QUALITY REPORT 2009/10

 

Introduction

The provision of safe quality services and experience for patients, staff and the public is central to Maidstone and Tunbridge Wells NHS Trust (the Trust).

 

The Health Act 2009 requires all NHS healthcare providers in England to provide an annual Quality Account from April 2010.

 

A Quality Account is intended to aid the public’s understanding of what the organisation is doing well; where improvements in service quality are required; what the priorities for improvement are for the coming year; and how the organisation has involved service users, staff and others with an interest in the organisation in determining those priorities for improvement.

 

Quality Accounts are both retrospective and forward looking. They look back on the previous year’s information regarding quality of services, explaining both what the organisation is doing well and where improvement is needed. But they also look forward, explaining priorities for improvement over the coming financial year, and how these will be achieved and measured.

 

In addition to being published as part of this annual report, Quality Accounts will be published electronically on the Trust’s section of the NHS Choices website.

 

 

 

Part 1 : Chief Executive’s statement

 

Thank you for reading Maidstone and Tunbridge Wells NHS Trust’s Quality Account and for taking an interest in the local health services we provide throughout Kent and East Sussex.

 

MTW is an open and publicly accountable organisation and we are pleased to share with you an overview of our ongoing journey to improve standards of patient care.

 

Everything we have achieved in 2009 and have set out to achieve in 2010 shares a single, simple focus and that is to improve the patient experience. It is a common aim for us all to follow.... it is a common aim for us all to share.

 

MTW has faced significant public challenges in the past. These have now been largely overcome. Last year we recorded the lowest rate of infection for Clostridium difficile, per thousand patient bed days, of any acute hospital in the south east.

 

Infection control stands at the heart of all that we do. Our patients deserve nothing less. We want, can and will always do more to better ourselves.

 

The trust faces a new set of challenges in the future to meet the changing health needs of the people we serve. We are developing two hospitals of national standing at Maidstone and Pembury, to continue to provide modern, high standards of care safely, in all that we do for all who we see. 

 

We are proud to be developing the country’s first NHS hospital to offer every inpatient their own single room with en-suite facilities. We have also invested over £100,000 million in service improvements at Maidstone in the last decade.

 

All of the achievements that you see in our Quality Account could not have happened without our highly skilled staff. As an organisation, we will work together on turning our future challenges into further accomplishments for our patients.

 

Thank you for reading our Quality Account. We look forward to working with our local communities further this year to identify new opportunities and ways of working to improve patient care further still.

 

 

 

CEO signature

 

 

 

Part 2

How we have prioritised our quality improvement initiatives for 2010/ 2011

 

The Trust’s plans for quality improvement have been developed in line with various stakeholder groups and align with, or compliment the Commissioning for Quality (CQUIN) scheme agreed with our commissioners.

 

Within the Trust’s annual report we have already highlighted:

Our goals for 2010-11

v  Infection rates will be the lowest in the South

v  Financial break even – every month our income will be greater than our costs

v  All access (waiting times) standards will be met

v  Patient feedback will be collected daily

v  Staff and stakeholders will know where services are to be located

v  Location of the birthing centre at Maidstone will be agreed

v  Work to be started on refurbishing the Nurses’ Home at Maidstone

v  Laparoscopic training centre will be open

v  Stroke unit at Maidstone will be fully functional

v  Detailed planning for Pembury changes to be completed

 

In setting our key priorities for 2010/2011 the Trust has consulted with patients, services users, LINkS, commissioners and staff to identify the priorities for the next year. In reviewing those that had been put forward we considered areas that had already been highlighted by external reports as well as the impact on quality improvement for patients that each would have and the required implementation plan.

 

The following have been identified as our key priorities for quality improvement:

·         Continuing to reduce the number of hospital acquired infections

·         Reducing the number of ward to ward moves for patients

·         Improve the quality of communication and information given to patients and the public.

·         Help deliver improved quality through local and national quality targets (CQUIN measures). These measures are included within Part3 – Quality Statistics. Highlighted priorities include the following patient groups:

o   stroke patients

o   reducing the number of patient incidents in relation to falls

 

 

To enhance our engagement with patients and the public, in line with our new strategy for Patient and Public Involvement we will build upon these 4 key elements:

 

 

 

Our selected priorities and proposed initiatives

 

Patient safety

Infection control

Continuing to reduce the number of avoidable healthcare associated infections

 

Our current rates of C. difficile infection are the lowest in the south east for 2009/10 for acute trusts. Our MRSA bacteraemia rate has reduced by 60% over the last seven years but requires further reduction, as you will note from the graphs below the MRSA rates were outside of the limits by the end of the year. As a Trust we have a zero tolerance approach to healthcare associated infection (HCAI) and aim to have no avoidable HCAI.

 

Aim/Goal

To reduce our C. difficile rate by 5% and MRSA bacteraemia by 60% in the next year

 

Current Status

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


Identified areas for improvement

 

Initiatives in 2009-10

 

New initiatives to be implemented in 2010-11

 

Board Sponsor: Dr Sara Mumford, Director of Infection Prevention and Control

Implementation Lead: Gail Locock, Deputy Director of Infection Prevention and Control

 

 

Reducing the incidence of patient falls

Slips, trips and falls can:

·         result in loss of confidence and self-esteem

·         result in cuts, bruises, broken bones or other injuries

·         lead to a longer hospital stay

 

Aim / Goal

We have challenged our teams to reduce patient falls (resulting in injury)  by 7.5% this year

 

 

Current status

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


Identified areas for improvement

 

Initiatives in 2009/10

 

 

New initiatives to be implemented 2010/11

·         Developing a root cause analysis tool to help identify further learning

·         Review footwear for patients at risk

·         E reporting will deliver comprehensive live data re falls in clinical areas

·         Business case for falls Co-ordinator

 

Board Sponsor  - Flo Panel-Coates, Director of Nursing

Implementation Lead   - Siobhan Callanan, Associate Director of Nursing

 

 

Clinical Effectiveness

As well as monitoring our performance in line with CQUIN measures as a whole, from our consultation, there are clear priorities in relation to the care of our stroke patients in order to meet the nine key national indicators.

 

Caring for stroke patients

 

To improve the quality of care and consequently health outcome for patients who have suffered a stroke.

There is research evidence that prompt admission to a stroke unit will optimise the patient’s outcome.

 

Aim / Goal:

To ensure stroke patients are admitted directly to the designated stroke units in order to ensure that we can implement the nine key actions identified as leading to improved patient outcomes.

 

Current Status:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


Identified areas for improvement:

 

Initiatives in 2009/10

 

 

 

New initiatives to be implemented 2010/11

 

 

Board Sponsor – Nikki Luffingham , Chief Operating Officer

Implementation Lead – Linda Summerfield, Associate Director of Nursing

 

 

 

Patient Experience

 

Reducing the number of ward to ward moves for patients.

This is a new issue which was raised by patients through our consultation process and reviewing of complaints.

 

As one of their Key Performance Indicators, Ward Managers are being asked to provide information on the number of moves that their patients experience. The patient Experience Matrons are working closely with the Associate Directors of Nursing to identify why patients are moved from ward to ward and to put processes in place to reduce this. In supporting the ‘Dignity Challenge’ patients will be treated as individuals by respecting them and offering a personalised service.

 

 

Aim

To ensure patients do not move more than three times (including A&E to MAU / AAU , and MAU/AAU to the ward) unless for clinical care / infection control reasons.

 

Current status

This is a new quality initiative for us – we do not yet have a baseline but will expect to see improvements month on month.

 

Identified areas for improvement

 

 

 

Board Sponsor – Flo Panel-Coates, Director

Implementation Lead – Chris Steele and Claire Spence, Patient Experience Matrons

 

 

 

 

Communication and Information

We want to improve the quality of communication and information given to patients and the public.

The Trust has patient survey scores comparable to other trusts in how well we communicate with our patients.  However, there is still room for improvement and patients tell us that they want more information.  This is also highlighted by some of the complaints we receive.

 

 

Aim / Goal

 

To increase patient satisfaction about how they receive communication and information through an increase in the national and local patient surveys, and to see a reduction in the number of complaints in which communication and information is highlighted as an area of concern.

 

Current status

 

Below are some graphs relating to the national patient survey results highlighting issues in relation to communication and information. The column on the right shows data from our live patient experience tracker (we will further align these to map them to the national survey.) These will be some of the areas of information and communication that we will be seeking to improve.

 

Were you involved as much as you wanted to be in decisions about your care and treatment ?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


Did you find someone on the hospital staff to talk to about your worries and fears?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


Did a member of staff tell you about medication side effects to watch for when you went home?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


Did hospital staff tell you who to contact if you were worried about your condition or treatment after you left hospital?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


Identified areas for improvement

 

 

Initiatives in 2009/10

 

 

 

 

New initiatives to be implemented 2010/11

 

·         Linking of local patient experience questionnaires to national patient surveys to enable prompt action to be taken in relation to specific issues

·         Full review of patient information leaflets

·         Introduction of new bedside folders for patients

·         Refresh training in relation to “customer care”  to be rolled out across the trust, prioritising areas of most concern highlighted via survey results and complaints

·         Improve information available to patients relating to medication

 

 

Board Sponsor Flo Panel-Coates, Director of Nursing

Implementation Lead Claire Roberts, Head of Quality and Governance

 

 

 

 

The Quality and Safety Committee, a sub-committee of the Trust Board, will monitor progress against the actions and targets set for each of the priorities.

 

 

 

 

 

 

Statements of Assurance from the Board

 

NHS services

 

During the year 2009/2010 the Trust provided and/or subcontracted 120 different NHS services across 32 specialties from our hospitals.

 

The Trust has reviewed all the data available to them on the quality of care in all 120 of these services.

 

The income generated by the NHS services reviewed in 2009/10 represents 100% of the total income generated from the provision of services by the Trust for 2009/10.

 

 

Clinical Audit

 

During the period April 2009 to March 2010 22 national audits and 2 national confidential enquiries covered NHS services that the Trust provides.

 

During that period the Trust participated in 86% national clinical audits and 100% national confidential enquiries of the national clinical audits and national confidential enquiries which it was eligible to participate in.

 

The national clinical audits and national confidential enquiries that the Trust was eligible to and actually participated in during 2009/10 are illustrated in the table below:

 

 

 

2.3 National Audits and Confidential Enquiries which Trust was eligible to participate in

Those the Trust participated in:

National neonatal audit

x

National diabetes audit

NO

Adult critical care units

x

National elective surgery (PROMS)

x

CEMACH perinatal mortality

x

Hip and knee replacements

x

Head and neck cancer

x

Lung cancer

NO

Bowel cancer

x

MINAP (myocardial infarction)

x

Heart failure

x

National hip fracture registry

x

National adult cardiac interventions

x

Heart failure

x

UK national hip fracture registry

x

TARN – severe trauma

NO

Sentinel stroke audit

x

National audit of dementia

x

Falls and bone health in older people

x

British thoracic society

x

College of emergency medicine- pain in children, asthma, fractured neck of femur

x

National mastectomy and breast reconstruction audit

x

National oesophago-gastric cancer

x

Continence care

x

National Confidential Enquiry into Patient Outcome and Death

x

Centre for Maternal and Child Enquiries

x

 

 

 

National Audits for quality accounts (Not submitted)

Reasons why data not submitted

NDA: National Diabetes Audit

Participation in audit delayed whilst data system (Diabeta3) installed in trust. This will be in place in 2010. Paediatric aspect registered this year.

NLCA: Lung Cancer

Development of a new data capture system needed to be developed to accurately record patients who receive treatment across the network. In 2010/11 audit programme, system in place and Cancer Data Analyst submitting data.

TARN: severe trauma

To be confirmed.

 

2.4 The national clinical audits and national confidential enquiries that the Trust participated in and for which data collection was completed during 2009/10 are listed below alongside the number of registered cases required by the terms of that audit or enquiry.

 

 

National Audit

Cases submitted as %

Notes

National neonatal audit

100%

 

Adult critical care units

100%

 

National elective surgery (PROMS)

47%

Based on information from IC website April-November 2009

CEMACH perinatal mortality

100%

 

Hip and knee replacements

70%

 

Head and neck cancer

98 patients

Unable to quantify total patients eligible until new system is installed. New system in place for 2010/11

Bowel cancer

100%

 

MINAP

100%

 

Heart failure

37%

 

National hip fracture registry

27%

 

National adult cardiac interventions

100%

 

Sentinel stroke audit

83%

 

National audit of dementia

100% (estimated)

 

Falls and bone health in older people

100%

 

British thoracic society

100%

 

College of emergency medicine- pain in children, asthma, fractured neck of femur

87%

 

National mastectomy and breast reconstruction audit

100%

 

National oesophago-gastric cancer

88%

 

Continence care

50% (so far)

 

National Confidential Enquiry into Patient Outcome and Death

100%

 

Centre for Maternal and Child Enquiries

100%

 

 

National benchmark being sort

 

 

2.5 The reports of eight national clinical audits published were reviewed by the provider 2009/10 and the Trust intends to take the following actions to improve the quality of healthcare:

 

 

2.5 AUDIT TITLE

2.6 ACTION

National Diabetes Audit - Fulfilling the requirement for the Diabetes NSF. 

Introduction of diabetes database (Diabeta 3) will transform MTW's ability to contribute usefully to future audits. Re-audit

 

National Mastectomy and Breast Reconstruction Audit. (RCN/NCASP)

None needed as Trust met standards Noted by division and presented to Trust Board

NCEPOD - For better or Worse? Review of the care of patients who died within 30 days of receiving systemic anti-cancer therapy

None needed as Trust met standards. Noted by division and presented to Trust Board

NHS Patient Survey - Adult Inpatient Survey 2008

The Trust has introduced a real time feedback monitoring system to enable us to respond quickly to trends that have been identified.

The Trust has worked with Department of Health and NHS West Kent to address deficits relating to the provision of single sex accommodation – work is ongoing but nearly complete.

Communication and information remains a key issue and is one of our priorities for 2010/11.

Mandatory National Audit: Head & Neck Cancer (DAHNO)

Continue to participate in the National comparative study. Ensure more cases are submitted next year when new data-capture software is introduced. Continue to work with colleagues across Kent and Medway to improve data capture and sharing for patients who are treated in more than one institution across the network

Mandatory National Audit: Bowel Cancer (NBOCASP)

Continue to submit data. Present to the Standards Committee for discussion across divisions.

National Mandatory audit: Oesophago-gastric (stomach) cancer (AUGIS/NCASP)

Continue to submit data. Present to the Standards Committee for discussion across divisions.

National audit of the Liverpool Care Pathway 2nd round.Care of the dying

Improve monitoring and measurement of LCP data to mark improvements, Improve skills for medical and nursing staff in delivery of end of life care,  Improve spiritual and psychological care provided to patients and next of kin/carers

 

The reports of 69 local clinical audits were reviewed by the provider in 2009/10 and Maidstone and Tunbridge Wells NHS Trust intends to take the following actions to improve the quality of healthcare provided (appendix 2).

 

 

Research

Commitment to research as a driver for improving the quality of care and patient experience

 

The number of patients receiving NHS services provided or sub-contracted by Maidstone & Tunbridge Wells NHS Trust in 2009/10 that were recruited during that period to participate in research approved by a research ethics committee was 1,669.

 

This increasing level of participation in clinical research demonstrates Maidstone & Tunbridge Wells NHS Trust commitment to improving the quality of care we offer and to making our contribution to wider health improvement.

 

Maidstone & Tunbridge Wells NHS Trust was involved in conducting 62 clinical research studies. Maidstone and Tunbridge Wells NHS Trust completed 70% of these studies as designed within the agreed time and to the agreed recruitment target. Maidstone & Tunbridge Wells NHS Trust has used national systems to manage the studies in proportion to risk.  Of the 62 studies given permission to start, a 60% percentage were given permission by an authorised person less than 30 days from receipt of a valid complete application.  48% of the studies were established and managed under national model agreements and 8% of the 62 eligible research involved used a Research Passport.  In 2009/10 the National Institute for Health Research (NIHR) supported 28 of these studies through its research networks.

 

In the last three years, 20 publications have resulted from our involvement in NIHR research, helping to improve patient outcomes and experience across the NHS.

 

 

 

Income

Within the new commissioning payment framework 0.5%  of the Trust’s income in 2009/10 was conditional on achieving quality improvement and innovation goals agreed between the Trust and any body they entered into a contract, agreement or arrangement with for the provision of NHS services, through the CQIN (Commissioning for Quality and Innovation) payment framework.

 

Within the new commissioning payment framework for 2010/11 1.5%  of the Trust’s income will be conditional on achieving quality improvement and innovation goals as indicated in the table below:

 

 

Plan

CQUINs

 

1

% of Adult Inpatients that have a VTE Risk Assessment  - June 2010 onwards

90%

2

% Positive Response to:  Were you involved as much as you wanted to be in decisions about your care and treatment?

68.29%

% Positive Response to:  Did you find someone on the hospital staff to talk to you about your worries and fears?

68.29%

% Positive Response to:  Were you given enough privacy when discussing your condition or treatment?

68.29%

% Positive Response to:  Did a member of staff tell about medication side effects to watch for when you went home?

68.29%

% Positive Response to:  Did hospital staff tell you who to contact if you were worried about your condition or treatment after you left hospital?

68.29%

3a

% Slips, Trips & Falls resulting in an injury per 10,000 admissions

7.5% 

3b

% of Falls with Risk Assessment & relevant action completed

80%

4a

% of Stroke patients receiving all 9 Key Setinal Audit Indicators

75%

4b

% of Stroke patients with EDD <7 days of admission

80%

4c

% of Stroke referral letters sent to next provider at least 24hrs before discharge

90%

5a

% of inpatient discharge summaries sent electronically

90%

5a

% of outpatient letters sent within 2 weeks of clinic and conforming to revised template

85%

6a

Pre-Op Process % Positive Response to: Did a member of staff explain what would be done during the operation or procedure?

78%

Pre-Op Process % Positive Response to: Were you told how you could expect to feel after you had the operation or procedure?

62%

6b

Food & Nutrition % Positive Response to: How would you rate the hospital food? 

tbc 

Food & Nutrition % Positive Response to: Did you get enough help from staff to eat your meals?

tbc 

7

Referrals to Stop Smoking Service

1500

8a

Diabetes - Audit of Insulin Medication Errors - TBC

tbc 

8b

Diabetes - Audit re patients admitted that got a foot check - TBC

tbc 

9a

% eligible staff trained in Dementia Awareness

10.0%

9b

Attendance at WK Dementia Forum

80.0%

10

Improve Quality of patient care - process milestones for 4 key areas:  Myocardial Infarction, Community Acquired Phneumonia, Heart Failure, Hip & Knee Replacements

 Process mile stones to be met in 2010/11

11

Improve Performance % of patients receiving pathway metrics for 4 key areas:  Myocardial Infarction, Community Acquired Phneumonia, Heart Failure, Hip & Knee Replacements

Different for each area 

 

 

Further details of the agreed goals for 2009/10 and for the following 12 month period are available on request from the Trust Director of Finance:

 

Paul Turner, Director of Finance

Maidstone Hospital, Hermitage Lane, Maidstone ME16 9QQ

 

 

 

Regulatory Requirements

CQC Registration

 

The Trust is required to register with the Care Quality Commission (CQC) and it has been registered to provide the following activities without conditions:

·         Treatment of disease, disorder and injury

·         Surgical procedures

·         Diagnostic and screening procedures

·         Maternity and midwifery services

·         Termination of Pregnancy

·         Patient Transport

 

In addition no conditions were attached to the Trust’s registration in relation the hygiene code.

 

The CQC has not taken enforcement action against the Trust during April 2009 to March 2010.

 

CQC Periodic reviews

The Trust is subject to periodic reviews by the CQC. In 2009 it was the subject of an unannounced hygiene code inspection and we were found to be fully compliant.

 

The Trust has not participated in any special reviews or investigations by the CQC during the reporting period.

 

Data Quality

Figures for end March 2010 will be inputted prior to publication – not yet received. Similarly benchmarking figures will be included once they have been released. (Expected end of May)

We do not anticipate these will be significantly different.

 

NHS number and medical code validity

The Trust submitted records during April 2009 to January 2010 to the Secondary Uses service for inclusion in the Hospital Episode Statistics which are included in the latest published data. The percentage of records in the published data which included the patient’s valid NHS number was:

93.6% for admitted patient care;

96.3% for out patient care; and

76.5% for accident and emergency care.

— which included the patient’s valid General Medical Practice Code was:

100% for admitted patient care;

100% for out patient care; and

99.9% for accident and emergency care.

 

The Trust score for 2009/10 for Information Quality and Records Management, assessed using the Information Governance Toolkit was 60%.

 

The Trust was subject to the Payment by Results clinical coding audit by the Audit Commission during the reporting period and the error rates reported in the latest published audit for that period for diagnoses and treatment coding (clinical coding) was 7.7%  from the specialties sampled and audited – the national average was 8.1% and our SHA average was also 8.1%.

 

 

Area  Audited

Specialty / Sub Chapter / HRG

% procedures Coded Incorrectly

% Diagnosis Coded incorrectly

% of Episodes Changing HRG

 

 

Primary

Secondary

Primary

Secondary

 

Theme

Paediatrics

6.7

0.0

5.0

9.9

4.0

Specialty

Endocrinology

24.4

11.8

15.0

6.5

16.0

Sub Chapter

General Surgery

4.8

4.8

11.4

6.0

1.4

HRG

ENT

8.0

10.0

3.3

0.0

6.7

Overall

 

11.6

7.8

9.7

6.3

7.7

 

 

 

 

 

 

 

Information taken from PbR Assurance Audit Sept 2009 (produced by the audit commission)

 

 

Part 3

Quality Overview

The Trust has made significant improvements in key quality measures over the last year.

 

There have been a number of important initiatives, such as those to reduce infection rates, reduce the length of stay in hospital for patients, and the refurbishment of a stroke unit for patients at both Maidstone and the Kent and Sussex Hospitals.

 

 

Patient Safety

Infection Control

 

Actions to maintain low levels of Healthcare Associated Infections (HCAIs) in 2009/10 include:

 

All elective admissions are screened for MRSA and the Trust has carried out a phased introduction of MRSA screening for emergency admissions which was fully implemented by March 2010.

Over the last seven years we have reduced MRSA blood stream infections by 60% in our hospitals.

This year we have also achieved a reduction of C. difficile infection by 5% in our patients which means that we have seen an 86% reduction in cases since 2005/6. The Trust has opened a new isolation area at Kent and Sussex hospital for patient’s with C. difficile ensuring they receive specialist nursing care.

To give assurance of the maintenance of high standards of infection control and cleaning we have implemented a comprehensive audit programme.

All cases of MRSA bacteraemia or C. difficile are subject to a root cause analysis to ensure learning and best practice is carried forward.

The Trust fully implemented the Pandemic Influenza plan and can report that no cases of cross infection were seen in the Trust.

 

The Trust continues to have a zero tolerance approach to all avoidable infections. As mentioned previously infection control remains a key priority area for the Trust.

 

Safeguarding

 

In addition to the existing systems to ensure we safeguard children, in 2009 the Trust has set up a Multi-agency Safeguarding Adults Committee. Its task is to prioritise the Safeguarding Agenda and develop work streams to meet it.

 

This Committee is chaired by one of the Trust non-executive Directors, alternating with the Director of Nursing, both of whom are well placed to bring to the Trust Board’s attention areas of good work and where further commitment and work is required to meet the national and local agendas.

 

Clinical Effectiveness

Fractured Neck of Femur Pathway

 

As part of our Improvement Programme the orthopaedic team worked to streamline the Fractured Neck of Femur Pathway. A key aspect of this is to build up patients’ strength and stamina with high energy drinks before they have their operation.  It also includes fast-tracking from A&E; standardising pain control; improving communication at every stage in the patient’s journey; prioritising their surgery; and ring-fencing beds. 

 

Hospital acquired pressure ulcers

We monitor the number of pressure ulcers that patients acquire while in hospital. We have a specialist nurse who works with the wards to investigate the cause of these and take action to reduce the risk of these happening again. All grade 4 pressure ulcers are now considered by our panel which reviews serious incidents to ensure that all possible action is being taken to help reduce the risk of these incidents further.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


Patient Experience

 

Real Time Patient Feedback

 

We have introduced a system which gives our patients the opportunity to tell us how satisfied they are with the care they receive. Patients are offered the opportunity to answer questions and input their views onto an electronic touch screen. The information received is completely anonymous and the results are available to be viewed by Ward Managers, Matrons and the Trust Board immediately. This enables us to respond to our patients’ concerns much more quickly than previous methods allowed.

 

 

 

 

Eating well

We introduced the Red Tray system and Protected Meal Times both of which are designed to ensure that ward staff create a quiet atmosphere in which patients can eat their meals without interruption and staff can easily identify patients that need assistance.  Previously meals were often interrupted by ward rounds, drug rounds, cleaning and other activities.  Patients are at risk of becoming malnourished in hospital which can result in impaired wound healing, increased risk of infection, physical weakness, depression, lethargy and a longer stay in hospital. Eating well is an important part of any patient’s overall hospital care, and this new system of protected meal times and the Red Tray system improves our patients’ experience and reduces the possibility of malnutrition.

As part of our emphasis on ensuring that our patients eat well the Patient Experience Committee held a blind food tasting event in December 2009, testing the ‘in-house’ food provided by the Maidstone Hospital caterers against food bought in for Kent and Sussex patients. Both suppliers of food were judged to be tasty and good quality by the tasters

 

 

 

 

 

 

Were you given a choice of food? (Information from the National Patient Surveys and from the in-house real time patient feedback system.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 


Privacy and Dignity

We have been working hard to improve the privacy and dignity of our patients and deliver same sex accommodation.  We have:

•         increased privacy in bathrooms and toilets

•         increased the number of en-suite rooms and the number of toilets and bathrooms

•         ensured that every bathroom and toilet door has a privacy sign

•         introduced improved privacy gowns to all our X-ray departments

•         designed a new gown for inpatients

 

The real time feedback system explained above enables our patients to tell us how well we are achieving our aims.

We are proud to confirm that mixed sex accommodation has been virtually eliminated in all our hospitals. This allows us to focus on avoiding breaches for nonclinical reasons.

When you were first admitted to a bed on a ward, did you share a sleeping area, for example a room or bay with patients of the opposite sex?

 

 

 

 

 

 

 

 

 

 

 

When you were first admitted , did you mind sharing a sleeping area, for example a room or bay with patients of the opposite sex?

 

 

 

 

 

 

 

 

 

 

 


Environment

As well as the progress to ensure we can deliver same sex accommodation throughout the trust, there is a planned programme for upgrading areas of Maidstone Hospital and the exciting development of the new hospital in Pembury. This hospital will begin taking patients in 2011 and be able to provide state of the art facilities for all.

 

Productive Ward

 

We have been rolling out the productive ward programme, which aims to promote a continuous improvement culture leading to real savings in materials, reducing waste and vastly improving staff morale, providing them with more time to spend with patients. Ten wards are currently on the programme.

 

To date we can report the following successes:

100% of the staff asked on the showcase wards said that since the introduction of Productive Ward the quality of work and patient care they have been able to deliver has improved.

 

7.3 fewer miles walked per commode clean saved per year.

 

116 miles saved per year as a result of moving the ward office.

 

 

 

 

 

 

 

Waiting time targets

 

Patients not attending out patient appointments

 

As you will see from the graph below we have a number of patients who do not turn up for their outpatient appointments. We realise that there may be many valid reasons for this, we would seek to work with you to reduce this number, however. We need to ensure that patients notify us as far in advance as possible if they are not able to attend an outpatient appointment so that we can book someone else in their place. This will help to ensure that appointments times are not wasted and that all patients can be seen as quickly and efficiently as possible.

 

We have just introduced a system whereby all patients will be reminded about their appointments via land line telephone, mobile voice or text message, which we hope will help to reduce the wasted appointments.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


Waiting times in Accident and Emergency

 

There are peaks and troughs in waiting times in A&E. You can see the impact that severe weather conditions and the winter vomiting bug had on these in January. We continue to seek ways to minimise the waits patients have and so improve the efficiency of the services we offer, however, there are occasions when the 4 hour target will be breeched. We keep these times under constant review. The target for the year is that 98% of patients should be seen within 4 hours – our year end achievement was 98.4%.

 

Again we would like to ask you to help us to help those who are real emergencies by ensuring that you seek to use other sources of health care if your situation is not an emergency, such as your GP, out of hours services or NHS Direct.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


Patients admitted for treatment within 18 weeks of referral by their General Practitioner

 

These figures are again under constant review to ensure that we can provide patients with care as soon as possible. The national target is that 90% of patients should be seen and treated within 18 weeks of referral by their GP. You can see the considerable improvements that we have made in achieving this target from under 60% in April 2008 to 95% in March 2010.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


Delay in transferring patients from the acute hospital to home or another care setting

 

The graph below demonstrates how, through working with other health and social care providers we have managed to ensure that patients are discharged from hospital in a timely way – this is obviously of benefit to both the patient, by ensuring that they are in the best place for them as well as for the Trust as it ensures that other patients’ admissions are not  being delayed.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


Staff awards

 

A number of our staff have received national recognition for awards resulting in enhanced quality of services delivered:

 

·         The Chemotherapy nurses were awarded the runner up prize for their nurse led services in conjunction with East Kent Hospital Trust at the Pfizer Clinical Excellence Award during 2009.

 

·         During 2009 our Midwifery nursing team won both a prestigious Royal College of Midwifery award and a runner-up recognition in a separate category. The award for Excellence in Recruitment and Retention was presented for the work the team did in tackling the chronic shortage of midwives affecting all trusts in the South East, and so enhancing quality and safety for women using the services.

 

From our staff survey the following areas have been recorded as above average when compared with the national benchmark:

 

 

Areas that we need to be working on as a result of the staff survey include:

 

 

 

 

Challenges


To further enhance quality we are reviewing our processes to further develop our learning from incidents, complaints and claims to improve care delivery. We will be rolling out an electronic incident reporting system and an audit tool to aid with investigations later this year. These will help to enhance the quality of data received and actions developed as a result of investigation, as well as ongoing monitoring of progress against the action plans.

 

Continuous contributions by, and development of, our workforce is central to improving services for patients. We have developed a robust action plan in response to our staff survey to address the concerns of our staff. One of these has been the area of involving staff more in making improvements at work. One of the recent actions taken has been the consultation with staff to contribute to the setting of the key priorities highlighted in this document.

 

The new cancer strategy commitments are now in place and whilst the Trust is committed to this process it has not quite met the all the new targets. A key factor for the underperformance is that as a major tertiary centre MTW receives high levels of referrals from other NHS Trusts. Often, due to the complex nature of these patients, they have either breached the target or are close to breaching by the time they are sent to MTW for treatment. 

 

On the NHS performance framework the Trust is seen to be “performing” – this indicates that we are meeting all the standards outlines by the CQC in line with access to healthcare by our patients.

 

 

Overview of the organisational effectiveness initiatives

 

There have been a number of initiatives over the last year to increase organisational effectiveness around quality and to embed quality throughout internal structures and processes.

 

They have included:

 

 

 

 

 

 

 

 

 

 

 

 

We continued to improve in our compliance with the Health Care Commission core standards, from 20 not met in 2007/08 to eleven in 2008/09 to three in 1009/10 – all of which were compliant by the end of March 2010. These core standards have been replaced by the registration requirements within the new regulatory framework. These are monitored by the Care Quality Commission, and the Trust has been registered to provide the following services across the three sites:

 

·         Treatment of disease, disorder and injury

·         Surgical procedures

·         Diagnostic and screening procedures

·         Maternity and midwifery services

·         Termination of Pregnancy

·         Patient Transport

 

 

Aligning Quality with the wider business strategy

 

The Trust is in the process of implementing a clinical strategy that is founded upon clear objectives to improve quality of care and clinical outcomes.  This involves the reconfiguration of some services to ensure the best possible clinical services are sustainable into the future, the opening of a brand new single room acute hospital at Pembury and major improvement work and investment in new technology being done at Maidstone Hospital.

 

New design of services and the environments from which we will provide them are predicated on productivity and innovation.

 

The Trust has worked, and will continue to work, hard to ensure patients and stakeholder groups are informed about the improvements and innovations happening in and around their local hospitals.  Developments in local services such as a new diabetes day centre in Tunbridge Wells have had great support and valuable input form patient groups.  We have also had extensive engagement with stakeholders in relation to our reconfiguration of consultant led maternity services; this has been revisited with Kent County Council (KCC) and the Health Overview and Scrutiny Committee.

 

The Trust is working with the Strategic Health Authority, NHS South East Coast, in relation to the new national programme – QIPP – Quality, Innovation, Productivity and Prevention.

 

Locally the Trust is working closely with NHS partners and KCC as part of a QIPP Board for the whole of Kent and Medway.  The focus is on quality, innovation, productivity and improvement as key means to sustain quality of services in years ahead in a more challenging economic climate.

 

 

NHS Constitution

 

The rights, pledges and principles outlined in the NHS constitution are wide-ranging and cover many areas of operational work.  MTW has adopted an approach of raising general awareness and taking opportunities to link rights and pledges into aspects of care in an ongoing manner.

 

MTW has reviewed its own organisational values and these are consistent with the NHS values.  The rights and pledges in the NHS constitution are well articulated aspects of providing good day-to-day management and experience for patients, the public and staff.  As such they are part of the common infrastructure within the organisation.

 

The Board confirmed its vision as being to provide excellent patient care and experience.  Board also reviewed organisational objectives and these have been adopted and turned into six areas, each with priority actions to be implemented as part of a five year plan.  These priority areas, covering all aspects of the NHS constitution, are reviewed twice a year.

 

Each of the rights and pledges are linked to a variety of external agency scrutiny and assurances such as Care Quality Commission core standards or to Auditors’ Key Lines of Enquiry, or other duties such as those under Health and Safety and bodies such as the Kent Safety and Children’s Board.

 

MTW is a signatory to the NHS Code of Practice and to specific contracting arrangements with PCTs.  These arrangements ensure that commissioning agreements are consistent with NHS principles, Codes of Conduct, good Governance and the rights and pledges outlined in the NHS constitution.

 

All contracts are subject to regular scrutiny and are consistent with external monitoring through Core Standards and now CQC registration, to give commissioners assurance that MTW is delivering services in line with best practice, health needs and commissioning intentions.  The NHS Constitution rights and pledges form part of this scrutiny process.

 

MTW uses external and internal scrutiny mechanisms to be assured that patients are receiving the best care, the public are well engaged and staff are being treated fairly and in accordance with good management practice. 

 

Key aspects of scrutiny include:

 

·         Care Quality Commission – annual health check, registration, periodic reviews

·         Royal College accreditation of training posts

·         Annual staff survey

·         Annual patient survey

·         Real-time patient experience tracker

·         Local Authority Health Overview and Scrutiny Committee challenge

·         Serious Untoward Incident root cause analysis and feedback of change to practice

·         Complaints and PALS processes

·         Delivering Same Sex Accommodation fortnightly returns to PCT and SHA

 

 

 

 

Statements to be added following review of the draft quality account by partner organisations: PCT, OSC, LINk