chief executive’s report - kingston hospital · 2.6 the report of the morecambe bay investigation...

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Kingston Hospital NHS Foundation Trust -Trust Board – Part 1 – March 2015

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CHIEF EXECUTIVE’S REPORT

Name of meeting: Trust Board Item: 6

Date of meeting: 25th March 2015 Enclosure: C

Purpose of the Report / Paper: To provide the Board with information on strategic and

operational issues.

For: Information Assurance Discussion and input Decision/approval

Sponsor (Executive Lead): Chief Executive

Author: Executive Team

Author Contact Details:

[email protected]

020 8934 2814

Risk Implications - Link to Assurance

Framework or Corporate Risk Register:

The issues outlined in this report touch on many of

the Trusts objectives and risks

Link to Relevant Corporate Objective:

The issues outlined in this report touch on many of

the Trusts objectives and risks

Document Previously Considered By:

Recommendations:

The Trust Board is asked to note and discuss the updates provided in the report.

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Chief Executive’s Report

March 2015

1. Summary

This paper provides the Board with an update on some of the key areas of activity that could

impact upon the strategic development of the organisation.

2. External Environment

2.1 SWL Collaborative Programme

The SWL Acute Provider Collaborative has now been set up and work has begun. The

Collaborative consists of the four SWL acute providers, who have agreed to work together to

identify how acute services in SWL might be made more clinically and financially sustainable, and

to respond to commissioners’ intentions in the Five Year Strategic Plan for South West London.

The work of the Collaborative will focus on building collaborative behaviours between providers;

delivering some quick wins; and answering the question “if the four acute providers were working

as one, in the best interests of their populations, how would they design services to maximise

clinical and financial sustainability?”

The Collaborative is now up and running, with some funding provided by commissioners. A

Programme Director, Alexandra Norrish, has been appointed; work has started on delivering

some Quick Wins, particularly around sharing consultant rotas, with close involvement from the

Medical Directors; and the work programme for the wider programme should be signed off

shortly. The work programme will look in particular at how the London Quality Standards might be

delivered in maternity, paediatrics and urgent and emergency care; and at delivering options

around elective care, including a multi-specialty elective centre. Commissioners have issued a

prospectus requesting providers to lay out how they would deliver a multi-specialty elective centre

by 2019, and the work of the Collaborative will include this amongst other options for elective

care. Proposals on the elective centre are due at the end of May, and on the other areas by the

end of July.

2.2 Update on Integration Work with Kingston & Richmond

Work continues with other providers in Richmond (Richmond GP Federation, Hounslow &

Richmond Community Trust, SWL & St George’s Mental Health Trust and Richmond Social

Services) on a joint response to Richmond Clinical Commissioning Groups (CCG’s) outcomes

based commissioning proposal, see Appendix 1 for an update from Richmond CCG on the OBC

proposal. The partners submitted a bid to become a ‘forerunner’ but were unfortunately not

successful. The feedback was that the bid did not meet the criteria they had set for forerunner

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sites as well as some of the other bids. There were nearly 300 bids with less than 20 sites

chosen. The team encouraged the partners to continue their work.

In Kingston discussions are also progressing. Kingston Clinical Commissioning Group (CCG) are

currently analysing the results and impact of the pilot projects and reviewing how they may be

scaled up. The Trust is fully engaged in these discussions.

2.3 CQC Inspection – Whipps Cross University Hospital

Barts Health NHS Trust has been placed into Special Measures, following the release of the

CQC report into the inspection of Whipps Cross University Hospital. The hospital was overall

rated ‘inadequate’, with 6 of the 8 core services rated as ‘inadequate’ and 2 rated as ‘requiring

improvement’. The key reasons for these ratings include;

The removal of 220 posts in 2013 and down banding of several hundred nursing staff had

a significant and damaging impact on staff and the service provided

A culture of bullying and harassment, and concerns not enough is being done to change

the culture

Staff morale was low - the 2013 NHS Staff Survey for the trust as a whole had work

related stress at 44%, the joint highest rate in the country for an acute trust. 32%

recommend it as a place to work - the third lowest in the country.

Some staff were reluctant to speak to members of the inspection team due to fear of

repercussions.

Staffing was a key challenge across all services with an environment not conducive to

recruitment and retention and sustainability of services

The implementation of IT systems had impacted on patient safety and care - patients

were struggling to get appointments and be recognised as needing care and treatment.

Patients, staff and stakeholders including Commissioners, MPs, Royal Colleges, Health

Education England and local branches of Healthwatch continued to raise concerns about

the quality of the service provided.

There was limited learning from incidents. Staff did not have the time to report incidents,

were not encouraged to report incidents and were not aware of any improvements as a

result of learning from these incidents. Some senior staff were unaware of serious

incidents and action plans that involved them leading the required change.

Patients well enough to leave hospital experienced significant delays in being discharged

because of documentation needing to be completed. During the inspection an estimated

30 patients were well enough to leave hospital but remained because their continuing

health care assessments had not been completed. Staff that previously completed this

paperwork were no longer in post because of the restructure.

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Operations were often cancelled due to a lack of available beds.

Staff told the CQC that the executive team were not visible.

Nursing staff who were previously supernumerary to the shift were no longer there to

provide leadership and guidance.

There were a number of vacant managerial posts and interim staff in post making it

difficult for staff to be well-led.

As part of the preparation for Kingston Hospital’s CQC visit, the findings of this report will be

reviewed fully to identify any key areas of learning for the Trust. The next wave of Trusts to be

inspected, in August 2015, has been announced and the Trust is not on the list of hospitals.

2.4 CQC Guidance on Display of Ratings and on the Regulations (Fundamental Standards)

The CQC has published on 12th March 2015 the final guidance documents for providers on two

key legislative requirements.

Display of Ratings - From 1st April 2015 all providers that have been inspected under CQC’s

new inspection regime and issued with a formal rating will be legally required to display that rating

at the premises where the service is being provided, and on their website. Trusts will have a

maximum of 21 calendar days to display ratings from the date the inspection report is published

on the CQC website.

The Regulations (Fundamental Standards) - The Fundamental Standards also come into force

on 01 April 2015. The finalised Regulations Guidance provides direction for providers on meeting

two groups of regulations:

Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which

encompass the new Fundamental Standards including the Fit and Proper Persons Test

(Regulation 5); the Statutory Duty of Candour (Regulation 20), and the Display of CQC

ratings (‘Performance Assessments’) (Regulation 20a). Further guidance about

Regulations 5, 20 and 20A will be published in March.

Care Quality Commission (Registration) Regulations 2009 (Part 4)

These replace in its entirety the CQC's Guidance about Compliance: Essential standards of

quality and safety and its 28 outcomes.

The Trust will undertake an assessment under new guidance to ensure it is compliant and will

report back to the next meeting.

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2.5 Adult Safeguarding (Savile Recommendations)

On 26th February 2015 the Department of Health published the Independent report for the

Secretary of State arising from the 44 investigations into matters relating to Jimmy Savile. The

themes and lessons learnt identified were summarised into 14 recommendations and include

guidelines and procedures which need to be tightened or changed across the NHS in order to

sufficiently safeguard patients.

The Trust has been reviewing and updating polices over recent months to include specific areas

of focus on adult safeguarding, volunteering (including DBS checks) and mental capacity. Further

changes will be required in light of the implementation of the Care Act from April 2015 and the

revision of the Pan London Adult Safeguarding Guidance (due April 2015). Recent

communications exercises have been undertaken regarding incident reporting, duty of candour

and raising concerns in the workplaces. A review of all volunteers DBS checks has been

concluded, recruitment and training procedures been changed to ensure greater visibility of the

safeguarding agenda has been achieved. Mandatory training for adult safeguarding has been

included in the staff handbooks and a higher degree of visibility and awareness has been

achieved with increased uptake of mandatory training.

Recommendations 9 and 12 (social media access for patients and visitors, and risk assessment

and management of Trust brand where celebrities are involved) are newly emerging themes in

the independent report which will need to be considered. The Safeguarding Adults Steering

Group reports quarterly to CQIC and CQRG meetings and will continue to provide oversight of

the actions required to address the recommendations in the Lampard Report (including

recommendations 9 and 12). The safeguarding annual report to the Trust Board will provide a

summary of how the Trust has responded to the Savile recommendations.

2.6 The Report of the Morecambe Bay Investigation

An independent investigation into the management, delivery and outcomes of care provided by

the maternity and neonatal services at the University Hospitals of Morecambe Bay NHS

Foundation Trust from 1st January 2004 to 30th June 2013 was undertaken, led by Dr Bill Kirkup

CBE. The report was published on 3rd March 2015 and details serious failures of clinical care in

the maternity unit at Furness General Hospital (FGH). The report details 20 instances of

significant failures of care in the FGH maternity unit which may have contributed to the deaths of

3 mothers and 16 babies. Different clinical care in these cases would have been expected to

prevent the death of 1 mother and 11 babies. The report says the maternity department at FGH

was dysfunctional with serious problems in 5 main areas:

Clinical competence of a proportion of staff fell significantly below the standard for a safe,

effective service. Essential knowledge was lacking, guidelines not followed and warning

signs in pregnancy were sometimes not recognised or acted on appropriately.

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Poor working relationships between midwives, obstetricians and paediatricians. There

was a ‘them and us’ culture and poor communication hampered clinical care.

Midwifery care became strongly influenced by a small number of dominant midwives

whose ‘over-zealous’ pursuit of natural childbirth ‘at any cost’ led at times to unsafe care.

Failures of risk assessment and care planning resulted in inappropriate and unsafe care.

There was a grossly deficient response from unit clinicians to serious incidents with

repeated failure to investigate properly and learn lessons. The report says proper

investigations into serious incidents as far back as 2004 would have raised the alarm. It

was not until 5 serious incidents occurred in 2008 that the reality began to emerge.

One of the areas highlighted in the report was the reporting and investigating incidents. It is worth

noting that the process at Kingston Hospital for all Serious Incidents include an external chair and

all reports are signed off by a Trust committee which includes CCG representation.

The issues however went beyond the maternity unit in how the operations of the Trust 7

opportunities to intervene were missed by including the North West Strategic Health Authority,

the Care Quality Commission, Monitor, the Parliamentary and Health Service Ombudsman and

the Department of Health.

The report makes 18 recommendations specifically for Morecambe Bay NHS Foundation Trust,

and a further 26 for the wider NHS and other organisations. Recommendations include:

Introduction of national standards of professional duties for clinical leads at all levels, with

a requirement for Trusts to evidence appropriate policies and training to meet these

standards;

Introduction of clear national standards setting out the duties for Trusts and staff in

relation to inquests

Strengthening local resolution and timeliness of complaints responses, with external

scrutiny of local resolution

Clear standards for incident reporting and investigation in maternity services,

A duty placed on all NHS Boards to report openly the findings of an external investigation

into clinical services, governance or aspects of operation of the Trust, including prompt

notification of relevant external bodies such as the CQC & Monitor.

The Head of Midwifery is undertaking a review of the all the lessons identified in the report which

will be reported through to the Clinical Quality Improvement Committee.

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2.7 Performance of the Foundation Trust Sector for Quarter 3 (to 31st December 2014)

A & E targets

NHS FT’s failed to meet the A & E four hour waiting time target for the fourth quarter in a

row. 42,600 people, an increase of 134% - waited on a trolley for more than four hours

between a decision to admit and arrival on a ward.

One of the main contributing factors was a shortage in emergency beds to meet the level of

emergency admissions. 2.7 m people attended A & E’s which was 8% higher than the same

period last year.

Cancer targets

There has been a steady decline in the performance of FTs against the 62 GP referrals

standard for the last 8 quarters

70% of FTs said complex diagnostic pathways were one of the main factors for the breach

Waiting time standards

Elective care performance was still below the 90% target for admitted referral to treatment

(RTT) target – but there has been a slight improvement

At the end of Q3 FTs had a combined waiting list of 1.65 m which was 40,000 less than the

previous quarter and c2.5% higher than the same quarter in 2013/14

An extra 40,000 patients were admitted for treatment and over 2.3 m non-emergency

patients were treated in the quarter an increase of 7% over the same period last year.

Financial performance

The sector deficit has increased by £67 m to £321 m. Almost five times bigger than the

planned deficit of £54m

o 78 FTs reported deficits totally £530 m

o 71 FTs made a surplus of £209 m

The forecast for the year end for the sector is a net deficit of £375 m

Spending on contract and agency staff is 123% above plan with an actual spend in Q3 of

£1,265 m. The London region had the highest spend at 8.4%.

Trusts made £810 m worth of cost savings which was £210 m less than planned

Monitor action

7 investigations are currently open

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Enforcement action is being taken against 28 FTs because of governance or finance

concerns

9 FTs are in special measures

2.8 Safeguarding Children Report (Rotherham)

On March 3rd 2015 the government issued a response to the chronic failure to protect children

from sexual exploitation in Rotherham. All agencies have been sent a letter setting out how and

when personal information should be shared. The Government document ‘Working Together to

Safeguard Children’ 2013, is being updated with the aim of giving clear guidance on everyone’s

responsibility to share information and they will also publish a myth busting guide to help

professionals take informed decisions. Local areas are also being asked to consider the following

principles for multi-agency working: Integrated working, joint risk assessments, victim focused

approach, and frequent reviews of operations. The letter also includes a summary of existing

legislation and guidance on information sharing: Data Protection Act, The Seven Caldicott

Principles, and Information Commissioners Office Data Sharing Code of Practice.

At present the Trust meets the requirements outlined through:

Safeguarding Children Policy – available on the Intranet, updated in line with national

guidance

Information Sharing Policy – available on the Intranet, updated in line with national

guidance

Close working with the Trusts information governance manager

Safeguarding Children Induction presentation

Mandatory Update Training updates – included in the booklets

Multi-agency attendance at local Safeguarding Children Committee

Named professionals attendance at multi agency forums

2.9 Shape of Caring: A review of the Future Education and Training of Registered Nurses and Care

Assistants

The Shape of Caring review Chaired by Lord Willis was published on 12th March 2015 and looks

at the future education and training needs of nurses and care assistants. The report underlines

the link between societal changes, technological advances and the preparation required for

practice and ongoing education of nurses and care assistants. The report makes 34

recommendations which are categorised into 8 themes, which are:

Enhancing co-production and the voice of the patient

Valuing care assistants

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Widening access for care assistants to enter the nursing profession

Assuring flexibility in nursing

Assuring a high quality learning environment in undergraduate education

Assuring predictable and sustainable access to ongoing learning and development for

registered nurses

Supporting and enabling research, innovation and evidence based practice

Funding and commissioning levers to support future education and training

The report outlines that care assistants should be a particular area for investment given they

provide approximately 60 per cent of hands on care, and have often had little access to training

and education. Furthermore the report emphasises the need to ensure that registered nurses are

valued throughout their carer with different carer models and post graduate development

mechanisms. The importance of nursing research to improving clinical effectiveness and care

experience is also underlined.

The implications of the report will be considered by national bodies including Health Education

England and the Nursing & Midwifery Council. The Trust will be considering the implications of

the report through various professional forums such as the Matrons Committee, the Sisters

Forum and the Safe Staffing Group. The recommendations will also be discussed with Kingston

University as part of our regular review meetings with the Trust.

3. Internal Environment

3.1 University Technical College (UTC) Bid

UTCs are all-ability and mixed sex state funded schools, independent of local authorities. They

are not extensions of or conversions from existing provision, but new 14-19 Academies, typically

with 500-800 pupils. UTCs specialise in subjects that need modern, technical, industry-standard

equipment, such as engineering and construction, and teach these disciplines alongside business

skills and a broad, general education. Pupils integrate academic study with practical learning,

studying core GCSEs alongside technical qualifications. The ethos and curriculum are designed

with local and national employers who also provide support and work experience for pupils. UTCs

are providers with strengths in the UTC’s specialist subject areas. UTCs should provide

progression routes into higher education or further learning in work, including apprenticeships.

The Trust has agreed to be one of the key employer partners for a Kingston UTC, and reflects the

desire for health sciences to be a core curriculum subject. A bid for a Kingston UTC is currently

being prepared to be submitted in October 2015, with a view to be open by September 2017.

There is local cross party support for a Kingston UTC, which is also supported by Kingston

University and Barclays.

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Given current and future workforce demand it is deemed important the Trust proactively works

with local provides to secure routes for future employees. The Trust is therefore fully engaged as

part of the bid process.

3.2 Open and honest care: Driving Improvement Programme

The Trust has agreed to become an earlier implementer on the Open and Honest Care

Programme. The Open and Honest Care: Driving Improvement Programme is a central part of

NHS England’s commitment to making more information available about the quality of care in the

NHS. The programme began in the North of England in December 2013 with 23 Acute

organisations publishing monthly reports. Subsequently the programme has advances with the

development of Community and Maternity metrics, and there are currently thirty two organisations

in the North publishing monthly acute, community and maternity reports. An independent

evaluation of the programme in the North has demonstrated that it is a highly valued part of the

NHS improvement strategy, which facilitates ward based staff to identify areas for improvement,

empowers them to act and contributes to a culture of learning across their organisations.

Organisations joining the programme are asked to publish a monthly report on the 23rd of each

month on their websites using an agreed template. The report will include safety metrics

comprising of the National Safety Thermometer data. Pressure Ulcer and Falls incidences and

Health Care Associated Infections (rates of C Difficile and MRSA bacteraemia); maternity metrics

comprising of the numbers and types of deliveries, numbers of actual harms in relation to staff

experience data; a patient’s story; an improvement story and any relevant additional information

that Trusts wish to include. In the near future Trusts will also be asked to publish data on safer

staffing and never events (Definitions and format for these to be agreed). A link to each Trusts

reports will be published on the NHS England Open and Honest Care webpage.

The Board will be updated on progress with implementation once a time line has been

established with the Open and Honest Care Programme Team.

3.3 Quality Account

In December 2014 and January 2015, an online survey was conducted to identify quality

improvement priority preferences of Kingston Hospital NHS Foundation Trust Members, patients

and staff and other stakeholders with over 140 responses received. The feedback is also being

used to help inform the next version of the Trust’s Quality Strategy. These results of the survey

were combined with feedback from various committees and forums, as well as current Quality

Improvement Projects, the Sign up to Safety projects and the draft Corporate Objectives 2015/16

to develop the long list. In February 2015 Trust Members, Patients, Staff, Governors, Volunteers,

Healthwatch and other stakeholders were invited to take part in a second survey to develop the

final nine Trust priorities. The Trust received 220 responses to this second survey.

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The Quality Account 2015/16 priories, as identified through these two surveys, are:

Safety

Reduce use of agency staff by reducing vacancies

Implement patient safety elements of Year 2 of the Dementia Strategy

Improved recognition and management of sepsis in hospital

Clinical Effectiveness

Increase in the provision of 7 day working of key staff and services

To work towards paperlight systems using information technology and record

management across the Trust

To ensure all our staff are up to date with core (mandatory) training, have clear

objectives, regular appraisal and a personal development plan reflecting our values

Patient Experience

To transform administration across the hospital and make improvements in

administration

Improvements in End of Life Care

Improvements in discharge planning and processes

3.4 Update on the People First Programme – improving patient administration

People First is the umbrella programme for a range of activities and workstreams aimed at

delivering sustainable improvements in patient administration across the trust. The main

workstreams are:

1. Patient Pathway Co-ordinator (PPC) model implementation

2. Implementing a new telephony system

3. Training (technical skills & customer care) & staff engagement

4. Letter sending / e-communications & CQUIN targets

5. Central team working

Since the presentation to the Board at the last meeting there has been significant progress

across all workstreams:

Patient Pathway Co-ordinator (PPC) model

Financial modelling has been completed enabling each service line that is adopting the PPC

model to proceed with the process of implementation. A consultation with the majority of staff

was concluded in early February; the Board will be aware of concerns raised by staff in General

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Surgery who were part of a separate consultation process which took place in October 2014.

Meetings have been held with the relevant Service Line Manager and administration team and

the issues have been addressed.

A PPC ‘state of readiness checklist’ is being followed helping to highlight particular gaps & needs

(for example in General Surgery, Gynaecology and Specialist Outpatients) leading to the roll-out

of more intensive support in these areas.

All service lines are on track to reach go live state by 30 March although it recognised that

enhanced transitional support will need to continue into April & May as a minimum.

Implementing a new telephony system

All the necessary works, testing and call flows have been concluded. For the first time, Service

Lines will have direct-dial departmental numbers supported by a call handling system with

significantly greater capability, including the ability for all staff to manage calls not just a few staff

members in each team.

The system is set to go live on 31st March 2015 and intensive communications around new the

numbers is underway. Main switchboard will remain unchanged (apart from a new menu of

choices) so our core service will be stable. In addition there will be additional call handlers for

two weeks around go-live to support with re-directing & in case of other issues. It should be noted

that the vast majority of changes are ‘behind the scenes’ and concern the installation of better call

handling software; apart from the introduction of direct access numbers, patients do not need to

do anything different.

There is a drop-in session on 26th March 2015 to demonstrate the new system to staff which

Board members are also welcome to attend.

Training, Letter Sending and Central Team working

Customer care training is now being rolled out. The Chief Executive, patients and a member of

staff have been filmed for videos addressing customer care best practice and reinforcing the

important role of our non-clinical front line staff. The videos are being used in the training to

prompt discussion points and development opportunities. This innovative approach has two

further key elements – a core learning session with action planning for personal development,

which is followed 6 weeks later by ‘Action Learning Set’ session to consolidate the learning. The

programme started March 2015, will run until June 2015, targeting around 240 non-clinical front

line staff.

In February 2015 the Trust combined the Letter Sending workstream within People First with

postage working group to address reducing costs across whole organisation and to reduce

number of letters in circulation. The project is focussing on tackling postage costs by changing

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how letters are prepared (it is cheaper for example to send an A5 envelope than a DL envelope

with same contents); reducing admin errors and thus the need to re-issue letters; significantly

increasing the use of Docman (our IT link with GP surgeries); moving to more e-communications

such as e-mail; and increasing use of on-site booking of follow-up appointments. The Trust

recently completed a ‘Market Testing’ survey to gain insights into our patient and carer appetite

and preferences around e-communications. A proposal paper for delivering e-communications

will be discussed at the Executive Management Committee on 1st April 2015.

As part of People First, the Trust identified that a central team managing receptions and holding

some administrative functions centrally would greatly enhance the efficiency and effectiveness of

some of our key activities. Over the last few weeks work has begun on: consolidating reception

functions for main outpatients and gynaecology and to ensure closer working with radiology; on

changing staff rotas to ensure full 9-5 coverage 5 days a week; agreeing the range of functions to

be held centrally. The new function will also take on responsibility for assuring Standard

Operating Procedures are being followed in Service Lines. A HR consultation, due to impacts on

staff, started mid-March and will last for 4 weeks.

Issues & Risks

People First is a significant programme of transformation which seeks to address one of the

Board’s priority areas. As with any change programme, the process will be and is at times

challenging but with robust structures in place it is possibly to act quickly and effectively on the

risks and issues once identified.

The current issues being managed include:

Intensive support to Gynaecology and Specialist Outpatients due to capacity challenges

and enhanced training needs

Potential for a dip in performance as staff get to grips with skills required for the new range

of responsibilities

Staff and clinical engagement - prioritising service lines with greatest need.

Working towards self-sufficiency – the intensive support currently being provided cannot be

sustained, nor is it helpful to do so. The Trust will take steps to maintain support into the

next phase of the programme during Quarter 1 of 2015/16 but with a view to tapering off

leadership and handing over ownership.

3.5 Workforce equality standards

The Workforce Race Equality Standard (WRES) is a new and innovative initiative which goes live

across the system on 1st April 2015. The aim of the standard is to improve the experience of

black and minority ethnic staff working in the NHS. It is commonly known and well evidenced that

across many indicators BME staff have a less positive experience of working in the NHS than

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white staff. The evidence of the link between the treatment of staff and patient care is particularly

well evidenced for BME staff in the NHS, so this is an issue for patient care, not just for staff.

Despite a multitude of race equality initiatives and examples of provider good practice since the

2004 Race Equality Action Plan, many of the key indicators are either static or actually getting

worse . In response to this challenge, the 2015/16 NHS Standard Contract includes a new

Workforce Race Equality Standard (“the Standard”) which will require almost all NHS providers of

NHS services (other than primary care) to start to address this issue. It states at Service

Condition 13:

‘The Provider must implement the refreshed Equality Delivery System (EDS2); and implement the

National Workforce Race Equality Standard and submit an annual report to the Co-ordinating

Commissioner on its progress in implementing the Standard’.

The Care Quality Commission will also consider the Workforce Race Equality Standard in their

assessments of how “well-led” NHS providers are from April 2016. This is a challenge requiring

Board level commitment and leadership within NHS organisations, not just to comply with the

new Standard and future CQC inspection standards, but because race equality is good for patient

care. The Standard will, for the first time, require organisations employing almost all of the 1.4

million NHS workforce, to demonstrate progress against a number of indicators of workforce race

equality, including a specific indicator to address the low levels of Black and Minority Ethnic

(BME) Board representation. There are nine indicators. Four of the indicators are specifically on

workforce data, four are based on data from the national staff survey indicators, and one

considers Board composition. The Standard will highlight any differences between the experience

and treatment of White staff and BME staff in the NHS with a view to closing those metrics.

Indicator 9 requires organisations to ensure their Boards are broadly representative of the

communities they serve.

This will be taken forward through the Trust’s Equality & Diversity Committee.

3.6 Duty of candour & whistleblowing

Sir Robert Francis QC’s Freedom to Speak Up Review recommended a wide-ranging reform of

culture in healthcare, to ensure that healthcare staff feel safe to raise concerns over patient care

and treatment without fear of reprisal. His stated priority is that “above all, behaviour by anyone

which is designed to bully staff into silence, or to subject them to retribution by speaking up, must

not be tolerated.” The Review emphasises with some force the requirement for NHS bodies to

encourage openness and transparency in handling concerns. There is a real emphasis on the

continued need for cultural change, with a focus on leadership, training and the proper

management of complaints. NHS bodies are encouraged to embrace this new culture. The

Review sets out 20 principles for change, themed around, culture, handling of cases when

https://freedomtospeakup.org.uk/wp-content/uploads/2014/07/F2SU_web.pdf

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concerns are raised, measures to support good practice, measures for vulnerable groups and

additional legal protection.

The Review does not recommend the creation of any further regulatory bodies, and notes in

particular that CQC concepts of the well-led organisation, and the recent introduction of the Fit

and Proper Person Requirement, need to be given time to take effect. The Review is clear that

the culture change, which is such a priority of the recommendations, needs to be achieved by

effective, visible leadership, instilling teamwork and reflective practices and not promoting a

culture of hierarchy. The Review envisages some important legislation changes for the NHS

specifically, and other measures which Sir Robert considers the NHS has a “moral obligation” to

adopt. It recommends the appointment of “Freedom to Speak Up Guardians” and an

Independent National Officer, appointed jointly by Regulators. The Secretary of State has

already confirmed that he is “accepting all [Sir Robert’s] recommendations in principle” and that

the NHS-specific legislation will be introduced before the election.

The Trust will review the implications of this report for the Trust and report to the next Board

Meeting.

3.9 Volunteering Conference

On Monday 16th March 2015, the Trust delivered its inaugural Volunteering Conference with over

200 participants from representing our volunteers, voluntary and community partners, local

authority public health partners, funders and NHS colleagues from across England. It was an

event of two parts, a morning to celebrate who are volunteers are and what they do. Highlights

included the first set of Volunteering Values Awards which celebrated ten shining examples of

volunteers who live the values and deliver visible results for their activities for themselves as

individuals, our patients and our hospital community. The Key note speech was provided by Nick

Ockenden, Director, Institute for Volunteering Research. The focus of the afternoon shifted to a

multi-sector debate about the future of hospital based volunteering. Olivia Butterworth, Head of

Public Voice, NHS England spoke and sessions included co-designing a blue print for Impact

Volunteering in hospitals, and volunteering to support the integration of care between hospital,

home and community.

The output of the conference, a Dossier on Impact Volunteering will influence national policy

makers, funders and local partners to think differently about the role of volunteering, social action

and community engagement in NHS hospitals and the principles for impact. The conference has

cemented Kingston Hospital’s role as the sector leader in this field.

Locally, the event attracted the attention of Councillor Julie Pickering and Rachel Bartlett of

Kingston CCG and has been accepted as a submission to the Active and Supportive

Communities Strategy for Kingston Upon Thames. Its early impact includes a conversation on

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23rd March with the CEO of the London Food Board, Rosie Boycott, to scope an increased

resource that will elevate Kingston Hospital’s Dining Companions Scheme as a model of best

practice to be replicated across the NHS and indeed, social care and community settings.

3.10 Midwifery Supervision

Following an independent review of the regulation of midwives in the UK, on 28th January 2015,

the Nursing and Midwifery Council’s (NMC) has accepted the recommendation that statutory

supervision should no longer be part of its legal framework. This will however take time for

legislation to change for this to take effect, so in the meantime Midwifery Supervision will need to

continue. Trusts in the transition phase need to reflect specifically on areas where the existing

supervision model is of benefit to women and staff. In particular:

"Organisations providing maternity care should consider how they will continue to provide

access for service users to discuss aspects of care"

A weekly midwifery supervision clinic is in place in the Trust where women are offered a debrief

from a previous experience or support for a birth plan outside guidelines. The maternity unit aims

to continue to provide this service which will be run by experienced midwives with the support of

the consultant midwife.

"The RCM and Directors of Nursing should consider how to fill both the current gaps in

professional leadership for midwifery and any gaps that would emerge as a result of

change to the NMC regulatory functions"

It is important to ensure that professional leadership remains strong within maternity. A gap

analysis will be carried out to identify any gaps. Existing key roles, including midwifery managers,

consultant midwife, practice development team, maternity risk manager and others will be

reviewed to determine what elements of professional leadership can be incorporate into these

roles.

4. Operational performance

4.1 Operational Performance

The Hospital continued to be busy during February and staff have worked exceptionally hard to

keep patients flowing through the hospital. The high number of patients with a delayed transfer of

care (DToC) in the hospital makes us a national outlier and we continue to work closely with our

partners to do all we can to discharge patients in a timely fashion with the appropriate care and

support in place. Despite everyone’s hard work the 4 hour A &E standard was not met in

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February. A plan to improve the flow of patients and to recover performance against the standard

has been developed based on the SAFER bundle and presented to the Tripartite.

Performance against the cancer standards has slipped in some areas predominantly due to a

mixture of patient choice and administrative errors. On a more positive note the 18 week Referral

to Treatment (RTT) standard was exceeded with the Trust undertaking additional activity on

behalf of NHS England.

4.2 A&E Refurbishment Delay

Given the deficit forecast for 2015/16, the amount of capital monies will be significantly reduced.

The Board have prioritised the capital programme for phase I and patient refurbishment, the

complete replacement of the windows in Esher Wing together with the start of the refurbishment

programme for theatres with two main theatres each year. The A&E refurbishment, whilst

extremely important to meet the increasing emergency demand will be put on hold.

4.3 Communications

The Team have been working on a number of campaigns and projects since the last Board

meeting in January, in particular campaigns to promote #hellomynameis and NHS Change Day

and communications support for the Volunteering Conference, car parking and the People 1st

(Patient Administration) programme. On an ongoing basis the communications team regularly

use twitter and facebook and monitor external activity and the number of followers. The Trust

currently has 1,520 facebook likes, 6,170 followers on twitter and more than 18,000 visitors to the

Trust website every week. Other projects include:

Planning for Hospital Open Day – 13th June;

Preparation of the Annual Report;

Support for Dementia Appeal and fundraising initiatives;

Development of awareness campaign for patient transport;

Car parking communications;

Co-ordinating and promoting the Monthly Staff Excellence Awards process;

Patient Flow programme communications;

Long Service awards;

Communicating the Trust’s vision and values;

Roll out of the Quality goals;

Publication of new Hospital magazine;

Production of Team Briefing;

Membership engagement

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Appendix 1

Outcomes Based Commissioning (OBC) Stakeholder Briefing

Work continues apace on the outcomes based commissioning community services contract and

we have recently undertaken a process to identify the Most Capable Providers that could deliver

the community services contract from 2016.

Work has also commenced on developing the project scope for community mental health

services including a programme of engagement which will build on the work begun last year.

Most capable provider selection process

Instead of running a traditional procurement process, Richmond CCG and LBRUT expect a group

of ‘Most Capable Providers’ to come together to form an alliance in order to deliver the

community services contract. This group or alliance will be accountable for integrating ‘out of

hospital’ health and social care for the adult population of Richmond.

An evaluation process has been undertaken and the CCG and Council have now defined the

group of providers whom we believe are the crucial and most capable set of providers to work

together to deliver the contract from April 2016.

We are delighted to announce that the four providers are:

Hounslow and Richmond Community Healthcare NHS Trust (HRCH)

Richmond GP Alliance

Kingston Hospital NHS Foundation Trust

West Middlesex University Hospital NHS Trust

The four selected providers will be invited to demonstrate that they have the appetite and

appropriate capability to be appointed as the alliance of ‘Most Capable Providers’ to deliver the

integrated services of improved quality and efficiency for the population of the borough of

Richmond from April 2016 onwards.

The next steps are to begin a process of engagement with the four providers, as a collective, in

order to work towards innovative ways of delivering services from April 2016.

Mental health services

Work began last month on the development of an outcomes and indicator framework for

community mental health services. The CCG and Council believe it is important to align mental

health with the physical health work already underway in community services and the scope of

the engagement and outcomes development will include

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Adults, with a focus on younger service users

Older adolescents

Service users of care that is or could be provided in Steps 1-4 of the mental health stepped

care model which includes people with common mental health problems such as anxiety or

depression and people with severe and enduring mental health problems

Carers for service users

People with dementia and carers for people with dementia

Out of scope for this phase are service users of child and adolescent mental health services

(CAMHS) and people with learning disabilities.

The engagement activity for this phase will build on the community services activity but will

involve more site visits to where service users already meet and less centrally-held workshops.

The focus of the engagement activity will be on people’s experiences of using services in

Richmond and what they want to achieve from their care. The feedback from these meetings will

be incorporated into the draft mental health outcomes and indicator framework which will be

presented to the OBC programme board in April 2015.

2015/16 contract

Good progress has been made in enhancing the 2015/16 contracts towards an OBC approach.

Contract negotiations started in December 2014 and meetings have occurred regularly with the

aim to sign off the contract in April 2015.

New features of the contract include the incorporation of some select outcomes and financial

measures to facilitate change prior to the full outcomes based contract in 2016/17. Changes to

service specifications and service delivery models in relation to Richmond Response and

Rehabilitation Team, the discharge process, community nursing, the IV service and the use of

beds at Teddington Memorial Hospital to deliver more co-ordinated and effective care models are

under discussion and negotiation. There will also be a requirement for providers to collect data to

show performance against the outcomes and highlight areas of concern more effectively.

Governance

A revised governance structure has also been approved at the programme board. The structure

consists of a programme board which will meet monthly and have oversight of the project and

hold the project team to account; an operational working group which will meet fortnightly and

drive progress against an overarching programme plan and produce recommendations for the

programme board as appropriate; and a contract team meeting which will review and progress

contract negotiations with HRCH for 2015/16.

chief executive’s report - kingston hospital · 2.6 the report of the morecambe bay investigation...

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