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Lancashire Teaching Hospitals NHS Foundation Trust

Annual Review 2012-2013

Excellent care with compassion


Contents

A challenging year Innovation in healthcare Pioneering research Working with you, for you Your health in safe hands A growing number of patients Leading experts in specialist care Staff who provide excellent care Developing expertise and skills Challenging times ahead “I have been treated with kindness, respect and efficiency at this hospital since I have been receiving care which is nearly three years now. I have always had my treatment fully explained to me by my Consultant who is in my opinion fantastic. Recently I have had a few days in hospital and saw my Consultant each day, the care I received was excellent. I have nothing but praise for all the staff who have taken part in my treatment plan and ongoing care. Thank you very much.” Urology patient

832,000 treatment episodes

Thanks to everyone who helped us reach our Lifesaver Appeal

£500,000

target! Lancashire Teaching Hospitals Annual Review 2012-2013


A challenging year This year we have continued to provide excellent care with compassion, drive innovation in healthcare, and deliver world-class education programmes in what has been exceptionally challenging circumstances. We continued to invest in equipment and facilities, with a number of significant developments that will improve specialist care for patients across the region, including a major expansion of the Rosemere Cancer Centre. We reached our target of £500,000 for the Lifesaver Appeal which raised money for a CT scanner for the newly established major trauma centre. This is a magnificent achievement in the current financial climate and we would like to thank our local community, staff, partners, and the Lancashire Evening Post for their generosity and support in raising money for this vital equipment. This winter and spring we were much busier than in previous years, with more people than usual requiring urgent care and treatment. This put pressure on the whole health and social care system and, despite everyone’s best efforts, resulted in some delays in treatment and postponement of planned procedures. In the first three quarters of this year we achieved a green rating for the standards set by Monitor, the regulator of foundation trusts, to make sure patients can access timely, safe and effective care. We were disappointed that the final quarter was amber-red rated because we did not achieve three standards due to delays in treatment for a number of patients in the winter and spring.

The NHS faces an unprecedented financial challenge to deliver savings of £20bn by 2015. We are committed to finding ways of working more effectively that enhance or maintain services for patients and save money, so we were pleased that we achieved our financial risk rating of 3, demonstrating we are financially stable, and were also able to deliver £19m efficiency savings. Locally and nationally there have been significant changes to health and social care as the new structures and governance arrangements introduced by the Health and Social Care Act became established throughout 2012-13. We are continuing to work very closely with the newly created clinical commissioning groups and GPs, commissioning support units and area teams, social care services and other healthcare providers to develop services that can meet the changing needs of our local communities. We wish to give thanks to our staff, volunteers, governors, and the organisations with which we work in partnership, for their continued support. This has enabled us to provide excellent care with compassion for patients and families in what has been an exceptionally challenging year. Karen Partington, Chief Executive Stuart Heys, Chairman

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Innovation in healthcare Our staff are at the forefront of advances in healthcare and this year we have invested in additional equipment, developed new techniques, and led research that will change how some conditions are treated in the future.

Our ear, nose and throat team has also been developing new techniques that improve quality of life for patients, and this year has pioneered a treatment for therapyresistant speech loss.

Our Specialist Mobility and Rehabilitation Centre continues to provide excellent services for disabled people, and pioneer new treatment. Last year the centre was one of only ten in the UK to care for Libyan trauma and amputee casualties, and has built on this outstanding performance by fitting the first ‘high-fidelity’ socket to an amputee outside the USA.

We have introduced advanced radiotherapy which targets tumours precisely, improving outcomes for prostate cancer patients. With a generous donation from Baby Beat we have purchased cutting-edge equipment that can immediately and painlessly diagnose jaundice in babies. In partnership with GPs we have purchased the North West’s first mini MRI scanner, enabling patients to access localised body part scanning in the primary care setting, which is more convenient and avoids an unnecessary hospital visit. A new 3D virtual reality system provides staff with access to a virtual environment to train to provide radiotherapy. We have also installed a realistic pregnant woman mannequin that can simulate pregnancy and labour, enabling students and staff to gain vital experience of treating obstetric emergencies. We have developed a ‘Tap The Bugs’ smartphone application to help junior doctors easily access information about antimicrobials, to prevent the spread of infectious disease.

“I had a total knee replacement operation and from arriving to leaving I could not complain about a thing. The nurses, doctors and surgeons all kept me well informed of what was going to happen and what to expect. I was looked after brilliantly and would like to thank everybody concerned especially the staff on Leyland Ward who are a credit to the NHS. Well done and thank you.” Orthopaedics patient Lancashire Teaching Hospitals Annual Review 2012-2013


Pioneering research Investing in medical advances is a growing priority for us, and in the past year we have significantly developed our research capabilities. Our Centre for Health Research and Innovation’s new two year strategy has four key aims : • Innovate in partnership with industry and biotechnology sectors • Lead more research and studies • Ensure quality and efficiency in research • Embed research within the organisation

Recruited

2147

patients to clinical trials “I don’t expect any miracle cures, but it’s good to know I’m contributing to this research which one day might result in a cure, so taking part is a win: win situation.” Patient involved in a clinical trial

Supported

1666

patients in clinical trials

The centre has given healthcare innovation a fantastic boost this year by developing a pathway that enables entrepreneurs to present their ideas to the NHS, making sure cutting edge technologies, scientific advancements and new practices can be reviewed and adopted – ultimately improving patient experience and outcomes. The centre continues to drive our participation in clinical trials and studies, enabling local patients to access emerging drugs and treatment. This year we were the lead NHS trust for a new programme of research that aims to facilitate early return to work through specialist health-based interventions which will support people following illness and injury, and could have a significant positive impact for the country’s economy. We are also working with partner universities to research the use of spectrochemical imaging in disease diagnosis.

16%

increase in research articles published by our staff

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Working with you, for you

Every

member of staff is appraised on their behavioural standards

We believe that actively seeking, listening to and responding to feedback is vital to continuously improve and develop services to meet the needs of patients and their families. We actively seek and monitor patients’ opinions in a range of different ways – every inpatient and outpatient is invited to complete a short, anonymous survey about their experience, every time they come to hospital. To date more than 100,000 patients have answered questions about their experience, and this year almost 91% of patients who completed the survey were satisfied overall with their care. The results of the national inpatient survey 2012 are consistent with our more detailed local findings, and showed significant improvement across a number of categories compared with the previous year. Patient satisfaction improved in respect of waiting for a bed on a ward, cleanliness, getting understandable answers, and information about treatment and discharge. The PALS (Patient Advice and Liaison Service) team offers advice and support to patients and their families, helping to ensure any issues are addressed promptly and identifying where we need to improve. Our customer care department registers and reviews every single compliment, comment and complaint we receive to make sure we can embed good practice and take action if things haven’t been satisfactory. We received 593 formal complaints this year, with the most common cause for concern relating to treatment and procedures, and more specifically cancellations and delays in appointments and diagnosis. The trend in complaints over the year is closely linked to periods of increased pressure on services. We are working with health, social care and community organisations to make sure patients receive the care they expect and deserve this coming winter. 5853 patients and families provided compliments and thank you cards this year, an increase of 12% compared with last year.

Lancashire Teaching Hospitals Annual Review 2012-2013


Our governors very ably represent the views of patients, their families, and the local community in shaping service development and delivery, and host a number of engagement and listening events during the year. The Bringing Healthcare To Life event in July provided an excellent opportunity for local people, staff and governors to interact and discuss services, treatment and experiences. 350 local people attended Focus on Dementia events to learn more about this condition and emerging treatment. Our governor led patient experience group has implemented a range of improvements this year. Your views count We review all of the feedback we receive and have made a series of changes based on what patients and families have told us, which includes: • Increased the presence of nursing staff within the ward bays, through bedside hand overs and frequent rounds • Streamlined the admissions process in Women’s Health to reduce the time patients wait on their day of surgery, and ensuring patient privacy and dignity are respected

2684

enquiries and issues managed by the PALS team • Introduced a new lighter evening meal menu, including ‘finger food’ for patients with dementia. We have also improved communication between wards and the catering team to make sure patients receive the meals they have ordered • Improved clinic letters and signage to help patients get to their appointment more easily • Improved the changing facilities in the daycase unit • Included behavioural standards in our appraisal and recruitment processes • Improved the website to make it easier to find information about the hospitals, services and treatment

“I was treated by the sister and staff with great patience, consideration and full instruction… They instilled confidence in me and what I dreaded didn’t seem so bad after all. I am 87 years old and probably impatient, but they soothed my furrowed brow.” Ophthalmology patient

5853

compliments and thank you cards

7


Your health is in safe hands Above all else, we believe that quality of care and patient safety is of paramount importance in the NHS. As long as quality and safety are the primary considerations in every decision we make, we know we’ll be doing the right thing for our patients. We employ many systems, processes, policies, and targets to help us make sure we’re delivering care that is safe and effective. Safety and quality information is displayed in all wards to ensure ward staff can identify best practice in their area, and see what requires improvement. We are committed to openness and transparency so this information is clearly visible to patients and visitors and our staff will always explain what this means for you if asked.

Preventing hospital acquired infection continues to be a challenging objective, and this year we reduced Clostridium difficile as planned. There were four instances of MRSA bacteraemia in 2012-2013, which was disappointing given the previous years excellent performance and should be viewed in the context of the significant reductions that have been made. We remain committed to ensuring zero tolerance of any preventable infection.

We won the Customer Service Excellence Standard Award for hotel services

7%

reduction in Clostridium difficile

Lancashire Teaching Hospitals Annual Review 2012-2013


We have implemented a series of improvements that has resulted in a significant reduction of hospital acquired pressure ulcers, and increased supervision has substantially decreased the number of inpatient falls that has resulted in harm. We also reduced harm associated with medication administration errors. The recently established integrated nutrition and communication service has improved access to specialist support, ensuring patients can receive supportive therapies quickly and easily, and begin recovery from illness as soon as possible.

The Commissioning for Quality and Innovation scheme awards additional funding to organisations that achieve stretching targets which aim to drive quality improvements in healthcare. In 2012-2013 we were awarded an additional £8.4m for a number of quality initiatives and innovations including : • Improving performance in relation to response to patient need • Establishing a new phone advice line to support GPs • Introducing urgent clinic slots to prevent patients being admitted to hospital unnecessarily

44

quality improvement projects submitted to our Quality Awards

• Improving the timeliness of providing hospital discharge information to GPs • Achieving high standards of dementia screening, risk assessment and referral • Increasing venous thrombo-embolism (blood clots) risk assessments We have made a range of changes to improve the experience of dementia patients, including refurbishing wards, enhancing lighting, introducing music and activity packs. The proactive elderly care team ensures patients aged 75 and over who are admitted for unplanned care and treatment receive a comprehensive geriatric assessment so all of their health and social care needs are identified and addressed promptly. The new breast care unit, costing nearly £1m, opened in the summer and allows clinical investigations and tests to be carried out in one day, enabling quicker diagnosis.

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A growing number of patients who need urgent care We had an exceptionally busy year, with the number of patient treatment episodes increasing by 12,000 to 832,000. Overall we treated more inpatients and outpatients, undertook more day cases, and saw more Emergency Department patients than expected. Along with other hospitals in the North West and across the country, we experienced unprecedented challenges during this winter and into the spring. Although we plan for winter pressures every year, this year there was a significant increase in the number of patients who required urgent treatment, and as many were frail and elderly with complex conditions, they needed a longer than average stay in hospital. This meant the hospitals were exceptionally busy for a sustained period. We did all that we could to ensure those patients who needed urgent treatment received the highest standards of care, whilst maintaining our usual hospital services, however circumstances were such that we had no option but to postpone planned procedures for some patients. Throughout this summer significant work has been undertaken by the hospitals, community and social care, and GPs to make sure services are joined up and can respond flexibly to increasing needs for urgent care in the winter. The bottom line We achieved our planned financial risk rating of 3 this year, confirming that we are a financially stable foundation trust. Our operating expenditure was £384m, and we generated £353m income from patient care and £49m from training levies, research funding, car parking, catering, retail outlets and from providing services to other organisations. Our Change For The Future programme aims to review and improve the way we work to both maintain or enhance the quality of care we provide for patients, whilst generating efficiency savings that will enable us to reinvest in services. The programme this year has delivered a number of projects that have improved the way we work, provided patients with a better experience, and saved money. We delivered £19m efficiency savings in 2012-2013.

£19m

efficiency savings

Lancashire Teaching Hospitals Annual Review 2012-2013


Leading experts in specialist care We continue to develop and deliver specialist care to patients across Lancashire, South Cumbria, and beyond. This year we invested £3.6m in expanding the Rosemere Cancer Centre to bring together services for cancer patients in one modern, purpose-built environment. This has improved patient experience and enabled us to deliver services more effectively. A new service that provides support, information and practical advice about living and coping with and beyond cancer, by a team of trained staff and volunteers at both hospitals was launched in the spring, with thanks to generous donations from Macmillan Cancer and Rosemere Cancer Foundation. The Rosemere Cancer Centre will be further extended in the coming year to incorporate an additional linac accelerator which provides radiotherapy treatment, offering more flexibility and a better service for patients.

The major trauma network, with the region’s major trauma centre at Royal Preston Hospital, was accredited at the beginning of the year and since then has been providing expert life and limb saving treatment for patients from Lancashire and South Cumbria. We were delighted that the North West Air Ambulance has decided to base one of its aircraft at Royal Preston Hospital, further reinforcing our strong partnership. The neuro-rehabilitation service relocated to Royal Preston Hospital this year, and we made further investments in neurosciences, burns and plastics services. Extensive work has been undertaken this year to improve access to care and the experience of renal patients, many of whom require long term and regular support.

“My recent experience at the Royal Preston Hospital was most commendable. I arrived early for my appointment with the Head of the Plastic Surgery department. I was seen well before my appointment time. They were pleasant and professional and put my mind at rest. My operation took place within two weeks and again I was attended to before the appointed time. The administration and the care and attention throughout were exemplary.” Plastics patient

£3.6m

investment in the Rosemere Cancer Centre 11


Staff who provide excellent care with compassion We believe that patients will receive the standards of care they expect and deserve when treated by staff who are highly competent, engaged and supported, and so we were delighted that our consultant leadership programmes won a prestigious national Training Journal award this year.

6745

staff

700

volunteers

Throughout the year we have focused on embedding our organisational values across the organisation, to help ensure all of our staff always provide excellent care with compassion : Care and compassion We treat everyone with dignity and kindness, give comfort, and do everything we can to show we care Recognising individuality We respect, value and respond to every person’s individual needs Seeking to involve We ask and listen, include everyone’s views when making decisions, and are always open and honest Team working We work together as one team, and involve patients, families and other organisations to provide the best care possible Taking personal responsibility We each take personal responsibility to give the highest standards of care and deliver a service we can always be proud of

Lancashire Teaching Hospitals Annual Review 2012-2013


Developing expertise and skills We provide award winning education programmes for medical, nursing, and allied health professional students. This year 100% of our medical students passed their exams for the third consecutive year, demonstrating the quality of our teaching. We have continued to work with colleges and universities to provide nursing education and training placements, ensuring sustainability in the local workforce for the future. Social inclusion is important to us and to our local community, so we are pleased to have been able to provide 120 work placements to date to local disabled students.

“The combination of excellent and motivated clinical teaching staff and doctors meant the quality of the teaching was superb. The people chosen are motivated, approachable and experts in their field‌ and the teaching facilities are fantastic.â€? Medical student

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Challenging times ahead Developing our regional specialist services is a key ambition for us and we are planning further significant investments in this area in the coming year. The expansion of the Rosemere Cancer Centre will be completed with the installation of an additional radiotherapy linear accelerator, which will increase our capacity, providing more flexibility and more timely care for patients. We are also working towards being recognised as a centre of excellence for vascular and interventional radiology, and will be expanding our renal dialysis facilities. We will be refurbishing the birth centre at Chorley and South Ribble Hospital in the coming year, and opening a new hotel for patients and families. An important priority this year is to work with health, social care and community services to improve access to urgent care services and prevent the capacity pressures we experienced this winter and spring. By working in partnership and planning proactively together aim to ensure that in the future local patients will be able to easily access the health and social care services they need, in the most appropriate setting. We will also be working with a wide range of partner organisations to plan the longer term strategy for patient services. So with the increasing needs for urgent care, the changing requirements of our ageing population, and financial pressures faced by the NHS, 2013-2014 looks more challenging than ever. However as long as we ensure that quality and patient safety are the key consideration in every decision we make, and with the support of our outstanding staff, governors, volunteers and partners we are confident we can continue to provide excellent care with compassion for patients and their families.

“First class treatment from first appointment with Consultant through to admission then to surgery, aftercare and discharge. Caring, professional staff. Could not fault anything. I was so nervous and frightened but the staff were there for me 100%. Well done and thanks to everyone who helped me. The hospital was spotlessly clean - I was so impressed. Food was good too. Thank you to all at the NHS - Chorley Hospital.� General surgery patient Lancashire Teaching Hospitals Annual Review 2012-2013


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“Car park staff very helpful in helping me find a space. Much appreciated.” Patient

“I think the nurses and doctors, all the staff are amazing at Chorley, they helped me so much I wouldn’t be here without them!! Hazel wood in particular is an outstanding ward.” Gastrointestinal Patient

“I was rushed in as an emergency, with a serious urological issue. The staff did their upmost to get me sorted as quickly as poss and got me into theatre as quick as they could. The wards were spotless and I was really impressed by the team of cleaners cleaning the corridors at night. The staff were very friendly, supportive and very caring. I felt peace of mind while I was on the ward. The 2 consultants and SHOs were very helpful, polite and respected my wishes and my dignity. If you are going into hospital, I recommend Preston, it’s a fab hospital! Thank you for getting me better so quickly! Urology Patient

Our full Annual Report and Accounts 2012-2013 is available on our website www.lancsteachinghospitals.nhs.uk For further information or alternative formats contact : Communication Department Office of the Chief Executive Lancashire Teaching Hospitals NHS Foundation Trust Royal Preston Hospital Sharoe Green Lane Fulwood Preston Lancashire PR2 9HT Telephone : 01772 522727 enquiries@lthtr.nhs.uk

Chorley and South Ribble Hospital Preston Road Chorley PR7 1PP Tel: 01257 261222 Fax: 01257 245495


Lancashire Teaching Hospitals Annual Review 2012 2013