. • supporting care and service delivery, manage their condition. projects and choose to share the information through volunteering and fundraising as they wish, with health and care Central to the ethos of the programme • build strong foundations for forming a • improving care and services, for professionals, relatives and carers. is strengthening the links between the formal accountable care partnership example by taking part in workshops Patients also have the ability to record Trust and the wide range of community- – influencing and responding to to re-design services their own information into their record. based services in north west London, emerging health policy across north including GP and primary care services west London and the rest of the • strategy, policy and planning, by By the end of 2016/17, over 1,000 and community and charitable groups. country. providing ‘lay partner’ input to project patients had registered with the Care We know that as cancer is increasingly groups and programme boards, Information Exchange, of whom 600 Accountable care approaches are a recognised as a chronic condition, for example. were active users across 13 services potential way of overcoming dispersed support services outside the hospital and five organisations. A further responsibility for the commissioning setting will be critical to the education, During the year, significant progress 500,000 records have been created in and provision of care. The programme self-management and adjustment was made on establishing new ways for the exchange, ready to enable many also involves lay partners in the of patients to their ‘new normal’. patients and the public to get involved. more patients to register and to become co-design of all aspects of the This includes: active users. emerging care model. • establishing a 12-strong strategic lay During 2017/18, the partnership plans forum – made up of patients, carers to test its shared principles in practice and local residents to oversee by redesigning a number of care the further development and pathways for a sample of the implementation of the strategy

24 Imperial College Healthcare NHS Trust | Annual Review 2016/17 25 Performance against corporate objectives

Objective: to realise the organisation’s potential through excellent England to be one of 16 global digital leadership, efficient use of resources and effective governance exemplars in acute care. As a global digital exemplar, we will receive funding and support to drive forward the use of Building financial sustainability At the start of 2016/17 we were not in digital technology and create products a position to sign up to our financial and approaches that can be used We made significant progress during control total set by NHS Improvement. by other organisations. the year towards achieving financial However, when we reviewed our financial sustainability, delivering one of our Our joint application with Chelsea and performance half way through the year largest ever cost improvement Westminster put our shared electronic we were then confident the Trust would programmes and putting in place robust patient record system at the heart achieve a ‘stretch’ plan that was £11 processes and support for devolving of our plan. Our bid also included million improved. Due to a huge amount more financial management to clinical commitments to record sharing to of hard work and commitment across directorates and corporate teams. And support integrated care and patient the organisation, plus the support of the this was achieved at the same time as engagement, development of financial improvement programme, this caring for more patients and continuing healthcare apps which will securely has enabled us to deliver our control to make improvements in quality. connect to the patient record, and total – of an operational deficit of technology to support population health. We were one of 16 NHS trusts to take -£41 million – which has allowed us to part in NHS Improvement’s national access non-recurrent, sustainability and financial improvement programme. transformation funding of £25.4 million, Kind to each other, We chose to partner with consultants delivering a year-end position of a kind to patients PricewaterhouseCoopers (PwC) whose deficit of -£15.3 million. This compares specialist team worked closely with our with our 2015/16 year-end position Staff are encouraged to reflect together clinicians and managers to ensure cost of a -£47.9 million deficit. on the personal aspects of their improvement schemes were planned sometimes emotionally challenging Our new processes and support have and implemented effectively. They also work in healthcare through a series of enabled us to be at a more advanced helped us to establish a project support open forums called Schwartz rounds. stage of planning and implementation office to oversee all cost improvement The rounds aim to directly support staff, for cost improvement schemes as we schemes, initially running it with their enhance relationships and communication entered 2017/18 but the financial own staff and then being part of its within and between teams, and challenge this year is even greater than careful transition to an on-going, contribute to a compassionate last year’s, with increasing demand in-house function. organisational culture while improving and additional cost pressures. We are patient and carer experience. We were also one of the first wave of continuing to develop in-year plans trusts to take part in Lord Carter’s review as well as focusing on how we can Since 2015, when Schwartz rounds of hospital productivity, helping us to address more strategic aspects of our were launched, we have hosted 23 benchmark ourselves against similar deficit, such as the costs we incur from rounds across our three main hospitals, trusts across the country to identify where having very old and inefficient estate attended in total by over 1,000 staff of we might be able to make further savings. and the high costs of some of our which around 10 per cent also work in very complex, specialist services. community settings. Staff consistently Projects that have contributed to our rate their experience of these meetings cost improvement programme include: very highly. • bringing our fertility service back Trust recognised as global Funding from Macmillan Cancer in-house, as the Wolfson Fertility Centre digital exemplar Support, Health Education North West • outsourcing our managed equipment Our role as a leader in the adoption of London (HENWL) and Imperial Health service digital technologies to improve patient Charity enabled us to set up and run care was recognised in March 2017 this project for the first 18 months, and • renegotiating contracts with some when, in partnership with Chelsea & continued support from Imperial Health of our big suppliers Westminster Hospital NHS Foundation Charity and HENWL will maintain • developing our private services. Trust, we were selected by NHS our programme through 2017.

26 Imperial College Healthcare NHS Trust | Annual Review 2016/17 27 Recognition for our staff

Highlights 2016/17

Venetia Wynter-Blyth, Ludwig Lupak, above left, a a gastrointestinal clinical nurse biomedical scientist at the Trust was specialist at the Trust was awarded awarded the Company Members Prize The gripAble™ device is designed for New technology partnership the Royal College of Nursing’s highest by the Institute of Biomedical Science, patients to use unsupervised in hospital to help patient safety and care honour, nurse of the year 2016, for her after achieving the top mark in the and at home. This simple device can holistic approach to getting patients higher specialist diploma in clinical The Trust has entered into a new improve the ability of patients with arm both physically and psychologically biochemistry. partnership with British technology disability to play physiotherapy-like fit for surgery. company DeepMind to help it harness computer games, according to new the latest digital technology to support research with stroke patients who had better patient care. suffered successive strokes with arm The five-year agreement will see paralysis at the Trust over six months. DeepMind and the Trust implement HRH The Prince of Wales 100,000 new cases of arm weaknesses technology for mobile clinical meets Trust’s nursing stars BBC2’s Hospital are diagnosed each year following applications (apps), including an a stroke. Often this impairs people’s BBC Two’s Hospital was a ground- His Royal Highness The Prince of application programming interface ability to carry out daily activities, breaking six-part documentary airing Wales visited St Mary’s Hospital in (API) to manage the secure exchange requiring long-term care. The use of Dionne Levy, a midwife from the Trust, January to February 2017 that went October 2016 to meet four nurses from of information between the Trust’s mobile-gaming could provide a cost- Dr Nicola Strickland, a consultant was crowned ‘rising star’ at the Nursing behind the scenes at our hospitals to the Trust who were shortlisted for the existing electronic patient record effective and easily available means to radiologist at the Trust, was elected Times Awards 2016. As a specialist show the complexity of the NHS in Nursing Times Awards 2016: Abby system and mobile apps for improve the arm movements of stroke as president of the Royal College mental health midwife she is action. The series received widespread Harper-Payne – nominated for a rising patient care. patients but in order to be effective of Radiologists. responsible for making sure pregnant praise for its honest, informative and star award, Becky Johl – nominated for patients of all levels of disability women with mental health problems compelling depiction of the NHS’s cancer nursing award, Dionne Levy should be able to access it. receive the right levels of integrated complex challenges and huge – winner of the rising star award and care at this crucial time. achievements, drawing record viewing Louise Savine and the tissue viability The team is now carrying out a figures and sparking debate across team – nominated for technology and feasibility study in north west London social media. A second series data in nursing award. His Royal to test the use of the device in started June 2017. Highness also received a demonstration patients’ homes. of a new app developed by nurses at the Trust to help prevent pressure ulcers. Wolfson Fertility Centre Life-saving technology Mr Ahmed Ahmed, a consultant in The Trust is now able to provide a for trauma patients upper gastrointestinal surgery and lead bariatric surgeon at the Trust, was Trust first in UK to pilot comprehensive fertility and IVF service Specialist trauma surgeons from the for patients at its Hammersmith Hospital presented with an award from the Dr Guri Sandhu, a consultant ear, Finnish-style baby boxes Mayor of London visits St Mary’s Trust are working with the National site in London. The fertility service, National Institute for Health Research nose and throat surgeon at Charing The Trust’s Queen Charlotte’s & Institute of Health Research Diagnostic The Mayor of London Sadiq Khan based at the Wolfson Fertility Centre, (NIHR) for recruiting the first patients Cross Hospital has been recognised Chelsea Hospital was the first hospital Evidence Cooperative and instrumentation visited the Trust’s major trauma centre can provide a full range of IVF onto a trial to test the use of a specialist for his outstanding contribution to in the country to offer Finnish-style baby designers from Developers Highland services at St Mary’s Hospital to treatments for patients, both on the stapler used in bariatric surgery. laryngology – receiving the Isshiki boxes for newborns as part of a pilot Biosciences to develop new technology learn more about the youth violence NHS as well as privately through Award from the British Laryngological project. The Trust distributed 800 baby to quickly detect whether a patient is intervention programme which aims Imperial Private Healthcare. The centre Association, and becoming only boxes, which in Finland is thought to suffering from internal bleeding. to tackle youth gang violence. The includes a state-of-the-art embryology the fifth recipient worldwide. have contributed to reducing the infant programme is the result of a partnership laboratory, which has recently The handheld device, called the mortality rate in the country from 65 between the Trust, Redthread and benefitted from a half million Coaguscan, is currently in early infant deaths per 1,000 births in 1938 Imperial Health Charity. pound upgrade of all equipment. prototype stage and will help clinicians to 2.26 per 1,000 births in 2015. The determine if a patient is suffering from UK has some of highest rates of infant internal bleeding and the exact number mortality in Europe, ranking 22nd out Virtual physiotherapy of blood products a patient requires of 50 European countries, with 4.19 from their transfusion. Professor Lesley Regan, head of Trust staff were part of the low-cost deaths per 1,000 births. It is thought obstetrics and gynaecology at St Mary’s invention, gripAble™ which was the small size of the baby box prevents Hospital, has been elected the first female recognised by a NHS England babies from rolling onto their tummies president of the Royal College of Innovation Challenge Prize in 2016 which experts think can contribute to Obstetricians and Gynaecologists as a means of delivering cost-effective sudden infant death syndrome. for 64 years. physiotherapy.

28 Imperial College Healthcare NHS Trust | Annual Review 2016/17 29 Our promise: Our promise: Our promise: Better health,Better forhealth, life for life R OBJECTIV Our objectives 2017-2019 OUR OBJECTIVES OBJECT Our objectives 2017-2019Our objectives 2017-2019 OU S OUR IVES 1. 2. 3. 4. 5. 1. 1. 2. 2. 3. 3. 4. Quality4. 5. 5. Strategy

Improving the way we Developing more person- Making the Trust a Improving the way we ImprovingDeveloping the way wemore person- DevelopingMaking more person- our care safer Making the Trust a MakingBuilding the Trust sustainability a run our hospitals centred approaches to care Making our care safer Making ourgreat care placesafer to work Building sustainability Building sustainability run our hospitals run ourcentred hospitals approaches to carecentred approaches to care great place to work great place to work

We will create care pathways with processes, ways We will work in partnership with our patients and We will build a culture where all our staff feel We will create a shared sense of belonging across We will continue to build an organisational culture ofWe working will create and care facilities pathways that consistently with processes, achieve Weways will create carepartnerWe pathwayswill work organisations inwith partnership processes, to create with ways sustainable our patients service Weand will work in partnershipsafetyWe will is build key, with area culture ableour patients to where ‘speak alland up’ our and staff understand feelWe will build a cultureourWe willorganisation, where create all a ourshared with staff staff sense feel feeling of belonging supported, acrossWe will create aandWe shared will strategy continue sense that of to belongingenable build usan toacrossorganisational deliver our promise, cultureWe will continue to build an organisational culture theof working best possible and facilities outcomes that andconsistently experiences achieve offor working and facilitiesandpartner organisational thatorganisations consistently models to createachieve that helpsustainable our population servicepartner organisationstheirsafety responsibilities; isto key, create are sustainable able andto ‘speak where service up’ patients and understand alsosafety feel is key, are valuedourable organisation, to and ‘speak fulfilled, up’ withand and staffunderstand make feeling a compelling supported, ‘offer’our organisation, effectivelyand with strategy staff and feelingthat sustainably. enable supported, us to deliver our promise,and strategy that enable us to deliver our promise, ourthe bestpatients possible and theiroutcomes families, and making experiences the most thefor ofbest possiblestayand outcomes organisationalas healthy and as experiences possible models andthat for ensurehelp our access populationand to theorganisational confidenttheir models responsibilities; to that raise help safety ourand populationconcernswhere patients and believe alsotheir feel they responsibilities; invalued terms and and ofwhere rewardfulfilled, patients and and recognition, alsomake feel a compelling wellbeing ‘offer’valued and and fulfilled,effectively and makeand sustainably.a compelling ‘offer’ effectively and sustainably. digitalour patients and other and newtheir technologies. families, making the mostour ofpatients andmoststay their as appropriate families, healthy makingas possiblecare thewhen mostand and ensure of where access it is needed.stay to the as healthy aswillconfident possible be addressed. to and raise ensure safety access concerns to the and believeconfident they to raisedevelopment.in termssafety ofconcerns reward and recognition,believe they wellbeingin and terms of reward and recognition, wellbeing and digital and other new technologies. digital and othermost new appropriatetechnologies. care when and where it is needed.most appropriatewill care be addressed. when and where it is needed. will be addressed.development. development. Key initiatives Key initiatives Key initiatives Key initiatives Key initiatives •Key *Outpatient initiatives improvement – including theKey initiatives•Key Hammersmith initiatives and Fulham integratedKey care initiatives •Key Safety initiatives culture – following research and Key initiatives•Key Embedding initiatives our values and behavioursKey – initiatives•Key Specialty initiatives review programme – a clinically-Key initiatives • establishment*Outpatient improvementof a patient service – including centre, the• *Outpatient• improvement–Hammersmith testing fully integrated– including and Fulham approaches the integrated to care• care inHammersmith • engagementSafety and Fulham culture with integrated – stafffollowing and careresearchpatients, andmaking • Safety culture• –promotingEmbedding following researchpositive our values behaviours and and behaviours and tackling• –poor Embedding • our ledSpecialty values approach and review to behaviours supporting programme –our specialties– a clinically-• Specialty review programme – a clinically- extendingestablishment digital of communicationsa patient service centre,and a major establishment ofcollaboration– atesting patient fully service integratedwith centre,other NHS,approaches local authority to care inand– testing fully integratedandengagement embedding approaches with improvements staff to andcare patients,in in core making areas engagementof withonespromoting staff through and positivepatients, support behaviours making and training and fortackling managers, poorpromoting positivetoled develop approachbehaviours unified to andsupporting andtackling sustainable ourpoor specialties clinical, led approach to supporting our specialties programmeextending digital of clinic communications refurbishments. and a majorextending digitallaycollaboration communications partners. with andother a majorNHS, local authority andcollaboration withpractice,and other embedding NHS,including local improvements how authority we report and in andcore learn areas from andof embedding improvementsactionones through on bullying support in core and areasviolence,and training of a greater for managers, focusones through supportworkforceto develop and andunified training financial andfor managers, sustainableplans. clinical, to develop unified and sustainable clinical, programme of clinic refurbishments. lay partners. incidentspractice, including in an open how and we fair report way. and learn from onaction equality on bullying and diversity and violence, and more a greater accessible focus workforce and financial plans. • *Improving patient flow – ensuring patientsprogramme of• clinic*Care refurbishments. information exchange – providing lay partners. practice, including how we report and learn from action on bullying• Corporate and violence, services a greater collaboration focus – identifyingworkforce and financial plans. incidents in an open and fair way. incidents in an opensenioron equality and leadership. fair and way. diversity and more accessibleon equality and diversity and more accessible • are*Improving cared for patientin the right flow place, – ensuring at the right patients• *Improving •patient patients*Care flow information and – ensuringtheir care exchange patients professionals – providing in north• *Care information• Critical exchange care reconfiguration – providing – improved • opportunitiesCorporate services for improvement collaboration and efficiency – identifying• Corporate services collaboration – identifying senior leadership. senior leadership. time,are cared by the for right in the healthcare right place, professional, at the right from are cared for in thewestpatients right London andplace, theirwith at thesecurecare right professionals online access in tonorth patients and •their co-ordinationCritical care professionals care reconfigurationof critical in carenorth across – improved our sites,• Critical care •reconfiguration One-stop workplaceCreating – improved portal a culture – improving of continuous improvementfromopportunities collaborative for improvement working, including and efficiency North opportunities for improvement and efficiency firsttime, contact,by the right through healthcare assessment, professional, diagnosis from time, by the righttheirwest healthcare Londonhealth records professional, with secure and the onlinefrom ability access to share to west London withincludingco-ordination secure bringingonline of criticalaccess together careto management across our sites, of all co-ordination •of staffOne-stopcritical experience care workplace acrossto increase by our replacing portalsites, and –our improving intranet sustain • withOne-stop the quality workplaceWestfrom of collaborativeLondonour portal services Pathology – improving working, and including roll out of North a joint from collaborative working, including North andfirst treatment, contact, through to ensuring assessment, a safe and diagnosis timely first contact, throughinformationtheir health assessment, recordssafely. diagnosis and the ability to share their health recordscriticallyincluding and ill thebringing patients ability together into dedicatedshare management areas by staffof allincluding bringingcombinedstaff together experience onlinemanagement accessby replacing toof allall ourour intranetbusiness withandstaff experienceelectronicWest by replacingLondon patient Pathology our record intranet and system withroll outwith of Chelsea a jointWest London Pathology and roll out of a joint discharge;and treatment, including to ensuring improvements a safe and in A&E,timely information safely. fullycritically trained ill patients in critical in dedicatedcare and organ areas support. by staff managementcombined onlinefor functions, ouraccess patients, includingto all our upgradedbusiness people and and stakeholdersandelectronic Westminster patient Hospitalrecord system NHS Foundation with Chelsea Trust. and treatment,• to*Way-finding ensuring a safe project and timely – implementing a Trust-information safely. critically ill patients in dedicated areas by staff combined online access to all our business and electronic patient record system with Chelsea assessmentdischarge; including and ambulatory improvements care facilities. in A&E, discharge; including improvements in A&E, fully trained in critical care and organ support.fully trained in criticalHRmanagement systems, care and an functions, organ internal support. socialincluding network upgraded and a management functions,and Westminster including Hospital upgraded NHS Foundation Trust.and Westminster Hospital NHS Foundation Trust. • wide*Way-finding approach toproject ensuring – implementing patients and a visitors Trust-• *Way-finding • Digitalproject programme– implementing – including a Trust- greater use of, • *St Mary’s Hospital redevelopment phase 1 assessment and ambulatory care facilities. assessment and ambulatory care facilities. comprehensiveHR systems, an internalresource social library. network and a HR systems, an internal social network and a • Waiting list improvement – ensuring the canwide navigate approach our to sites ensuring easily patients and feel and a sense visitors wideof approach• toandDigital ensuring easier programme access patients to, and electronic– including visitors patient greater records, use• Digitalof, programme – including greater use of, • –*St bringing Mary’s together Hospital the redevelopment majority of St Mary’s phase• *St 1 Mary’s Hospital redevelopment phase 1 comprehensive resource library. comprehensive resource library. • mostWaiting effective list improvement management –of ensuring our planned the• Waitingcare, list improvementwelcomecan navigate throughout –our ensuring sites their easily the journey. and feel a sense canof navigate ourautomatedand sites easier easily accessalerts and feel toto, identify electronica sense deteriorating of patient records, and easier access• Recruitment to, electronic and patient retention records, action plan – outpatient– bringing togetherand related the diagnosticmajority of services St Mary’s in – bringing together the majority of St Mary’s withmost a effective focus on bettermanagement processes of our and planned training care, to welcome throughout their journey. patientsautomated and alerts clinical to decision-makingidentify deteriorating support. • developingRecruitment our and ‘employer’s retention offer’, action promoting plan – it oneoutpatient modern and building, related reflecting diagnostic a servicesnew model in most effective• *Children’smanagement servicesof our planned – expanding care, and welcome throughout their journey. automated alerts to identify deteriorating • Recruitment and retention action plan – outpatient and related diagnostic services in improvewith a focus data on quality, better enhanced processes clinical and training reviewwith to a focus on better processes and training to patients and clinical decision-making support.patients and clinicalmoredeveloping decision-making effectively, our ‘employer’s internally support. offer’,and externally, promoting and developingit our ofone‘employer’s outpatient modern offer’, building,care. promoting reflecting it a new modelone modern building, reflecting a new model • refurbishing*Children’s ourservices paediatric – expanding intensive and care unit,• *Children’s services – expanding and andimprove more data responsive quality, enhancedcapacity planning. clinical review improve data quality, enhanced clinical review simplifyingmore effectively, our recruitment internally processes.and externally, andmore effectively,of internallyoutpatient and care. externally, and of outpatient care. plusrefurbishing a wider redesignour paediatric of our intensive care and care facilities unit,refurbishing our paediatric intensive care unit, and more responsive capacity planning. and more responsive capacity planning. simplifying our recruitment processes. simplifying our recruitment processes. forplus children. a wider redesign of our care and facilitiesplus a wider redesign of our care and facilities for children. for children. *Supported by *Supported by Our strategies *Supported by Our strategies Our strategies

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ensure that patients healthcare integrateddevelopment care closer of to increasecontinuous and improvement sustain quality, to efficientsavings andways moreof working recruiting,and developing engaging indata care to pathways,be shared enablesafely, re-developmentbuild on the St andMary’s new translationalopportunities research to align deliveryquality, ofresearch our clinical, and andactively our communities shape, and development of continuous improvement to savings and more recruiting, engaging in care pathways, enable re-development and new opportunities to align delivery of ourToquality clinical,develop private highand our communities To develop high integratedhome, the consolidationcare closer to increaseincluding and through sustain a quality,Trust- efficientso that we wayscan moveof working to andsufficient developing staff datahelp to empower be shared patients safely, andbuild Charing on the Cross St Mary’s sites, translationalacross our expanded research quality,workforce research strategies and canactively help shape, contribute and integrated care closer to increase and sustain quality, efficient ways of working and developing data to be shared safely, build on the St Mary’s translational research quality, researchpracticequality and on private all of our actively shape, and quality private ofhome, specialist the consolidation care on fewer wideincluding quality through improvement a Trust- soa sustainable that we can financial move to withsufficient the right staffskills tohelp take empower an active patients role in withand Western Charing EyeCross Hospital sites, academicacross our health expanded science workforceincluding strategiesthrough to,can every help aspect contribute of our home, the consolidation including through a Trust- so that we can move to sufficient staff help empower patients and Charing Cross sites, across our expanded workforcesites,practice strategies with on all all surplus of ourcan help contribute practice on all of our ofsites specialist where care it improves on fewer methodologywide quality improvement and using the position,a sustainable allowing financial us to withand the capabilities right skills totheir take care, an activeand support role in withrelocating Western Eyeto the Hospital St centreacademic partnership health science and to multi-professionalincluding through to,work, every including aspect asof ourlay of specialist care on fewer wide quality improvement a sustainable financial with the right skills to take an active role in with Western Eye Hospital academic health science includingsites,being through with reinvested all surplusto, to every aspect of our sites, with all surplus sitesoutcomes where and it improves safety, methodologyCare Quality Commission’s and using the position,invest sufficiently allowing us toin inand the capabilities right roles, populationtheir care, andhealth, support using Mary’srelocating site, and to athe smaller St implementcentre partnership our biomedical and to multi-professionalapproaches, new partners,work, including co-design as layand sites where it improves methodology and using the position, allowing us to and capabilities their care, and support relocating to the St centre partnership and to multi-professionalbeingimprove reinvested care andwork, to including as lay being reinvested to andoutcomes the advancement and safety, of Carequality Quality framework Commission’s – investthe development sufficiently in inresponding the right roles, to populationour Cerner health, electronic using Mary’sre-development site, and a onsmaller the researchimplement centre our programmebiomedical educationalapproaches, models new partners,research co-design participants, and outcomes and safety, Care Quality Commission’s invest sufficiently in in the right roles, population health, using Mary’s site, and a smaller implement our biomedical approaches,supportimprove new NHS care services. andpartners, co-design and improve care and andpersonalised the advancement medicine. of safe,quality effective, framework caring, – ofthe our development staff, services changingresponding needs to and patientour Cerner record electronic system as Hammersmithre-development and on Queen the researchin partnership centre programme with andeducational increased models use of researchvolunteers participants, and and the advancement of quality framework – the development responding to our Cerner electronic re-development on the research centre programme educationalsupport models NHS services.research participants, support NHS services. personalised medicine. responsivesafe, effective, andpersonalised well-led. caring, medicine.of ourand staff, estate.safe, services effective, changing caring,service needsmodels. andof our staff,patient servicesthe record foundation. systemchanging as needsHammersmithCharlotte’s and &patient Chelsea and Queen record site. systemin asImperial partnership Hammersmith College. with andtechnology Queenand increased for learning. inuse partnership of withvolunteersfundraisers. andand increased use of volunteers and responsive and well-led. and estate.responsive and well-led.service models. and estate.the foundation.service models.Charlotte’s & Chelseathe foundation. site. ImperialCharlotte’s College. & Chelseatechnology site. for learning.Imperial College.fundraisers.technology for learning. fundraisers.

Our values Our values 30 Our values 31 Kind Expert Collaborative Aspirational Kind ExpertKind CollaborativeExpert AspirationalCollaborative Aspirational Performance against the five domains of quality Performance against the five domains of quality Safe

Goal: To eliminate avoidable harm to patients in our care events occurred in 2016/17. We carried as shown through a reduction in the number of incidents out a major review and, as a result Our quality strategy is Safe Effective of this work, we are starting to see causing severe/major harm and extreme harm/death delivered through the To eliminate avoidable harm to To show continuous improvements in compliance with achievement of our patients in our care as shown improvement in national clinical the five steps to safer surgery. quality goals which through a reduction in the audits with no negative We reported 12 avoidable infections: ensure quality is our number of incidents causing outcomes. In 2015 we began to report ‘avoidable’ severe/major harm and incidences of MRSA blood stream number one priority. extreme harm/death. We want to ensure our We have reduced the number of infections (BSI) and Clostridium difficile Our goals are: infections. Although we did not meet patients are as safe as non-clinical transfers of patients between our hospitals out-of-hours and our target, we had a slight decrease possible while under our care have reported none which occurred in avoidable infections in 2016/17, and that they are protected without clinical agreement: The move reporting 12 compared to 13 the from avoidable harm. of acute medicine from Hammersmith previous year and with an overall Hospital to the Trust’s other main reduction in both infections. sites at Charing Cross and St Mary’s There are two key elements to Caring Responsive Well-led Safe quality highlights hospitals has supported a decrease reducing the risk of infections occurring in the number of inter-site transfers To provide our patients with the To consistently meet all national To increase the percentage of in hospital, which we will continue We remain below average for incidents out-of-hours occurring for capacity best possible experience by access standards. our staff who would recommend to work on into 2017/18: causing severe or extreme harm to reasons, with none occurring in increasing the percentage of this Trust to friends and family patients: We had fewer incidents December 2016. For the second year in • reducing the inappropriate use inpatients and A&E patients as a place to work or a place for which cause the most harm to patients a row, we have not reported any serious of anti-infectives (antibiotics) who would recommend our treatment on a year-by-year compared to other acute trusts this incidents where a non-clinical out-of- • improving hand hygiene – we Trust to friends and family if basis. year and have decreased the number hours transfer was a contributory factor. developed a new audit which will they needed care or treatment overall, with 28 reported in 2016/17 allow us to monitor and improve to 94 per cent. compared to 31 in 2015/16. We have achieved a 50 per cent reduction in the number of grade 3 and compliance for all of the five We increased our incident reporting 4 pressure ulcers since 2014: Although moments of hand hygiene. rate: An important measure of an we have not achieved our target of a We did not meet the VTE (Venous organisation’s safety culture is its 10 per cent decrease compared to thromboembolism) assessment target willingness to report incidents affecting Our quality improvement priorities 2015/16, we are proud that we have between December and March this patient safety, learn from them and for 2016/17 were defined in our quality reduced the occurrence of these types year: The risk of hospital acquired VTE deliver improved care. A high reporting account last year following consultation of pressure ulcer by nearly 50 per cent – blood clots in the vein - can be rate is viewed as evidence of a positive with our clinical and management teams, in three years and that we have not had reduced by assessing patients on reporting culture, as staff feel able and with our external stakeholders a grade four pressure ulcer – the most admission. In 2015/16, an internal audit to report incidents that occur. By the and patient representatives through serious kind – since March 2014. raised concerns about recording VTE end of the year, we had increased our quality steering group. assessments. We have been working our reporting rate to 49.09 per 1,000 throughout 2016/17 to ensure effective Progress with these goals and the bed days, which puts us in the top Safe quality challenges recording of this assessment. Once this targets which support them is described 25 per cent of reporters nationally. We reported four surgical related never is fully embedded, we expect a return here under each quality domain. We maintained safe staffing levels: events: Never events are defined as to reporting above target. Areas where we are proud of the Although our vacancy rates remain higher serious, largely preventable patient improvements we have made or than our target, we have ensured staffing safety incidents that should not occur sustained are outlined under ‘quality meets planned safe levels this year. if the available preventative measures highlights’. Areas where we have not The use of temporary workers is one of have been implemented. In 2015/16, performed as well as we would wish are the ways we have achieved this. Where we reported six never events related to summarised under ‘quality challenges’. shifts were not filled, staffing arrangements practice in surgery. Improvements were For full details, please see our quality were optimised and any risk to safe implemented in response, including account, which is published on care minimised by the senior nurses. training and audit programmes. our website. However, four more surgical never

32 Imperial College Healthcare NHS Trust | Annual Review 2016/17 33 Performance against the five domains of quality

Effective Caring

Goal: To show continuous improvement in national clinical against our goal. We will change Goal: To provide our patients with the best possible five years that the survey has audits with no negative outcomes our goal next year so that we are experience by increasing the percentage of inpatients and been running. able to measure our performance We have exceeded our target to more effectively. A&E patients who would recommend our Trust to friends and family if they needed care or treatment to 94 per cent respond to 90 per cent of complaints Our PROMs health gain was unable within the timeframe agreed with the to be measured for all procedures due patient: In 2015/16 we restructured to insufficient numbers of forms being the complaints service and process returned: Patient Reported Outcome following feedback to create a more The goal and targets in our remained low, with our Trust being Measures (PROMs) measure quality We know that treating our The percentage of our A&E patients responsive and caring service for our from the patient perspective and seek patients and identify learning for our effective domain are designed amongst the five lowest risk acute Trusts patients with compassion, who would recommend us is over our in the country throughout the year. to calculate the health gain experienced target and significantly above national staff. We have continued to build on to drive improvements to following four surgical procedures: kindness, dignity and average: Like many NHS trusts, we the improvements we made last year, Reviewing every death which occurs support good practice in surgery for groin hernia, varicose veins, respect has a positive effect continue to struggle to meet the focusing on analysing themes and in our hospitals enables us to learn hip replacement and knee replacement. national standard for A&E patients learning from complaints to enable us our services and ensure from any errors and pick up quickly on recovery and clinical We are working to ensure more waiting under four hours to be treated to direct quality improvement based the best possible outcomes on potential issues which could result outcomes. To improve their questionnaires are completed and discharged or admitted. Despite on what our patients are telling us. in harm to other patients. Of the for our patients. by patients to allow us to make experience in our hospitals, this, we are pleased that 95 per cent of 1,897 deaths which have so far improvements based on what we ensure that we listen to our patients would still recommend our been reviewed through our new our patients are telling us. A&E services, which we are continuing Caring quality challenges online system, five of them have been our patients, their families Effective quality highlights to work to improve. confirmed as avoidable deaths. These We have not achieved our target to and carers, and respond The percentage of outpatients who would recommend our Trust to friends Our mortality rates remain consistently have all been investigated as serious discharge at least 35 per cent of our to their feedback. Our results in the national cancer low and we have a system in place to incidents and the actions and learning patients on relevant ‘pathways’ before patient experience survey (NPES) show and family is below average and has review all deaths that occur in the Trust: have been shared across the Trust. noon: Untimely discharge has been significant improvement: Considerable dropped to 91 per cent from 94 per As part of our drive to deliver good identified as one of the most common work has been undertaken to improve cent the previous year: Although we Since December 2016, we have had a Caring quality highlights outcomes for our patients we closely reasons why A&E departments fill and the experience of patients with cancer, are disappointed that this percentage system in place to enable us to review monitor our mortality rates, using patients have long waits to be seen, We have exceeded our target for the most notably through our partnership has declined, we are confident that the cardiac arrests occurring outside our two indicators, HSMR (Hospital admitted or discharged. We have not percentage of our inpatients who would with Macmillan Cancer Support. Results changes we are making as part of our intensive care units and emergency Standardised Mortality Ratio) and met our target this year. This is partly recommend us to friends and family in 2016 demonstrate the positive impact outpatient improvement programme – departments: this is because when a SHMI (Summary Hospital-level due to patients being unable to be and have maintained our performance of that work – they are the best set of see page 15 – will significantly improve cardiac arrest happens outside these Mortality Indicator). Both of these have discharged as they are waiting for a in the national inpatient survey results that we have returned in the outpatient experience. two areas, it is often due to patients not bed at a care home. We are working published in July 2016, with results being monitored properly or staff failing with our partners in the community very similar to other acute NHS Trusts: to recognise and act on deterioration to solve this issue. 97 per cent of our inpatients said they in their condition. Any incidents where would recommend the Trust to friends We did not meet our target to ensure harm has been found are now able to and family. be properly investigated and learning that 90 per cent of clinical trials recruit shared. Since this process was their first patient within 70 days: Since For patients reporting a positive implemented, one case has been 2014, up until quarter one 2016/17, experience, interaction with staff is found to have resulted in harm. we have consistently reported above usually the most significant factor. 90 per cent against this target. However, When patients report a negative our results fell below target in quarter experience, the cause is usually due Effective quality challenges two 2016/17, reflecting changes to to ineffective systems and processes. the Health Research Authority (HRA) We continue to take steps to improve We have not been able to report approvals process for clinical trials. and to ensure that waiting and delays against our goal to show continuous The average approval times have are kept to a minimum and, where improvement in national clinical increased nationally as well as locally. they are unavoidable, patients are audits with no negative outcomes: We are identifying ways of shortening kept informed and the environment Unfortunately, as national clinical approval times so that we can meet and staff are as welcoming and audits report in different ways, we our target. supportive as possible. have struggled to measure performance

34 Imperial College Healthcare NHS Trust | Annual Review 2016/17 35 Performance against the five domains of quality

Responsive

Goal: To consistently meet all national access standards

Having responsive services we worked hard to minimise them being that are organised to meet cancelled on the day of surgery. We did deliver the 0.8 per cent target for three people’s needs is a key quarters of the year, but not in quarter factor in improving four where we delivered 0.9 per cent. experience and preventing We also increased our theatre capacity delays to treatment. To in key surgical specialties and through the new Riverside Theatres at Charing consistently meet national Cross hospital. For more, see page 17. standards, we will continue As a major centre for emergency care to review our processes to and trauma in London, we do have to ensure they are as efficient work to make sure that planned surgery as possible, while keeping is not impacted by the nature of our the needs of our patients emergency work. A project is underway for 2017/18 to ensure that planned surgery central. and care gets the priority it needs. We know we have much work to do to We have not met the standard for all tackle long-standing pressures around patients who have planned operations demand, capacity and patient flow cancelled for non-clinical reasons on to enable us to meet these targets. the day of surgery (or day of admission) to be offered another binding date within 28 days. A full review of this Responsive quality highlights is underway for 2017/18. We continue to deliver our outpatient We have not met the national four hour improvement programme and are A&E standard: Like many NHS trusts, seeing improvements as a result: We we continue to struggle to meet the 95 2016 and March 2017 compared to on minimising delays and improving our We have not improved our PLACE have reduced the amount of outpatient per cent standard for A&E patients to the national standard of 92 per cent. waiting list processes to ensure patients (Patient led assessment of the care clinics cancelled by the trust, reduced be treated and discharged or admitted are treated in a timely manner, we have environment) scores in all categories: the number of patients who do not We also reported 1,578 patients who within four hours, reporting 89.6 per implemented robust arrangements to We have improved our performance attend their outpatient appointments had waited over 52 weeks for treatment cent against this target in 2016/17. ensure that patients are not coming to in three of the areas measured by by improving our communications with throughout the year, with 475 in October Pressures on A&E are complex and clinical harm as a result of waiting too long. PLACE – cleanliness, food and them, and increased the number of reducing to 275 in March compared to include pressures on the entire urgent hydration, and condition, appearance appointments made within five working the national standard of zero. Our failure We have not consistently met all eight and emergency care system, with acute and maintenance – compared to our days of receipt of referral from 70.7 per to meet these standards is due to poor cancer standards: We met four out trusts, ambulance services, mental scores for 2015/16. However, in the cent in August to 78.9 per cent in March procedures for managing waiting lists of eight cancer standards in all four health and social services all reporting three other areas – privacy and dignity, 2017. For more on outpatients, see internally and to a mismatch of demand quarters this year. However we did not major challenges to delivery. dementia and disability – our results page 15. and capacity in some specialties. achieve the targets for the following We have an on-going programme of have deteriorated. A detailed action standards across every quarter: two improvements and interventions in In response we developed a waiting plan is underway with themes of week wait from urgent referral to first place to reduce waits, improve flow list improvement programme, which is flooring repairs, access such as seating Responsive quality challenges being seen; two week wait from referral and capacity and manage extra winter working closely with our commissioners and hand rails, and improved signage. We have not consistently met the for breast cancer to first being seen; demand. For more, see page 16. and NHSI, and is making good Dementia and disability requirements national standard for non-clinical and 62-day wait for first treatment from progress. For more, see page 16. are at the heart of the designs for on-the-day cancellations of surgery: We have not met the national urgent GP referral and from screening. our new outpatients departments, We experienced increased demand performance targets for referral to We recognise that extended delays will We have been working hard to stabilise A&E departments and strategy for emergency care in 2016/17 which treatment (RTT) within 18 weeks: negatively affect patients’ experience and improve performance and met all to improve our wayfinding. did contribute to the cancellation of a We reported 83.9 per cent of people of care and cause associated anxiety but two of the standards by quarter four. number of planned operations, although treated within 18 weeks between April and distress. While we are focusing

36 Imperial College Healthcare NHS Trust | Annual Review 2016/17 37 for 73 per cent of our programmes, which was an improvement of almost 50 per cent on the previous year. We are pleased that we have succeeded in slightly improving still further, with 76 per cent of students agreeing that ‘overall Well-led (they are) satisfied with their placement’ in 2016/17. • General Medical Council’s national training survey (GMC NTS): Our Goal: To increase the percentage of our staff who would results have improved significantly recommend this Trust to friends and family as a place with a reduction in red flags (where we are a significant national outlier) to work or a place for treatment on a year-by-year basis by 50 per cent. We have also more than doubled the number of green flags (where we are doing well) from 20 to 54, with three times as many programmes having green flags than in the previous survey. Evidence shows that staff staff voluntarily leaving the Trust this year from 10.6 per cent to 10.2 per cent. We re-ran our ward accreditation who are engaged and happy programme and saw improvements Our sickness absence rate remains in their jobs, respected and in 25 wards: Our programme of ward low: Low sickness absence is an given opportunities to learn, inspection carries out regular checks indicator of effective leadership and and instigates immediate improvement provide better care for their good people management. This year where necessary. Overall, out of 75 we have focused on embedding our patients. We have implemented areas reviewed across the Trust, 25 sickness absence policy, which was a number of improvements had improved since 2015/16. The launched last year, and on supporting to increase staff engagement Trust’s quality improvement team the health and wellbeing of our staff. is supporting projects on individual throughout the organisation Our Occupational Health service wards to help address their key issues. and to help us to deliver provides a range of activities and our annual targets. services, including staff counselling, stress management services, yoga and Well-led quality challenges meditation classes, weight management We have not increased the percentage programmes, smoking cessation clinics Well-led quality highlights of staff who have had a performance and rapid access physiotherapy. We have achieved our goal to increase development review (PDR): Our the percentage of staff who would We have increased the percentage of appraisal scheme for staff is aimed recommend our Trust as a place to our doctors who have had an appraisal: at driving a new performance culture work and as a place for treatment: Although we are still slightly behind our across the Trust. Although we are below We monitor staff engagement through target of 95 per cent, we are pleased target and slightly below last year’s the national staff survey and through that our appraisal rates for doctors result, our rate remains high at 86.2 per our annual internal survey Our Voice, are now above national average. cent with over 7,200 staff completing their PDR. We will continue to embed Our Trust which was run between We have significantly improved our and improve the process in 2017/18. July and September 2016. We were results in the General Medical Council’s very pleased to see a significant National Training Survey of junior doctors We have not achieved our target of 90 improvement in the scores for both and have maintained our performance per cent of staff being compliant with core of these; they are our best results for placement satisfaction for all skills training, with 85.6 per cent of our for these two questions since the medical student placements: As one staff fully trained by the end of March staff survey was introduced in 2013. of London’s largest teaching hospitals, 2017: Our core skills training programme We have slightly decreased our voluntary we want to provide the best training for ensures the safety and well-being of all turnover rate: A key aspect of reducing our doctors, as we believe this is a key our staff and patients and we continue the voluntary turnover rate (the number element of being a ‘well-led’ organisation. to target areas where compliance is of staff who choose to leave and work We launched a comprehensive education particularly low. We are reviewing all elsewhere) is to ensure staff have the transformation programme in 2015 mandatory training modules to streamline opportunity for career progression, feel and have seen improvements in the and improve them. their job is worthwhile and fulfilling, and satisfaction of our trainee doctors and they are supported to develop. Although medical students as shown through: we have not met our target, we are pleased • Student Online Evaluation (SOLE): that we have seen a slight decrease in In 2015/16, we achieved this target

38 Imperial College Healthcare NHS Trust | Annual Review 2016/17 39 Sustainability report

Sustainability means in engaging them in supporting our spending public money well, an eiin ene ue future energy reduction plans. When the systems integration is complete, the smart and efficient use e the reporting interface will display 2 of natural resources and costs, consumption and emissions building healthy, resilient data at main entrances and employee communities. workstations. an The combined heat and power system, We are developing a sustainable now operating for extended hours, development management plan. has led to additional electricity export The aims will include the following: as il Coal lectricit ree electricit income and heat savings. • minimising our carbon footprint We have installed LED lighting and, • reducing our energy usage and across the board to achieve both cost Reducing our energy usage through a continuous review of the 2 increase our proportion of green and carbon (CO e) reductions. We and increase our proportion building management system, adjusted energy have improved our advanced buying of green energy temperature set points and system allowance, from the carbon reduction operating times to ensure improved • ensuring water efficiency commitment energy efficiency scheme, Whilst, with a spend of £9,345,463 on energy efficiency. • encouraging sustainable transport saving £32,000 on our carbon tax energy in 2016/17, costs continue to During the year we also saw benefits payments. Two of our sites, rise (a 1.1 per cent increase in spend • ensuring procurement that is sustainable arising from a number of projects Hammersmith and Charing Cross from 2015/16), the Trust achieved both environmentally and socially which have reduced overall electricity hospitals, are no longer required to be a small reduction of 2.9 per cent in consumption, reduced gas consumption • improving our preparations for in the carbon reduction commitment energy used over the same period. by eight per cent and also reduced adverse climate impacts. energy efficiency scheme; this will On-going energy saving initiatives water consumption (with a total give a net reduction in our carbon and favourable climate conditions The plan will show how we consider reduction of 13 per cent from 2012/13). tax liability of almost £2 million have enabled this reduction despite the social and environmental impacts over the next five years. increases in clinical activity. However, The Trust is now planning to connect to ensure that the legal requirements the age of much of our estate, its combined heating and power plant in the Public Services (Social Value) We recognise that there is more to particularly on the St Mary’s, to the UK Power Network, benefitting Act (2012) are met. The Trust currently be done to reduce the impact of Trust Hammersmith and Western Eye sites, the Trust both environmentally and has 294,304m2 of floor space. activities on the environment. During makes it very difficult to reduce energy financially. This will help the Trust to 2017/18, we plan to reinvigorate and consumption. The breakdown overleaf significantly reduce its carbon emissions revive our plans with reference to also demonstrates that the Trust as well as to save on pass-through Minimising our carbon footprint the NHS Sustainability Development has yet to procure green energy as, costs on our utility bills i.e. transmission Unit guidance. We acknowledge the responsibility at present, this is cost prohibitive. and distribution charges. to our patients, local communities and Our application for a flue gas heat Work continues to review the the environment by working hard to recovery project at Charing Cross mechanical and electrical infrastructure minimise our carbon footprint. As an Hospital has received funding approval Ensuring water efficiency across all sites to assess both current NHS Trust, it is our duty to contribute in the form of an interest-free loan, and and future needs. This work focuses on The Trust has been working on water towards the national aim of reducing will be completed in 2017/18. This will the development and implementation efficiency measures for the past five the carbon footprint of the NHS, public help the Trust to achieve a reduction of of an automated meter reading system, years. Significant progress has been health and social care system by the 1,738 tonnes per annum in emissions and improved integration with the made on reducing water consumption equivalent of 28 per cent by 2020, at Charing Cross. The Trust is also building management system and waste through a variety of initiatives. (from the footprint created in 2013). planning to make a subsequent energy monitoring, as well as targeting Unfortunately, water consumption has It is our aim to go beyond this target application to upgrade burners and and reporting systems. This will provide increased this year, partly due to and, thus far, against our own stretch controls for boilers at Hammersmith improved ‘real time data’, and an Thames Water identifying a meter that target, emissions in 2016/17 are down Hospital, draught proofing at Charing improved speed and quality of plant they had not previously billed against, 18 per cent compared with 2010. Cross Hospital, as well as carry out performance and energy consumption some infrastructure leaks and the loss lighting upgrades across all sites. Every action counts, and we are a lean data. The data will be visible to staff, of the borehole service at Hammersmith organisation trying to realise efficiencies patients and visitors and this will assist Hospital for a significant period of time.

40 Imperial College Healthcare NHS Trust | Annual Review 2016/17 41 Sustainability report

Resource 2013/14 2014/15 2015/16 2016/17 Trust has ensured that both current Annual report and projected environmental Gas Use (MWh) 85,332 82,453 86,702 82,617 conditions are addressed in the tCO2e 18,102 17,299 18,145 17,266 To view our full annual report including our accountability report and estates redevelopment programme Oil Use (MWh) 553 2,834 2,843 1,495 financial statements please go to the publications page on our website: approved by the Trust board. tCO2e 177 907 908 474 www.imperial.nhs.uk/about-us/who-we-are/publications Electricity Use (MWh) 52,617 54,034 53,444 54,749 We have developed and implemented a number of policies and protocols in tCO2e 27,809 31,669 28,898 27,105 partnership with our site partners and Coal Use (MWh) 0 0 0 0 other local agencies to mitigate the 2 tCO e 0 0 0 0 impact of these changes including heat Green electricity Use (MWh) 0 0 0 0 wave and business continuity plans. tCO2e 0 0 0 0 Total energy CO2e 46,088 49,874 47,951 44,845 Total energy spend £8,835,331 £8,916,631 £9,012,756 £9,345,463

Water 2013/14 2014/15 2015/16 2016/17 Mains m3 446,440 408,319 428,001 493,895 tCO2e 407 372 390 450 Water & sewage spend £630,451 £640,411 746,213 940,393

Category 2013/14 2014/15 2015/16 2016/17 Patient and miles 1,597,675 1,801,377 1,741,784 1,608,420 visitor travel tCO2e 590.30 661.88 629.89 581.30

The Trust’s non-emergency patient reporting and analysis of the carbon transport service undertakes about impact of the various procurement streams. 325,000 journeys per annum. Recent The Trust purchases all furniture via the changes to the vehicle fleet have Crown commercial services framework, introduced more appropriate vehicles which is Forestry Commission certified. to improve service quality and also It also purchases most paper and deliver lower vehicle emissions. stationery from the ‘premier elements earth’ range, which has a high post- consumer waste content. We recycle medical equipment that is decommissioned through auctions and reinvest these funds in new medical equipment.

Ensuring procurement that is The Trust is considering the use of the sustainable both environmentally good corporate citizenship (GCC) tool to help promote social sustainability and socially awareness in 2017/18. The Trust uses the approved Department of Health terms and conditions for procurement, which contain sustainability Improving our preparations clauses, and regularly review our for adverse climate impacts compliance against these. We use the Events such as heat waves, cold snaps NHS e-class procurement system and and flooding are expected to increase will be looking to implement improved as a result of climate change, and the

42 Imperial College Healthcare NHS Trust | Annual Review 2016/17 Quality Strategy

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