SUMMARY REPORT ABM University Health Board Quality & Safety Committee Date: 19 June 2014 Agenda item : 2.3 Subject Update on Dignity and Care of Older People within the acute hospitals of ABMU Health Board Prepared by Deborah Thomas, Strategic Nursing Lead, Trusted to care Taskforce Approved & Christine Williams, Acting Director of Nursing Presented by Andy Phillips, Director of Therapies and Health Science Purpose To update the Quality and Safety Committee on progress made on Decision the implementation of the Older Persons action plan incorporating Approval key recommendations of the Andrews Report „Trusted to Care’. In Information addition to update the committee on future reporting arrangements of the action plan. Other Corporate Objectives Safety Quality Efficiency Workforce Health Governance Executive Summary Significant improvements in the care of older people are urgently being taken forward following publication of the „Trusted to Care‟ report from Professor June Andrews. Key Recommendations Discuss the challenges in improving care of older people in these key areas. Note that the „Trusted to Care‟ report from Professor June Andrews has made recommendations to further improve the care of older people in a number of key areas. Note that reporting arrangements for the above will be directly to Health Board. Assurance Framework Healthcare Standard 10 Dignity and Respect. Next Steps To support the Taskforce in driving forward the recommendations from within the Andrews Report. 1 MAIN REPORT ABM University Health Board Quality & Safety Committee Date Agenda item: XX Subject Update on Dignity and Care of Older People in ABMU Health Board Prepared by Deborah Thomas, Strategic Nursing Lead, Trusted to Care Taskforce Approved & Christine Williams, Acting Director of Nursing Presented by Andy Phillips, Director of Therapies and Health Science 1. SITUATION In April 2011, Ruth Marks, then Older People‟s Commissioner set out 12 recommendations for the improvement of Dignity and Care of Older People in Hospital in Wales. Of the 12 recommendations made in the report, the assessment was that care of people with dementia, collecting and acting on patient experience and continence care required the most significant improvement. ABMU Health Board set out a detailed action plan to deliver these recommendations. Subsequently, in 2013, in response to a series of concerns, the Minister Mark Drakeford commissioned an independent review of care in Neath Port Talbot and the Princess of Wales Hospitals. Professor June Andrews undertook the review between December 2013 and April 2014 and the report Trusted to Care was published in May 2014. In her review Professor Andrews made a further 14 recommendations for ABMU Health Board and 4 for Welsh Government in relation to the care delivered within the 2 hospital settings. The 3 areas for improvement identified by Ruth Marks were also identified within Trusted to Care. Despite making progress, it is evident that insufficient progress has been made in these areas and that they require immediate and urgent attention across all our hospital sites to ensure that the frail elderly within our hospitals receive consistently excellent care. Because of the urgency and importance of the implementation of the recommendations of the Andrews Report, Trusted to Care, the Health Board has put in place a Taskforce of experienced staff from several disciplines to take forward improvements with urgency and pace and act rapidly on the reports‟ recommendations across the whole Health Board. An action plan has been developed and its implementation will be overseen by a Trusted to Care Steering Group, chaired by the Chief Executive. The Steering Group will need to ensure that appropriate action is taken to give assurance to the Board, our patients and their families, our citizens and Welsh Government that all the recommendations of the Andrews Report are being implemented effectively and with appropriate pace. The Older Persons Action Plan will be incorporated into the overarching Trusted to Care Action Plan and future reporting arrangements will be directly to Board. 2 2. BACKGROUND The Commissioner‟s Review in 2011 focused on hospital inpatient care because of the strength of concerns expressed about the impact on older people of a poor hospital experience. In response, ABMU Health Board established a multi-professional and multi-organisational Older Persons Steering Group. An action plan was developed and approved by the Board in September 2011 and updates against the detailed action plan were subsequently considered by the Board on a number of occasions. In addition, we have set out specific plans for improvement of care of people with dementia, continence care and care for people at the end of life, and these are detailed within the Health Boards Integrated Medium Term Plan (IMTP). Some of the key outcomes to date achieved as a result of the older persons action plan include: . The development of a Dementia Care Pathway that is currently being piloted. The Butterfly Scheme has been rolled out across acute hospital wards, but has variable implementation and needs to be used routinely. Booklets such as the Alzheimer Society „This is Me‟ are increasingly used to provide Healthcare staff with information about the lives, personality, families, likes and dislikes. Dementia Champions have been identified for all ward areas in 2013 with a plan to ensure all have completed a five day training program by the end of 2014. The e-learning module developed within the Health Board will be used to provide all Health Board staff with basic understanding of caring for people with Dementia. A policy framework for continence care has been developed and training events are regularly held. A standardized referral process into the continence service across the organisation have been developed and implemented . An outline of the responsibilities for the role of link nurses and champions has been developed and circulated. There is a Health Board intranet page dedicated to continence and is utilized as a resource for staff to access the most up to date information. The establishment of a clinically led combined Patient Experience Improvement Team (PEIT). Future plans/outcomes include: . The introduction of a Health Board wide Patient Experience Barometer utilising the Friends and Family Test. Pilot in one Hospital a Patient Advisory Liaison Service. Develop a better equipped and resourced PEIT and Investigations and Redress Department which efficiently and effectively investigates and manages cases in a way that is focussed on the individual and ensures timely learning. 3 . Develop an integrated web based reporting system for POVA, complaints, claims, and incidents that is integrated with Myrddin. Create a comprehensive and effective Patient Experience Feedback Section on the home page of the Health Boards intranet site. End of life care needs and preferences are identified and communicated effectively, where this is wanted by patients and their families. The care received by people approaching the end of life matches their needs and preferences. 3. ASSESSMENT The Professor Andrews‟ report ‘Trusted to Care’ found that some of the poor professional practice which was evident in the past is still happening on some of the wards of the Princess of Wales and Neath Port Talbot Hospitals today. The report states that “this is unacceptable and requires immediate concerted action, in addition to the required longer-term cultural and behavioural change. It is important to make it clear that these concerns are not of a scale to warrant action being taken by the Minister in respect of the current leadership of the Board”. It also states that “There are examples of exemplary practice throughout both hospitals.” When issues were identified at the Princess of Wales Hospital in March 2013 immediate action was taken. These actions resulted in an improvement in mortality rates, a reduction in hospital acquired infections and pressure ulcer rates and there was 95% positive feedback via the Friends and Family Test (ward-based feedback system). The Health Board has restated its commitment to urgently replacing any remaining pockets of poor care with consistently excellent care. In May 2014, Mark Drakeford, Minister for Health & Social Services wrote to all Chairs and Chief Executives of Health Boards and NHS Trusts in Wales to highlight the publication of the Andrews Report “Trusted to Care”. The Minister wrote “the review team‟s findings and observations will be for everyone in the NHS. I am determined that nothing of this sort will be tolerated in any hospitals, any Health Board or Trust in NHS Wales in the future”. The Minister gave each organisation a four week period ending 11th June 2014 to absorb the findings of the report and satisfy themselves that such departures from basic professional standards are not present in their organisations. In the immediate weeks after this, all district general hospitals will be visited, unannounced by a team of senior individuals to undertake a series of “spot checks” in the following four areas of care: . In giving patients their medication; . In ensuring that patients are kept hydrated; . In the overuse of night-time sedation; . In basic continence care. In preparation for this, unannounced spot checks are being undertaken across ABMU hospitals by the Heads of Nursing and Corporate nursing team during the out of hours periods. 4 Feedback proformas have been developed and the Heads of Nursing have been tasked with ensuring these are acted upon. Themes identified from the unannounced spot checks to date include: . Staffing levels in some areas need urgent attention, evidence includes some wards still settling down at 1.00 am . The majority of staff are aware of the Andrews Report and of its findings, not all had read the entirety of the report, a few were not aware of the report. The majority of staff have been welcoming, positive and enthusiastic with good patient interaction observed. Some imbalance in ward staffing was observed with no shared staffing arrangements in place when particular areas were busy.