leeds teaching hospital nhs trust structure and governance: …… · 2019. 2. 8. · 2. we know...

Leeds patient training Leeds Teaching Hospital NHS Trust – Structure and Governance:

‘How we make decisions and organise safe, high quality

patient centred services’

Rosie Horsman – Lead nurse for patient experience and involvement

January 2017 V1

Leeds Engagement Hub: working together to strengthen citizen voice

Housekeeping

• Introductions

• Timing of session

• Breaks

• Toilets

• Fire alarm


Groundrules

• Stick to the agenda

• Be honest

• Be open to new ideas

• Listen to others

• Respect confidentiality

• Don’t judge

• Enjoy


Getting to know each other

Please state your name and tell us:

1. What was the last big decision you had to

make?

2. What did you have to think about before the

final choice?


What do you want from today?

In pairs or in groups have a conversation with

those around you about what you would like to

get from this session. We will then compare

these with what we have prepared

• Please pick up to two things

• We will then share this as a group


Aims and objectives of the session

Aim

‘………………’

Objectives

• To….


Outcomes

By the end of the session participants will be able to:

Describe the role of a patient champion

Understand what a clinical Service Unit (CSU) is and

how they work

Understand what governance means and why it is so

important

Understand how decisions are made about services

and how we check they are the best they can be

Understand how they can be involved in the work of

LTHT


Agenda

1. An introduction to patient champions

2. Clinical service units

3. Governance at LTHT

4. Ensuring quality

5. Involving patients


1. An introduction to patient champions The value of engagement

‘Internationally, PPE is increasingly seen to enhance all

healthcare, by being a marker of services that are

oriented, planned and delivered towards patient

interests. The involvement of patients provides a

different perspective from that of clinicians.’

Patient and Public Engagement (PPE)

PPE in Clinical Audit 2009

Healthcare Quality Improvement Partnership

http://www.hqip.org.uk/assets/PPE/HQIP-A-guide-to-developing-a-patient-panel-for-

clinical-audit-Feb-2014.pdf

http://www.hqip.org.uk/assets/PPE/HQIP-A-guide-to-developing-a-patient-panel-for-clinical-audit-Feb-2014.pdf


























1. An introduction to patient champions Involvement in Leeds

Places to get involved

in healthcare


1. An introduction to patient champions Involvement in Leeds

Ways to get involved in healthcare in Leeds

As an individual (sharing your personal

opinion)

• Friends and family test

• Filling in surveys about service change

• Filling in surveys about your GP

practice

• Patient Opinion/NHS Choices

(Complaints or compliments)

• Attending focus groups

• Patient Participation Groups (PPG)?

Bo

th a

re v

alid

en

gag

em

en

t ro

les

As a ‘patient

champion’ (championing the

needs of the wider

community)

• Patient Participation Groups (PPG)?

• Patient Assurance Groups (PAG)

• ‘Patient champion’ on a steering group


1. An introduction to patient champions Why patient champions?

• Lots of evidence about the

value of involving patients

• It’s a statutory duty to

involve patients

• We need to involve

patients at every stage of

the commissioning cycle


1. An introduction to patient champions What is a patient champion?

‘Patient leaders are patients, service

users and carers who work with, and for

others to influence decision-making at a

strategic level’

Centre for Patient Leadership

http://engagementcycle.org/wp-content/uploads/2013/03/Bring-it-on-40-

ways-to-support-Patient-Leadership-FINAL-V-APRIL-2013.pdf

http://engagementcycle.org/wp-content/uploads/2013/03/Bring-it-on-40-ways-to-support-Patient-Leadership-FINAL-V-APRIL-2013.pdf





























1. An introduction to patient champions What is their role?

Patients, carers and the public

Commissioners and providers


1. An introduction to patient champions What is their role?

It isn’t to:

• Promote a personal campaign

• Criticise existing services/processes

It is to:

• Contribute to improving services

• Ensure that we consider feedback from patients

• Be open-minded

• Understand the health needs of the wider public

• Champion the needs of the wider public

• Ensure that we act of the feedback of patients/public

• Share the responsibility for difficult decisions

• Focus on improving patient experience

• Support the engagement


1. An introduction to patient champions How do we support them?

By providing access to:

• engagement reports

• patient experience data

• patient reader group

• training

• peer support

• the comms and engagement team

• ‘Engaging Voices’

• social media


1. An introduction to patient champions Who are patient champions?

• Patients, carers and members of the public

• People interested in improving services

• People from our patient network

• People involved in our engagements

• People from the VCF sector

• People from Healthwatch

• People from all the CCGs

• People from PRGs

• Different people

• Objective people


2. Clinical service units Understanding CSUs

• In 2013 Leeds Teaching Hospital Trust moved from a ‘divisional structure’ to a

clinically-led one. This meant putting Nurses, doctors, managers and other

health professionals in decision making triumvirate (more on this later).

• We have 18 Clinical Support Units. These range from Acute Medicine,

Neuroscience, Women's Services and Urgent Care.

• As part of this number of CSU’s we also have a number of support services to

help the CSU’s run on a daily basis. This includes Finance, Estates and

facilities, Patient Administration, Human Resources and Corporate Nursing.

• The structure is quite complex and making this happen are over 14,000

members of staff and additional volunteers

• Every week a member of the Trust Board takes a ‘walkaround’. This gives them

a chance to experience how it is on the ground and talk to patients, families,

family carers and staff.


2. Clinical service units Triumvirate model – at the core of the organisation

This team are in charge of the day to day running of their Clinical Support Unit. Each

has its own work plan and they report to the Chief Nurse/Chief Operating Officer

Suzanne Hinchcliffe and ultimately the Trust Board.

Clinical Director

Head of Nursing General Manager

Lead Clinician

Matron Business manager


2. Clinical service units Question time

Do you have any questions about what you

have heard?

Please write your first thoughts on flipchart and

your final questions on the card provided.


3. Governance at LTHT What is governance?

Understand what Quality Governance means, why it is important and what

this looks like at Leeds Teaching hospital Trust 1. The purpose of the NHS is to provide high quality services, free at the point of

delivery to those who need it.

2. In 2003 Lord Dhazi described high quality services as safe, effective services

with a positive patient experience. All three of these criteria must have equal

weighting to provide excellent services.

3. Quality is a moving target and we have seen over the years that what is

acceptable as high quality care one day may not be the next. Within the Trust

we work hard to make sure we delivery high quality care everywhere, to every

patient every day.

4. This means we have to have systems in place to make sure this is happening

5. Staff working on the front line work within certain rules daily that help ensure that

high quality care is delivered consistently.

6. However, ultimately it is the Board and Leaders in our Trust who take

responsibility for any improvements, success in service delivery and any failures

in the quality of care we provide.


• Ensures we are providing ‘at least’ the minimum standard

of quality and patient safety set out by the regulator

• Ensures we are continuously learning and improving

• Enables the trust to target any areas of concern across the

trust in terms of practice

• Helps the organisation to celebrate excellent work and

boost moral

• Creates a culture in which all hospital staff and volunteers

can contribute to providing the highest quality of care

achievable

• Maintains financial Sustainability

3. Governance at LTHT Why is governance so important?


1. We know what we should be achieving – standards • Indicators (e.g. Infections, Falls)

• Best Practice Guidance (e.g. NICE)

• External Recommendations specific to our service (e.g. from

External Agency Visits)

2. We know and can Evidence where we are against the

standards/recommendations.

3. We make a judgement as to whether where we are is

good enough and where we want to be.

4. We plan what we are going to do, by when, and who will

do it.

5. We track progress against our plans.

3. Governance at LTHT What does good governance look like?


4. Ensuring quality Board committee structure

The Leeds Engagement Hub: working together to strengthen the citizen voice

Board of directors

inance e o mance ommittee

Research, Education &

Training

Committee

Risk Management

Committee

a it ss ance

ommittee

it

ommittee

em ne ation omination ommittee

Focus on: developing and

monitoring risk management policy;

engaging colleagues in risk management activities

decisions to ensure prudent control of risk (in accordance with the Board’s risk appetite);

managing Health & Safety;

managing Fire Safety;

decisions to ensure revenue protection;

emergency preparedness

Focus on: alignment of innovation

and research priorities to corporate strategy

ensure patient benefits are realised from the Academic Health Science Network and research activities undertaken by LTHT

ensure research utilisation and uptake enhance clinical practice, growth and performance

maintain standards of research governance

develop and maintain links with the University and AHSN

develop and deliver the Board’s research strategy from options provided by the Executive

ensure education & training performance/delivery

Focus on: assuring financial and

operational performance

recommending the total financial risk the Trust is prepared to voluntarily accept to execute strategy;

reviewing limits for individual types of financial risk;

monitoring the financial risk profile;

recommending adjustments to budget/investment priorities in response to performance or changes to risk;

reviewing the effectiveness of financial decisions or decisions which impact upon the Trust’s financial plans;

reviewing and recommending significant financial investments or transactions;

Focus on: reviewing quality

governance policies and contents of Quality Account/Report;

overseeing adequacy and scope of clinical audit work;

monitoring continuous quality improvement / learning;

reviewing assurance that patient safety, clinical outcomes and patient experience meet strategic expectations;

reviewing assurance that CQC Registration Regulations are complied with;

reviewing adequacy of future workforce plans

Focus on: reviewing accounting

policies and contents of financial reports;

monitoring disclosure controls and procedures, and the internal control environment;

considering the adequacy and scope of external and internal audit;

overseeing the relationship with external audit;

considering and recommending to Board the Trust’s overall risk appetite;

reviewing assurance that principal risks are properly identified and managed effectively

Focus on: remuneration policy;

performance of executive directors; and

the appointment, or where necessary the removal, of executive directors.


4. Ensuring quality Quality committee and governance structure


4. Ensuring quality Outside agencies that also check quality

1. Care Quality Committee: (Experts by

Experience programme)

2. Monitor: NHS funded services (Foundation

Trusts also)

3. Health watch Leeds (Enter and View)

4. Local Schemes (Quality Checkers)


4. Ensuring quality Question time

Do you have any questions about what you

have heard?

Please write your first thoughts on flipchart and

your final questions on the card provided.


5. Involving patients Question time

• Patient Leaders (Representation)

• Patient Reference Group (Engagement

Strategy)

• ‘Doing’ involvement (interviews)

• Training, recruitment and checking services


Session review

• Citizens need patient champions to put experience at the

heart of decision-making

• Commissioners need patient champions to help them

improve the quality of services and make difficult decisions


Questions


Quiz

• How many Clinical Service/support units does the Trust have?

• Can you give two examples of a clinical Support/service unit?

• What model of management does the Trust use in each of the Clinical Service Units?

• Can you name two roles within this structure? • What is the name of the Chief Nurse/operating Officer? • Name two opportunities for getting involved with the trust? • Name an outside agency that checks the quality of the

Trusts Services? • Give one reason why governance is important? • Name one part of ‘Monitors’ definition of Quality

Governance?


Session review - feedback

One thing you’ll take away from the session

Make a pledge


Evaluation and close

Please take five minutes to fill in our online evaluation of

the session. You can find the survey here: link

Please be honest so that we can improve the session.

leeds teaching hospital nhs trust structure and governance: …… · 2019. 2. 8. · 2. we know...

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