Our improvement plan & our progress

1. Our improvement plan & our progress At Buckinghamshire Healthcare NHS Trust we are committed to ensuring our patients’ experience of our services is a good one. We take the quality of our care very seriously and constantly strive to improve and develop. We have developed our Quality Improvement Strategy accompanied by the Quality Improvement Plan which builds on the actions identified as part of the Keogh review. Our top goal is to deliver safe and compassionate care every time. We will do this by reducing harm, reducing mortality and providing a great patient experience. We continue to engage with our staff, patients and the local public along the way. We want to know, and hear back from you, whether the changes we are making are having the right impact and learn from what you, the public, have to say. We have held seven ‘Big Conversations’ with our local communities and as a result are acting on what we have been told. We will be reporting back through our website. There will be regular updates on NHS Choices and subsequent longer term actions will be included as part of a continuous process of improvement. What are we doing? Keogh review made 17 recommendations on 11 July 2013. Initial actions have been signed off into our ongoing quality improvement plan. The progress we have made was acknowledged by those attending the follow-up Risk Summit chaired by NHS England on the 4 December 2013. Specifically, Keogh said that we need to: Strengthen leadership at Board level and improve some of the Board processes – this is important because the Board sets the direction for organisational culture and leads organisational change Strengthen processes within our urgent care pathways. This is important because strengthening these processes will improve patient experience and may have a positive impact on clinical outcomes. Strengthen how we learn from patient experience. This is important because patient feedback is an important element of quality and we can more quickly identify areas for improvement. Improve the way data is used to provide intelligent information in relation to clinical effectiveness and operational performance data. This is important because such information is key to strategic decision making and for understanding our quality and patient experience. Formally review staffing levels and skill mix and take action where appropriate. This is important because having the right staff numbers and with the right skills is central to the delivery of a quality service. This ‘plan & progress’ document shows how we are making these improvements and demonstrates how we’re progressing against the plan. This document builds on the ‘Key findings and action plan following risk summit’ document which we agreed immediately after the review was published: (http://www.nhs.uk/NHSEngland/bruce-keogh-review/Pages/published-reports.aspx). While we take forward our plans to address the Keogh recommendations, the Trust is in ‘special measures’. More information about special measures can be found at: http://www.ntda.nhs.uk/blog/2013/07/16/nhs-tda-places-five-trusts-in-special-measures/ Oversight and improvement arrangements have been put in place to support changes required. More detail is shown further in the document.

2. Who is responsible? Our actions to address the Keogh recommendations have been agreed by the Trust Board Our Chief Executive, Professor Anne Eden, is ultimately responsible for implementing actions in this document. Other key staff are the Medical Director Dr Tina Kenny and the Chief Nurse and Director of Patient Care Standards, Professor Lynne Swiatczak (and as from April 2014 Carolyn Morrice) as they provide clinical leadership within the organisation. The Chief Operating Officer and Director of Human Resources also play key roles in the delivery of the plan. Dr Stephen Dunn is our Trust Development Authority representative and he is helping us to implement our actions by supporting & performance monitoring the delivery of this plan. In addition an Improvement Director from the Trust Development Authority, Marie-Noelle Orzel, is working with the Trust to support the delivery of the plan. At a follow-up meeting held on 4 December, Trust staff outlined the improvements made to patient care over the past six months. Representatives from the Trust Development Authority, NHS England, Care Quality Commission and local CCGs thanked staff for the tremendous amount of work that had been undertaken in response to the Keogh recommendations and expressed that real progress had been made and demonstrated, with all areas of concern addressed. In March 2014 the Trust was inspected by the CQC’s Chief Inspector of Hospitals, it is expected to report back in the next two months If you have any questions about how we’re doing, contact us on everypatientcounts@buckshealthcare.nhs.uk . Our improvement plan & our progress How we will communicate our progress to you Details of our action group and action plan have been published in a dedicated area on our website - http://www.buckshealthcare.nhs.uk/everypatientcounts- A report will be presented to and discussed at our Board every month – these meetings are held in public bi-monthly and anyone is welcome to come along and listen We developed a blog - http://everypatientcounts.wordpress.com/ - to share the work we are doing to improve and develop care, quality and the patient experience. And we want people to get involved by posting their comments and questions, sharing ideas or participating in discussions We will also use twitter to update and engage people – follow us http://twitter.com/BucksHealthcare We will be reporting to the Buckinghamshire Health and Adult Social Care Select Committee with regular updates Members of the Trust will receive frequent email updates, as will other key stakeholders such as our local Healthwatch, councils, MPs, commissioners and our patient experience group We are working with our local commissioners so that GPs are kept up-to-date with our progress We will actively work with our local media – ensuring they are provided with updates and an opportunity to ask questions through our public Board meetings A dedicated section has been set up on our staff intranet, providing regular updates and an opportunity for staff to post comments and ask questions. As we progress against our action plan, we will continue to use our weekly staff bulletin and monthly team brief to provide updates. Divisional Boards and professional meetings, for example our Nursing & Midwifery Board, discuss this action plan as a standing item at their monthly meetings. - In January 2014, we launched the Trust’s new Quality Improvement Strategy, which directs our ongoing quality improvements

3. What have we delivered so far? The Trust is now reviewing every patient death in a detailed and systematic way. This has helped us to quickly identify if there are clinical improvements we need to make. We have set up a Learning Collaborative for the care of the acutely unwell patient. Initial focus has been around use of the Early Warning Scores and fluid management. A dedicated phoneline has been established for healthcare professionals in community services to access GP support more quickly out-of-hours Additional doctors are working at weekends in Stoke Mandeville Hospital to support emergency medical patients on the wards and ensuring that each and every patient admitted at the weekend is reviewed on a daily basis A review of nurse staffing levels and skill mix has taken place and wards sisters and charge nurses are receiving clear information about the staffing levels and skill mix for their areas. The Board has approved an investment to increase numbers of nurses on ward areas. We have reviewed urgent patient transfers between our two acute sites and confirmed the small number of transfers undertaken (2-3 per day) are safe and clinically effective. We have also determined ongoing monitoring criteria Our recruitment programme continues and there has been some success, although there is still a way to go. A new process for auditing medical patients taken to ITU within 72hrs of admission has been put in place – allowing doctors to identify sub-optimal care and learn the lessons in real-time The new Quality Improvement Strategy vision and goals have been agreed by the Trust Board along with the supporting improvement methodology. We have trained over 400 staff to become Quality Ambassadors, with more to follow. This is helping us to strengthen our quality culture in the organisation. We have installed dashboards outside every ward so patients and visitors can easily see how well it is performing in key areas such as infection control, falls and the patient experience. The Health & Social Care Information Centre has published the Summary Hospital-Level Mortality Indicator (SHMI) statistics for the period April 2012 to March 2013, revealing that the mortality rate for Buckinghamshire Healthcare NHS Trust has reduced, placing the Trust in the ‘as expected’ range. Since 2010 it had recorded ‘higher than expected’ mortality rates. We have carried out a series of ‘big conversation’ events, a county-wide listening and engagement programme to help shape our continuing quality improvement programme. Seven public events took place between November and February 2014. Smaller focus groups also took place and people were able to participate online. Full details and the report are available at www.buckshealthcare.nhs.uk/abc. The Dr Foster Good Hospital Guide 2013, published on Friday 6 December, shows that the mortality rate for hospitals in Buckinghamshire has continued to improve over the last year. The Hospital Standardised Mortality Rate for the year April 2012 – March 2013 is now in the ‘as expected range’ for the first time in recent years. We also performed better than the national average for urgent readmissions, having surgery within two days for a broken hip, and urgent access to MRI scans. At the follow-up meeting held on 4 December, Trust staff outlined the improvements made to patient care over the past six months. Representatives from the Trust Development Authority, NHS England, Care Quality Commission and local CCGs thanked staff for the tremendous amount of work that had been undertaken in response to the Keogh recommendations and expressed that real progress had been made and demonstrated, with all areas of concern addressed.

4. Our improvement plan This table shows the actions we’re taking to address the concerns about the quality of our services which were raised in the Keogh report. It also shows how we are progressing against our actions.

5. Our improvement plan continued…

6. How our progress is being monitored and supportedThis table shows how and when we are checking that the actions we’re taking are making a real difference across our clinical services. It also highlights how we will be communicating our progress to our local community. Key for progress reports Blue -delivered Green – on track to deliver Narrative – disclose delays/risks/plan to recover Red – not on track to deliver