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Delivering Improvement in Practice NHS Providers Governance Conference 7 July 2016 Sir Mike Aaronson Chairman, Frimley Health NHS Foundation Trust 2006-2016

Frimley Health FT

Turnover £600m 8,200 staff: 410 consultants 400 junior doctors 3,500 nurses & midwives

Ministry of Defence Unit

Activity: 230k A&E – 4th largest activity in England 80k Emergency Admissions 20k Inpatient - elective 78k Day Cases 800k Outpatients 10k Births

Comprises: Frimley Park Hospital Heatherwood Hospital Wexham Park Hospital

Provides specialist services: Vascular Heart Attack Stroke Plastics Cystic Fibrosis

CQC Rating: Frimley – Outstanding (Sept 14) Heatherwood – Good (Feb 14) Wexham – Inadequate (Feb 14)

FPHFT Acquisition of HWPFT

• 1 October 2014 (18 month process)

• Substantial financial support from DH (capital and revenue)

• Regulatory encouragement and political support

• Willing partner in HWP Board

• No major competition issues

• FPH Board in strong position to insist on terms

Wexham Park Hospital: CQC Inspection Feb 2014

Wexham Park Hospital CQC Inspection Oct 2015

Critical Success Factors

• Leadership (executive and clinical)

• Emphasis on Values

• No compromise on bad behaviour

• Recognition of Staff

• Communication

• Honesty

• Hard work

Frimley Health – Leadership

Frimley Park Director of Operations

Deputy Director of Nursing Deputy Medical Director

Wexham Park Director of Operations

Deputy Director of Nursing Deputy Medical Director

Chief Executive

(and Execs)

Chiefs of Service

Orthopaedics & Plastics

General Surgery & Urology

Emergency Department

Obstetrics & Gynaecology

Anaesthetics, ITU, Theatres

Head of Nursing Associate Director

Associate Director Head of Nursing

Associate Director WPH Associate Director FPH

Head of Nursing Specialist Surgery

Medicine

Paediatrics

Head of Nursing

Head of Nursing

Radiology

Pathology & SPS

Associate Director

Associate Director

Head of Midwifery

Head of Nursing

Head of Nursing

Frimley Health Wexham Park - Objectives

Improve governance, quality and

safety Financial recovery

Improve the infrastructure

Raise and sustain

performance

Get the culture right

Getting the culture right Positive values and behaviours

“We are committed to excellence in

everything we do, striving to be one of

the best acute trusts in the

country.”

“We are working together as one

team dedicated to meeting patient

needs.”

“We are facing the future, continuously

improving our performance and

adapting services to meet demand”

Getting the culture right Frimley Health - Values

Committed To Excellence ✔ We make safety and quality a

priority for ourselves and others

✔ We go the extra mile

✔ We set ambitious goals for ourselves

✔ We strive to achieve our goals consistently to the highest possible

quality standard, getting the basics

right every time

✔ We have a positive attitude

✔ We deliver what we promise

✔ We work hard to solve problems if

things go wrong and make them right

✔ We take responsibility for our own

performance and for bringing our

values to life

Working Together

✔ We are friendly, welcoming,

courteous and caring

✔ We act fairly and compassionately

✔ We are open, honest and candid

with others

✔ We treat other people as

individuals and respond to their needs

✔ We respect others’ privacy and dignity

✔ We listen and ensure we understand

✔ We encourage and support colleagues

✔ We work as part of one team with

colleagues within and outside the

Trust in support of patient needs

Facing The Future

✔ We challenge poor performance

in others and expect to be

challenged if our own performance

is poor

✔ We are open to developing

ourselves and to constructive

feedback

✔ We change things for the better

✔ We make best use of public money

by being as efficient as possible

✔ We engage with others to improve

how things are done

✔ We speak up if things could be done

in a better way

✔ We see change as an opportunity not

as a problem

We are committed to excellence in everything we do, striving to be one of the best acute trusts in the country.

We are working together as one team dedicated to meeting patient needs.

We are facing the future, continuously improving our performance and adapting services to meet demand.

All appraisals including “living“ the values

Getting the culture right

What are we proud of?

Living the values

Leadership development and team approach

Listening Into Action

Long service and recognition awards

Intolerance of dysfunctional behaviour

Ward staffing: 1:8 days – 85%

1.10 nights – 95%

31 students recruited for WPH – last year 2

Less bullying

FFT scores as place to work 40% to 57%

FFT scores as place to be treated 45% to 69%

Welcoming a speaking up approach

No agency staff in maternity since April

Public engagement & encouraging feedback

Compliant

We want staff to work “FOR” Wexham not “AT” Wexham

What can we do better?

Supporting the junior doctors

Focus on retention initiatives

7 day consultant service for emergencies & very sick patients

Turnover 14% (20% nursing)

Reduce reliance on agency staff – nursing 270 vacancies – 1250 wte (100 nurses pre employment checks), therapy and radiography vacancies

Bringing good governance at the heart of patient care What have we done so far

Quality Assurance Committee – Board Committee

Wexham Quality Committee – CQC Requirement notices

Pan Trust Clinical Governance Committee – spread good practice

Patient Safety Committee

Mortality and Morbidity Committee

Speciality dashboards

Audit

Cancer steering group

Trust wide Control of Infection and Drugs and Therapeutics committees

What has improved?

Monitor targets delivered Q1 & Q2 15/16

Identification of SIRIs

MDTs more effective

Stronger focus on outcomes (CRAB - cardiac arrest, pneumonia, AKI - hydration)

Consultant delivered services – weekends and new medical and plastics models – 16 new consultants

More transparency with consultant job plans

Radiology out of hours and open access for GP referrals

Duty of candour – openness and transparency

New serious incident process

WHO checklist

Safeguarding and DOLS

Falls & pressure sores

DNA CPR

Control of infection

Sepsis

Acute kidney injury

Deteriorating patient

Mandatory training

MDT working

Structured handover

Creating a learning environment

Structured approach to audit

Learning from incidents, especially SIRI and never events

Encourage more incident reporting

Supporting staff when things go wrong

Impact

Better than average mortality – SHMI 86

Harm reduced

Surgical complication rate better than expected

Keeping our patients safe

Getting the quality right for patients

What are we proud of?

Strengthening the culture- getting the basics right

Values based customer care programme - 348 leaders

Improved access times

Released more time to care

Being more proactive and open

Cleanliness

Valuing unregistered staff

Support at mealtimes

Patient Friends and Family test improving – 93%

What can we do better?

Noise at night

Dementia

Discharge process

Involving patients and carers

Antibiotic policy

Learning disabilities

Patient moves

Frimley Health performance – top quartile

2014/15 2015/16

Q3 Q4 Q1 Q2

4 Hours X X

18 Weeks X X

C.Diff Cancer

2 week rule Cancer

31 day standard Cancer

62 day treatment X X

Estates – improving the infrastructure

What have we done so far? Roof and floor repairs 2nd Cath lab - Wexham Improved security of Wexham at night Improved way finding – all sites Improved the responsiveness of estates department – toolbox meeting – 50% of urgent requests done on the day Approved 500 additional car parking spaces Point of care - ED

Estates – improving the infrastructure

Wexham

Paediatric Critical Care Unit 5 inpatient beds Separate parents room with en-suite

£1.25m

Second CT scanner and replace existing New X-Ray rooms C arm

£2.5m

New Teenage Unit

Estates – improving the infrastructure What we are working on – development control plan

Wexham

£45m investment

Short stay beds – 72 hours

Ambulatory care assessment

unit – multi speciality – 12 hours

New emergency department –

4 hours

Redevelopment of maternity - £10m

En suites in all delivery rooms including Midwifery Led Unit

New bereavement suite with discreet access.

Separate maternity and gynaecology outpatient waiting areas

Improved outpatient consulting and waiting area in outpatients

Fully equipped Gynaecology procedure rooms for Colposcopy/ early pregnancy and urodynamic

Estates – improving the infrastructure

Estates – improving the infrastructure

New Heatherwood Hospital 6 operating theatres 48 beds 16 day case beds Outpatients Diagnostics Will move some additional activity from Frimley Need to sell part of the site to generate the funding

£63m

Securing financial balance £600m turnover

2015/16 - £14m deficit Need to save £26m per annum

How? Reduction in agency cost Productivity – output per head needs to improve New Heatherwood needs to make a surplus Better purchasing Improved discharge process

CQC Requirement Notices February 2014 inspection

Notice Action

Governance process New governance structure. Quality Committee, M&M Committee and CRAB, speciality dashboards

Staffing vacancies 270 vacancies of 1250 ward establishment , 100 nurses going

through pre-employment checks

Access times Delivered Monitor standards for Q1 and Q2

Patient safety Embedding key standards

Culture “Can do attitude”- Frimley Health values and behaviours

Deteriorating patient Outreach consultant 8am – 6pm

24/7 Outreach nurse – plus resus team 8am to 8pm Mon - Fri

Cancer pathways and MDT working MDTs functional and improved pathways

Critical care capacity Transfers out - 2 for Q1 and 0 for Q2 – Establish Medical HDU

WHO checklist 96.7% compliant

Bookings and cancellations No capacity list – reduced from 10k to 300 – 100 one week

beyond target follow up date

Responsiveness of complaints and patient feedback

200 Complaints backlog eliminated. Wexham Park complaints have reduced from 50 per month to 33.

Patient environment £130m of investment secured

Improved maintenance turnaround times

Wexham Park – FHFT Key priorities

Top performing District General Hospital

Cancer – onsite radiotherapy

7 day consultant delivered service

£130m investment in estate. New ED and assessment area, upgrade maternity,

radiology

Heart attack centre

Provide HDU capacity for medicine

New models of care for frail elderly

Secure additional elective activity

Slough +16% Chiltern +20% Windsor +9%

Children – HDU teenage unit

Building a reputation for quality

Eliminate the deficit

Wexham Park Hospital Today

Better place to receive

care

Inspiring staff to care and lead

Bedding in the new

governance arrangements

Stronger focus on clinical outcomes

Reduced harm events

Better place to work

Improved and sustained

performance

Deficit support package has resulted in more

focus on quality

Learning from complaints and

incidents

Clean

Working with Commissioners to redesign and improve care

Strengthened culture - Alignment of purpose - Rebuilding confidence

and self belief

Reflections as Chairman

• Put patients at the centre of thinking and decision-making

– only ‘tick the box’ after this, not the other way round

• Understand and support the role of the chief executive

– leave the long screwdriver at home

• Assert the independence of the Board

– innovation and improvement takes courage; risk needs to be rewarded

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Delivering Improvement in Practice NHS Providers Governance Conference 7 July 2016 Sir Mike Aaronson Chairman, Frimley Health NHS Foundation Trust 2006-2016