Annual review 2013 14

Lancashire Teaching Hospitals NHS Foundation Trust

Lancashire Teaching Hospitals NHS Foundation Trust

Chorley and South Ribble Hospital Preston Road Chorley PR7 1PP

01257 261222

Royal Preston Hospital Sharoe Green Lane Fulwood Preston PR2 9HT

01772 716565

Annual Review 2013-2014 Excellent care with compassion

www.lancsteachinghospitals.nhs.uk

@LancsHospitals

15 number of miles walked by our porters every day for our patients

5,000



number of meals per day served by our catering teams

390,000 - the local population we serve 100% pass rate achieved by our medical students for the fifth consecutive year

150,000 how many square metres of hospital our domestic assistants clean each day

Annual Review 2013-2014

90,000 surgical procedures performed every year

13,000 mail items processed by our post room every day

200 number of research studies we are involved in each year

61.7% 4,000 our response rate for the 2013 staff survey, compared with a national average of 46.9%

calls handled by our switchboards each day

813,000 number of patient contacts per year

Contents • A Clean Bill of Health.......................... 4

• Safe, Reliable,.......................................... 6 and Compassionate - Improving Your Experience................... 8 - Recognising Individuality.................... 10

200 number of cancer patients receiving radiotherapy each day

1.5 million number of people living in the area where we provide specialised services

21,729 people are members of our foundation trust

3,000

700 volunteers give their time freely to support our work

number of patient diagnoses and treatments supported by our pathology staff every day

• Leading Experts In............................... 11 Specialist care

• Leading Lights....................................... 12 In Innovation • Balancing the Books......................... 12

• Developing World............................... 13 Class Staff - A Workforce for the Future................. 13 • The Big PLAN............................................ 14

03

Annual Review 2013-2014

We provided

813,000

episodes of care this year

£2.2m

investment in 120 additional nursing posts

A clean bill of health Our population is changing.

The elderly population is growing, and more people are living for longer with chronic conditions. This is cause for celebration, and testament to the quality of care the NHS provides – and so is something we can all be proud of.

But this also creates a challenge, which in the current financial climate means hospitals are under more pressure than ever before to ensure patients receive timely, safe and effective care, whilst balancing the books.

We need to work differently to ensure the right services are available when they are needed, to help people stay well and enable them to leave hospital when they no longer require specialist care.

During the past year we have been working with local health and social care agencies to review how urgent care services are organised and provided, and the initiatives we have introduced are already benefitting many patients.

“Although our hospitals have been exceptionally busy, our staff have demonstrated passion and commitment to making sure our patients have received the standards of care they deserve.”

The increasing demand for urgent care during the winter continued into the spring and although we met the majority of national standards, this additional pressure meant we weren’t able to provide timely care for all inpatients who needed planned procedures.

As a consequence, Monitor, the health sector regulator, opened an investigation to determine if this was a result of problems with how our hospitals are run.

We are delighted to report that Monitor has now given us a clean bill of health following a rigorous investigation and independent governance review, and during the past year we have made great progress in improving access to care for our patients. We have also improved the quality of care

we provide – inpatient mortality, hospital acquired infection, and incidence of harm have reduced, and patient satisfaction has increased. So although our hospitals have been exceptionally busy, our staff have demonstrated passion and commitment to making sure our patients have received the standards of care they deserve.

Along with the whole of the NHS we have had to continue to deliver significant efficiency savings, and the entire organisation, led by the board, has demonstrated commitment to reducing costs whilst always maintaining or improving care and services.

Through rigorous management of our finances we have been able to continue to invest in developing services and facilities. The expansion of our cancer centre was completed, and we invested £1m in creating a dementiafriendly hospital environment.

The birth centre at Chorley was refurbished, and our Specialist Mobility and Rehabilitation Centre was one of only seven facilities in the country to provide care for both serving armed forces personnel and veterans. And with a generous donation from the Royal Voluntary Service we opened a hotel for patients and their families.

We have also invested £2.2m in 120 additional nursing posts in the past year, and recruitment to appoint the extra staff is well underway.

We opened a hotel for

patients and their families For the fifth consecutive year 100% of our medical students passed their exams, which reflects the outstanding quality of the teaching programmes we provide, and we recruited more than 1500 patients to clinical trials to support the development of new drugs and treatment for the future.

We have also created a Big Plan that sets out our strategy for the future, to help us ensure we can develop, flourish, and remain financially viable in the coming years.

It’s been a challenging year, and we wish to thank our fantastic staff, volunteers and governors for their commitment to enabling us to provide excellent care with compassion for patients and their families.

Stuart Heys Chairman

Karen Partington Chief Executive

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01 Annual Review 2013-14

Annual Review 02 2013-2014

Safe, reliable and compassionate Our quality strategy Safe, Reliable and Compassionate - aims to ensure we have the right approach and processes in place to deliver the highest standards of care, for every patient, on every occasion. We monitor every aspect of care quality, from the comments patients make to detailed analysis of data, to make sure we can identify issues and take prompt action, share best practice, and so continuously improve the services we provide.

18%

reduction in mortality in the past five years

“We have introduced a range of resources for patients with dementia, including boxes containing activities to occupy and stimulate patients, such as activity blankets that help alleviate the common problem of ‘restless hands.’ And tea parties have been arranged to encourage socialising and reminiscing which improves cognitive ability”

The quality of care we provide has improved significantly over recent years. Our mortality rate has reduced by 18% since 2008-9, and avoidable harm (medication errors, blood clots, catheter associated urinary tract infections, and pressure ulcers) has continued to reduce, and compares favourably with the national average. The number of falls has remained static despite a significant increase in the number of frail, elderly patients, who are more prone to falling, in the hospitals. Preventing falls has been a key focus for us this year, and we have introduced enhanced risk assessments, additional supervision, environmental improvements, and monitoring devices. Our Falls and Fracture Prevention Service has introduced falls clinics, a carers’ forum and a new pathway to help prevent falls both within hospitals and in the community.

15%

reduction in Clostridium difficile this year Although hospital acquired Clostridium difficile decreased

by 15% in the past year, we did not achieve the challenging reduction we aimed to. An independent review of our infection prevention and control procedures confirmed our practice is good but we will continue to work towards further improvements. We have also started offering a probiotic drink to inpatients as the friendly bacteria can reduce side effects of antibiotics including Clostridium difficile.

We are committed to being amongst the best dementiafriendly hospitals, and over the past year we have invested more than £1m in improving the hospital environment. Significant refurbishment work has been undertaken to contrast colour code walls, floors and doorways, and toilet seats to make it easier for patients with dementia to move around safely. Different pictures above beds help patients to orientate themselves, and we are encouraging families to create memory books to support their relatives to reminisce. We have introduced new dementia training and have recently achieved the Royal College of Psychiatrists Quality Mark for the care of older people.

Nutrition nurses now work

seven days a week

Ensuring patients are wellnourished when in our hospitals is vital to aiding good recovery.

96% of patients have a nutritional assessment within 48 hours of admission, and those who are malnourished or at risk of malnourishment are seen by a dietician who works with the patient and the nursing team to create an individual nutrition plan.

Nutrition nurses now work seven days a week to make sure advice and support is provided whenever a patient is admitted.

With a generous donation from the Royal Voluntary Service we opened a hotel in 2013 to provide overnight accommodation for patients and their families. This new facility will particularly benefit patients who need spells of daily treatment, and families who want to be close to those who are critically ill.

07

Annual Review 2013-2014

The

Bringing

Healthcare To Life

event was a huge

success A Care Quality Commission (CQC) inspection of our hospitals in 2013 found that we have systems in place to manage risks and assure the health, welfare and safety of people who receive care, and that we are protecting patients from infection. The CQC found that we fully achieved five out of five standards at Chorley and South Ribble Hospital, and there were minor concerns about three of the five standards at Royal Preston Hospital. Overall this is a positive review of the care we provide and we are pleased that the CQC had no significant or moderate concerns. We have already taken action to address the minor concerns that were raised and are confident that a future inspection will reflect this improvement.

Our quality strategy has proven to be effective in improving the quality of care since its introduction. In 2013-14 we revised this strategy to incorporate the recommendations of the Francis and Berwick reviews of Mid-Staffordshire NHS Trust, and new national guidance. We have set three key ambitions for the future to further improve the quality of care: • Achieve 98% harm free care • Reduce inpatient mortality by 15% • Achieve and sustain 90% positive patient feedback

Improving your experience Ensuring our patients have a positive experience is vitally important to us, and we’re pleased to report that feedback from a range of sources, including national patient questionnaires, the Friends and Family Test, and our own comprehensive surveys continue to demonstrate high levels of satisfaction.

We ask both inpatients and outpatients for their feedback about a range of quality indicators, including dignity and respect, communication, involvement, responsiveness and privacy.

Overall satisfaction improved slightly compared with last year.

We are striving to increase patient satisfaction further this year, with a particular focus on improving communication with patients and their families.

We also obtain feedback through our governors, who represent your views, and from the membership events we produce throughout the year. The Bringing Healthcare To Life event in 2014 was attended by hundreds of members who learned more about the services we provide and had the opportunity to engage with a wide range of staff. Members attended focus groups to give us feedback about services for people with long term conditions, creating a dementia-friendly hospital

environment, and improving patient food. Our members also completed surveys to help us improve communication with them.

Last year we received 5088 compliments, and 582 complaints (11 fewer than in 2012-13). We investigate every complaint we receive objectively and thoroughly, and are committed to learning and continuously improving how we work. We reviewed how we manage complaints this year, and have made a number of improvements including : • A better triage process to identify what issues we can resolve immediately • A new process that peer reviews a sample of complaints to ensure we are meeting standards • A new feedback survey for everyone who has complained so we can improve the process and patient and family experience • Better information about the complaints process We also aim to resolve issues promptly and informally as they arise, which can alleviate concerns and prevent problems escalating which is a better outcome for patients and their families. PALS (Patient Advice and Liaison Service) can support this process and now visits patients in wards and clinics to resolve issues quickly.

“The new multi-agency Children’s Safeguarding Group has introduced new systems and processes to alert staff if there are safeguarding concerns about any child attending the Emergency Department, which enables appropriate action to be taken to protect them from harm.”

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01 Annual Review 2013-14

Recognising individuality

Listening and responding We have made a wide range of changes this year as a result of your feedback

• A new bereavement service for children and young people was launched.

• Better processes have improved care for patients when they are moved from assessment units to wards.

• A new Emergency Medical Decisions Unit has been created to improve care pathways.

• We have improved processes for arranging follow-up appointments.

• A new treatment for anaemia has been introduced which means patients receive just one injection rather than have to visit hospital once a week for six weeks.

• Our occupational therapy team is now involved in caring for patients who have splits, which is reducing occurence of pressure ulcers.

• A new Day of Surgery Admissions Area is providing a better environment for patients who need a planned procedure.

• A new, patient-friendly website has been launched.

Making sure all patients and families, regardless of ethnic group, age, gender, sexuality, religion or disability can access care is critical to delivering a universal health service that recognises and responds to the diversity of our local communities.

This year we have also made good progress in supporting people who have additional needs to access care, including : • Developing a pain management assessment tool for patients who have a learning disability • Advice about ongoing care requirements for carers of patients who have a learning disability • Information packs about caring for patients with learning disabilities for staff and GPs • Training for learning disability champions • Training for staff about caring for elderly patients with dementia • New carpark signage to make it clearer and more readable • Reviewing the language interpreter service

Our workplace familiarisation programme has gone from strength to strength and we are supporting more young disabled people to access work experience and jobs in our hospitals. This year we have also introduced a widening access scheme to support local people who have been unable to find employment to develop the skills and experience necessary to get a job.

We have also made good progress in supporting people who have additional needs to access care

Annual Review 02 2013-2014

Leading experts in specialist care During the year we continued to invest in developing specialist services for people across Lancashire and South Cumbria.

The expansion of the Rosemere Cancer Centre was completed, and a new treatment - stereotactic radiotherapy - was introduced.

This treatment uses specialist equipment to deliver high dose x-rays very precisely at small brain tumours, and improves outcomes for patients with this condition.

We are a European reference site for use of this equipment and have hosted international visitors keen to learn about our approach. Our new children’s cancer suite was opened to enable young cancer patients to receive supportive care locally. A cancer information service, generously funded by Macmillan, was introduced to provide practical advice and support about living with and beyond cancer.

One of only seven facilities in the country to care for armed forces amputees

Our Specialist Mobility and Rehabilitation Centre, which provides care for disabled people and amputees, was one of only seven facilities in the country accredited to provide services for both serving armed forces staff and veterans, which reflects the quality of treatment provided. The centre opened a new gym this year to facilitate rehabilitation, including a state of the art anti-gravity treadmill which supports amputees to use their prosthetic limbs.

This year we established a new neuromuscular team to provide care and advice for children and young people with this condition closer to home, and so reduce the need to travel to Liverpool or Manchester for support.

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01 Annual Review 2013-14

Annual Review 02 2013-2014

Leading lights in innovation

Developing world class staff

Our Centre for Health Research and Innovation had a very successful year, with more than 2000 patients participating in research studies about a range of subjects including cancer, renal, neurosciences, genetics, diabetes and child health.

We believe that having the right staff, with the right skills and attitude is fundamental to providing the quality of care our patients deserve.

More than 200 research studies are actively recruiting patients in our hospitals at any given time showing how much we are investing and committing to developing new drugs and treatment to benefit our local communities and the wider population. We have appointed a statistician in partnership with Blackpool Teaching Hospitals NHS Foundation Trust and the University of Central Lancashire to expand our research capability.

Innovation pathway scoops two national awards Our research and development taskforce, along with a local manufacturer have developed a female urinal. This was created because women said it was challenging to remain independent

when using a bed pan or commode. The new urinal is a practical solution that improves privacy and dignity, reduces bed pan related pressure ulcers, alleviates anxiety and promotes independence, and this innovation has won two prestigious awards.

Our new innovation pathway ‘From Brain To Bedside’ which is designed to fast track new ideas that could benefit our patients, was successfully piloted this year and has already won two national awards.

We believe we are the first hospital in the country to introduce patient iBooks - online information including videos, 3D animations and interactive diagrams - about neurosurgery and we are in the process of developing these for all services and treatments.

The new urinal improves privacy and dignity

This year we introduced laparascopic hysterectomies which enables this procedure to be undertaken using keyhole rather than traditional open surgery, which reduces the likelihood of complications and aids recovery.

We also participated in a national research trial that has pioneered the use of inflatable leg wraps to reduce the risk of stroke.

2016

patients recruited to clinical research studies

101

research articles published

Balancing the books Last year we achieved our planned risk rating of 3 which means our finances were well-managed.

We received £369m income from patient care, which is an increase of 4.5% compared with last year. A further £46m from training levies, research funding, car parking, catering, retail outlets and from providing services to other organisations was also received in income. Our expenditure in 2013-14 was £412m, an increase of 4% on the previous year, and we achieved £16m of efficiency savings which is a great achievement given the continuing challenging financial climate.

During the past year we have invested £2.2m in establishing 120 additional nursing posts. This additional investment will support staff to give the highest standards of care even when the hospitals are very busy, and provide our patients with the best possible experience because the little things can make such a difference. However there is a national shortage of nurses so we are undertaking a wide range of activities to help us appoint everyone we need, including local, national and international recruitment events. We are also developing programmes with local schools and colleges to promote nursing as a career to help us grow a workforce for the future.

Our award winning leadership programmes are supporting even more staff this year to grow and develop, which is driving innovation, improving standards, and increasing morale – and this results in better care for our patients.

We have introduced a range of initiatives this year to improve staff health and wellbeing, including salary sacrifice schemes, mediation, fitness classes and social activities which helps us recruit and retain the best staff and improves wellbeing. We also produced a video this year to recognise and thank our staff for their passion and commitment to providing excellent care with compassion.

The national staff survey results show that our investment in

creating a great place to work is improving staff satisfaction.

More than 60% of staff completed the survey this year, which is the fourth highest response rate in England and demonstrates a highly engaged workforce.

We’re in the top 20 in the country for staff training, learning and development opportunities, and the number of staff who said they would recommend us as a place to work increased by 12% compared with the previous year.

We provided

32,000

learning, development and leadership opportunities last year

A workforce for the future We are delighted that 100% of our medical students passed their exams for the fifth consecutive year, which is testament to the high standards of education programmes we provide and our world class teaching facilities.

We teach and train 260 medical students as well as foundation trainees and post-graduate doctors, and provide work-based experience for trainee nurses, allied health professionals and healthcare scientists.

100%

of our medical students passed their exams for the fifth consecutive year 13

01 Annual Review 2013-14

Annual Review 02 2013-2014

We need to save

£22m

in 2014-15

And we have developed a number of delivery strategies that set out our goals to help us work towards achieving these strategic aims.

The Big Plan This is a period of unprecedented change for health and social care. A difficult financial climate and the biggest reorganisation in the history of the NHS, along with an increase in long term conditions and an ageing population, has created a significant challenge for health and social care services.

In 2014 we launched our Big Plan, which has been developed to enable us to address these challenges, respond to the changing needs of our local communities, and ensure we are always able to provide excellent care with compassion.

The Big Plan sets out our strategic aims, which define our long term ambitions, and describe our core business :

• To expand and develop specialised and tertiary services • To deliver local hospital services for Preston, Chorley and South Ribble communities • To enhance our workforce and reputation through education, research and innovation

We have recently been designated a major Vascular Centre in Lancashire and South Cumbria, and will be establishing this service and building a new specialist operating theatre over the next two years.

We will be expanding our critical care facilities to enable us to look after the increasing number of patients who have complex and serious conditions. And we will be developing more renal dialysis facilities closer to patients’ homes.

In the coming year we will continue to work with local health and social care organisations to change urgent care services.

More services in the community will help people stay well and recover from illness, and new urgent care centres at both hospitals will ensure patients can access treatment and advice when they need it. The development of these alternative services, together with a reorganisation of how our hospitals are run, will enable us to make sure timely care is provided for people who need the specialist treatment only a hospital can provide.

We have had great success in establishing research programmes to develop new drugs and treatment in recent years, and we have plans to lead more clinical trials and studies in the future that will benefit the whole population.

Educating students remains an important objective to help us grow the workforce for the future, and the practice of teaching and mentoring improves the skills and knowledge of our staff.

Making this a great place to work is critical to recruiting and retaining the best staff, and an engaged and motivated workforce is proven to provide better care for our patients - so this remains a key focus in the coming year. We will continue to invest in staff development and leadership programmes, and whilst it is always important to continuously improve we also need to celebrate our achievements as this improves staff morale and reassures patients and families about the quality of care we provide.

and invest in facilities, equipment and services whilst continuing to provide the same or improved standards of care and this is increasingly difficult to achieve.

So there are challenges ahead, but with the support of our governors, volunteers, partners and our fantastic staff, and in partnership with patients and families, we are confident we have the right foundations and plans to continue to always provide excellent care with compassion.

We need to save £22m in 2014-15 to enable us to maintain financial viability

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