NHS Improvement: Highlights 2017/18
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NHS Improvement: 2017/18 highlights collaboration trust respect innovation Annualcourage report 2017/18compassion highlights | 1 We support providers to give patients safe, high quality, compassionate care within local health systems that are financially sustainable. Annual report 2017/18 highlights | 2 Introduction NHS Improvement is “ The NHS is a dynamic “ The NHS faced continued responsible for overseeing institution that has constantly pressure from rising demand NHS foundation trusts, NHS evolved over the last 70 years. for its services in 2017/18, but trusts and independent If we continue to face the its staff met the challenge with providers. We offer the challenges the way the NHS’s dedication and resilience. The support these providers original founders did, we will proportion of trusts that the need to give patients succeed. NHS Improvement Care Quality Commission rated consistently safe, high quality, has a crucial part to perform as ‘good’ rose from 39% compassionate care within in this.” to 45%.” local health systems that are financially sustainable. By holding providers to account and, where necessary, intervening, we help the Baroness Dido Harding Ian Dalton NHS to meet its short-term Chair Chief Executive challenges and secure its future. Annual report 2017/18 highlights | 3 This short report gives you an insight into what we have done The Single Oversight in 2017/18 towards achieving our 2020 objectives. Framework, introduced in It is organised around some of our main work programmes: 2016, identifies how we can quality improvement; financial control and turnaround; help trusts improve patient operational performance; provider productivity; strategic services. It is designed to change; workforce, leadership and improvement. Each is increase the number of equally important, and all are interconnected. trusts achieving ‘good’ or ‘outstanding’ Care Quality Read our full Annual report and accounts 2017/18 Commission (CQC) ratings, and is closely aligned with CQC’s approach. We With NHS England we published updated NHS planning guidance assign trusts to one of four in February 2018. This explained how the extra £1.6 billion revenue ‘segments’ depending on the funding for the NHS in the November 2017 Budget and the level of support they need. additional £540 million from the Department of Health and Social We updated the framework Care for core frontline services would be distributed. It reinforced in November 2017 based on our intention to move further towards system working through feedback and lessons from its sustainability and transformation partnerships in 2018/19. first year of operation. Annual report 2017/18 highlights | 4 Quality improvement With help from nine trusts, months, one ward had reduced We define quality in the NHS we created a national mental falls by 30%, while another in terms of patient safety, health improvement model. went 20 days without a fall; clinical effectiveness and We involved people who use previously it had only managed patient experience. Quality services, their families and six days. improvement and particularly carers throughout. the improvement of patient Our criteria-led discharge safety become ever more We set up a support team improvement collaborative important when pressure in with NHS England to help involved 13 trusts tackling delays the system increases as the local health systems eliminate in discharging patients who are NHS responds to growing inappropriate out-of-area well enough to leave hospital. demand. We provide clinical placements for acute mental Our national Stop the Pressure and managerial leadership health inpatient care by programme aims to eliminate and improvement expertise April 2021. avoidable pressure ulcers: 172 to support trusts’ care quality, We completed our falls trusts submitted improvement including patient safety. Much improvement collaborative plans to eliminate pressure ulcers. of what we achieve can only begun in early 2017, which be done in partnership with encouraged 19 trusts to reduce others. fall rates by 5%. After two Annual report 2017/18 highlights | 5 Focusing on patient National maternal and • The percentage of trusts experience neonatal health safety rated ‘good’ by CQC rose collaborative from 39.1% to 44.8%, Our Board agreed a statement and the percentage rated of intent to embed the patient, Every maternity unit in England ‘outstanding’ rose from public and carer voice in our is taking part in our three-year 6.0% to 6.5%. work. We co-designed and collaborative, launched last commissioned a learning year, to reduce maternal deaths, • A total of 20 trusts network for heads of patient stillbirths and neonatal deaths improved from ‘inadequate’ experience, which 153 trusts and brain injuries by 20% by or ‘requires improvement’ joined. And we provided 2020 and 50% by 2030. to ‘good’ or ‘outstanding’, bespoke leadership development Trusts in the first wave against our own target focused on patient experience developed 176 improvement of 17. to 18 trusts. projects in areas such as smoke- • We published the first of free pregnancies, stabilising our patient safety review the very pre-term infant, and and response reports, six- recognising and managing monthly summaries of how deterioration in mother or baby. we reviewed and responded Learning will be shared through to issues reported to us. local learning systems that support local maternity systems. Annual report 2017/18 highlights | 6 Financial control and turnaround We introduced Use of The ongoing cost of private We are committed to Resources assessments finance initiative (PFI) schemes restoring trusts to financial in autumn 2017. They are is significant for many trusts. balance and improving designed to help providers, We therefore set up a working their use of resources national bodies and the public group to help ensure the NHS while delivering continuous understand how effectively gets the best possible value improvements in the quality trusts are using their resources. from PFI deals – for example, of patient care, as well as We developed them with CQC, by improving the way trusts securing long-term clinical which will combine our ratings manage PFI contracts. And we and financial sustainability. with its own in an overall trust- carried out a survey of how level quality rating. trusts manage these contracts. Spending on agency staff has continued to decrease since we introduced controls, falling by a third since 2015/16. Trusts spent £90 million less than planned in 2017/18 and £520 million less than last year. Annual report 2017/18 highlights | 7 Financial Improvement Programme We closely track trusts’ performance to help them Eighteen trusts volunteered for Wave 2 of our Financial address financial and Improvement Programme, which matches ambitious management operational issues. teams with external experts to enhance cost improvement programmes. It focuses on transferring skills and expertise to trust • 212 out of 234 trusts staff. Wave 2 built on the learning from Wave 1. accepted their financial control totals; almost 64% either met or exceeded them. Patient-level costing • Trusts closed the year with We made excellent progress towards the NHS being able to a deficit of £960 million, calculate precisely the cost of care for every single patient – not compared to £791 million in only drugs, tests and appliances but the time doctors and nurses 2016 /17. devote to their care and treatment. In 2017, 70 acute, mental health and ambulance trusts implemented patient-level costing • Despite this, the year-end and sent us data on £21 billion of costs. After consultation, we financial position represents decided that all acute trusts should record the costs of their continued progress by activity at a patient level from 2018/19. the trust sector towards financial sustainability. Annual report 2017/18 highlights | 8 Operational performance Throughout the year, the NHS To increase the use of criteria- Our aim is that NHS providers experienced rising demand and led discharge, our nursing maintain and improve high levels of bed occupancy. directorate published evidence- performance against the We therefore made planning based principles and ran standards in the NHS for winter – when these trends collaboratives involving 3,000 Constitution. We support reach a peak – a priority. For the patients, gaining international them to do so, to cope first time, formal winter planning interest. with increased demand – began in July. for instance, during winter Our emergency flow months – and to have In the 12 months to February improvement tool helps sustainable strategies to 2018, numbers attending trusts identify bottlenecks and maintain their performance. accident and emergency stress points. Since its launch in departments increased by September 2017, over 500 staff 1.8% and emergency hospital from 122 acute hospitals have admissions by 3.7%. The NHS used the tool. treated 160,000 more A&E patients within four hours over the winter compared to the previous year. Annual report 2017/18 highlights | 9 Using technology to increase At the first pilot site, The Royal We took part in the national bed capacity Wolverhampton NHS Trust: response to several major incidents: A key part of our role is to help • patients were three times more trusts develop new ways of likely to be allocated to an • We advised trusts on action working to improve care and appropriate ward to combat the WannaCry meet demand. ransomware cyberattack. • operations cancelled due to Five trusts are piloting patient bed unavailability reduced by • After the Grenfell Tower flow system technology, which 60% fire, we ensured all trusts enables hospital staff to see real- identified any risks to time data on available beds so • length of stay fell by 11%. their buildings and took they can allocate patients to the necessary action. most appropriate ward first time. • When Carillion declared They can also locate equipment insolvency, we had already and housekeeping or portering drawn up plans to maintain staff available to clean a bed or patient services without transport a patient. interruption at the 14 trusts affected.