IMPACT Magazine - July 2021

July 2021

IM Welcome to the first edition of Impact Inside find out more about

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Trust Quality Improvement Plan Fracture Clinic

Digital Developments Windows 10 / BadgerNet

New Cataract Suite opens on Ward 20 at RSH

£9.3million transformation for the Emergency Department

June 2020 The Shrewsbury and Telford Hospital NHS Trust

To achieve this, we have embarked on our Getting to Good programme, which focuses on quality improvement, culture and behaviours, leadership, improvements in our estate and our digital capability, recruitment and retention, our finances, and the quality of our data and analytics and the insight we can draw from that.

Getting to Good is only possible if it is a shared goal and a shared journey. Everyone has their part to play. In this new newsletter – Impact – we will share more about our vision and explain what we want to achieve. Our strategy is, in essence, to provide high quality care in a way that is sustainable both now and in the future.

Every month, Impact will bring you information about changes and improvements you are making across the Trust, and the value they bring to patients and colleagues, while also being open and honest about the challenges we still face.

Message from Louise Barnett, Chief Executive At SaTH, our role is to provide high quality care for our population. While much of that takes place in the acute setting of our two hospitals, increasingly, we are also providing that care out in the community.

COVID-19 has dominated our lives for so long now. Over the winter months we coped with an increase in COVID-positive patients, increased numbers in critical care, and COVID-19 outbreaks at both of our hospitals. The work of colleagues at all levels during this time, and since, has been remarkable.

Now that the number of COVID-19 positive patients in our hospitals remains low, the focus is on restoring our services and clearing waiting lists. A phased re-introduction of services is being carried out with plans being developed to restore our full elective capacity. Additional weekend theatre sessions have already been taking place to clear any urgent backlogs.

Despite the challenges the pandemic has brought, it is important we remain focused on our overarching vision: to provide excellent care for the communities we serve.

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www.sath.nhs.uk

To help us achieve our goals, we have entered into an improvement alliance with University Hospitals Birmingham NHS Foundation Trust (UHB) and a maternity improvement partnership with Sherwood Forest Hospitals NHS Foundation Trust. We will share more about this work in future editions.

Impact is a forum to showcase your work and in future editions we will share more about our priorities and future improvement work. I hope you like it. If you have any feedback, please do let us know. Equally, if you have something you think Impact could focus on, please get in touch.

You can share your ideas and comments by emailing sath.commsteam@nhs.net Thank you.

Louise Barnett, Chief Executive

Cherry West has joined SaTH as our new Improvement Director Cherry has joined SaTH as part of our Improvement Alliance with University Hospitals Birmingham (UHB).

In this role she reports to Louise Barnett, our Chief Executive, and also to Sue Holden, National Director of Intensive Support and NHS England/Improvement.

Cherry’s role is to support Louise and the Trust to deliver the Getting to Good plan.

Cherry began her NHS career as a healthcare scientist (clinical physiologist) before moving into operational management 20 years ago.

She joined UHB as Chief Operating Officer in August 2014. In April 2019 she was appointed to the role of Chief Transformation Officer across the whole of UHB, encompassing Healthcare Transformation, the digital agenda, long-term planning, Service Reconfiguration, Service Improvement & Quality Improvement Strategy, and Capital Developments.

Cherry’s aim is to deliver and maintain effective, high quality services, providing timely, evidenced based pathways and best possible outcomes to the patients we serve. She believes that in complex health systems this requires distributed leadership supported by digitally enabled services designed to ensure that patients receive the right care, in the right place, at the right time

Transforming Care ‘Getting to Good’ Our transformational priorities Our patients and community

Our people

Our Service delivery

Our Partners

Our Governance

Quality improvement strategy and plan

Leadership capability and development

Urgent and Emergency Care

System improvement and integration plan

Oversight, assurance, roles and accountabilities

Reducing mortality and excess deaths

Clinical standards, skills and capabilities

Restoration and recovery (incl. COVID19 learning)

Develop OBC for Hospital Transformation Programme

Financial controls

Quality / regulatory compliance

Culture and behaviours

Digital transformation and infrastructure

System long term plan

Maternity transformation

Communication and engagement

Physical capacity and estate developments

Risk management

Increasing community engagement

Recruitment and retention

Improving service sustainability

Programme and project management

Performance data, quality, insight and analytics

Quality improvement approach and methodology

Areas where we are working with the Improvement Alliance

www.sath.nhs.uk

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Our partners

Hospitals Transformation Programme (HTP) We are extremely committed to our Hospitals Transformation Programme (HTP), which has been established with the aim of delivering safer care and better outcomes for our patients and communities. Work is now accelerating as we move towards the completion of our Strategic Outline Case (SOC).

Earlier this year an external review of the HTP was undertaken to assess its status and reset future plans.

Linked to the recommendations of that review, a number of key focus areas were identified and are being progressed at pace: • Updating of a number of specific areas of content to finalise the Strategic Outline Case (SOC); • Resetting of programme timelines and strengthening governance arrangements; • Accelerating the implementation of acute reconfiguration clinical models; • Addressing the affordability challenge.

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To support this work, in June we appointed PA Consulting as our external partner to support the finalisation of the SOC in the coming months (subject to timely confirmation of funding by NHS England/Improvement).

As well as this, a new system-level HTP Programme Board has been established, led by the Trust. This will provide a platform through which programme progress, including the acute reconfiguration and the development of out-of-hospital models of care, will be more actively performance managed.

Additionally, opportunities to accelerate the implementation of the HTP clinical models are being explored to bring forward benefits that come from the acute reconfiguration and accelerate parts that could help address immediate operational issues.

The development of our Trust strategy is key to this so we have clear direction to inform these plans. Work on developing the strategy will begin soon and we are keen for as many staff as possible, across the Trust, to get involved to shape our future.

Our Service delivery

Digital Developments Windows 10

BadgerNet

The Windows 10 update is vital to improve the security of devices used across the Trust. The WannaCry Ransomware attack in May 2017 disrupted a third of NHS Organisations and led to the cancellation of 6,900 appointments across the country. The Windows 10 update will help guard against future attacks.

Last year the Trust successfully

The Windows10 project completed a review with an external partner in August. The outcome of this was a recommendation to make security improvements for our 5,000+ Windows devices at SaTH, whether they are on Windows 7 or already on Window 10.

Over the coming months the IT department will be carrying out audits of all PCs (laptops and desktops) to complete the necessary work.

Before an upgrade can happen, certain tasks will need to be completed in order to ensure that data which is currently stored locally (on the device) is transferred to secure networks which are routinely monitored and backed up.

One of the key changes you will see is the implementation of a policy which will prevent storage of data on local (C:) drives. Alternative locations and ways of working will be shared as part of wider communications as the project progresses. To support all Training – FAQ’s and hints and tips, examples and ways of working will be published in a dedicated section of Milo. We expect to expand this through the roll out. http:/milo/windows10/

secured Digital Aspirant funding to implement an EPR Programme.

The money have been used to procure a suite of different systems and products to support and deliver our digital transformation. These include the BadgerNet Maternity System.

BadgerNet Maternity is a maternity system that allows real-time recording of all events wherever they occur: in the hospital, community, or home. This includes both high-risk and low-risk pregnancies. Based on a patient-centred care model, the BadgerNet Maternity system comes with a portal for women to view and access their own maternity records online.

The Maternity Notes App is available from the Apple app store on an iPhone or Google Play on Android phones and allows service-users to access maternity records via smart phone, tablet or PC. There are 2 systems that have been purchased for Maternity, the BadgerNet Maternity module and the Viewpoint ultrasound reporting system, these will both be rolled out in the near future. In addition we have also purchased an enhanced version of the Neonatal module that we already have in place with BadgerNet which will allow the systems to talk to each other.

BadgerNet can also send emails, text message and push notifications to send important health information updates to you during pregnancy.

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Training on the system is under way. The design process includes clinical sign-off to ensure the system provides an efficient and clinically-approved solution for the Care Group.

It is anticipated it will be fully operational in the E first half of 2021. www.sath.nhs.uk

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Our patients and community

Trust’s Quality Improvement Plan Fracture Clinics Before the COVID-19 pandemic, SaTH was piloting a virtual fracture clinic at PRH. As the pandemic hit, Trauma services were relocated to the Robert Jones and Agnes Hunt Orthopaedic Hospital in Gobowen. When Trauma returned to SaTH in the summer, a rapid virtual fracture clinic model was rolled out.

Patients who have sustained an injury and visited the Emergency Department at either RSH or PRH may be offered a review in the Virtual Fracture Clinic. A call is be made to the patients on a telephone number provided.

The design of the clinic was led by Mr David Ford, Consultant Trauma and Orthopaedic Surgeon and Clinical Director for Trauma & Orthopaedics, and Consultant Orthopaedic Surgeons Mr Rohit Singh and Lt Col Carl Meyer.

The Virtual Fracture Clinic Team consists of senior trauma and orthopaedic surgeons, physiotherapists and associated practitioners. The team discusses with the patient their injury and how best to manage it.

Mr Singh said: “The clinic has been designed with the trauma patient in mind, and brings all the services into one dedicated, bigger and better space. This is something that we have aspired to have for our patients for some time and we are very pro ud that it has now come to fruition.”

This is just one of the improvements made to Trauma and Orthopaedics.

Earlier this month, a new state-of-the-art Fracture Clinic opened its doors at RSH. The new facility includes 11 fracture treatment cubicles, a new plaster room, treatment rooms for physiotherapy and hand therapy, and a dedicated waiting and reception area.

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www.sath.nhs.uk

Hazel Hughes, Trauma & Orthopaedics Operations Manager, said: “This is a state-of-the-art new clinic which will provide a much more streamlined service. It will not only improve the hospital experience for our trauma patients, but also gives our hard working staff the very best environment in which to care for those patients, both in the hospital and virtually too.”

Our patients and community

Virtual Clinic stats A In the first six months:

1,518 (53%) reviewed virtually

50% of patients reviewed virtually had a face-to-face review

2,850 patients referred to fracture clinic services

The remainder were discharged home, to physiotherapy or had a follow-up telephone clinic

www.sath.nhs.uk

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Our service delivery

£9.3million transformation for ED The Emergency Department at RSH is undergoing a £9.3million transformation as part of a programme of work to improve patient care.

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Betty Lodge, Divisional Director of Nursing, Emergency Care Division, said: “As well as great news for our patients, it is also good news for clinical colleagues working hard to deliver positive change, as they will be working in environment that will enable them to do this.”

Clinical space in the ED is being increased to include a new and improved Majors department, as well as a new designated Emergency Zone for Children and Young People and provision for vulnerable patients.

There will also be a new Clinical Decisions Unit.

Nigel Lee, Chief Operating Officer, said: “The quality of care that we provide to our patients, and their experience whilst they are in our hospitals, is our priority.

The capital investment is part of an overarching Quality Improvement Programme to help improve patient care and safety.

“It is widely documented that the demand for the services provided by our Emergency Department at RSH currently exceeds capacity.

Building work will take place in four phases over the next 12 months, with the first phase already under way to create the larger and improved Majors zone for those who are seriously ill.

“We hope that the improvements we are making to our infrastructure will help us to continue to drive forward our Quality Improvement Programme and help address the issues raised in previous CQC inspections.”

www.sath.nhs.uk

Governance

Acute and General Medicine teams receives positive feedback from GIRFT programme Our Acute and General Medicine services have received positive feedback from a national programme designed to improve the treatment and care of patients.

The national Getting It Right First Time (GIRFT) team has asked to share our areas of good and exemplary practice with other trusts.

The GIRFT programme aims to improve patient care through in-depth review of services, benchmarking, and presenting data-driven evidence to support change.

The findings from a virtual visit of Acute and General Medicine in May were: • Excellent Clinical Leadership and dedicated staff • Development of Advanced Care Practitioners (ACPs).

Acute Medicine is being used as a hub for learning and even once ACPs return to their own specialties they can return to Acute Medicine to assist with furthering their learning • Continued development of Same Day Emergency Care (SDEC) services including ACP lead role and cross-site standardisation of systems and processes • Excellent proportion of patients coming from GP service together with a lower than national average of patients coming from the ED at both sites • Consistently low readmission rate across multiple specialties at both sites • Review capacity of AMUs as they are currently too small • Review the coverage of speciality services at weekends Dr Aruna Maharaj, Consultant Acute Physician, said: “We are delighted with this very positive feedback from the GIRFT team.

“One key compliment was the excellent length of stay for patients in the Trust and also the very low re-admission rates. This is something we are very proud of and will continue to work on to maintain these excellent figures.”

www.sath.nhs.uk

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Our Service delivery

SpaceOAR and SABR SaTH is using innovative techniques to improve outcomes for cancer patients. The Trust has recently been commissioned to introduce SpaceOAR for patients receiving radiotherapy for prostate cancer.

When treating prostate cancer patients with radiotherapy, the goal is to destroy the cancer cells while avoiding damage to surrounding healthy tissue.

For patients receiving radiotherapy the aim is to deliver a high dose to the prostate and to minimise the dose to the rectum. However, as the margin between the rectum and the prostate is small it is not possible to treat the prostate without the rectum receiving some radiation dose. This results in some patients experiencing short- and long-term side effects which can significantly affect their quality of life.

SpaceOAR is a hydrogel which can be inserted between the prostate and anterior rectal wall, creating a temporary space between the two organs.

This means that the dose to the rectum can be reduced, minimising rectal damage.

The SpaceOAR Hydrogel procedure has been performed in more than 50,000 patients worldwide and has been demonstrated in clinical studies to reduce radiation toxicity by approximately 70%.

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SaTH is also delivering SABR (Stereotactic Ablative Radiotherapy) Treatments for lung cancer.

SABR delivers an extremely high dose of radiation to the tumour site while limiting the dose to critical organs such as the spinal cord, heart and healthy lung. The radiation beams use advanced technologies to focus the high dose of radiation onto a very small tumour volume, which can only be done by specialised treatment planning and imaging during treatment.

SABR will improve outcomes for these patients, especially those unfit for surgery.

Extensive work has been carried out by a multidisciplinary SABR team, preparing protocols, pathways and work flows for safe delivery. These include oncologists, radiologists, scientists, dosimetrists, radiographers, nurses and other dedicated members of the radiotherapy team.

The first patient received this treatment in June.

Well done to the Radiotherapy team, who picked up the ‘Ambitious’ Values Award at the Trust Awards this month.

Governance

NELA By engaging with surgical and anaesthetic teams, critical care, theatres and management SaTH has worked together to change the culture in our hospital to prioritise emergency surgery, better identify frail patients and patients with multiple conditions and improve access to critical care throughout the pre-op and post-op period.

This work has led to SaTH has being highly commended in the West Midlands Academic Health Science Network’s (WMAHSN) esteemed Meridian Celebration of Innovation Awards.

SaTH was runner-up in the ‘Above and Beyond’ Adoption of Innovation Award for its work on the National Emergency Laparotomy Audit (NELA).

A clinical audit like NELA is undertaken by an independent body to assess the quality of care in hospitals by looking at how it treats its patients and the outcomes of those patients.

NELA is a national clinical audit being carried out in over 180 hospitals in England and Wales.

SaTH has been working over the last two years to provide better care for emergency laparotomy patients by putting NELA principles at core of service development.

With support of data from Getting It Right First Time (GIRFT), the Trust has recruited four more general surgeons to support the emergency workload and to allow us to provide a consultant delivered service and better training for juniors.

Emergency Laparotomy data has helped to help secure funding to build a new surgical assessment unit which, combined with new diagnostic pathways, will allow more timely patient diagnosis and treatment, which will be wonderful for our patients and communities.

www.sath.nhs.uk

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Patients and Community

New Cataract Suite A new cataract operating suite has opened on Ward 20 (Copthorne Building) at RSH. This latest addition to our Ophthalmology Department is part of a wider project that started in October 2016 to improve eye care services for people in Shropshire, Telford & Wrekin and Mid Wales.

Tony Fox, who four years ago was named the Executive Sponsor for the improvement programme, said: “We now have a service centre that we can be proud of.”

Suresh Sagili, Clinical Lead for Ophthalmology, thanked everyone involved with the project for their dedication. He said: “With our new facilities we will improve the sight for so many patients in the region.”

Improvements include: • New cataract operating suite • New adult and paediatric departments • Engagement across all clinicians, nurses, allied professionals and community stakeholder groups • Fully staffed with substantive positions • Fully functional clinical areas • Daily safety huddles and robust governance This is a huge achievement for the teams and brings positive benefits for our patients and communities.

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www.sath.nhs.uk

Our Service delivery

Endoscopy Modern endoscopy services are a vital part of the diagnosis of patients with cancer and other serious illnesses.

SaTH has signed an agreement with healthcare technology provider Althea UK to help transform endoscopy and decontamination facilities at our two hospitals.

The programme includes a major reconfiguration of facilities at RSH and PRH with the provision of two additional endoscopy procedure rooms and a new decontamination facility in Shrewsbury and the construction of an additional procedure room and a new decontamination facility in Telford, providing greater clinical capacity and larger space to accommodate patients in need of endoscopy procedures, while also bringing important cost-efficiencies.

Mark Cheetham, Division Medical Director Consultant General and Colorectal Surgeon

This will support the Trust in meeting current and future demand while ensuring compliance with the Joint Advisory Group on GI Endoscopy (JAG), the Institute of Healthcare Engineering and Estate Management (IHEEM) and Health Technical Memoranda (HTM).

Mark Cheetham, Medical Director for Surgery, Anaesthetics and Cancer, said: “We are pleased to partner with Althea in order to develop our endoscopy services. This collaboration will mean that we can scale up endoscopy capacity, maintain modern standards of decontamination and keep equipment up to date.”

www.sath.nhs.uk

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