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Agenda Item: 7.

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To: From: Date: Healthcare standard Title:

Public Trust Board Jane Lewington Chief Executive 7 January 2014

Keogh Review – Monthly Progress Report

Author/Responsible Director: Jane Lewington Chief Executive Lynne Young Programme Director Purpose of the Report: To provide the Board with a monthly opportunity to consider progress in implementing the recommendations of the Keogh Review. The Report is provided to the Board for: Information Assurance

Discussion

Summary/Key Points: Monthly update on governance implementation and patient outcomes related to the delivery of the Trust’s Keogh action plan. Recommendations: The Board is asked to note and discuss the governance arrangements, implementation progress and the impact on patients. The Board is also asked to consider the focus areas for further Board assurance over the next month. Strategic Risk Register Performance KPIs year to date

Resource Implications (eg Financial, HR) Assurance Implications Patient and Public Involvement (PPI) Implications Equality Impact Information exempt from Disclosure Requirement for further review?

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Agenda Item: 7.1 1 1.1 PURPOSE The purpose of this paper is to provide the Board with a monthly opportunity to consider progress in implementing the recommendations of the Keogh Review. The Board is asked to note and discuss the governance arrangements, implementation progress and the impact on patients. The Board is also asked to consider the focus areas for further Board assurance over the next month.

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BACKGROUND On 6 February 2013, the Prime Minister asked Professor Sir Bruce Keogh, NHS England Medical Director, to review the quality of the care and treatment provided to patients by our Trust (along with 13 other NHS organisations). In June 2013, the Keogh Review recommended 57 different ways that we could improve the quality of our services. In July 2013, our Trust attended a risk summit to discuss the findings of the Keogh Review and to agree an action plan for our most urgent recommendations. While we take forward our plans to address all 57 recommendations, we have been placed in ‘special measures’ by the NHS Trust Development Authority (TDA). Every single member of staff employed by our Trust can help improve the quality of our services. The changes we are collectively making for our patients are being driven on a day-to-day basis by Jane Lewington, our Chief Executive. Jane is being supported by our dedicated and committed staff, our Executive Team and our Board. Further external support is being provided by Jeff Worrall, Portfolio Director at the NHS Trust Development Authority. A partnership with Sheffield Teaching Hospitals NHS Foundation Trust has been established to share best practice to support our improvements in the quality of care. During 2014, our success in implementing the recommendations of the Keogh Review will be independently assessed by Professor Sir Mike Richards, the Chief Inspector of Hospitals.

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GOVERNANCE ARRANGEMENTS A weekly Executive oversight meeting has been established, to drive the delivery of our detailed action plan, to ensure that staff members are supported, and to enable rapid remedial action to be taken if progress deviates from trajectory. Regular updates are being provided to our relevant Board sub-Committees on the progress of individual Keogh actions, providing ‘confirm and challenge’ opportunity to test our improvements. The discussion of this paper, on a monthly basis, enables our Board to review and test the evidence of our improving services. Page 2 of 9

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Agenda Item: 7.1

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Before each Board meeting, focussed Board-level assurance visits to frontline services are conducted – to examine how the actions we are taking are benefiting patients. These activities are informed by the focus areas in our Keogh action plan. External review of progress will be conducted at regular locality forums. Monthly accountability meetings are being held with the NHS Trust Development Authority, Clinical Commissioning Groups, the Local Area Team and local Healthwatch, to monitor our improvements.

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IMPLEMENTATION PROGRESS The Keogh Review recommended 57 different ways that we could improve the quality of our services, and ranked these recommendations by priority (urgent; high; and, medium). The implementation of each of these recommendations is dependent upon the completion of a number of enabling milestones. In total, we plan to successfully complete 261 milestones over the coming weeks and months. A detailed action plan is in place – operating as a live monitoring and management tool. Our action plan is, by necessity, highly detailed in nature. However, our progress in implementing the 57 recommendations and completing the 261 milestones can be seen below (in sections 4.5 and 4.6). As part of the Keogh review the complaints service has undergone a comprehensive review and redesign. A new pathway for managing concerns and complaints has been designed and approved at Patient Experience Committee and Executive Team. This will include an audit of complaints handling and once the final response is sent, the complaint will not be formally closed. The complaints manager will contact the complainant within one month of completion to assess satisfaction. This pathway is now being implemented and will be presented in a separate paper to the Board.

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Agenda Item: 7.1 4.5 Percentage of Keogh recommendations implemented by ULHT:

% Recommendations Implemented
80% 60% 40% 20% 0% Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 High Priority Jan-14 Feb-14 Mar-14 Apr-14 Urgent Priority Medium Priority

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Percentage of Keogh milestones implemented by ULHT:

% Milestones Completed
100% 80% 60% 40% 20% 0% Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 Urgent Priority High Priority Medium Priority

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IMPACT ON PATIENTS The previous section provides a snapshot of our progress in implementing the recommendations of the Keogh Review and our enabling milestones. What it does not, and cannot, provide is insight into whether these changes are making the positive impact on our patients that we intend. In order that our Board is able to assure itself that our patients are experiencing improving services, a small number of key issues have been selected to provide insight into the impact of the entirety of the changes we are making. Each issue has a supporting metric, to allow for an evidencebased assessment of progress each month. Our seven measures of success are set out below.

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Agenda Item: 7.1 5.3 Measure One: Is the mortality rate at our Trust higher than would be expected?1

Trust-wide Mortality Rates
115.00 110.00 105.00 100.00 95.00 90.00 85.00 HSMR SHMI 88.07 Q1 12/13 Q2 12/13 Q3 12/13 Q4 12/13 Q1 13/14 Q2 13/14 Q3 13/14 Q4 13/14 Expected Rate 114.15 108.27 100 108.20 103.45 100 108.44 105.55 100 111.74 108.48 100 100 100 94.29

Crude Mortality
270 250 230 210 190 170 150 243 225 169 183 194 185 259 245 215 196 183

Crude Mortality

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Measure Two: How effectively is our Board connecting with leadership at our clinical levels? 2

Listening into Action Staff Pulse Check
30% 25% 20% 15% 10% 5% 0% Aug-13 % Positive Responses % National Average 27% 21%

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HSMR and SHMI rates are reported at varying intervals; they are retrospectively rebased; and, should be considered as purely indicative in nature. 2 Measured using composite score from our LiA Staff Pulse Check; next survey date to be confirmed

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Agenda Item: 7.1 5.5 Measure Three: How effectively do we respond to patients who become unwell?

Responding to the Deteriorating Patient
30 25 20 15 10 5 0 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Calls to the Cardiac Arrest Team Feb-14 Mar-14 Apr-14 16 20 25 26 26

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Measure Four: How responsive is our complaints process to our patients?

Number of Complaints
80 75 70 65 60 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 Number of Complaints Received 70 67 78 78 72

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Measure Five: Do patients have a positive experience of our services?

Friends & Family Test
68 66 64 62 60 58 56 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 FFT Score (Combined In-Patient / A&E Unify Submission) 60 60 60 66 65

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Agenda Item: 7.1 5.8 Measure Six: Do we have sufficient staff to care safely for our patients?3

Safe Staffing Concerns
100 80 60 40 20 0 Jul-13 Aug-13 Sep-13 Oct-13 45 18 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 89 71 70

Number of staff concerns about the effect of staffing on patient care

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Measure Seven: Are we delivering our priorities for high quality care?

Delivering High Quality Care
100.00% 98.00% 96.00% 94.00% 92.00% Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 % New Harm Free Care 95.41% 95.06% 97.40% 96.11% 95.43%

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Safe staffing metric being further developed to reflect those concerns that have been validated.

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Agenda Item: 7.1 6 6.1 FOCUS AREAS FOR FURTHER BOARD ASSURANCE In addition to the overview (above) on how the changes we are making are impacting on our patients, the Board should note that the following urgent recommendations have been implemented thus far: o The Trust should work with the TDA to undertake a Board competency review. The Trust should develop and implement a plan in response to the Board diagnostic (Recommendation 5) o The Trust should re-launch its Track and Trigger system (Recommendation 14) o The Trust should re-launch its current escalation policy with respect to patient flow (Recommendation 15) o The Trust should develop a standardised escalation policy (Recommendation 16) o The Trust should introduce a PALs function (Recommendation 22) o The Trust should undertake a review of its current complaints process and develop a suitable replacement that is fit for purpose (Recommendation 24) o The Trust should undertake a fundamental review of its Patient Experience strategy. The Trust will be supported by the TDA in this (Recommendation 25) o The Trust should engage in an urgent dialogue with its commissioners to determine whether higher staffing levels can be sustained or if reduction in bed capacity should be auctioned. Following on from this discussion, the Trust should engage in a discussion with NHS England, the TDA and commissioners to discuss any actions arising and the impact on the health economy as a whole (Recommendation 27) o The Trust should implement live reporting of staffing levels on all wards across all three sites and report weekly to the TDA (Recommendation 28) o The Trust should start recruitment for student nurses earlier on in the cycle (Recommendation 29) o The Trust should work with the Deanery to understand its trainee posts from August and to consider converting locum positions to be substantive (Recommendation 31) o The Trust should relaunch its current quality strategy to address the immediate concern raised (Recommendation 33) o The Trust should review the DNAR process…and implement monthly audits of DNAR forms (Recommendation 54) Page 8 of 9

Agenda Item: 7.1

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Before this Board meeting, Board-level assurance visits to frontline areas have been conducted – to enable Board members to see first-hand the impact and robustness of the actions we are taking, and to test our implementation at ward / department level. Reflecting on the information provided above (in sections 5 and 6.1), Board members are asked to agree upon the focus areas for further Board assurance over the next month.

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RECOMMENDATIONS The Board is asked to note and discuss the governance arrangements, implementation progress and the impact on patients. The Board is also asked to consider the focus areas for further Board assurance over the next month.

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