Incorporating community services in Exeter, East and Mid Devon Compassion Excellence Annual Report Integrity Diversity Support 2012/13 Northern Devon Healthcare NHS Trust Contents Introduction ............................................. 3 Patient safety ......................................... 21 What we do .............................................. 5 NHS Safety Thermometer............................................22 North Devon District Hospital, Barnstaple ..........5 Hourly RU OK? checks provide extra reassurance for hospital patients..........................................................22 Community hospitals and resource centres ........6 Reducing falls.............................................................. 23 Community teams ..............................................7 Matron walkrounds......................................................23 Specialist community services ............................7 Reducing pressure ulcers for patients in our care, in Foundation Trust update.....................................8 hospital or at home.................................................... .24 Quality .....................................................9 MRSA..........................................................................24 End-of-year performance dashboard ................ 11 C. Difficile infection.................................................... .24 TV and rugby star opens new children’s unit Reducing the number of infections after surgery..........24 at NDDH ...........................................................12 Inspection by the Care Quality Commission................ 25 Sidmouth Hospital set for £1.2million refurbishment ..................................................12 Seaton Home Nursing Team wins Patient experience .................................. 26 Healthcare Hero Awards ................................... 13 ‘You said, we did’ ..............................................28 Clinical effectiveness................................ 14 Trust launches Friends and Family Test .............29 Trust plays a leading role in the newly-formed Trust’s ‘mystery shoppers’ give feedback on Academic Health Science Network....................14 services ............................................................30 Mortality rates.................................................. 15 Improving the experience of patients with Supporting good communication skills across dementia .........................................................30 integrated services............................................16 Rapid assessment at home launched in Exeter Shorter recovery time for patients through area .................................................................. 31 enhanced recovery programme.........................17 Barnstaple Leg Club offers vital support Innovative ‘telehealth’ support system for people for patients .......................................................32 with Chronic Obstructive Pulmonary Disease....17 Hospital at Home scheme in East Devon Audit Commission report rates Trust as one of ‘fantastic’ ..........................................................32 best in country for day case surgery...................18 Nurse-led service for deep vein thrombosis Reduced waiting times for eye patients..............19 improves patient experience............................. 33 Improved approach to wound care.................... 19 Complaints ....................................................... 33 East Devon dementia service scoops national Operating and Financial Review ............... 40 innovation award.......................... .................... 19 Annual Governance Statement ................ 55 Pathfinder – right care, right time, right place ..20 Remuneration Report .............................. 77 Head of Internal Audit Opinion ................. 80 Accounts 2012/13 .................................... 89 2 Annual Report 2012/13 Introduction Welcome to our annual report for 2012/13, which sets out progress in our continuing drive to improve care for the people we serve. Over the last 12 months, we have completed a systematic review of our governance arrangements. This is to ensure that we can demonstrate to the taxpayers, our regulators and our patients that we operate effectively, understand our risks and deliver high-quality care. This review was commissioned both in response to the Francis report into failings at Mid Staffordshire NHS Foundation Trust and as part of our own NHS Foundation Trust application. Where our systems were strong, they are now stronger. Where there were gaps, we have addressed them. The Board receives a tremendous amount of data about its services, which allows us to maintain a keen oversight of the quality of care being delivered to patients. Care Quality Commission inspection reports, complaints, Patient-Led Assessments of Clinical Environments (PLACE), the patient safety walkabouts, the real-time patient experience data and our own staff feedback are all used to assess the quality of services. We ensure as much data, decision-making and feedback as possible is reported publicly, taking to heart the duty of candour that was a recommendation from the Francis report. You will see examples of this in most of our corporate materials, from the ‘being open’ priority of the Quality Account, to the steadily-increasing amount of data being reported monthly on our website. Taking meaning from the data has been another key priority of ours as we set the clinical and the performance data against what we know from patient and staff feedback through complaints and incident forms.Through this triangulation we have been able to expose areas of concern that needed immediate attention, and are proud that this ensures the Board can listen to the front line. We are frequently tested on the quality of our services and you will read how well we responded to these tests throughout this annual report. Over the last year, we had a big drive on patient documentation and clinical supervision, to reinforce their importance as fundamental to high-quality care. You will read about our achievements in controlling infections within our hospitals – both MRSA and Clostridium Difficile. You will also read that NDDH was ranked 11th in the country in terms of meeting the standards of care that most mattered to patients (see page 11). We also worked with our partners and commissioners to trial new models of healthcare in our communities that see us leading the way in integrating care and fulfilling our vision of supporting people to live independently in their own homes. All of this would not have been possible without the dedication and determination of our staff. Nothing typified the demands that are placed on our NHS staff more than our experiences over the 0122 winter. Staff pulled out all the stops to ensure continuity of care for patients during periods of unprecedented demand. We know from the letters we receive every week from patients, their friends and families, that we speak for many when we express our gratitude to our NHS staff for their hard work and compassion. 3 Northern Devon Healthcare NHS Trust Looking forward to the coming year, we, along with all other NHS organisations, face the challenge of transforming services to ensure that we are ready to meet the changing demographics of our population whilst dealing with very constrained budgets. This will require the redesign of many services across northern and eastern Devon, and will involve many of our local communities to work in partnership and as critical friends with us as we consider how best to provide services which are sustainable, as well as providing equity of access and value for money. We are also looking forward to working with our primary commissioners, Devon County Council and Northern, Eastern and Western Devon Clinical Commissioning Group, to develop and implement our shared vision for the future pattern and provision of community services across northern and eastern Devon. We commit to sharing our ideas as they evolve, so you, as part of the community we serve, can play a full part in helping to shape local NHS care for the future. Roger French Jac Kelly Chair Chief Executive 4 Annual Report 2012/13 What we do Northern Devon Healthcare NHS Trust operates Integration - a ‘joined up’ approach – is essential across 1,300 square miles, providing care for people to this way of working. The Trust was one of the from Axminster to Bude and from Exmouth to first in England to integrate acute and community Lynton. healthcare services, in 2006, adding adult community health and social care services in 2008. The Trust offers both acute services, centred on North Devon District Hospital (NDDH), and At that stage, the Trust covered only northern community services, which span a network of 17 Devon. However, the success at integrating care community hospitals and nine clusters, across laid the groundwork for the transfer to the Trust of Torridge, North Devon, East Devon, Exeter, Mid an additional 12 community hospitals and complex Devon, Teignbridge and West Devon. care teams, and all of the pan-Devon specialist community services, in April 2011. At any one time, the Trust supports 6,000 patients in their own homes and 600 people in hospital beds. It employs more than 4,300 staff and serves a population of around 484,000, with a budget of £209 million. From its headquarters in Barnstaple, the Trust is responsible for the management of, and services provided from, the following bases: North Devon