Council of Governors Board Room, The Royal Marsden, London Wednesday 10 th June 2015, 11am - 1pm followed by lunch Governors are asked to attend a private meeting with the Senior Independent Director at 10:30am to discuss the outcome of the Chairman’s Appraisal. Objective 1. Welcome from the Chairman 2. Minutes of the meeting held on 4 th March 2015 (Chairman) (enclosed) To approve 3. Presentation: “Monitoring our Performance” (Steven Francis, Interim Director of Performance and Information) (presentation) To discuss 4. Finance and Capital Report 4.1. Finance Report: Month 12 4.2. Financial Plan 2015/16 (Chief Financial Officer) (enclosed) (enclosed) To discuss To note 5. Chief Executive Report (Chief Executive) (enclosed) To discuss 6. BRC Annual Report (Chief Operating Officer) (enclosed) To discuss 7. Quality and Performance 7.1. Annual Quality Account (David Pontin, Deliotte LLP) 7.2. Quality Accounts for February 2015 – April 2015 7.3. CQC Inpatient Survey (Chief Nurse) 7.4. Staff Survey (Chief Operating Officer) (enclosed) (enclosed) (enclosed) (enclosed) To note To discuss To discuss To discuss 8. Items from Governors 8.1. Pharmacy Waiting Times 8.2. Surgical Strategy 8.3. IT Strategy (Governors to lead the discussion) (verbal) To discuss 9. Governor’s Register of Interests – For information (enclosed) To note 10. Any Other Business Date of next meeting: Wednesday 23 rd September 2015, 11am - 1pm Board room, Chelsea
Transcript
Council of Governors Board Room, The Royal Marsden, London
Wednesday 10th June 2015, 11am - 1pm followed by lunch
Governors are asked to attend a private meeting with the Senior Independent Director at 10:30am to discuss the outcome of the Chairman’s Appraisal.
Objective
1. Welcome from the Chairman
2. Minutes of the meeting held on 4th March 2015 (Chairman)
(enclosed) To approve
3. Presentation: “Monitoring our Performance” (Steven Francis, Interim Director of Performance and Information)
(presentation)
To discuss
4. Finance and Capital Report 4.1. Finance Report: Month 12 4.2. Financial Plan 2015/16 (Chief Financial Officer)
(enclosed) (enclosed)
To discuss
To note
5. Chief Executive Report (Chief Executive)
(enclosed)
To discuss
6. BRC Annual Report (Chief Operating Officer)
(enclosed)
To discuss
7. Quality and Performance 7.1. Annual Quality Account (David Pontin, Deliotte LLP) 7.2. Quality Accounts for February 2015 – April 2015 7.3. CQC Inpatient Survey (Chief Nurse) 7.4. Staff Survey (Chief Operating Officer)
(enclosed)
(enclosed) (enclosed)
(enclosed)
To note
To discuss To discuss
To discuss
8. Items from Governors 8.1. Pharmacy Waiting Times 8.2. Surgical Strategy 8.3. IT Strategy (Governors to lead the discussion)
(verbal) To discuss
9. Governor’s Register of Interests – For information (enclosed) To note
10. Any Other Business
Date of next meeting: Wednesday 23rd September 2015, 11am - 1pm Board room, Chelsea
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Council of Governors Board Room, The Royal Marsden Hospital, Chelsea
Wednesday 4th March 2015 11am – 1pm
Minutes
Present:- R. Ian Molson (Chairman) Governors as per attached attendance list In attendance Cally Palmer (Chief Executive) Dame Nancy Hallett (Non-Executive Director) Professor Dame Janet Husband (Non-Executive Director) Dr. Liz Bishop (Chief Operating Officer) Marcus Thorman (Chief Financial Officer) Dr. Shelley Dolan (Chief Nurse) Professor Martin Gore (Medical Director) Nicky Browne (Director of Performance & Strategy Implementation) Syma Dawson (Head of Corporate Governance) (minutes)
MEETING BUSINESS 1 Apologies – as noted in the attached attendance list
2 Minutes of meeting held on the 10th December 2014 The minutes of meeting held on the 10th December 2014 were approved as an accurate record.
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Trust Constitution The Head of Corporate Governance explained that the Trust has reviewed its Constitution to ensure that this is kept up-to-date with NHS Constitutional Standards and regulatory requirements. Section 2 of the enclosed report identifies the key changes which are being proposed alongside the reasons why. It was noted that Governors have received a full copy of the Constitution for their reference. The Council of Governors noted the proposed changes and approved the Trust Constitution.
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Cancer Drugs Fund The Medical Director reported on changes and restrictions in the Cancer Drugs Fund. Following a query raised by Governor Robert Freeman as to how the Cancer Drugs Fund affects patient outcomes at the Trust, the Medical Director responded that drugs are prioritised on their effectiveness and based on objective quantitative scoring. He explained that the process for agreeing funding for a drug had not changed but the number of indications previously in use via the Cancer Drugs Fund have been reduced significantly. The Chief Executive informed the Council that the Cancer Taskforce has plans to publish a new cancer plan in Summer 2015 which considers how existing resource can be used more efficiently, including resource for drugs.
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5.1. Membership and Communications Report Governor Ann Curtis and Co-Chair of the Membership and Communications Group presented the enclosed report and noted the positive progress the group has made. The Chairman took the opportunity to thank the Governors for their work in this area and encouraged all Governors to engage in this area of work.
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5.2. Media Briefing The Director of Marketing and Communications summarised the recent highlights set out in her report. She added that the Trust is currently reviewing the Trust website and will seek Governor feedback on this before its launch in Summer 2015. The Chairman emphasised the Trust’s challenge of building brand awareness and highlighted that The Royal Marsden is not just an NHS Trust but also has national and international relevance, a position which is currently not reflected in the amount of funding it has raised when compared with other cancer charities.
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Finance and Capital Report 6.1. Finance Report The Chief Financial Officer gave an update on the following areas: the efficiency programme, cash and revenue position and the capital programme. He concluded that overall he expects the Trust to achieve its plan for the 2014/15 outturn position although the financial environment is extremely challenging. 6.2. Presentation of Financial Plan 2015/16 The Chief Financial Officer delivered a presentation on the Financial Plan 2015 / 16 which summarised the key assumptions, key risks and next steps. Governor Ann Curtis queried whether the LCA has considered pooling nurses between hospitals to which the Chief Nurse explained that this was less possible with junior nurses but they are considering this option with the Clinical Nurse Specialist resource. However there are concerns about the impact this will have on Trust resource so the Trust is considering all its options in conjunction with other providers. The Council discussed self-referrals and the recent policy change relating to patient access. The Chief Operating Officer highlighted that the Trust’s aim is to ensure the right patients get the right access to Trust services and clinicians. Following a query raised by Governor Colin Peel about the role of Monitor and NHS England, the Council discussed the significance of the election and how this may impact on the providers’ roles. The Chief Executive concluded the item by highlighting the new models of care the NHS is moving towards including a greater focus on care outside hospital settings and more streamlined and integrated pathways of care for patients.
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Capital Developments 7.1. Maggie’s Centre The Chief Operating Officer gave an update on the development of the Maggie’s Centre on the Sutton site and confirmed that the project is financed by Maggie’s. 7.2. Sutton for Life The Chief Executive reminded the Council of the background and context behind the Sutton for Life project. She confirmed that at this stage the Trust is unable to contribute any further investment to progress to the next stage of the project until there is clarity and assurance on project plans. Currently the land on the Sutton site is not for sale and while the Trust supports the concept of Sutton for Life to provide investment and modernisation of the Sutton Hospital site, it is not possible to commit resources for patient care to further project work for the Sutton for Life programme. 7.3. MR Linac The Chief Operating Officer explained that this was a joint project with the ICR and the Trust expects to receive the prototype in April 2016 and will be one of five centres in the world trialling this new technology. 7.4. The Royal Brompton and NHS England Review The Chief Executive was pleased to report that the Trust is working constructively with The Royal Brompton and is considering a shared service model as well as the estate options to support this model. The Trust is awaiting the Memorandum of Understanding from NHS England (London) which may support an application for capital from the Department of Health.
8 Care Quality Commission Inspection The Chief Nurse commented on the history and context behind the new CQC inspection regime and explained what the Trust should expect. She described the Trust’s view of the inspection as one which provides an opportunity for the Trust to reflect on current practice in order to enhance performance. Following a query from Governor Duncan Campbell, the Chief Nurse explained that the CQC approach with Governors varies as some have / have
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not been interviewed in other inspections.
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Quality and Performance 9.1. Key Performance Indicators Q3 The Director of Performance and Strategy reported that the Trust had met all of Monitor’s indicators for Quarter 3 with the exception of cancer waiting times where there is a national problem with achieving the target. She explained that this is often a result of late referrals and so the Trust is looking at ways in which it could enhance performance in other organisations. She noted how the Trust achieves its target in this area when late referrals are reallocated and commented on the Trust’s long standing effort to introduce a reallocation policy, something which the Medical Directors, including the Trust’s own Medical Director, are collectively advocating. The Council also discussed the appraisal rate and noted that efforts were being made to improve this. Following a query raised by the Chairman about areas of improvement, the Director of Performance and Strategy confirmed that additional surgical capacity is a high priority for the Trust. 9.2. Quality Accounts for November 2014 – January 2015 The Chief Nurse highlighted the following two main areas from the enclosed Quality Accounts: i) Healthcare Associated Infections: the Trust had three cases which were attributed
as avoidable in 2014/15. These cases are now being reviewed externally. For next year the trajectory has doubled.
ii) Staffing: the difficulty with nurse recruitment was noted and the ways in which the Trust is trying to attract and retain nurses was discussed.
9.3. Quality Account Projection for 2015/16 The Chief Nurse explained that since 2010 there has been a requirement for NHS Trusts to produce an annual Quality Account which considers its main priorities. A key area which was highlighted from last year is the use of plain English in communicating with patients. Following an audit from Deloitte it was also suggested that the Trust reduce and prioritise the indicators contained in the Quality Accounts. The Chief Nurse invited the Governors to put forward their suggestions for a priority indicator for Governors in 2015/16. The other two indicators were noted as the 18 week wait and the 62 day cancer wait. Following a query raised by Governor Colin Peel, the Council agreed to include non-chemotherapy waiting times into the Quality Accounts.
10 Any other business The Chairman informed the Council that Non-Executive Director Sir John Craven has confirmed that he will not be seeking reappointment at the end of his term on the 31st March 2015. The Nominations Committee will therefore function accordingly in finding a successor.
Date of next meeting: 10th June 2015, 11am – 1pm, Board Room, Chelsea
SIGNED…………………………………………………………………………..
DATED……………………………………………………
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Council of Governors Attendance List 10th December 2014
Elected Governors
Constituency
Signature
Maggie Harkness Kensington & Chelsea and Sutton & Merton 3 Joyce Herve Kensington & Chelsea and Sutton & Merton 3 Colin Peel Kensington & Chelsea and Sutton & Merton 3
Fiona Stewart Elsewhere in London Apologies Dr Peter Lewins Elsewhere in London Apologies Vikki Orvice Elsewhere in England Apologies Simon Spevack Elsewhere in England 3
Lesley-Ann Gooden Carer 3 Duncan Campbell Carer 3
Public Governors Dr Carol Joseph Kensington and Chelsea 3 Janet Mountford Sutton & Merton 3 Ann Curtis Elsewhere in England 3 Robert Shearer Elsewhere in England Apologies Staff Governors Hardev Sagoo Corporate Support Services 3 Richard Keane Clinical Professionals 3 Vacant Clinical Support Staff Apologies Dr Claire Dearden Doctor Apologies Maureen Carruthers Nurse 3 Nominated Governors
Cathy Scivier Institute of Cancer Research Apologies Robert Freeman Local Authority: Borough of Kensington &
Chelsea 3
Kate Law Cancer Research UK (Charity) Apologies Cllr Stephen Alambritis Local Authority: Boroughs of Sutton & Merton Apologies Dr Chris Elliot Clinical Commissioning Group Apologies Dr Philip Mackney Clinical Commissioning Group Apologies
COUNCIL OF GOVERNOR PAPER SUMMARY SHEET
Date of Meeting: 10th June 2015
Agenda item Item 3.
Title of Document: Presentation: “Monitoring our Performance”
To be presented by
Interim Director of Performance and Information
Executive Summary The Interim Director of Performance and Information will deliver a presentation to the Council which provides an update on the Trust’s Performance Management framework, including scorecards and key performance indicators. It will include a review of 2014/15 Q4 performance and look at the challenges for 2015/16. Recommendations
The Council is asked to note and discuss the presentation.
Author: Steven Francis, Interim Director of Performance and Information
QUARTER 4 2014/15 1. PURPOSE This paper is intended to provide the Council of Governors with an update on the Trust’s performance for quarter 4 2014/15. The scorecard and narrative is also submitted to the Trust Board. The report includes the balanced scorecard for the Trust and a commentary on the red-rated indicators in the quarter 4 report including actions underway to improve performance. The Staff Friends and Family Test did not take place in quarter 3 as the annual staff survey is undertaken during this time period and therefore quarter 4 data has been compared to quarter 2.
2. KPI REVIEW
The scorecard, including its KPIs and definitions and thresholds, will continue to be reviewed during quarter 1 2015/16 to ensure the indicators remain relevant. The market share indicator has been removed as the data is not available. 2.1 52+ week waiters There has been a change in the reporting of the number of patients waiting 52 weeks. Previously, the number reported were the patients waiting >52 weeks at the end of the quarter. This has now been amended to ensure all distinct patients waiting >52 weeks throughout the quarter are captured as this is more accurate. 2.2 Hospital Mortality Standardised Ratio (HSMR) Dr Foster Intelligence (DFI) publishes HSMR figures for NHS Trusts in England. DFI, however, does not include The Royal Marsden in their publications due to the specialist nature of the Trust. Historically, the Trust has commissioned DFI to produce quarterly HSMR data using their national methodology. The HSMR compares a Trust’s observed in-hospital patient deaths against an expected number, which is calculated by DFI on a risk-adjusted basis and takes into account each trust’s patient population in terms of age, gender, socio-economic deprivation, diagnosis, procedure, co-morbidities and palliative care. An HSMR above 100 represents more in-hospital deaths than expected, a figure below 100 means less than expected. Data for the most recent quarter has not yet been received, and the Trust is currently in negotiations over the format of this report. The recent increase in HSMR has been shown to be due to:
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1. DFI changing their risk-model for the latest quarter 2. a high, but not unprecedented number of inpatient deaths in the latest quarter 3. a further increase in the number of private (and therefore less well coded) inpatient
deaths However, elements of the HSMR figure for The Royal Marsden will always be outside of the control of Trust, and we can never fully understand the extent to which other trusts are correctly coding their own complexity and palliative care against which we are benchmarked. Furthermore, the Trust has a relatively small number of inpatient admissions and those admissions typically have high acuity. In-hospital death ratios will therefore be subject to fluctuation. Approval has been given to commence coding Private inpatient activity to NHS coding standards from August. Until this correctly coded data is included in the HSMR calculations the mortality ratio shown on the scorecard will be limited to NHS patients, as this is the only data that is directly comparable nationally. An audit has been carried out and no concerns have been raised as a result. Regular quarterly audits are now in place. 3. PERFORMANCE FOR QUARTER 4 The Trust met all of the Monitor indicators and targets for quarter 4. The Monitor targets are included in the scorecard in red text. Attachment 1 shows the balanced scorecard report for quarter 4 for 2014/15. As agreed a commentary is only provided for indicators where performance is ‘red’ rated. (NB ▲ shows improvement from the previous quarter, ►◄ shows no change and ▼ shows deterioration). 3.1 Quality Account Indicators The quality account indicator is rated amber in quarter 4 due to one case of MRSA for the year to date against a national standard of zero tolerance. The number of cases of MRSA is no longer a Monitor indicator. Forecast: Green 3.2
Q4
62 day wait for first treatment – GP referral to treatment (before reallocation)
Actual : 76.8% Target : 85% Forecast : Meet trajectory
The Trust met all cancer waiting times targets, with the exception of the 62 day wait for treatment GP referral to treatment before reallocation. The Trust met the standard after reallocation. A detailed analysis of reasons for underperformance has been undertaken and the key issues are detailed below. During quarter 4 there were 39.5 accountable breaches. Out of the Trust’s control
• Admin delays (4) RMH continues to receive a high number of late referrals and this is shown against performance in the chart below.
The Trust has set a trajectory for improvement against the 62 day urgent GP referral standard which has been shared with NHS England. RMH has met the trajectory for quarter 4. The trajectory for the open Exeter measure is to meet the 85% standard prior to reallocations by September 2015, however this depends on referring Trusts referring patients earlier in the pathway in addition to internal actions at RMH. The Trust expects to continue to meet the standard post reallocation.
3.3
Q4
No. of patients waiting >52 weeks at quarter end Actual : 4 Target : 0 Forecast : 0
excluding breaches due to patient choice
In three of the four cases, there are patient choice adjustments which will be applied to the pathway once completed. Therefore three pathways will not be 52 week breaches once complete. The remaining case originally had a patient choice adjustment which had to be removed as the case was cancelled by the hospital to make way for an urgent surgical case. Each of these pathways has been carefully reviewed and learning has been taken forward. The pathways have been shared with commissioners.
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3.4 Q4 PP Income Variance Actual : -£4,144k Target : Break even Forecast : N/A
Although the PP income position was 15% ahead of prior year, it fell behind plan due to number of challenges with new business cases. Capacity in Horder Ward was unavailable for PP use and a delay in the business case for revising the tariff structure for diagnostic tests also contributed. The PP adverse income variance was however largely offset by significant cost savings and unspent reserves that reduced the overall gap to the planned surplus. 3.5 Q4 Achievement of Efficiency Programme Actual : 63% Target : 100% Forecast : N/A
The efficiency programme delivered an achievement of 63%. The majority of the shortfall related to the PP revenue programme as discussed above as well as the unfunded services review cost improvement programme which is still being developed. Whilst the specific CIPs identified in business planning have not been fully delivered, the Trust met its financial plan through a combination of NHS income performance and management of its costs without detriment to patient care.
3.6 Q4 No. of inpatients discharged whose LOS >15 days Actual : 255 Target : <200 Forecast : N/A
Although the number of patients with a length of stay of fifteen days or more was greater than normal, the Trust has robust procedures in place to monitor all patients with a length of stay greater than 10 days. All patients are reviewed to ensure there is a clear treatment or care plan in place, discharge planning is underway and any delayed discharges are escalated to senior managers to ensure all appropriate actions are taken to facilitate the patient discharge. In view of continued red for this measure, a review of the data across elective and non-elective patients is being undertaken to establish what is driving the length of stay to determine a meaningful measure and threshold. No forecast has therefore been included in this report.
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3.7 Q3 (1 Q in arrears)
Percentage of closed commercial interventional trials meeting contracted recruitment target
Actual : 61% Target : >85% Forecast : N/A This measure includes trials that the Trust has hosted over the past 12 months and includes clinical trials with a status of either ‘open to recruitment’, ‘closed to recruitment – in follow up’, or ‘closed to recruitment – follow up complete’. For many trials, there is an extremely long follow-up period which can, in some cases, be up to ten years meaning that some trials can remain part of this measure for up to 11 years. Many of the older trials were set up when investigators were less realistic with recruitment targets which subsequently resulted in failure to meet them. These trials however cannot be removed from this measure until their status has been closed to recruitment i.e. follow up is complete for 12 months. The NIHR CCF are currently undergoing a review of how they analyse and report performance against this benchmark. It is likely that any agreed changes in the reporting process will result in better analysis and may address some of the above issues.
3.8 Q4 Bank and agency spend as % of total pay expenditure Actual : 10.2% Target : 8% or less Forecast : Amber
Cancer, Clinical and Community Services have all seen a significant increase in agency expenditure during quarter 4. There are a variety of reasons for the increase in expenditure. These include a number of gaps on the junior doctor rota requiring cover to ensure compliant rotas, gaps within the medical secretary staff group that have been covered externally as well as inpatient and day care nursing vacancies that require cover. Due to the current temporary staffing systems in place this figure is based on expenditure rather than usage during the quarter. This increase in expenditure follows the usual trend of delayed processing of invoices prior to the financial year end. The Trust has procured a temporary staffing and e-rostering system that is currently being rolled out. This will enable real time reporting on usage and ensure robust management of resources across all staff groups. This will also enable the divisions, with support from HR, to reduce the amount of reliance on bank and agency. The below graph charts progress over the last year.
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3.9 Q4 Appraisal and PDP rates Actual : 73.3% Target : >85% Forecast : Amber
The appraisal rate in month 12 increased to 77% following a dip earlier in the quarter. The actions taken in the previous quarter, led by the Director of Workforce, are beginning to take effect leading to an improvement in all divisions, although progress is slower than anticipated. Audits of data reported have identified some under reporting which is currently being addressed. More frequent reporting along with targeted action related to hotspots identified by HR and managers are now in place. The appraisal data is now reported on the intranet through the WIRED mandatory training and appraisal monitoring system, enabling easy access for managers to identify where further action is required. This enhancement was implemented at the end of March 2015.
BALANCED SCORECARD
Patient Safety, Quality & ExperienceQ4 Actual
Trend from Q3 Q3 Actual
Monitor governance risk rating ►◄
Quality Account indicators ►◄
Certification against compliance with requirements regarding access to health care for people with a learning disability ►◄
MortalityHospital Standardised Mortality Ratio (qtr in arrears - NHS patients only) TBC 97.2%30 day mortality post surgery 0.9% ▼ 0.6%30 day mortality post chemotherapy 0.3% ►◄ 0.3%100 day HSCT mortality in previous 6 months (Deaths related to SCT) 5.4% ▼ 5.0%100 day HSCT mortality in previous 6 months (All deaths) 5.4% ▼ 5.0%
Cancer stagingStaging data completeness sent to Thames Cancer Registry (1 qtr in arrears) 76.0% ▲ 68.0%
Patient satisfaction Inpatient 90.8% ▲ 90.3%Outpatient 85.2% ▲ 82.8%Day Unit 87.4% ▲ 87.3%Waiting times for day chemotherapy (over 3 hrs) 11.0% ▲ 11.3%Mixed sex accommodation breaches 0 ►◄ 0PP access to single rooms - Chelsea % 99.4% ▼ 99.9%PP access to single rooms - Sutton % 99.0% ►◄ 99.0%
Cancer waiting times targets2 wk wait from referral to date first seen: all cancers 98.4% ▲ 96.8%
symptomatic breast patients 95.6% ▼ 96.4%31 day wait from diagnosis to first treatment 99.1% ▼ 99.4%31 day wait for subsequent treatment: surgery 97.1% ▼ 99.2% drug treatment 100.0% ►◄ 100.0% radiotherapy 98.4% ▼ 99.0%62 day wait for first treatment: GP referral to treatment (reallocated) 86.1% ▼ 86.9%
Referral to treatment waiting timesMaximum time of 18 wks from referral to treatment - admitted 95.2% ▼ 95.4%Maximum time of 18 wks from referral to treatment - nonadmitted 98.9% ▲ 98.2%Maximum time of 18 wks from referral to treatment - still waiting 94.5% ▼ 95.1%
No of patients waiting > 52 wks at quarter end. (distinct patients across the quarter) 4 ▼ 3
end Q4, 2014/15
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1. To achieve the highest possible quality standards for our patients, exceeding their expectations, in terms of outcome, safety and experience
Finance & Efficiency Q4 ActualTrend
from Q3 Q3 ActualMonitor financial risk rating 4 ►◄ 4Capital Servicing Capacity (times) 3.2 ▼ 3.3EBITDA Margin (%) 5.7% ▲ 4.8%Achievement of planned year to date operating surplus (%) 122.5% ▲ 99%NHS activity Income Variance (£000) 2,740 ▲ 290PP activity Income Variance (£000) -4,144 ▼ -2,622Liquidity (days) 26.5 ▲ 24.9Achievement of Efficiency Programme (%) 63% ▼ 66%CQUINS % achievement - Acute TBC 100%CQUINS % achievement - Sutton and Community Services TBC 100%
Asset utilisationBed occupancy - Chelsea 88% ►◄ 88%Bed occupancy - Sutton 84% ▲ 81%Theatre utilisation - Chelsea 93% ▲ 89%Theatre utilisation - Sutton 77% ▲ 76%Utilisation of diagnostic radiology (target under review) 28871 ▼ 29387
3. To deliver the Trust's clinical and research strategy; redefining our market position to better meet the needs of patients and commissioners, and increasing market penetration
Clinical and Research Strategy Q4 ActualTrend
from Q3 Q3 ActualNew referralsTotal new referrals 5471 ▼ 5595Total GP referrals 2436 ▼ 2456GP referrals - urgent suspected cancers for diagnosis 1486 ▲ 1484Referrals from Surrey 916 ▼ 950
Personalised care - building molecular diagnosticsInternal referrals 1549 ▲ 915External referrals 973 ▼ 994Number of samples sent from patients recruited to CRUK Stratified Medicine Programme 66 ▲ 42
Private carePP referrals 997 ▼ 1034
Efficient clinical modelsNo of inpatients discharged whose LOS > 15 days 255 ▲ 265
Research 70 day target (for externally sponsored trials only) (1Q in arrears)
NIHR Adjusted figure (excluding delays attributed to sponsor/neither sponsor or trust) 95% ▲ 94%
Accrual to target (1Q arrears)% of closed commercial interventional trials meeting contracted recruitment target 61% ▲ 59%
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2. To improve the productivity and efficiency of the Trust in a financially sustainable manner, within an effective f k
4. To recruit, retain and develop a high performing workforce to deliver high quality care and the wider strategy of the Trust
WorkforceQ4 Actual
Trend from Q3 Q3 Actual
Human Capital - workforce establishmentBank & agency as % of total FTE 11.1% ▼ 10.5%Bank and agency spend as % of total pay expenditure 10.2% ▼ 9.2%Agency as % of total pay bill 5.4% ▼ 4.8%
Quality & developmentConsultant appraisal (number with current appraisal) 81.4% ▼ 84.0%Appraisal & PDP rate 73.3% ▲ 68.0%Statutory and Mandatory Staff Training 80.3% ▼ 81.0%
5. Monitor Community Measures
Q4 ActualTrend
from Q3 Q3 ActualCommunity care - referral to treatment information completeness 75.0% ►◄ 75.0%Community care - referral information completeness 78.6% ►◄ 78.6%Community care - activity information completeness 76.2% ►◄ 76.2%
Staff FFT is not undertaken in Q3 Q4 ActualTrend
from Q2 Q2 ActualRecommend – Care 96% ►◄ 96%Not recommend – Care 1% ►◄ 1%Recommend - Work 74% ▲ 73%Not recommend - Work 11% ▼ 10%
Delivering or exceeding Target ▲Underachieving Target ►◄Failing Target ▼
ImprovementNo change
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MONITOR TARGET
6. Staff Friends and Family Test - How likely are you to recommend this organisation to friends and family… as a place to receive care or treatment ('care')… as a place to work ('work')
Deterioration
COUNCIL OF GOVERNOR PAPER SUMMARY SHEET
Date of Meeting: 10th June 2015
Agenda item Item 4.1.
Title of Document: Finance Report: Month 12
To be presented by
Chief Financial Officer
Background This report provides a brief summary of the Trust’s financial results for the 12 months ended 31st March 2015. Recommendations The Council is requested to note the position for the year and the continued focus on securing the future financial sustainability of the Trust. Author: Marcus Thorman, Chief Financial Officer
Contact Number or E-mail: x2151
Date: 28th May 2015
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THE ROYAL MARSDEN NHS FOUNDATION TRUST
FINANCE REPORT – 12 MONTHS ENDED 31st March 2015
1) Introduction
This report provides a brief summary of the Trust’s financial results for the 12 months ended 31st
March 2015.
2) Summary
After twelve months the Trust is reporting a development reserve for investment of £14.4m
against a plan of £11.6m, a favourable variance of £2.8m. In March, the Trust achieved a
development reserve of £4.0m, a favourable variance of £3.2m. The position in month was
driven by additional NHS clinical income above that planned, but was particularly impacted
favourably by the late notification of additional funding for complex patients. There were a
number of expected non-recurrent charges to expenditure in month including Sphere setup
costs, but the position was worse than planned due to a loss on sale of assets and the Private
Care division not meeting its forecast.
Most divisions met their agreed forecast outturn for the year. There were two areas that did not
deliver against their forecasts these were Private Care and Facilities. Private Care had an
adverse variance overall of £1.4m for the year and a change in forecast in March of £0.8m,
predominantly driven by lower than expected income in month. Facilities had an adverse
variance of £0.3m for the year, which was £150k worse than expected due to additional
invoicing at the end of the year.
The focus is now on delivering the plan for 2015/16 with particular emphasis on the required
efficiencies and the development of the Transformation Board themes: medicines optimisation;
inpatient and outpatient transformation; surgical strategy; temporary and medical staffing.
The Trust has maintained its low risk Continuity of Service Risk Rating of 4 (out of 4) using the
Monitor metrics.
£0
.5
£0
.8
£1
.4
£2
.5
£4
.4
£5
.2
£7
.4
£9
.1
£8
.8
£9
.7
£1
0.4
£1
4.4
-£1.0
£1.0
£3.0
£5.0
£7.0
£9.0
£11.0
£13.0
£15.0
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Development Reserve for Investment
Actual Plan
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3) Cash
The chart below shows the cash balance at the end of March (£29.6m) using the scale on the left
hand axis and the liquidity days for the Trust, using the scale on the right. The balances over the
last 12 months are shown for reference:
The cash position continues to improve as a result of a number of debts reducing in recent
months including private care, as a result of the reduced billing cycle and NHS clinical income
over-performance being paid to month 8. In addition, the Trust has received in March Public
Dividend Capital funding for a number of projects and the capital programme underspent
against the plan. The Trust has also drawn down more of the loan than it has actually spent
year-to-date, thereby increasing the cash position.
4) Revenue The waterfall graph below shows the key variances from the financial surplus plan.
£1
4.1
£1
1.7
£9
.8
£8
.9
£1
0.2
£1
2.4
£1
6.9
£1
8.1
£1
7.9
£2
0.3
£2
4.9
£2
9.6
0
5
10
15
20
25
30
35
£0.0
£5.0
£10.0
£15.0
£20.0
£25.0
£30.0
£35.0
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Da
ys
£m
Cash and Liquidity
Cash £ Liquidity days
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4.1) Income NHS Clinical income is showing a favourable variance, which is driven by acute services over-performance of £0.8m in month and £2.7m for the year. The key variance is the cancer drug fund which is £6.7m above the plan for the year however, this is offset by expenditure. NHS acute services income was above plan in month, mainly due to several inpatients being discharged from the hospital in month with high levels of CCU days included, hence the over-performance. Other key variances to date are Private Care, which has a £4.1m adverse variance to plan and clinical research which has a £3.2m adverse variance to plan. Clinical research is offset by expenditure underspends whereas Private Care is only partially offset by the expenditure position, although is showing a year on year increase in income of 13%. 4.2) Expenditure Operating expenditure is £7.7m adverse variance for the year. Key adverse variances are as follows: Cancer services division (£2.5m adverse) – staffing cost variances in nursing and junior
doctor driven by temporary staffing usage (£1.3m) due to vacancies, sickness and maternity cover. There are adverse expenditure variances for non-pay which relate to income over performance.
Clinical services division (£2.5m adverse) – staffing cost variances in pharmacy and pathology due to increased costs ahead of reconfiguration, and in critical care nursing due to recruitment difficulties. The division has been broadly break-even since January, which is a significant improvement in the final quarter compared to the beginning of the year.
4.3) Efficiency
The efficiency programme finished the year with an adverse variance against the plan of £5.1m.
The divisions have committed to delivering their financial targets in 2015/16 through the
Business Planning process and will be held to account throughout the year against this position.
£11,602 £14,396
£2,740
£992 £6,693
£460
£7,800
£8,116 £1,430
£5,573
£773
£0
£5
£10
£15
£20
£25£
m
YTD Drivers of Development Reserve for Investment
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Some medium term efficiency programmes have been setup through the development of the
Transformation Board and this will ensure delivery of the longer term financial plan.
5) Capital
The table below shows capital expenditure against the plan, covering both NHS and Charity
funded schemes.
The Trust ended the year £2.9m below its capital plan, with £2m of this against loan funded
equipment and infrastructure, and £1m against internally financed capital schemes. In light of
the overall outturn position for the Trust, these underspends have been carried forward into the
2015/16 capital plans.
6) Conclusion
The Trust has broadly achieved the financial plan for the year and has ended the year with an
overall risk rating of a 4.
The key risks looking forward continue to relate to external issues on tariff and its structure for
income, whereas for expenditure they are associated with cost control and margin improvement.
Recent external focus has seen collaboration with other specialist Trusts in London on tariff
issues, these are expected to continue. Internally the focus has been on reducing expenditure
run rates in line with the financial plan for 2015/16.
The Council of Governors are requested to note the position for the year and the continued focus
on securing the future financial sustainability of the Trust.
Executive Summary This paper provides details on the final plan that was submitted to Monitor. The plan was updated from the draft for external factors and the outcome of the Trust’s internal business planning process. It details the key planning assumptions and provides an analysis of the key financial risks and mitigating actions in relation to those risks. Recommendations The Council of Governors are asked to note the financial plan.
Author: Marcus Thorman, Chief Financial Officer
Contact Number or E-mail: x2151
Date: 28th May 2015
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Council of Governors – 10th June 2015
Financial Plan 2015/16
1 Introduction and Background
The Board approved a five-year strategic plan in June 2014, which was reviewed by the Council of Governors and submitted to Monitor. The second year of this plan forms the basis of the detailed financial planning and budgeting work for 2015/16. The draft plan for 2015/16, along with the underlying assumptions were presented to and approved by the Board in November 2014. A presentation was provided to the Council of Governors in March 2015 on the draft financial plan for 2015/16.
The Board reviewed the final draft financial plan for 2015/16 at its March meeting. The plan had a range of sensitivities and the Board delegated authority to the Audit and Finance Committee (AFC) to approve the draft submission to Monitor in early April.
This paper provides details on the final plan that was presented to the Board in May and submitted to Monitor as per the timetable. The plan was updated from the draft for external factors and the outcome of the Trust’s internal business planning process. It details the key planning assumptions and provides an analysis of the key financial risks and mitigating actions in relation to those risks.
2 Business Planning Process and Timetable
Monitor issued a planning timetable in December 2014. This required that the Trust submit a financial plan for 2015/16 in two stages: a high level draft plan and short assumptions paper, and a final plan with 20 page operational plan. The results of the revised national tariff were published in January; a majority of Trusts rejected the tariff proposals and therefore an updated planning timetable was issued by Monitor to take account of the delay. The table below sets out the revised timetable the Trust followed and the process of approval of the plans.
Original Submission
Date
Revised Submission
Date
Trust Board Sign off
Draft financial plan 28th Feb 7th April April AFC – approve final draft plan
NHS Contracts agreed 11th Mar 31st Mar Contracts still to be finalised
Final plan 10th Apr 14th May May Board
The Trust’s internal business planning process with the divisions and directorates was completed by the end of March. Each area had at least two meetings to review their plans and ensure they met the target set whilst understanding the risks within their plans.
3 Financial Plan
The table below sets out the Statement of Comprehensive Income (SOCI) with expenditure analysed by division. The table shows the 2014/15 plan and outturn and the plan for 2015/16.
Appendix A presents the SOCI with expenditure by type.
Overall income has increased from outturn for 2014/15 by £10.9m, expenditure by £10.7m, resulting in a £0.2m increase in the development reserve for investment. Changes to the capital plan are set out in section 4.4.
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4 Key Assumptions and Movements
4.1 Activity and Income
The SOCI above shows a growth in income overall for the 2015/16 plan compared with the 2014/15 plan and forecast outturn. The key drivers of this increase relate to private patient income and donated asset income. The assumptions underpinning the changes in the income position are detailed below:
NHS Clinical Income – is broadly neutral from outturn 14/15 to plan 15/16, with the reduction relating to minor activity and tariff changes. The key change was from plan 14/15, which relates to the increase in the Cancer Drug Fund. This is expected to continue in 15/16.
Private Patients – despite an ambitious target increase in 14/15 not being achieved a year on year increase of 14% was delivered in 14/15. For 15/16 a growth of 8.5% on outturn has been planned for.
R&D income – another decrease in funding is expected in 15/16 due to loss of CRN activity based funding.
Donated Income – the key increases relate to the forecast grants for the MR Linac and RL Breast Unit.
2014/15 2014/15 2015/16
Income and Expenditure (by Division) Plan Outturn Plan
£000s £000s £000s
Income
NHS Clinical Income 191,467 211,830 209,685
Private Income 81,029 77,520 84,081
R&D Income 19,364 18,821 18,096
Other Income 52,220 47,412 49,183
Donated asset income 3,113 3,976 9,431
347,193 359,559 370,476
Expenditure
Private Patients 28,239 25,334 26,763
Cancer Services 82,913 85,573 83,513
Clinical Services 77,750 80,337 83,958
Community Services 34,713 34,433 36,137
Other Divisions, other Expenditure and Reserves 56,735 64,768 63,282
Divisional Income 47,216 44,909 52,424
327,565 335,354 346,077
Operating Surplus - EBITDA 19,628 24,205 24,399
EBITDA Margin 5.7% 6.7% 6.6%
Other Operating and Non-Operating Items
Depreciation (13,355) (13,097) (14,495)
Impairment - (4,308) -
Loss Disposal FA - (850) (1,177)
PDC Dividend (4,714) (4,868) (4,714)
Interest Payable (232) (159) (289)
Interest Receivable 33 45 41
Surplus /(Deficit) for year 1,360 968 3,767
Depreciation 13,355 13,097 14,495
Impairment - 4,308 -
Loss Disposal FA - 850 1,177
Donated Asset Income (3,113) (3,976) (9,431)
Development Reserve for Investment 11,602 15,247 10,007
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4.2 Expenditure
The SOCI above presents the changes to divisional expenditure budgets for 2015/16. The key changes are as follows:
Private Care – the increase above outturn relates to the investment for additional activity captured as income in the section above.
Cancer Services – has reduced budgets in relation to pharmacy outsourcing, a key QIPP and CIP scheme for the Trust in 15/16. Additionally, education income budgets have been reclassified as divisional income, hence reducing the net budget.
Clinical Services – has increased following budget transfers from Private Care for the costs of clinical support services for extra private capacity, cost changes associated with the pharmacy outsourcing, and transfer of education income to divisional income.
Community Services – has increased to reflect the increase in contract value with Commissioners for the RIO contract and other agreed service developments.
Other Divisions, other expenditure and reserves – has reduced in relation to additional cost efficiencies and various other budget transfers that have been made.
Divisional income – has increased by £8.2m following further updates as detailed in the divisional positions above.
Depreciation – has increased following changes to the capital expenditure programme.
Loss on disposal of fixed assets – reflects the loss on transfer of assets to Sphere on 1st April 2015 following finalisation of the agreement.
In Appendix A the plan is presented by type of expenditure. Key assumptions which have been made are:
Pay costs – inflation uplifts of 1% have been assumed to cover the costs of the pay awards which have been agreed nationally. In addition employers’ contributions for the NHS Pension Scheme will be increasing by 0.3% from April 2015.
Non pay costs – 1.9% has been set aside in reserves to cover inflation costs on non pay. This excludes pass-through drugs where increases in costs will be offset by income.
4.3 Efficiency Programme
The Transformation Board (TB), chaired by the Chief Operating Officer has met to consider the key themes that it will oversee in 2015/16.
The key efficiencies that are being considered in 2015/16 are as follows:
Medicines optimisation
Outpatient transformation
Inpatient transformation
Surgical strategy
Temporary staffing
Medical staffing
In addition to the themes within TB, as part of the business planning round non-clinical areas were required to find seven percent savings. A few of the other key schemes are as follows:
Private Care Strategy
Procurement
Facility services
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A great deal of the efficiency savings related to reviewing posts and not replacing like-for-like upon them becoming vacant, plus identifying alternative funding streams for areas that were counted as critical but not funded through the normal NHS route.
4.4 Capital Expenditure Programme
The proposed capital programme for 2015/16 is set out below and shows £30.6m funds available, an improvement on the draft plan of £2.6m following an increase of £1m in internally financed capital reflecting underspends from 2014/15, £0.6m reduction in donated spend following updated forecasts and to PDC being available in 2015/16 as opposed to 2014/15. The internally financed section is predicated on ensuring surpluses are delivered in line with plan. This has been approved by the Capital Review Group. The plan incorporates the final drawdown of £4.4m from the original £21m loan.
5 Key Financial Risks
The key financial risks and mitigating actions are set out below. The risks for 2015/16 were first discussed and reviewed at the Audit and Finance Committee in January and they are continually refined as the risks evolve. An update was presented to the Trust Board on 18th March and the AFC on 1st April. It is expected that throughout the year the AFC will
2014/15 2015/16 2016/17
Capital Programme Outturn Expected Plan
£000s £000s £000s
Internally Financed
Medical Equipment & Infrastructure 446 - 500
IT Schemes 2,840 3,000 1,500
Backlog & Minor Works 1,469 1,500 1,500
Private Patients Chelsea & Sutton 165 3,484 2,456
Other identified schemes 483 1,498 -
Other (from development reserve for investment) - 718 3,794
Total Internally Financed 5,403 10,200 9,750
Loan Financed Capital
Medical Equipment (Existing Loan) 11,868 4,358 -
Medical Equipment (New Loan) - 4,000 2,000
Total Loan Financed Capital 11,868 8,358 2,000
Public Dividend Capital Funded Capital
Blood Tracking System 447 225 -
Electronic Document Mgmt/ Archiving 41 997 -
Co-ordinate my Care - 1,350 -
Total PDC Funded Capital 488 2,572 -
Donated Capital Expenditure
Robot 1,900 - -
MR Linac - Infrastructure 876 4,590 284
MR Linac - Equipment (2017/18) - - -
RL Breast Cancer Research Centre 452 2,511 37
Maggie's Centre - 500 -
Other Schemes 865 1,830 500
Potential schemes:
Haemato-oncology at Sutton - - 10,000
Total Donated Capital 4,093 9,431 10,821
Total Capital Programme 21,852 30,561 22,571
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constantly review the risks and ensure the Board are assured that progress is being made in each area.
Risk Mitigation
NHS Tariff – impact of marginal rate The Trust has rejected the two proposals from NHS England and will be working to a 14/15 rollover contract.
Private Care Strategy:
Risk that growth is not delivered Strategic plan developed and marketing plan agreed.
Risk to cash flow – growth expected through shift from UK sponsored to embassy activity; embassies are slower to pay
International Patient Manager in place to develop relationships with Embassies to improve payment. Monthly review of debt reported to PRG.
Divisional expenditure controls and CIPs:
Temporary staffing costs Controls on agency usage to continue and be strengthened assisted by the business case for temporary staffing programme and controls.
Lack of project management for CIP Transformation lead appointed Jan 15 and Transformation Board in place to oversee the programme.
Risk that procurement strategy does not deliver expected savings
Procurement savings plan signed off at Financial Strategy Group (Feb 15) and performance monitored through Performance Review Group
Risk the access policy is not fully implemented
Ongoing monitoring of admissions against policy criteria through PRG. Specialist group to review key changes.
IT Shared Services Ensure effective management of the service and joint venture through Directors sitting on Sphere Board and at PRG
Equipment replacement programme – the Trust is heavily reliant on major diagnostic equipment a number of which require replacement in the next 5 years.
Equipment replacement programme has been developed but requires funding. Internally financed capital is not sufficient to deliver requirements.
Clinical IT capital requirements – implementation of the EPR.
An agreed incremental strategy has been agreed by the Board. Internally financed capital is not sufficient to deliver requirements
Community Services – risk of stranded costs if the service is not retained.
Plans are being developed to identify overhead reductions.
These risks will also be regularly reviewed at the Finance Strategy Group and Performance Review Group to minimise the impact on the financial plan.
6 Conclusion and Recommendations This is a year of transition, which has caused a great deal of uncertainty in being able to set
the financial plan. Internal progress has been assisted by all areas engaging in delivering
upon what is required, however the external environment has created a large amount of
flux meaning there are a number of risks that the Trust is managing, over and above the
usual issues at this time of year. The key issue that impacts upon the financial plan is the
size of surplus that enables replacement of equipment and clinical IT systems. This is
driven by the unsatisfactory national tariff position for which the Trust is engaged with
Monitor and NHS England to improve the position from 2016/17 to ensure sustainability.
The Board were asked to approve the following:
Approve the financial plan for 2015/16 for submission to Monitor by 14th May. The
key elements of the plan are as follows:
o Surplus of £3.8m
o Continuity of Service Risk Rating of 3
o Capital investment of £30.6m, of which £10.2m is internally financed
The Council of Governors are asked to note the financial plan approved by the Board and
submitted to Monitor for 2015/16.
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Appendix A – Income and Expenditure Account – by Type
2014/15 2014/15 2015/16
Income and Expenditure (by Type) Plan Outturn Plan
£000s £000s £000s
Income
NHS Clinical Income 191,467 211,830 209,685
Private Income 81,029 77,520 84,081
R&D Income 19,364 18,821 18,086
Other Income 52,220 47,412 48,715
Donated asset income 3,113 3,976 9,431
347,193 359,559 369,997
Expenditure
Pay 198,635 197,888 207,253
Drugs 53,657 62,917 64,050
Clinical Supplies 30,491 30,352 33,837
Non Clinical Supplies - 5,574 5,215
Other 44,783 38,623 35,242
327,566 335,354 345,598
Operating Surplus - EBITDA 19,627 24,205 24,400
EBITDA Margin 5.7% 6.7% 6.6%
Other Operating and Non-Operating Items
Depreciation (13,355) (13,097) (14,495)
Impairment - (4,308) -
Loss Disposal FA - (850) (1,177)
PDC Dividend (4,714) (4,868) (4,714)
Interest Payable (232) (159) (289)
Interest Receivable 33 45 41
Surplus /(Deficit) for year 1,359 968 3,766
Depreciation 13,355 13,097 14,495
Impairment - 4,308 -
Loss Disposal FA - 850 1,177
Donated Asset Income (3,113) (3,976) (9,431)
Development Reserve for Investment 11,601 15,247 10,007
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Appendix B – Statement of Position and Cash Flow Statement
2014/15 2014/15 2015/16
Statement of Financial Position Plan Outturn Plan
£000s £000s £000s
Non Current Assets 248,388 227,179 246,069
Current Assets
Stock 4,248 6,518 6,218
Debtors & Prepayments 43,924 54,138 55,053
Cash 11,602 29,579 14,988
Total Current Assets 59,774 90,235 76,259
Current Liabilities
Creditors (55,789) (73,482) (67,671)
Loan Principal due in 1 year (2,288) (1,823) (2,421)
Total Current Liabilities (58,077) (75,305) (70,093)
Non Current Liabilities
Creditors - (55) (55)
Loan Principal due in 1 year (17,147) (13,677) (19,738)
Total Non Current Liabilities (17,147) (13,732) (19,793)
Total Assets Employed 232,938 228,378 232,443
Taxpayers Equity
Public dividend capital 101,518 104,281 104,579
Income and expenditure reserve 106,671 106,144 109,910
Revaluation reserve 24,749 17,954 17,954
Total Taxpayers Equity 232,938 228,378 232,443
2014/15 2014/15 2015/16
Cash Flow Statement Plan Outturn Plan
£000s £000s £000s
EBITDA 19,627 24,204 24,400
Movement in working Capital (5,511) (2,356) (6,000)
Cash flow from Operations 14,116 21,849 18,400
Investment Cash Flows
Capital expenditure (30,205) (19,105) (34,561)
Financing Cash Flows
Public Dividend Capital Received - 2,763 298
Dividends Paid (5,014) (4,778) (5,144)
Loan drawdown 14,080 9,000 9,080
Loan repayment (1,144) - (2,421)
Interest Received 33 45 41
Loan interest paid (217) (146) (285)
Sphere loan - -
Net Cash Inflow/Outflow (8,351) 9,627 (14,592)
Opening Cash 19,954 19,953 29,580
Closing Cash 11,603 29,580 14,988
2014/15 2014/15 2015/16
Monitor Metrics Plan Outturn Plan
£000s £000s £000s
Capital Service Cover Metric 4 4 3
Liquidity Metric 4 4 3
Overall Continuity of Services Metric 4 4 3
COUNCIL OF GOVERNOR PAPER SUMMARY SHEET
Date of Meeting: 10th June 2015
Agenda item Item 5.
Title of Document: Chief Executive Report
To be presented by
Chief Executive
Executive Summary The Chief Executive will report on Trust matters with regard to Research, Treatment and Care, Service Quality and Financial Performance. Recommendations
The Council is asked to note the position and invited to discuss accordingly.
Author: Cally Palmer, Chief Executive
Contact Number or E-mail:
Date: 28th May 2015
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COUNCIL OF GOVERNORS
Chief Executive’s Report
1. Research
1.1 Research Breakthrough
As Governors may have heard, there has been significant news coverage in the last week about a breakthrough in cancer treatment using immunotherapy.
Results from a phase III trial led by Dr James Larkin, Consultant Medical Oncologist at The Royal Marsden specialising in the treatment of patients with cancer of the kidney and cancers of the skin, including melanoma, showed that immune-boosting drugs - ipilimumab and nivolumab in combination have stopped melanoma cancer advancing for nearly a year in 58% of cases. The Royal Marsden was the leading global recruiter for this study. Dr Larkin was the lead author and Professor Martin Gore was a co-investigator. The results were announced at the 2015 meeting of the American Society of Clinical Oncology (ASCO) - the most important oncology conference globally, which brings together 30,000 oncology professionals from around the world.
Melanoma is the most serious form of skin cancer and accounts for more than 2,000 deaths in Britain each year. Immunotherapy harnesses the body's immune system to attack cancerous cells. The "double hit" treatment helped shrink tumours or bring them under control in 58% of people with advanced melanoma - allowing patients to live 11.5 months without tumours growing.
By giving these drugs together our clinicians are effectively taking two brakes off the immune system rather than one so the immune system is able to recognise tumours it wasn't previously recognising and react to that and destroy them. We have never seen tumour shrinkage rates over 50% for immunotherapies so this is a significant breakthrough in the treatment of cancer.
The trial received widespread international and national broadcast and print media coverage, including front page reports in The Times, Daily Telegraph, Daily Express and Daily Mail. There was also extended coverage in The Guardian, BBC News at Six and Ten, ITV News, BBC World News, and Radio 5 Live. Three Royal Marsden patients who have all shown great progress on the trial were featured in the media discussing their experience on the trial and their support for The Royal Marsden.
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1.2 MR/Linac Development
The Royal Marsden is one of five centres in the world developing prototype MR/Linac technology. This is a key area of the work of The Royal Marsden and Institute of Cancer Research as a Biomedical Research Centre, and the aim of this programme is to create technology which can enhance soft tissue imaging, provide real time imaging which is non-invasive, and eliminate the need for doses of radiation. Funding for this project includes £9.6m from the Medical Research Council and £2.5m from a Cancer Research UK programme grant.
The design of the MR/Linac Centre at Sutton is complete, and planning permission has been awarded. Phase 1 of the contract is underway to create the bunker and link the structure and service to the existing radiotherapy department. Phase 2 follows the installation of the magnet early in 2016, and completion of shielding, connecting of services and commissioning of the prototype.
1.3 Ralph Lauren Breast Cancer Research Centre
This is a £3m development in Chelsea to extend and enhance existing laboratory accommodation to provide more extensive space for the excellent and vital work The Royal Marsden and the ICR undertake in breast cancer research, led by Professor Mitch Dowsett.
The design of the Centre has been completed and planning permission has been given for the scheme. The project is ahead of its original completion date of April 2016 and we hope that Mr Lauren will be able to officially open the Centre in May 2016.
1.4 Application for Biomedical Research Centre Status 2016/17
As Governors will be aware, The Royal Marsden receives significant research funding from the NHS to operate as a Biomedical Research Centre, working with the ICR to translate research findings into patient benefit. This is a five year contract and during 2015 The Royal Marsden and the ICR will be preparing a visionary but achievable bid to maintain excellence in the current 8 BRC themes and to focus particularly on additional value in imaging and radiotherapy, including our UK leadership role in MR/Linac technology.
The NHS R&D budget is likely to be under considerable pressure and as The Royal Marsden receives a relatively high proportion of NHS funding for cancer research relative to other centres like Cambridge, it will be vital to justify the difference RM and ICR are able to make to patient care and the wider NHS.
The Annual Report for the BRC is included on the Council’s agenda for Governors’ information and comment. One of the areas where we will need to demonstrate excellent practice is in patient and public involvement in our research, and Governors’ further advice on this would be much appreciated.
1.5 BRC Website and Advance Magazine
A new BRC website and research magazine called “Advance” have been launched recently to provide news and information on our research programmes and achievements.
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2. Treatment and Care
2.1 Vanguard Models
The Five Year Forward View identified a number of new care models that will transform the way in which care is delivered in the NHS. 29 projects have been selected as Vanguard sites for 3 types of models which focus on community provision and integrated primary and acute care systems.
Bids are now invited for a fourth group, new models of acute care collaboration, and these options include but are not limited to:
- Innovative forms of Accountable Clinical Networks, such as through joint NHS-led vehicles running particular services, characterised by clear leadership, with decision rights to reshape care, backed by a clear organisation form
- NHS service franchises such as Moorfield@, The Marsden@ - NHS management groups or chains of multiple organisations, for example,
under a NHS “foundation group” The aim of this programme is to develop replicable new organisational arrangements that support quality, productivity and efficiency improvements in the delivery of acute and specialist services. The Royal Marsden’s original submission was based on the extension of The Royal Marsden’s@ model currently in operation at Kingston, but we have now been invited to review the scale and nature of our proposal as we wish to ensure it is financially viable and capable of being delivered quickly, with a model that could potentially be used nationally.
It is also important to note that the Chief Executive of NHS England has recently talked about changes in funding cancer services to ensure sustainability. This appears to be a move away from a payment by results tariff which does not support a more integrated and “whole systems” approach to service delivery, to funding via population based payments through networks and lead providers.
Governors will be kept informed of progress.
2.2 Chelsea Estate
The Royal Brompton and The Royal Marsden are continuing to work with NHS England (London) on the development of a Strategic Outline Case for a shared vision of the estate in Chelsea. The aim of this is to address the Royal Brompton’s need for modernisation and The Royal Marsden’s need for additional co-located capacity and to assess whether there is likely to be sufficient value to apply for Treasury funding for this scheme. The Strategic Outline Case will be available at the end of July. Constructive discussion is continuing between the senior management and clinical teams at both Trusts.
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2.3 Sutton Estate
Planning is underway on the development of the Maggie’s Centre on the Sutton site, which is expected to be built and operational, subject to planning permission being granted towards the end of 2016.
The Royal Marsden Board approved the proposal to build a Maggie’s Centre on the Sutton site November 2014. The £6m scheme will be funded by Maggie’s with a contribution from the Royal Marsden Cancer Charity of up to £500k for enabling works.
The architectural design is integral to the philosophy of the Maggie’s Centre, with the design based on the needs of a person living with cancer. Maggie’s seek to create unique environments which have a direct and positive impact on people’s wellbeing. Core to this vision is a place that is friendly and informal but with a clear professional structure of help which includes accessible information, a programme of relaxation therapies through which patients can help themselves, and emotional support for patients and their families.
The new facility will also provide a very significant enhancement to the Sutton site as Maggie’s Centres are architecturally exceptional with excellent landscaping and a new entrance to the Sutton site will be created from Chiltern Road.
Award winning architect, Ab Rogers has designed the new Maggie’s Centre ‘from the inside out’, and this will include internal courtyard gardens providing both communal and private spaces. The scheme also features landscaping by Piet Oudolf, the designer behind the landscaping of Peter Zumthor’s 2011 Serpentine Pavilion.
Also at Sutton, The Royal Marsden is continuing to support the ICR and Sutton Council on the development of the Sutton for Life initiative to create a thriving biotech and academic centre on the adjoining Sutton Hospital estate.
3. Performance
3.1 Service Quality
The Trust met all Monitor’s indicators and targets for Quarter 4, and all cancer waiting time targets with the exception of the 62 day wait from GP referral to treatment before reallocation of breaches to partner Trusts for late referrals to The Royal Marsden. Following reallocation, the Trust met the standard of 85% of patients receiving treatment with 62 days. The patient pathway is being reviewed to ensure that we can work with our neighbouring Trusts to improve performance and speed up access to treatment for all patients. A presentation on the way in which the Trust monitors its performance across a range of indicators will be given to Governors at the Council meeting. Further information will also be given on the results of the CQC Inpatient Survey and Staff Survey.
5
3.2 Financial Performance
The Financial Plan for 2015/16 is on the Council’s agenda. There are a few points worth drawing out in my Report. The uncertainty and risk over the cancer tariff continues, and until this is addressed through structural change for specialised services funding and delivery of care or through tariff adjustment, the Trust cannot consider that it has long term financial sustainability. The Board has decided that it will therefore adjust the plan from a Continuity of Services Risk Rating of 4 to a risk rating of 3 for the first time, and will only sign off a declaration to Monitor for a 1 year period (as opposed to 3 or 5 year period). The NHS contract discussions have now been concluded satisfactorily, and the Trust was finally awarded Project Diamond funding for 2014/15 shortly before the accounts were submitted to Monitor in May. This will not be offered to any Trusts in 2015/16 or beyond and should be regarded as the final allocation for service complexity for London Trusts with specialist service and research portfolios. Overall income has increased by £10.1m, expenditure by £9.7m resulting in a £0.4m increase in the development reserve for investment. It is vital that the Trust’s efficiency programme is delivered in full this year as there is no further flexibility in allowing us to meet our plan this year. In addition, a Transformation Board has been set up to develop and implement a defined number of major efficiency initiatives longer term including the transformation of inpatient and outpatient services, optimisation of medicines, and improved performance on temporary staffing and medical staffing both of which caused major overspends and impact on service to patients last year. Finally, I would like to thank the CFO and senior management and clinical teams for the exceptional contribution they made to the end of year position for 2014/15, and the resolution of contracts and preparation for the year ahead. The financial environment is extremely difficult and the focus, positive approach and delivery of results by clinicians and managers are essential to our ability to provide patients with excellent care and to continue to invest in the environment for both patients and staff.
Cally Palmer 2 June 2015
COUNCIL OF GOVERNOR PAPER
SUMMARY SHEET
Date of Meeting: 10th June 2015
Agenda item 6.
Title of Document: Biomedical Research Centre Annual Report
To be presented by
Chief Operating Officer
Background The Royal Marsden and Institute of Cancer Research NIHR Biomedical Research Centre was first established in 2007 and Centre funding was renewed in 2012 for a five year period. Clinical leadership is provided by Professor David Cunningham as joint RM and ICR Director of Clinical Research, with support from Dr Naureen Starling as Associate Director. The RM/ICR BRC receives a total of £61,544,000 over five years from the NIHR and this funding is awarded to support translational research based in the NHS. The current portfolio includes phase I and II trials, blood/tissue collections, blood/tissue analysis, biomarker identification (including imaging biomarkers), diagnostic/prognostic/predictive test development and translational bolt on studies to phase III trials. Executive Summary The combination of medically-qualified, research and hospital management leaders have been instrumental in making a number of successful changes to the BRC. These include the further development of BRC research training and Patient Involvement strategies; progress in Athena Swan, led by Professor Paul Workman; increased levels of performance management and the expansion of a range of core BRC services. There is an established ICR and RM joint Cancer Centre Research Strategy Board and included in this Board’s remit is oversight of the BRC research strategy. The 2014/15 BRC Annual Report highlights these changes in more detail and provides an overview of key BRC metrics. Most notable are:
• The large number of active studies and the increase in early phase studies • The ICR achieving first place in the Research Excellence Framework • The development of the RM CTU to compliment the work of the ICR CTSU • The expertise and activity within the joint RM/ICR Centre for Molecular Pathology • West Wing Clinical Research Centre has treated more than 300 patients across 38
trials since opening in March 2014 • Doubling the number of samples in the RM Biobank
The main challenge for the BRC will be assessing the impact in healthcare provision and how the joint research of The RM/ICR is translated into clinical practice for the benefit of RM patients and beyond.
Recommendations The Council of Governors is invited to comment on the summary of the annual BRC report. Author: ICR and RM BRC theme leads; Director of Clinical Research and BRC Director
Contact Number or E-mail: 8127
Date: 26th May 2015
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Biomedical Research Centre – Annual Report Summary
1.0 Background
The Royal Marsden and Institute of Cancer Research NIHR Biomedical Research Centre (BRC) was first established in 2007 and Centre funding was renewed in 2012 for a five year period. Clinical leadership is provided by Professor David Cunningham as joint RM and ICR Director of Clinical Research, with support from Dr Naureen Starling as Associate Director. The RM/ICR BRC receives a total of £61,544,000 over five years from the NIHR and this funding is awarded to support translational research based in the NHS. The current portfolio includes phase I and II trials, blood/tissue collections, blood/tissue analysis, biomarker identification (including imaging biomarkers), diagnostic/prognostic/predictive test development and translational bolt on studies to phase III trials.
2.0 Overview of activities
2.1 Short term
496 studies were active in the BRC portfolio during 2014-15; the majority were interventional (353) and the number of phase 1 studies rose from 108 in 2013-14 to 117 in 2014-15. Research to identify predictive and prognostic biomarkers (genetic, molecular and imaging) from tissue collected through interventional trials forms an increasing component of the portfolio (101 studies which is an increase from 67 in 2013-14). This means that within our BRC we are identifying new predictors of response and using these to conduct trials of targeted therapy. With the support of the BRC funded Clinical Trials Unit (RM CTU) we are using trial designs that allow acceleration of new drugs into the clinical setting.
2.2 Medium term
We have continued to develop expertise and capacity within our Centre for Molecular Pathology (CMP). Our success in the CRUK Stratified Medicine Programme (SMP) resulted in our selection as key centre for the next phase SMP 2, and we are one of a small number of Centres piloting the analytical approaches to the UK’s 100k Genome Project. We are leading the cancer component of the West London GMC within the 100k Genome Project. This segues with one of our BRC’s strategic developments to personalise treatment through the routine collection of blood and tumour for molecular profiling that is underway or in development across our tumour units. We continue to work strategically with industry to secure access to targeted therapies. This is aided significantly by our high performance against the NIHR 70 day target and the launch of our Industry Pack –“Guidance for the set-up of Hosted Clinical Trials”. We noted in the 2013/14 overarching report of BRCs that Cancer accounts for the largest number and range of Industry interactions in the UK (largely drug trials). Performance against the 70-day metric improved from 90% in 2013/14 Q3 to 95% by 2014/15 Q3.Performance against the delivery metric improved from 44% in 2013/14 Q3 to 57% by 2014/15 Q3. We have continued to invest in our facilities and opened the West Wing Clinical Research Centre (WWCRC) in March 2014. WWCRC has provided treatment for over 300 patients in 2014/15 across a portfolio of 38 trials
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2.3 Long term
We have made significant progress in increasing our research activity in the areas of surgery, rehabilitation, and health service research (HSR) to enable personalisation in the broader aspects of cancer treatment and care. This year our BioBank has gone from strength to strength, doubling the number of samples held during the year from 5,000 to over 10,000 samples (FFPE, blood and fresh frozen tissue). 1,235 patients were recruited in the year. The BioBank received ethical approval this year, providing our researchers with a resource for both basic and translational studies, vital for precision medicine, and accelerating progression through the research pathway, allowing rapid set up of new research that utilises BioBank tissue.
3.0 Progress with leadership, governance and management RM/ICR Cancer Centre Research Strategy Board – the BRC Strategy was reviewed by an International External Review Panel in September 2014 who provided constructive feedback on the achievements and strategic direction of the BRC. RM/ICR Clinical Research Governance Board, – Prof Paul Workman was appointed CEO of ICR in 2014 and co-chairs the Board with RM CEO Cally Palmer. Key areas of business within its first year included oversight of work relating to Athena Swann and oversight of aspects of joint working between RM and ICR. The Research Excellence Framework (REF) results were announced in December 2014. The ICR came first overall in the Times Higher Education league table of university research quality compiled from REF 2014. The ICR was the leading higher education institution in the UK for the impact of its research on society. The ICR was also judged to have the highest concentration of top-quality research in the UK, and ranked first for both biological sciences and clinical medicine. It is the second successive time that the ICR has led the UK for the quality of its academic research, after also finishing first in the 2008 Research Assessment Exercise. These results include submissions from double the number of research active NHS staff than in 2008 and are an endorsement of the unique partnership between ICR and RM, enabling us to carry out translational and clinical research and to systematically turn our discoveries into improved outcomes for patients. The BRC Steering Committee – has continued to meet and award BRC funding to high quality studies of strategic importance and to review the BRC’s progress against strategy including PPI and Training. Of the BRC’s 7 NIHR Senior Investigators, 4 are Theme Leads and steering committee members. The Clinical Research Executive – has continued to ensure delivery of the BRC strategy and in particular engages with the ECMC and Imaging Clinical Research Facility. As proposed in last year’s return, during 2014/15 we implemented quarterly Financial and Performance Reviews with our research teams to ensure active oversight of BRC spend. The resource within RM CTU has expanded to accommodate its increasing research portfolio. This has included recent establishment of an RM CTU Strategy Board, comprising senior clinical academics. We have appointed the following posts in 2014-15:
• BRC Training Manager with responsibility for the delivery of our training strategy • BRC PPI Manager with similar responsibility for our PPI strategy. • 3 clinician scientists to the BRC
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Significant developments in implementing the strategy We were successful in winning £10.1m of MRC support from the Clinical Research Capabilities and Technologies Initiative to support the establishment of an MR Linac. We will lead the clinical development teams across the Elekta MR Linac consortium for prostate, breast and cervix and we are also developing significant new research activity in pelvic, thoracic and paediatric malignancies. The ICR has completed the building of the £20m Centre for Cancer Imaging, which will provide state-of-the art facilities for pre-clinical imaging research which we will translate for patient benefit in the BRC. To further strengthen our imaging research we have recruited a Professor of Nuclear Medicine, Prof Wim Oyen, an international expert in this field. 4.0 BRC’s achievements during the 2014/15 financial year 1. We established the antitumour activity of the PARP inhibitor olaparib in metastatic castrate resistant prostate cancer (CRPC), demonstrating a 30% response rate in patients with mutations in DNA repair genes. This indicates the potential benefit of using genomic testing to guide the delivery of precise treatments for advanced prostate cancer. 2. We are accelerating the incorporation of assays of circulating tumour DNA (ctDNA) to routine clinical use in the NHS. As ultrasensitive biomarkers, ctDNA enable the monitoring of residual disease after therapy via “liquid biopsies”. We continue to build on the pioneering work of the Breast Theme in utilising ctDNA to predict early relapse following treatment for primary breast cancer (presented internationally, 2014) and are also, leading an international trial using ctDNA to direct treatment in metastatic breast cancer. We have shown for the first time that screening liquid biopsies in metastatic colorectal cancer may be more accurate than using archival material for predicting response to anti-EGFR therapies. 3. We have significantly advanced our programme of clinical immunotherapy studies across all solid tumours in collaboration with industry. We were lead author on the Checkmate 037 study that led to FDA approval for the anti-PD1 checkpoint inhibitor nivolumab in advanced melanoma. We are advising NICE on its review of nivolumab in lung cancer, and have opened the first randomised trial globally to investigate immunotherapy as a novel maintenance therapy in oesophago-gastric cancer. Good progress has been made in the following 8 themes (detail can be provided in the full BRC annual report):
- Cancer Genetics - Molecular pathology - Cancer therapeutics - Clinical studies - Breast cancer - Cancer imaging - Radiotherapy - Prostate cancer
5.0 Patient and public involvement and engagement Over the past year we have increased our commitment to patient and public involvement (PPI) and have undertaken several initiatives to increase how PPI is embedded in the work of the BRC and beyond. Principles of PPI are ensured through plans that include: rolling out a PPI training programme for trainees and investigators, and developing existing training for trial co-ordinators. We became involved in developing an NIHR PPI online training package and shaping PPI for NIHR trainees. Two BRC researchers have been involved in this, as has the BRC patient representative.
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We have launched the overarching PPI strategy, having consulted widely to develop this, including significant patient involvement in the BRC PPI working group and the RM Patient and Carer Research Review Panel. The strategy is published on the BRC website, launched this year with a significant PPI section to complement the RM Trust’s website PPI section. Our BRC patient representatives are Steering Committee members on the NIHR BRC/U PPI workstream and have pushed forward the issue of how the public are engaged in this work; our BRC will host the next event. Having published work on PPI together in 2014, our patient representative and PPI Lead presented at INVOLVE on PPI work at our BRC. Another patient member and the PPI lead have also continued to input on developing Health Research Agency PPI workstream, as members of the working group. The RM Patient and Carer Research Review Panel has seen its activity increase over the past year, with quarterly meetings and over 70 studies reviewed, and training taking place (shaped according to patient, public and carer demand). We have seen a broadening of senior investigator involvement in patient public involvement and the panel’s work, with widespread clinician engagement. A priority-setting patient survey, the PACER study, has been initiated by the Clinical Studies Theme. In addition we crowd-source research ideas through our BRC website. We have appointed another remunerated BRC patient representative who contributes to the decisions made about how the BRC funding is allocated, alongside the previously appointed BRC patient representative, and another PPI advisor, also remunerated as per INVOVLE guidance. We encourage researchers to seek PPI funding for PPI activities. Recognising this expansion of PPI, we have also employed a PPI Manager to operationalise some of our future plans, and to assess progress of our strategy. Clinicians are increasingly approaching PPI at the earliest conceptual and design stages. Metrics collected in relation to impact of PPI have been expanded, for all the 70 studies reviewed via the panel and all the BRC studies, and we can now see how each study has been changed as a result of ongoing PPI, and studies are followed through to completion. These metrics are reported on to the BRC steering committee meetings and the director bi-annually. The PPI lead is also delivering PPI training to all the Theme and Research leads to ensure PPI remains central to each BRC Theme. We strive to increase visibility of research, signposting patients to research, particularly through the BRC website, the BRC magazine Advance, RM Magazine articles, clinical units’ newsletters, posters for patients and families around the hospital and web portals.
6.0 Training In 2014-2015 a number of successful local and national training events were run by the RM/ICR BRC. The Imaging Theme ran the 2nd BRC National Oncological Imaging Course (Royal Marsden, Nov 2014). The event was successful and was again over-subscribed with a multi-disciplinary audience. Within Clinical Studies the GI team held 2 BRC training events; The 2nd Colorectal Forum (Royal College of Physicians, April 2014) and a National Pancreatic Cancer Study Day (Royal Marsden, November 2014). Both of these national events focussed on personalised medicine were fully attended with a cross section of doctors, nurses and allied health professionals and with highly topical agendas pertinent to the work of our BRC spanning innovative therapies/drug development, circulating biomarkers, the genomic revolution/genetic stratification, imaging and toxicity considerations/patient experience. For clinician and non-clinical trainees (i.e. scientists conducting translational research and our AHP physicist group) , the collaborative RM/ICR and Imperial career development event “Postdoc to PI” (Imperial, 12th February 2015) comprised formal presentations followed by networking (including “speed networking”) with funders (BBSRC, EPSRC and the Wellcome Trust), new clinician scientists and senior scientists/PIs. The event also served to cultivate mentorship opportunities where attendees had indicated an interest in mentorship across the two BRCs.
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We have designed/delivered several innovative BRC courses for ongoing embedding of our research culture, increase in research awareness across all our BRC research/support groups thus increasing the visibility/accessibility of clinical research across both our NHS and University arms. The highly successful 4 part April 2015 BRC seminar series “De-mystifying the Science Behind Targeted Cancer Treatments” was well attended by a diverse range of research support groups. This included service managers, engagement with whom is recognised as critical for adoption and diffusion of research findings. A unique RM/ICR BRC Education and Training Strategy has been written and encompasses all BRC related researchers and support staff and supports the vision to develop/retain world-class researchers and further embed research and a flourishing research culture within the NHS. Consultation over the strategy has taken place over the last year with all relevant parties and was approved through the ICR’s Academic Board in March 2015. The strategy which sits under the BRC’s overall strategy, links and complements other strategy documents including the BRC’s PPI Strategy, the RM Health Services Research (HSR) Strategy, the overall RM Education Strategy, the Royal Marsden School (nursing) curriculum and the ICR’s Education and Training Strategy. This ensures that BRC research training is uniquely identified and referenced as such. We have identified that we will need to provide training in various aspects of Molecular Pathology and outreach work to local histopathologists, biomedical scientists, bioinformaticians and clinicians to support NHS transformation in Genomic Medicine. Our BRC biomedical scientists in pathology/molecular pathology have been highlighted as a group of healthcare associated scientists for whom there are new training needs and opportunities to support our growth. BRC Training and Education Manager has been appointed to support the training lead in delivering the Strategy and implementing the operational plan. Due to start in June 2015, the training manager will work across the ICR and RM workforce development groups, and with our HSR Lead (ProfWiseman) and our PPI manager and will report to the BRC Steering committee. This will further consolidate the high quality training programmes delivered to all staff groups in our BRC and will provide another level of oversight, quality assurance and project management and will develop the RM/ICR BRC Virtual Training Hub on the BRC website. Total direct expenditure on Training: £502,730. Additionally RM spent £2.9m on training and supporting staff within the Trust, across research and service.
7.0 Links with industry Working in partnership with industry has remained a key focus, with regular face-to-face interactions atnational and international meetings, resulting in the generation of key clinical trials. We believe that liaising personally with sponsors is key to improving trial set-up. We have hosted visits from Bristol Myers Squibb, Quintiles and Roche in 2014/15 to review issues with set-up of studies. This year we produced and launched our Industry Pack – Guidance for the set-up of Hosted Clinical Trials, to facilitate the faster set-up of studies with our industry partners. We continue to do well with research delivery times and accrual targets; we know that if efficiency and speed can be optimised that the UK can compete on a global scale. We have continued to strengthen and develop strategic partnerships with key commercial pharmaceutical organisations, positioning our Drug Development Unit as the site of choice for a large phase I portfolio of novel translational studies. 8.0 Links with other NIHR infrastructure The RM continues to take an active role in the leadership of the South London Clinical Research Network (SLCRN). Prof Stan Kaye (BRC Fellow) and Dr Sanjay Popat (Research
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Lead, RM Lung Cancer Unit) lead Division 1 (Cancer) of the SL CRN. Jane Lawrence, Assistant Director of Clinical Research is member of the Management Executive Committee of the SL CRN, and The RM continues to host all Division 1 (Cancer) staff working flexibly in South West London. Within the RM, Network and BRC staff work together in tumour based clinical research teams to deliver seamless transition from the BRC into Network portfolio studies. RM patients account for >50% of the SL CRN’s total recruitment to cancer trials with in excess of 2,500 patients recruited in 14/15 across 181 non-commercial studies. RM/ICR investigators undertake the Chief Investigator role in ~ 50% of these studies many of which are the result of work that has originated within the BRC and rolled out into larger scale Network studies. T he Network is also becoming increasingly important in enabling the delivery of BRC studies of targeted therapies at external sites, where multi-centre working is necessary to recruit patients whose tumours display specific molecular profiles. We are active in advising the SL CRN on the challenges of research involving personalised medicine strategies and the role of the Network in supporting these. We are collaborating with other BRCs for example Imperial and Experimental Cancer Medicine Centres (ECMCs) including Cambridge, Guys Hospital, Manchester, Oxford, Cardiff and Newcastle. The LCA (Director of Research: Prof Stan Kaye) as the integrated cancer system across south and west London is clinically-led and working collaboratively across 15 NHS provider organisations and two academic health science centres. Across the LCA, there are 3 BRC, 3 ECMC and two Local Clinical Research Networks.
9.0 Impact on healthcare provision As the leading global recruiting centre for the Checkmate 037 study we have been instrumental in the FDA approval of the anti-PD1 checkpoint inhibitor nivolumab. We have continued to implement the oncogenetic care pathway, making gene testing available for all individuals with a 5% risk of having a gene mutation in BRCA1 and/or BRCA2. This has resulted in significantly more patients undergoing genetic testing at RM (45 in Q1 2013, 230 in Q1 2015). Our model of mainstreaming genetic testing is now being adopted up by other clinical units across the UK and also being used as a model for a study coordinated by AstraZeneca to implement the oncogenetic model in sites across the US and Europe.
COUNCIL OF GOVERNORS PAPER
SUMMARY SHEET
Date of Meeting: 10th June 2015
Agenda item 7.1.
Title of Document: Quality and Performance: Annual Quality Account
To be presented by
David Pontin, Deliotte LLP
Background For the last five years NHS Trusts have been required by the Department of Health (DH) and Regulators to produce an Annual Quality Account (QA). Each year the DH and Monitor, the regulatory body for Foundation Trusts, issues specific guidance as to content. Executive Summary Further to the draft Quality Account discussed at the Council meeting in March, the final Quality Account is attached. Recommendations The Council is asked to note the Annual Quality Accounts. Author: Shelley Dolan, Chief Nurse
Contact Number or E-mail: x2121
Date: 26th May 2015
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Quality Account 2014/15 Contents Part 1 What is a Quality Account? Statement on Quality from the Chief Executive Part 2 Performance against priorities for Quality improvement 2014/15 Statements of assurance from the Board Priority 1- Reduction in Healthcare Associated Infections (MRSA bacteraemia and Clostridium difficile infections): applies to Hospital and Community Services Priority 2- Reduction in the rate of incidents resulting in severe harm or death: applies to Hospital and Community Services Priority 3- Percentage of admitted patients risk assessed for venous thromboembolism: applies to Hospital Priority 4- Avoidance of emergency re-admissions to hospital within 28 days of discharge: applies to Hospital Priority 5- Reduction in attributable community acquired category 3 and 4 pressure ulcers: applies to Community Services Priority 6- Increase the numbers of patients who have a Holistic Needs Assessment Priority 7a- Ensuring that we are responding to inpatients’ personal needs: applies to Hospital Priority 7b- Introduce the Friends and family test question for community services clients: applies to Community Services Priority 8- Percentage of staff who would recommend The Royal Marsden to friends or family needing care: applies to Hospital and Community Services Priority 9- Reduction in chemotherapy waiting times and improvement in patient experience related to waiting times: applies to Hospital Priority 10- Improve communication, particularly when patients arrive for first appointments Priority 11- Reduce the length of time a patient waits for medicines or equipment at the point of discharge: applies to Hospital Priority 12- To improve health outcomes for children in Reception year: applies to Community Services Part 3 Outline of Quality Improvements in 2014/15 The new quality priorities for 2015/16 The quality objectives and priorities of the Trust for the last six years Statements of assurance from the Board Part 4 Review of quality performance previous years performance Appendices Appendix 1: Quality indicators where national data is available from the Health and Social Care Information Centre Appendix 2: Trust values Appendix 3: Statements from key stakeholders Appendix 4: Statement of Director’s responsibilities in respect of the Quality Account Appendix 5: Independent Auditor’s Assurance Report
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What is a Quality Account? All NHS hospitals or trusts have to publish their annual financial accounts. Since 2009, as part of the drive across the NHS to be open and honest about the quality of services provided to the public, all NHS hospitals have had to publish a quality account. You can also find information on the quality of services across NHS organisations by viewing the quality accounts on the NHS Choices website at www.nhs.uk. The purpose of this quality account is to: • summarise our performance and improvements against the quality priorities and
objectives we set ourselves for 2014/2015; and • set out our quality priorities and objectives for 2015/2016.
To begin with, we have given details of how we performed in 2014/2015 against the quality priorities and objectives we set ourselves under the categories of: • safe care; • effective care; and • patient experience. Where we have not met the priorities and objectives we set ourselves, we have explained why, and set out the plans we have to make sure improvements are made in the future. Secondly, we have set out our quality priorities and objectives for 2015/2016 under the same categories. We have explained how we decided upon the priorities and objectives, and how we will achieve these and measure our performance. Quality accounts are useful for our board, who are responsible for the quality of our services, and they can use it in their role of assessing and leading the trust. We encourage frontline staff to use quality accounts to compare their performance with other trusts and to help improve their service. For patients, carers and the public, this quality account should be easy to read and understand, and highlight important areas of safety and effective care provided in a caring and compassionate way. It should also show how we are concentrating on any improvements we can make to care or experience. It is important to remember that some parts of this quality account are compulsory. They are about important areas, and are generally presented as numbers in a table. If there are any areas of the quality account that are difficult to read or understand, or you have any questions, contact us through the Patient Advice and Liaison Service (PALS) by phoning 0800 783 7176, or visit our website at www.royalmarsden.nhs.uk. This quality account is divided into the four sections.
Quality Information
Look Back
Set out priorities Quality Improvement 15/16 Look Forward
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Part 1 Introduction to The Royal Marsden NHS Foundation Trust and a statement on quality from the Chief Executive (CE)
Part 2 Performance against 2014/2015 quality priorities for improving quality and
statements of assurance Part 3 Outline of improvements made in 2014/2015 Part 4 Review of quality performance
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Part one Introduction to The Royal Marsden NHS Foundation Trust and a statement on quality from the Chief Executive
The quality of care patients and their families receive, and their experiences, are central to all that we do. The Royal Marsden is the largest cancer centre in Europe and, with the Institute of Cancer Research, is responsible for the largest cancer research programme in the UK. This year has been another outstanding year for us as we have continued to achieve high ratings from our two major regulators – Monitor and the Care Quality Commission. Our commitment to meeting the challenges of continuing to provide quality care and experience within a cost-effective framework underpins the following four corporate objectives for 2014/2015.
1. ‘Improve patient safety and clinical effectiveness’ 2. ‘Improve patient experience’ 3. ‘Deliver excellence in teaching and research’ 4. ‘Ensure financial and environmental sustainability’
Our commitment to improving quality is demonstrated by the following achievements in the year from 1 April 2014 to 31 March 2015. • Customer Service Excellence Standard We are proud to have been the first hospital in 2008 to be awarded the Customer Service Excellence Standard in recognition of public services that are ‘efficient, effective, excellent, equitable and empowering – with the citizen always and everywhere at the heart of public services provision’. We are assessed regularly and in January 2015 we kept the award for the seventh year. • Looking after our staff In February 2015, Schwartz Rounds were introduced. Schwartz Rounds are meetings that allow staff across every area of the hospital to get together and reflect on the stresses and dilemmas that they have faced while caring for patients. Schwartz Rounds were originally developed in Boston and about 100 NHS Trusts in the UK now run them. Research has shown that those who attend Schwartz Rounds feel they communicate better with their patients and colleagues, feel less isolated, feel more supported, cope better with the emotional pressures of their work, and get a better understanding of how colleagues think.
• Research Excellence
The Research Excellence Framework is a new system for assessing the quality of research in UK higher-education institutions. In December 2014, the results of the Research Excellence Framework were announced and the Institute of Cancer Research held its top ranking in the table of excellence. As part of the assessment, 18 of our clinical academics provided their research. This is a very high number for any single hospital. In 2014/15 we were delighted to appoint our first Professor of Cancer Nursing. Dr Theresa Wiseman was awarded the Chair from Southampton University and is a renowned expert in health-service research, particularly in patient experience. • Sign up to Safety
We joined the national Sign up to Safety campaign to reduce avoidable harm and make hospital care safer. We have chosen three areas to focus on and are joining colleagues across England to pilot safer practices and care, and more effective communication. As part of The
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Royal Marsden’s campaign, we have produced a safety video to help patients improve their own safety in hospital.
• Gathering feedback of patient experience in the community
The successful integration with Sutton and Merton Community Services continues and we have introduced a new customer-feedback system for patients. This new system gives us access to feedback as it is given, and helps services to be more focused in their plans for improving quality. • Strengthening our values We have promoted a set of 16 distinct values (see appendix 1) that help make sure that our patients receive the best possible treatment and care. Each month, examples of how a particular value has been demonstrated by a range of staff are shared. Frontline staff have also agreed a set of 10 ‘always events’ – behaviours that we will always aim to get right for every patient. These range from always introducing ourselves to always having the medicines patients need to take home prescribed early so that they do not have to wait. • The Royal Marsden School The Royal Marsden School is the UK's only dedicated-provider of cancer education. The school continues to be a vital part of the organisation by providing high-quality education in cancer care, leadership, and ongoing professional development and training. For the fourth year in a row, the school was awarded 100% in the assessment of its Quality and Contract Performance Management, confirming its position as London’s best-performing provider of continuing personal and professional development for nurses and allied health professionals (health care professionals outside nursing, medicine and pharmacy). This is the sixth year that we have published a quality account and we are grateful for the feedback we received on last year’s from patients, carers and the public through Healthwatch, the Health and Wellbeing Boards and our commissioners and governors. We are also very proud of the excellent hard work that our staff do every day, and their commitment to safety and quality. We have aimed to demonstrate this in this quality account and allow our staff to personally express the importance of this by including personal quotes. I would like to thank all patients, carers, staff, Healthwatch, Health and Wellbeing Boards, governors and commissioners who have contributed to this quality account. On behalf of the Board of The Royal Marsden NHS Foundation Trust I can confirm that, as far as I know and believe, the information in this quality account is accurate and fairly represents the range of services we provide.
Cally Palmer CBE Chief Executive May 2015
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Part two Performance against priorities for quality improvement 2014/15 and statements of assurance Introduction The quality priorities and targets for 2014/15 are shown in the table below. The priorities and target in blue were mandatory in 2014/15 (that is, we had to include them) and the priorities in red are the priorities and targets we set ourselves. Priorities in black have not changed. Table 1: Quality priorities and targets for 2014/15 Category Quality Priority Target Safe care 1 Reduction in Healthcare
Associated Infections (MRSA bacteraemia and Clostridium difficile infections). Applies to hospital inpatient beds at The Royal Marsden and patients of Sutton and Merton Community Services.
For there to be less than one case of MRSA infection per year. For there to be fewer than 16 cases of Clostridium difficile infection per 100,000 bed days. (A bed day is when a patient is in hospital overnight. It is measured in a large number to spot trends.)
Safe care 2 To reduce the rate of patient-safety incidents and percentage resulting in severe harm or death. (A patient-safety incident is an incident which could have or did lead to harm for a patient.) (In 2013/14 the rate of severe harm or death from incidents per 100 admissions was 0.008 for acute and 0.00 for community). Applies to hospital inpatient beds at The Royal Marsden and patients of Sutton and Merton Community Services.
Reduction in the rate of reported patient safety incidents per 100 admissions that have caused severe harm or death to below 0.01.
Safe care 3 To maintain the percentage of admitted patients assessed for the risk of venous thromboembolism (getting a blood clot in a vein).
For the percentage of patients who have been assessed to stay above 95%.
Effective care
4 To reduce the incidence of emergency readmissions to hospital within 28 days of patients being discharged.
For the number of avoidable readmissions to be below 0.3%.
Effective care
5 To reduce the incidence of category-3 pressure sores (full-thickness skin loss) and category-4 pressure sores (full-thickness tissue loss) developing in patients while they are receiving community care. Applies to Sutton and Merton Community Services.
For the percentage of category-3 and category-4 pressure sores arising in patients receiving community care to be less than 0.2%. For 90% of category-3 and category-4 pressure sores, both already existing and developing while receiving community care, to have healed or improved to category
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1 or category 2 within three months.
Effective care
6 To increase the number of patients who have a holistic needs assessment (an assessment that considers all aspects of a person’s needs, such as emotional, social and cultural needs, not just their medical needs).
For the proportion of appropriate patients offered a holistic needs assessment to have increased to 80% by the end of 2014/2015.
Patient experience
7 a To make sure that we are responding to inpatients’ personal needs.
b To introduce the ‘friends and family test’ question for patients receiving community care. (The friends and family test question asks people who use NHS services whether they would recommend the services to others.)
For us to still be in the top 20% of trusts for results in the friends and family test for hospital inpatients. For us to set a baseline for our friends and family test results and increase patient satisfaction, using an audit tool called the CARE measure, to over 80% for community services.
Patient experience
8 To increase the percentage of staff who would recommend The Royal Marsden to friends or family needing care.
For more than 87% of surveyed staff to say that they would recommend The Royal Marsden.
Patient experience
9 To reduce waiting times at chemotherapy appointments and improve patients’ experiences relating to waiting times.
For no more than 10% of patients to have to wait more than one hour.
Patient experience
10 To improve communication, particularly at first appointments.
For the percentage of positive comments on clinic appointments to be above 90%.
Patient experience
11 To reduce the length of time a patient waits for medicines when they are discharged.
For the number of patients who wait for more than two hours to be reduced by 10%.
Children’s services
12 To improve health outcomes for children in reception class, in line with the ‘Healthy Child programme 5-19 years’. (This programme sets out a framework for services for children and young people to promote good health and well-being.)
Where health needs have been identified, for the school nursing service to conduct a health assessment of 90% of children in reception class and, where appropriate, for a plan of care to be agreed with the parents or carers.
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Priority 1: To reduce the number of cases of health-care related infections (MRSA infection and clostridium difficile infection). Applies to patients at The Royal Marsden and patients of Sutton and Merton Community Services. Patients with cancer are more vulnerable to infection, and the longer the infection lasts, the more likely it is to cause serious complications. So reducing the incidence of health-care related infections is an essential safety and quality priority. This priority was first set in 2009/2010 and was still an important priority in 2014/2015. Target: For there to be less than one case of MRSA per year, and for there to be fewer than 16 cases of clostridium difficile infection per 100,000 bed days. Quote: “The infection prevention and control team work alongside our clinical colleagues to make sure that no patients, staff or visitors are harmed by preventable infection”. Pat Cattini Lead Nurse/Deputy Director Infection Prevention and Control What we did in 2014/2015 • The Infection Prevention and Control team improved the way they provide timely and
accurate information to staff to inform patient care across the organisation. • We provided a summary of key performance indicators to give feedback to staff on our
performance relating to preventing infection. • We looked at how we get important messages across so we are giving our staff clear
guidance. • We reviewed the risk-assessment form for new patients, which allows us to identify
patients who may be at risk of infection, and changed it to include assessments for several resistant bacteria.
• We introduced new auditing of the clinical departments alongside staff in the
housekeeping department. This will help us to make sure we have a clean safe environment.
How we performed in 2014/2015 • We maintained excellent hygiene standards and made sure the correct cleaning products
and standards were maintained to reduce the risk of clostridium difficile infection.
• The Infection Prevention and Control team prioritised the use of isolation rooms to reduce the risk of cross infection.
• The total number of clostridium difficile cases due to a lapse in care was three, improving
our performance against our target of 16. • There was one case of MRSA infection, meaning that we failed to meet our target.
Actions to improve our performance • Promptly isolating patients with suspicious loose stools or other symptoms, thorough
cleaning, effectively managing the use of antimicrobials and promoting thorough hand washing with soap and water.
• Keeping accurate records of prescriptions for antimicrobials, hand washing, device care
and cleaning audits. • Completing the infection-risk assessment. • Ensuring all new patients having a nose and groin swab for MRSA risk assessment within
24 hours of admission. • Patients seen for pre-operative assessment having a full MRSA screen in good time before
admission. • Introducing a system for patients to have an antiseptic wash and mouthwash before
surgery before surgery to help reduce their risk of developing a surgical site infection.
• Carrying out regular screening of patients known to be carrying MRSA. This includes weekly screening of critical care and inpatient haematology or oncology inpatients.
• Issuing an updated MRSA policy in March 2015. • Promoting ‘Catch it Bin it Kill it!’ for good cough and sneeze hygiene. How improvements will be measured and monitored Improvements will be monitored by the Infection Prevention and Control team at monthly meetings. This meeting is chaired by the Chief Nurse, who is the Director of Infection Prevention and Control for the Trust. Infections caused by MRSA and MSSA, vancomycin-resistant enterococci (VRE) and E.coli will be reported to Public Health England, as will all confirmed clostridium difficile infections. The numbers of certain infections will be reported to our board and published in the Integrated Governance Reports issued every three months.
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Priority 2: To reduce the rate of patient-safety incidents and the percentage resulting in severe harm or death. Applies to patients at The Royal Marsden and patients of Sutton and Merton Community Services. Target: For the rate of reported patient-safety incidents that have caused severe harm or death to be below 0.01 per 100 admissions. (In 2013/14 the rate of severe harm or death from incidents per 100 admissions was 0.008 for hospital and 0.00 for community.) Quote: “It is encouraging to see that the rate of reported patient safety incidents (severe harm or death) is far below the target of 0.01. We have robust systems in place to ensure that we learn from incidents reported in the Trust and this ongoing process continues to improve patient safety cross the organisation. Jessica Hargreaves Clinical Risk Advisor Risk Management. All NHS trusts in England to report all serious patient safety incidents to the Care Quality Commission as part of the Care Quality Commission registration process.
What we did in 2014/15
• In 2014 we introduced the ‘Nursing Metrics Dashboard’. This contains essential quality and safety information such as patient-safety incidents, infections, complaints, serious incidents, patient experience and the workforce’s performance. The dashboards allow teams to understand and review their data for their area and share their knowledge with colleagues.
• In February 2015 we developed a safety improvement plan as part of the ‘Sign up to Safety’ campaign. This is a national campaign aimed at reducing harm and saving 6,000 lives over three years. The plan highlights five safety priorities that we will focus on for reducing harm – sepsis (bacterial infection of a wound or tissue), medicines, blood clots, falls and pressure sores.
• We introduced the Open and Honest Care: Driving Improvement Programme. This programme is a central part of NHS England’s commitment to making more information about the quality of care in the NHS available. It aims to make sure that every patient receives high-quality care and to build improved services for the future. The programme forms part of the key actions of the Nursing Midwifery and Care Staff Strategy: Compassion in Practice.
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• We updated the ‘Being Open and Duty of Candour’ policy to incorporate the new requirement to follow the Duty of Candour. This is when a patient must be informed of any harm (moderate or more) that has been caused due to an incident.
If an incident is graded moderate harm or above, staff need to follow a specific process to meet the requirements of the duty of candour.
− The patient or their family (or carer) must be told that a patient-safety incident has or may have happened. This must be done within 10 working days of the incident being reported to local systems.
− The patient or their family (or carer) must be told in person (face-to-face where possible) and offered the notice in writing. The notice given must be recorded in the electronic patient record for audit purposes.
− A sincere apology must be given, both in person and in writing.
− A step-by-step explanation of what happened, in plain English and based on fact, must be offered as soon as is reasonably possible.
− Any reports on the investigation of the incident must be shared with the patient or their family within 10 working days of being signed off as complete.
− If the requirements of the contractual Duty of Candour are not met, the Clinical Commissioning Group can withhold the cost of care or, if the cost is not known, fine the trust £10,000.
How we performed in 2014/15 • We reported all recorded patient-safety incidents to the National Reporting and Learning
Service (NRLS). Before NRLS produced their six-monthly reports, we re-submitted all changes made as a result of investigations. (These changes may not be reported by the NRLS so the information we hold may not be the same as that reported by the NRLS.)
• The tables below separate out the information for the acute hospital sites of Chelsea and Sutton and for Sutton and Merton Community Services. Both tables show an increase in reported incidents. This is due to an increased awareness of incident reporting.
• Table 3 shows that the Chelsea and Sutton sites have made an improvement and reduced
the rate of reported incidents that caused severe harm or death from 0.010 in 2012/2013 to 0.008 in 2013/2014 and 0.008 in 2014/2015.
Table 1: Chelsea and Sutton patient safety incidents
Measure 2012/13 2013/14 Q1* Q2* Q3* Q4 2014/15 Inpatient and daycase admissions and regular day attendees
61366 64106 16406 16666 16779 16697
66551
Rate of reported patient safety incidents (severe harm or death), per 100 admissions
0.010 0.008 0.006 0.012 0.006 0
0.003
Number of patient safety incidents (severe harm or death)
Patient safety incidents (severe harm or death) as % of all patient safety incidents
0.28% 0.21% 0.17% 0.31% 0.14% 0%
0.07%
* retrospective data not updated between quarters
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Table 2 shows that there have been no patient safety incidents resulting in severe harm or death for the period 2014/15 in community services. Table 2: Sutton and Merton Community Services patient safety incidents
Measure 2012/13 2013/14 Q1* Q2* Q3* Q4 2014/15 Number of contacts (total number of face to face and non face appointments attended and ‘outcomed’)
532,119 541,387 129,091 123,750 127,282 133,584
513,707
Rate of reported patient safety incidents (severe harm or death), per number of contacts
0 0 0 0 0 0
0
Number of patient safety incidents (severe harm or death) 0 0 0 0 0 0
0
Total patient safety incidents 869 983 169 220 271 274 1034 Patient safety incidents (severe harm or death) as % of all patient safety incidents
0% 0% 0% 0% 0% 0%
0%
* retrospective data not updated between quarters Comparison with national figures (this will be updated in April 2015) The National Reporting and Learning Service report that for the period April-September 2013 the proportion of incidents resulting in severe harm or death remains less than 1% of all incidents reported. For the period April 2013 to March 2014, The Royal Marsden is well below this rate at 0.21% for the hospitals during 2013-14 and 0% for Community Services as displayed in the tables above.
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Priority 3: To maintain the percentage of admitted patients assessed for the risk of venous thromboembolism (getting a blood clot in a vein). Target: For the percentage of patients who have been assessed to stay above 95%. Quote: “The risk of a venous thromboembolism (VTE) is seven times as high among patients with cancer as among people without the disease. And nationally 20% of all diagnosed VTEs are in patients with cancer- there is clear imperative that we must raise patient and staff awareness in order to help minimise this risk.” Jen Watson, Clinical Nurse Director Venous thromboembolism (VTE) is a single term for both deep-vein thrombosis and pulmonary embolism. A deep-vein thrombosis is a blood clot that forms in a deep vein (usually in the leg). If a clot breaks off and travels to the arteries of the lung, it causes a pulmonary embolism, which can be life-threatening. VTE can be avoided by giving preventative treatment (prophylaxis) to patients at risk. Patients with cancer are at greater risk of developing VTE, so this continues to be a safety priority for us. The VTE Steering Board is now well established and VTE risk assessments are carried out for all appropriate patients. All planned inpatients are sent information leaflets before their appointment to tell them what they can do to help prevent clots forming, how to recognise the signs and symptoms of clots and what to do if they have any of these signs and symptoms. There are also posters and information leaflets throughout the hospital and available from Patient Advice and Liaison Service (PALS). The VTE risk assessment may be carried out using either the patient’s drug chart or by using the electronic clinical documentation system. What we did in 2014/2015 • The VTE Steering Board is now well established and VTE risk assessments are carried out
for all appropriate patients.
• We send all planned inpatients information leaflets before their appointments to tell them what they can do to help prevent clots from forming, how to recognise the signs and symptoms of clots and what do if they have any signs or symptoms.
• There are posters and patient information leaflets on VTE throughout the hospital and
available from Patient Advice and Liaison Service (PALS). More specifically, the VTE Steering Board has done the following. • Made sure that every confirmed diagnosis of VTE developing in hospital undergoes a
‘root cause analysis’ to find out the underlying cause of the VTE and if any other preventative action could be taken.
• Investigated each VTE diagnosed at the Royal Marsden to find out whether it should be defined as a ‘hospital acquired thrombosis’ and reported to the wards to raise awareness.
• Investigated each patient with a ‘hospital acquired thrombosis’ to ensure that all risk assessments and treatment has been prescribed.
• Made sure that detailed performance reports are sent out to appropriate staff daily and
appropriate prophylaxis prescriptions are monitored monthly. • Developed a specific patient information leaflet and poster which advises, among other
things, that patients should stop smoking, keep well hydrated and consider buying stockings if they notice a reduction in energy levels and reduced mobility when at home.
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• Updated the VTE patient information booklet ‘Blood clot prevention – A guide for patients and Carers’ in line with NICE guidance published in June 2012.
• Completed an audit of how many patients receive information (written and spoken) about VTE when they are admitted.
• Developed inpatient and outpatient VTE ‘pathways’. These make sure that patients receive the booklet ‘Blood clot prevention – A guide for patients and Carers’ and a letter for their GP to make sure they are told about the diagnosed VTE and the management plan. And we have also designed a specific handheld record for patients. This describes their treatment, and they are advised to show it to all healthcare professionals.
How we performed in 2014/2015 We have achieved the NHS Commissioning for Quality and Innovation (CQUIN) target of 95% success in making sure all of our patients are appropriately assessed for the risk of developing VTE. We have continued to monitor appropriate prescribing of preventative treatment. We have also achieved this at more than the 95% level of appropriate preventative treatment being prescribed to prevent VTE. Percentage of patients
who have had a risk assessment completed
Percentage of preventative treatment prescribed
2012/2013 96.5% 96% 2013/2014 96.75% 98.25% 1st quarter of 2014/2015 97.23% 94.8% 2nd quarter of 2014/2015 96.5% 95.4% 3rd quarter of 2014/2015 97.8% 96.5% 4th quarter of 2014/2015 97% 95% Total for 2014/2015 97.1% 95.4% Actions to improve our performance • Sending daily score cards to clinical leads who monitor the number of patients with VTE. • Launching of a safety film and booklet, including information on VTE, for all patients
admitted to the Royal Marsden. • Having all diagnosed clots reviewed by consultants who will check for recurring themes. • Attributing clots to inpatient wards where appropriate (HAT). Wards are told of these as
part of their monthly Nursing Metric Dashboard. • Holding a VTE Steering Group meeting every month. • Including a discussion and presentation on VTE in junior doctors’ inductions. • Developing specific patient information for patients in day care. • Checking whether patients are given VTE patient information, both in person and in
writing. • Continuing to monitor VTE pathways. • Improving understanding of the types of clots diagnosed within Royal Marsden, where
these are diagnosed and the signs and symptoms that were shown. (This information will be shared with the VTE Steering Group.)
• Developing an area specific to VTE on the intranet. This will hold the policy as well as various resources.
• Holding VTE ‘raising awareness’ study days. • Raising awareness of the national Harm Free Care strategy (which VTE is part of) during
nursing training and Harm Free Care roadshows. • Developing a VTE care plan. How improvement will be measured and monitored
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The VTE Steering Board will monitor VTE incidents, assessments and prevention procedures. Performance will also be monitored at the trust’s Key Performance/CQUIN Steering Board and through the monthly board scorecard. The scorecard is reviewed at each trust board meeting and among other items contains the number of patients with a VTE. We have reached our targets, but this will continue to be included as a priority for 2014/2015 as this remains an important indicator of our improvement in protecting patients from avoidable harm.
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Priority 4: To reduce the incidence of emergency readmissions to hospital within 28 days of patients being discharged. Target: For the number of avoidable readmissions to be below 0.3%. Quote: “It’s about ensuring all discharge planning and liaison with Community Services is of a very high standard. Clinical care and judgment is key in making sure patients are ready, fit and able for discharge’ Rebecca Martin Advanced Nurse Practitioner Urology Since 2012/2013, quality accounts should show the percentage of patients of all ages and sexes who were readmitted within 28 days of being discharged, and the national average. It is important to note that some readmissions will include patients who are admitted because of the side effects of treatment, so it may be difficult to explain any differences between us and other NHS trusts. How we performed in 2014/2015 Graph 1 shows the percentage of patients who were readmitted within 28 days from April 2012 to January 2015. Readmissions have stayed below 1% of all admissions since April 2012. Some emergency readmissions are an unavoidable consequence of the original treatment. However, some could be avoided by making sure that patients receive: • the best possible treatment according to their needs; and • careful planning and support for caring for themselves when they leave hospital. Graph 1: percentage of emergency readmissions within 28 days
Table 5: Number of patients who were readmitted within 28 days from 1 April 2014 to 31 March 2015.
Month Number of patients readmitted within 28 days April 2014 6 May 2014 12 June 2014 6 July 2014 16 August 2014 12 September 2014 13 October 2014 14 November 2014 6 December 2014 4 January 2015 5 February 2015 5 March 2015 0 Total 99
Actions to improve our performance • Continuously reviewing and evaluating medical care using the Enhanced Recovery
Programme (ERP). • Developing a liver surgery Enhanced Recovery Programme. • Developing closer links with community services. • Developing short-stay surgical procedures. • 10% of readmissions being reviewed and common themes explored.
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Priority 5: To reduce the incidence of category-3 and category-4 pressure sores developing in patients while they are receiving community care. Applies to Sutton and Merton Community Services. Targets: • For the percentage of category-3 and category-4 pressure sores
arising in patients receiving community care to less than 0.2%.
• For 90% of category-3 and category-4 pressure sores, both already existing and developing while receiving community care, to have healed or improved to category 1 or category 2 within three months.
Quote: “Community nursing does not come without its challenges; the care provided is on the basis of identified health needs. The teams adopt both a proactive and reactive approach to support, prevent and educate patients and their families regarding health care provision and delivery. At times it can be very technical, intensive and practical, often requiring innovative ways to manage identified risks. Community nursing is unpredictable and changeable; as community nurses we are responsive, adaptable and flexible. On a day to day basis we strive for excellence in the delivery of our care to patients. Therefore, we celebrate and develop the home as a safe and appropriate setting for health care now and in the future.” Angella Barrett. District Nurse- Senior Sister, Sutton and Merton Community Services This remains a challenging but important priority for community services and we have continued to focus upon the prevention and management of pressure ulcers for the benefit of patients. What we did in 2014/2015 • Community nursing staff worked to increase the number of patients who have a
pressure-sore risk assessment. How we performed in 2014/2015 • From 1 April 2014 to 31 March 2015 we met our first target of having less than 0.2% of
patients developing category-3 and category-4 pressure sores while under the care of community services. See table 6 over the page for more details.
• From 1 April 2014 to 31 March 2015, 49 patients developed category-3 and category-4
pressure sores while under the care of community services. • From 1 April 2014 to 31 December 2015, 94% of patients referred to community nursing
received a pressure-sore risk assessment at their first appointment. • From 1 April 2014 to 31 March 2015 100% of category-3 and category-4 pressure sores
improving to at least category 2 within three months of being diagnosed. See table 7 over the page for more details.
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Table 6: Number of category-3 and category-4 pressure sores developed while receiving care from community services. Number of
category-3 or category-4 pressure sores developing while under the care of Sutton and Merton Community Services
Percentage Total percentage over quarter
April 2014 Category 3 = 4 Category 4 = 0
0.14% Quarter 1 (1 April to 30 June): 0.18% May 2014 Category 3 = 5
Category 4 = 0 0.17%
June 2014 Category 3 = 7 Category 4 = 0
0.2%
July 2014 Category 3 = 3 Category 4 = 0
0.10% Quarter 2 (1 July to 30 September): 0.09% August 2014 Category 3 = 2
Category 4 = 1 0.09%
September 2014 Category 3 = 2 Category 4 = 0
0.06%
October 2014 Category 3 = 3 Category 4 = 0
0.10% Quarter 3 (1 October to 31 December): 0.12%
November 2014 Category 3 = 4 Category 4 = 0
0.14%
December 2014 Category 3 = 4 Category 4 = 0
0.13%
January 2015 Category 3 = 6 Category 4 = 0
0.2% Quarter 4 (1 January to 31 March): 0.15%
February 2015 Category 3 = 3 Category 4 = 0
0.1%
March 2015 Category 3 = 5 Category 4 = 0
0.15%
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Table 7: Number of category-3 and category-4 pressure sores that have healed or improved to category 1 or 2. Number of
category-3 or category-4 pressure sores still existing after three months
Number of category-3 and category-4 pressure sores that remained after three months and improved to at least category 2 in that time
Percentage Total percentage over quarter
April 2014 3 3 100% Quarter 1 (1 April to 30 June): 100%
May 2014 7 7 100% June 2014 3 3 100% July 2014 6 6 100% Quarter 2 (1 July
to 30 September): 100%
August 2014 6 6 100% September 2014 3 3 100% October 2014 3 3 100% Quarter 3
(1 October to 31 December): 100%
November 2014 5 5 100% December 2014 4 4 100%
January 2015 7 7 100% Quarter 4 (1 January to 31 March): 100%
February 2015 4 4 100% March 2015 4 4 100%
Actions to improve our performance • Community services continuing a large programme of work to adopt strategies for
preventing and managing pressure sores. How improvement will be measured and monitored All diagnoses of category-3 and category-4 pressure sores will be investigated and the findings presented at panels every two months in order to identify root causes and to learn from incidents to improve care for patients.
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Priority 6: To increase the number of patients who have a holistic needs assessment. Target: For the proportion of appropriate patients offered a holistic needs assessment to have increased to 80% by the end of 2014/2015. Quote: “‘ We know early interventions minimise long term troubling concerns we have worked hard in ensuring that all patients are offered a HNA- this isn’t always easy, but the benefits make this an essential component of care at the Royal Marsden”. Andreia Fernandes Clinical Nurse Specialist Gynaecology The National Cancer Survivorship Initiative (NCSI) has delivered a programme of work designed to improve patient outcomes and their experience of healthcare. A vital intervention identified as being the most important building block for achieving good outcomes is the ‘recovery package’ – a combination of assessment and care planning, treatment summary and cancer-care review, and patient education and support events (Health and Wellbeing clinics). A holistic needs assessment (HNA) is a process of gathering information from the patient or carer in order to lead discussion and develop a deeper understanding of what the patient knows, understands and needs. If the patient specifies any concerns or needs, a care plan which takes account of those needs is agreed. Holistic needs assessment is not a one-off exercise; it is the basis of assessing and planning care from diagnosis onwards. What we did in 2014/2015 • We introduced holistic needs assessments and care planning for patients with all types of
tumour at two points during the patient’s care and treatment from diagnosis onwards. • We were chosen as a prototype site for the Macmillan electronic Holistic Needs
Assessment (eHNA) project, to test the assessment and provide feedback to shape further development.
eHNA is currently used for breast and gynaecology patients at the start and end of treatment. Macmillan patient support workers lead the assessment with clinical nurse specialists providing support for care planning and reviewing. We have been successful in bidding to Macmillan for further support.
How we performed in 2014/2015
• We met the London Cancer Alliance metric (standard) of 25% of patients between 1 April
2014 and 30 September being offered a HNA, increasing to 50% from then onwards.
• The metric had stated that each person will be ‘offered’ a holistic needs assessment, and those accepting will have a care plan developed. The wording was altered slightly in the second quarter (1 July to 30 September) and now refers to the number of patients ‘receiving’ a HNA: • firstly within 31 days of diagnosis or care transferring to us; and
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• secondly, six weeks after the end of primary treatment, which varies for each type of tumour).
• Table 8 below shows the number of patients who were seen by a clinical nurse specialist
(CNS) and offered a holistic needs assessment. Table 8: number of patients offered a holistic needs assessment (HNA) 2014-15 Q1 Q2 Q3 Q4 Clinical nurse specialist’s own record of how many patients were offered a holistic needs assessment
687 588 366 No longer collected
Recorded on patient electronic record that a HNA had been offered to the patient
267 318 257
Actions to improve our performance • Offering practical support to all those having a holistic needs assessment. • Individual teams and clinical nurse specialists carrying out service evaluations to
demonstrate the strengths and weaknesses of their own areas, and developing action plans.
• Clinical nurse specialists exploring the best ways of following up from holistic needs assessments, such as phone and face-to-face clinics. Teams with support workers have been more successful.
How improvement will be measured and monitored A spreadsheet has been designed to help clinical nurse specialists collect information each month. This information is then sent to the Divisional Clinical Nurse Director (DCND), who sends it on to the London Cancer Alliance and The Royal Marsden Quality Account. We electronically capture HNA information provided by clinical nurse specialists and from November 2014 they stopped collecting the data in paper form.
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Priority 7a: To make sure that we are responding to inpatients’ personal needs. Target: For us to still be in the top 20% of trusts for results in the friends and family test for hospital inpatients. Quote: “The trust has continued to perform extremely well in the “Friends and Family Test”. In Quarter 4 we had 1800 respondents with over 97% either likely or extremely likely to recommend the trust. Richard Schorstein, Matron The ‘friends and family test’ was announced by the Prime Minister on 25 May 2012. Under this test, all NHS patients are asked whether they would recommend a particular A&E department or ward to their friends and family. The results of the test will be used to improve the experience of patients and highlight priority areas for action. The question asked is: “How likely are you to recommend our ward to friends and family if they need similar care or treatment?” The patients then choose their answer from the following.
We then ask a second question: ‘What was good about your care and what could be improved?’ Patients answer this question freely. Comments are reviewed by the matrons and ward staff and, where appropriate, action is taken. What we did in 2014/2015 • Since May 2009 we have been frequently gathering feedback, using hand-held devices,
from patients in our day units and outpatient areas. • Matrons developed action plans in response to common concerns. These are being used in
the inpatient areas. • We have a poster about the friends and family test, and a collection box for responses,
outside all wards. We ask all patients to fill in the friends and family test form and put it into a collection box. Once a week the forms are collected and an external company processes the feedback and gives us details.
• In March 2015 we further extended the survey to paediatric areas meaning that all patients now have the opportunity to feedback on our service.
• In addition to the FFT question we have introduced additional questions allowing patients to rate our services on 5 key areas of performance. These are dignity, involvement, information cleanliness, and staff.
How we performed in 2014/2015 Table 8 below shows our performance Table 8: Royal Marsden and national results for NHS inpatients. Average
national score of patients who recommend the ward
Our trust score
Number of responses we received
Average percentage of patients responding rate: Royal Marsden
Average percentage of patients responding: national
April 2014 73 93 185 35.1% 34.9% May 2014 74 93 219 35.9% 39.4% June 2014 74 95 229 42.9% 38% July 2014 74 95 249 43% 38.2% August 2014
74 95 281 52.8% 36.9%
September 2014
94% 94% 208 38.8% 36.6%
October 2014
94% 94% 137 24.4% 37.6%
November 2014
95% 100% 197 37.96% 37.1%
December 2014
94% 97% 91 16.61% 33.6%
January 2015
94% 99% 162 31.4% 36.1%
February 2015
95% 100% 211 38.3% 40.1%
March 2015
Details unknown
Details unknown
Details unknown
Details unknown
Details unknown
NHS England displays the information that has been collected each month for 170 acute NHS trusts and independent sector providers for inpatients. The information is on the website at www.england.nhs.uk/statistics/statistical-work-areas/friends-and-family-test/friends-and-family-test-data/. Note: from September 2014, the average national score and trust score are no longer used. A recommended percentage is used instead. Actions to improve our performance • Continue to encourage all patients to let us know how we can improve our services using
the “Friends and Family Test” questionnaires. • Continue to disseminate results to trust staff, patients, relatives and carers by discussing
at meetings and publicly displaying results on ward notice boards and the trust website. • Identify key themes for improvement through analysis of the comments received. • Develop local and trust wide improvement plans for identified areas of action. How improvement will be measured and monitored Results will continue to be passed to the ward sisters and matrons each month and we will take action following any comments for improvements. The results will continue to be included in our monthly quality account.
Priority 7b: To introduce the ‘friends and family test’ question for patients receiving community care. Target: For us to set a baseline for our friends and family test results and increase overall patient satisfaction, using the CARE Measure, to over 80% for community services. Quote: “Following a successful quality initiative, we now gather Friends and Family Test responses routinely within our Patient Engagement Strategy. Patients accessing all services are encouraged to feed back their views in a variety of ways. Feedback from patients is important to us and is used by our clinical teams to improve and develop their services.” Carol Pickering, Business and Service Development Manager, Sutton and Merton Community Services
As well as asking patients receiving community care the friends and family test question, we also use the CARE Measure (a questionnaire of 10 questions) to measure staff empathy in consultations. What we did in 2014/2015 • We routinely ask our patients receiving community services the friends and family test
question • We use the CARE Measure and produced an overall summary for community services
from only 66 surveys from 1st October 2014 until 31st December 2014. The services collecting the feedback were: o Community Dietetics o Parkinsons Nursing o Family Nurse Partnership o Early Supported Discharge o DTALD
How we performed in 2014/2015 CARE Measure • A target of 80% satisfaction is set for each CARE Measure question (with satisfaction
being defined as an ‘excellent’ or ‘very good’ response). The combined result from all questionnaires for this time period is 90.49% (85.09% for Q1 and Q2). Response to question 1 is shown below.
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Friends and family test • We have achieved all our targets in 2014/2015, including asking all patients of community
services, or their family or carers the friends and family test question.
The overall results (for all services) to the question “How likely are you to recommend this service to friends and family if they needed similar care or treatment?” are shown below.
FFT Response Summary
66%
29%
2%1%0%2% 1 - Extremely Likely
2 - Likely
3 - Neither Likely orUnlikely
4 - Unlikely
5 - Extremely Unlikely
6 - Don't Know
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Actions to improve our performance • Sutton and Merton Community Services continuing to survey patients by phone, web link
or paper, depending on the suitability for the service. • Using any of our general surveys, as well as the specific friends and family test question
and CARE Measure, to get feedback from patients using community services, and sharing the feedback as part of the national friends and family test initiative for community services.
• Making sure that when we carry out surveys by phone, patients are contacted at an agreed time by someone who is not involved in their care.
• Developing a survey, which will include the friends and family test question, for patients who are discharged from our services.
• Providing the opportunity for patients to meet one of our service improvement leads to give their views on their experience of our clinic services.
How improvement will be measured and monitored Immediately available reports will allow services to monitor and tackle issues throughout the year. Survey results will be reported back to the Clinical Commissioning Group (via the Clinical Quality Review Group) every three months.
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Priority 8: To increase the percentage of staff who would recommend The Royal Marsden to friends or family needing care. Target: For more than 87% of surveyed staff to say that they would recommend The Royal Marsden. Quote: “The quotes below are samples from the anonymous comments provided by staff on why they would recommend The Royal Marsden to friends or family needing care:
‘We are professional and provide a high standard of care. I have also been a patient at the Royal Marsden and have never met such caring professionals anywhere else in the NHS’
‘My main reason is the level of quality of care received by patients is a high standard and the staff are caring, compassionate and friendly’. We will continue to review this regular feedback from our staff to identify both what we are doing well and where we can improve further” Samantha Greenhouse, Assistant Director - Organisation Development
Each year we carry out a staff survey (the annual staff survey) and ask staff how strongly they agree with the statement: ‘If a friend or relative needed treatment, I would be happy with the standard of care provided by this trust.’ In 2013/2014, 87% of staff agreed or strongly agreed with the statement What we did in 2014/2015 • We asked all staff to give feedback every three months, as well as running the annual staff
survey in quarter three (1 October to 31 December). • We asked staff the friends and family test question: “How likely are you to recommend
this organisation to friends and family if they needed care and treatment”. • We used the results and comments from the staff ‘friends and family’ test to guide plans
for further improvement. • We continued to share the findings of patient surveys with staff.
How we performed in 2014/2015 • In the 2014/2015 annual staff survey carried out in quarter three, 89% of staff agreed or
strongly agreed that if a friend or relative of theirs needed treatment they would be happy with the standard of care provided by us. This improves on the already high rate of last year’s result. This is the second year that all staff (rather than a sample) had the opportunity to give feedback through the staff survey, and accounts for the higher number of respondents than in 2013 and 2014.
The results for the last four annual staff surveys are shown in table 9 below.
Table 9: Results of staff asked how strongly they agree with the statement: “If a friend or relative needed treatment, I would be happy with the standard of care provided by this trust.”
Agreed or strongly agreed
Neither agree nor disagree
Disagreed or strongly disagreed
2014 1670 (89%) 167 (9%) 37 (2%)
2013 1450 (87%) 179 (11%) 41 (2%)
2012 421 (87%) 51 (10%) 13 (3%)
2011 408 (85%) 55 (11%) 19 (4%)
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• The results of the friends and family test are shown in table 10 below.
Table 10: staff response to how likely they are to recommend The Royal Marsden as a place for care or treatment
How likely are you to recommend this organisation to friends and family … as a place to receive care or treatment (‘care’)
Quarter 1 2014
Quarter 3 2014
Quarter 4 2014
Quarter 2 2014
Recommend – Care 95% 96% - 96%
Not recommend – Care 1% 1% - 1% Note: we did not ask the friends and family test question in quarter three as we carried out the annual staff survey then. Actions to improve our performance
• Continuing to encourage staff to give feedback on how to improve our patient services.
• Continuing to ask staff the friends and family test question every quarter, and using the feedback to make improvements.
• Promoting the monitoring reports and other information on our performance, including patients’ responses to the friends and family test question, to staff.
How improvement will be measured and monitored Through the quarterly staff ‘friends and family’ survey responses and annual staff survey.
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Priority 9: To reduce waiting times at chemotherapy appointments and improve patients’ experiences relating to waiting times. Target: For no more than 10% of patients to have to wait more than one hour.
Quote: ‘”It’s vital for us to continue to improve and challenge the service we provide our patients in reducing waiting time, we know how valuable peoples time is, and every day we endeavour to limit time wasted”. Emily Keen, Medical Day Unit Sister.
Managing chemotherapy waiting times is a particular challenge for us because of the complexity of checking it is safe to go ahead with the chemotherapy. Chemotherapy drugs need to be prepared in an aseptic unit (where staff wear gowns and gloves). Also, several checking procedures have to be followed. Some chemotherapy drugs take up to four hours to prepare once they have had the go-ahead for treatment.
What we did in 2014/2015 • We asked patients to give their feedback as they left the outpatients department.
Volunteers ask patients to give their responses to a variety of questions about their appointment. This is the sixth year that patients have been asked to answer questions about their experience.
• We introduced a new appointment system at the Chelsea site to improve treatment appointments and reduce waiting times.
• Sutton introduced the new chemotherapy scheduling system in March 2014. Improvements included pre-prescribing chemotherapy drugs to give the pharmacy time to prepare them before the visit.
• We produced a new patient information leaflet to tell patients about the process of preparing chemotherapy drugs.
• We improved communication between staff and patients to keep them informed about their wait.
• If clinics were running behind, we made announcements every 30 minutes in the outpatients department.
• We appointed staff members to tell individual patients in the Medical Day Unit why they have to wait.
• In January 2015 we held an information evening for patients. Future evenings will be open to all new patients to attend to receive information, get involved in discussions about the environment of the Medical Day Unit, and discuss how to manage the side effects of chemotherapy and how to ‘keep safe’ on chemotherapy.
How we performed in 2014/2015 • As shown in graph 1 over the page, there has been a gradual improvement in the number
of patients seen either on time or early. There has also been a significant reduction in the number of patients waiting between 30 minutes to one hour.
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Graph 1: How do you feel about how long, from your stated appointment time, you had to wait for your treatment to start? (Medical day-case units)
- - - Target Percent Positive
• 24% of patients between 1 October 2014 and 31 December 2014 felt that the waiting time
was ‘much better than expected’. • From 1 January 2015 to 31 March 2015, 74% of patients felt that the length of time they
waited for their appointment was ‘about right’
Actions to improve our performance • Producing new information leaflets explaining the visits for treatment. • Holding chemotherapy information evenings open to all patients. • Continuing to display information about waiting times on the. • Staff continuing to speak to individual patients when there are delays to appointments. • Bringing the daily schedule of medical staff more in line with appointment times at the
Medical Day Unit. How improvement will be measured and monitored Results will continue to be discussed with the outpatient teams and, where relevant, action plans will be produced to make improvements. The results will continue to be reviewed at the Patient Experience and Quality Account committee every quarter.
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Priority 10: To improve communication, particularly at first appointments. Target: For the percentage of positive comments on clinic appointments to be above 90%. Quote: “The Royal Marsden is committed to improve communication for all patients and their families and carers but particularly for those patients that are coming to the hospital for the first time. Information is provided by post before this first visit and includes information about their treatments and also about the environment that they are coming to. On arrival at the hospital they will be met by staff who believe that good communication between health care professionals and patients is key to understanding any worries or uncertainties and that might exist. Staff will introduce themselves with courtesy and helpfulness and will communicate openly and honestly, and will listen fully to everything you say, answering questions to the best of our ability.”
Mo Carruthers, Interim Clinical Nurse Director Within our outpatient departments we aim to communicate well with our patients to make sure that they have a good experience, particularly at their first appointment. We are continually gathering feedback on our communication, and for several years we have asked patients to give their feedback as they leave the department. What we did in 2014/2015
• Reception staff continued to make regular tannoy announcements to update patients on clinics that were running late.
• We introduced a better structure for the administrator role in each clinic, including having a dedicated PC in each clinic, reminding doctors what the admin co-ordinator can help with, allocating tasks and using checklists.
• We consulted patients on ways to improve the waiting area. • On doors in each clinic we put up ‘how to get the most from your consultation’ posters
to give patients tips on how to get explanations and appropriate information during their appointment.
• We introduced strategies to reduce waiting times in order to reduce the pressure in clinics and allow for good communication between clinician and patient.
• We developed a urology DVD to inform patients about diagnosis and treatment. • All nursing staff undertook “Sage & Thyme” communication training. • We reviewed all patient information in the outpatient department to make sure they
are complete and up to date. • We introduced earlier opening times for the phlebotomy service for chemotherapy
patients to make sure results are ready for their clinic appointment. Information regarding this clearly marked on patients appointment cards
• We introduced a patient-reminder system using text messages to remind patients of their appointments and to allow them to cancel or change their appointments more easily.
• We set up a ‘Multi-professional Systemic Anti-Cancer Therapy’ (SACT) working group to introduce non-medical chemo-toxicity assessment for patient in order to help with the smooth-running and communication of chemo clinics.
How we performed in 2014/2015 (Combined average results for Sutton and Chelsea) The following show some of the questions we asked patients when gathering feedback, and the responses.
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Did you understand the purpose of your visit and what to expect? Quarter 1
1 April 2014 to 30 June 2014
Quarter 2 1 July 2014 to 30 September 2014
Quarter 3 1 October 2014 to 31 December 2014
Quarter 4 1 January 2015 to 31 March 2015
Yes, completely
95% 85% 96% 94%
Yes, to some extent
4% 15% 4% 4%
No 1% 0% 0% 2% Don’t know
0% 0% 0% 0
When you arrived at the outpatients department, were you greeted politely at reception and made to feel welcome? Quarter 1
Were you kept informed about your waiting times? Quarter 1
1 April 2014 to 30 June 2014
Quarter 2 1 July 2014 to 30 September 2014
Quarter 3 1 October 2014 to 31 December 2014
Quarter 4 1 January 2015 to 31 March 2015
Yes 58% 50% 18% 59% No, but I would have liked to have been kept informed
29% 50% 45% 38%
No, but I didn’t mind
11% 0% 36% 3%
Don’t know/can’t remember
2% 0% 0% 0
Did the member of staff explain the results of the tests in a way that you could understand? Quarter 1
1 April 2014 to 30 June 2014
Quarter 2 1 July 2014 to 30 September 2014
Quarter 3 1 October 2014 to 31 December 2014
Quarter 4 1 January 2015 to 31 March 2015
Yes, completely
80% 73% 82% 85%
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Yes, to some extent
10% 18% 12% 8%
No 10% 9% 0% 5% Don’t know 0% 0% 0% 2% Did the member of staff listen to what you had to say? Quarter 1
1 April 2014 to 30 June 2014
Quarter 2 1 July 2014 to 30 September 2014
Quarter 3 1 October 2014 to 31 December 2014
Quarter 4 1 January 2015 to 31 March 2015
Yes, definitely 91% 92% 92% 95% Yes, to some extent
7% 8% 8% 3%
No 1% 0% 0% 0 Don’t know 1% 0% 0% 1% If you had any worries/concerns about your condition or treatment, did you feel able to discuss them with the staff in charge of your area? Quarter 1
1 April 2014 to 30 June 2014
Quarter 2 1 July 2014 to 30 September 2014
Quarter 3 1 October 2014 to 31 December 2014
Quarter 4 1 January 2015 to 31 March 2015
Yes, completely 88% 85% 86% 94% Yes, to some extent
10% 15% 14% 4%
No 2% 0% 0% 0 Don’t know 0% 0% 0% 2% If you were given any new medication, or your medication was changed, did the staff explain the reason in a way you could understand? Quarter 1
1 April 2014 to 30 June 2014
Quarter 2 1 July 2014 to 30 September 2014
Quarter 3 1 October 2014 to 31 December 2014
Quarter 4 1 January 2015 to 31 March 2015
Yes, completely 82% 75% 84% 87% Yes, to some extent
7% 25% 11% 4%
No 11% 0% 5% 8% Don’t know 0% 0% 0% 1% Were you given any written or printed information about your condition or treatment? Quarter 1
1 April 2014 to 30 June 2014
Quarter 2 1 July 2014 to 30 September 2014
Quarter 3 1 October 2014 to 31 December 2014
Quarter 4 1 January 2015 to 31 March 2015
Yes 97% 92% 100% 97% No, but I would have liked it
3% 8% 0% 2%
Don’t 0% 0% 0% 1%
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know/can’t remember Were you allocated a ‘key worker’, or someone to contact if you were concerned about your care/treatment before your next appointment? Quarter 1
1 April 2014 to 30 June 2014
Quarter 2 1 July 2014 to 30 September 2014
Quarter 3 1 October 2014 to 31 December 2014
Quarter 4 1 January 2015 to 31 March 2015
Yes 80% 92% 83% 84% No 18% 8% 17% 13% Don’t know 2% 0% 0% 3% Actions to improve our performance in 2015/2016 • Continuing with the Patient Experience Working Group and using the results from the
frequent feedback survey to identify action points to prioritise new initiatives to improve patients’ experiences and communication.
• Continuing to regularly review Picker patient feedback and reviewing action points each quarter.
• Setting up a ‘Managing Attendance’ working group to develop a system for monitoring doctors’ leave in order to manage clinic numbers and reduce waiting times, so improving patients’ experiences and communication.
• Continuing with the ‘Demand and capacity’ analysis for each clinical unit to make sure appropriate resources are in place.
• Working with the London Cancer Alliance to review the most appropriate course of treatment and care for patients.
• Redesigning patient information boards to give feedback about actions we have taken in response to comments.
• Reviewing key-worker information in the Rapid Diagnostic Access Centre to make sure patients who have not been diagnosed with cancer understand who to contact.
• Developing zones for clinics to better link waiting areas to clinics and improve communication to patients in waiting areas.
• Developing a generic information sheet for patients being discharged to give them appropriate contact information, and having specific information added for each clinical unit.
How improvement will be measured and monitored We will measure and monitor any improvement by: • analysing Picker data and action planning; • reviewing feedback from the friends and family test question in outpatient areas; • regularly reviewing waiting times; • regularly reviewing feedback from Out Patient Department and the Rapid Diagnostic
Assessment Centre Steering Group; • regularly reviewing feedback from the OPD patient-experience monthly meetings; and • regularly reviewing feedback and action plans from the Managing Attendance working
group
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Priority 11: To reduce the length of time a patient waits for medicines when they are discharged. Target: For the number of patients who wait for more than two hours to be reduced by 10%.
Quote: “Through good communication and organisation we know we can make a big difference to patients’ experience around discharge. The introduction of the twice daily ‘huddles’ have significantly improved the planning of discharge and allowed a cohesive team approach to managing the safe and efficient discharge of our patients”.
Mark Evans, Associate Chief Pharmacist What we did in 2014/2015 • We set up a project group to look at improving the discharge procedure. This has focussed
mainly on two pilot wards on the Chelsea site – BC and Ellis. These wards were chosen as they are fast-turnover short-stay surgery wards where improvements will have a large effect on patients’ experiences.
• On the pilot wards we started holding daily discharge-planning meetings between pharmacy and the nurse co-ordinators. The aims of these meetings are to plan for the day’s discharges and discuss anticipated discharge times. This allows the multidisciplinary team to effectively plan and focus on discharges, as well as to review the number of patients waiting for discharge prescriptions (TTAs).
• We have worked on several initiatives aimed at reducing the time taken from the prescription being written to the medicines being available. These initiatives include having pre-printed TTA forms for certain types of short-stay surgery, reviewing the drug chart and designing of a short-stay surgery chart which includes a TTA section.
• We started evaluating the benefit of having labelling facilities present on the pilot wards for the pharmacy technicians to use, and introducing pre-packed medicines for commonly prescribed painkillers.
• We developed twice daily ‘ huddles’ where all ward sisters meet with a pharmacist and the clinical site practitioner to discuss patients who are ready to be discharged. Checks have been put in place to assess patients’ readiness for discharge and priorities have been made to make sure discharge is prompt and efficient.
• We have set ourselves a target of discharging patients before midday where clinically appropriate.
How we performed in 2014/2015 • We made some improvement in planning discharges and medication being available at
discharge, particularly on those wards with a dedicated Medicines Management Technician.
• Although a number of prescriptions were still written immediately before discharge, information collected from the pilot wards has shown some improvement. The latest figures from these wards show that 65% of patients have their discharge medication available on the ward at least one hour before their planned discharge time. This figure increases to 100% when TTAs are prescribed more than three hours before the planned discharge time.
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Graph 1: Performance data for Discharge planning and medicines availability for pilot wards, Q4 (Jan-March) 2014-15
0%
20%
40%
60%
80%
100%
120%
% Prescribed>24hrs in advance
% prescribed>3hrs in advance
of which: % onward >1hr pre-
discharge
% on ward >1hrpre-discharge
(overall)
JanuaryFeb March
Actions to improve our performance • An external organisation providing our dispensing services from mid-2015. • Potentially holding ‘discharge flow’ meetings twice a day on both the Sutton and Fulham
Road sites. These flow meetings would aim to share information about expected discharges and make sure effective plans are in place to discharge patients in good time.
How improvement will be measured and monitored The previous methodology for assessing performance relating to TTAs focused on the time it took to process a prescription from the time the pharmacy received it. This method gives a false impression of efficiency as it does not consider information about when a patient is expected or ready to be discharged. Additionally, previous audit work has highlighted that the main reason for delayed discharges related to medication. In future we will continually monitor prescribing times and the availability of medication at discharge. We will look at monthly performance associated with huddles and communicate our prompt and efficient discharges to medical staff. When our dispensing services are provided by an external organisation, their performance will be measured against performance indicators set in the contract.
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Priority 12: To improve health outcomes for children in reception class, in line with the ‘Healthy Child Programme 5-19’. Target: Where health needs have been identified, for the school nursing service to conduct a health assessment of 90% of children in reception class and, where appropriate, for a plan of care to be agreed with the parents or carers. Quote: “Following a change in communication with parents about the reception year questionnaire we have received back an improved response rate from parents. This has reduced our need to spend time following up and therefore have more time to focus on the content of the returned questionnaires. We are then able to plan the appropriate interventions to improve the health outcomes of the children.” Anne Howers Clinical Children’s Services Director, Sutton and Merton Community Services What we did in 2014/15 Children started school in September 2014 and so the first report of activity is being done for the period October to December 2014. The report will be submitted to the Divisional Management meeting for approval in March. Then it will be forwarded to the Public health Commissioners. We started the above process in September 2014. We had a very similar process prior to this date, however we have updated the health questionnaire in an attempt to aid responses from parents and therefore our assessment. School nurses offer targeted health assessments in response to that information. The service is currently reviewing the schools on their health needs- the option of ‘Parent Drop-In' is being considered in those identified as high need. How we performed in 2014/15 The Target for Health Assessments is 90%, we achieved overall uptake of 91.5%. Context In Sutton there are 14 school nurses and 2 nursery nurses in the team. They cover 58 schools with a school population of 34,508. 39 of these schools have reception classes with 2493 children in them. We achieved an uptake of 2303 health assessments which is 92% In Merton there are 13 school nurses and 2 nursery nurses in the team. They cover 55 schools with a school population of 27,844. 43 of these schools have reception classes with 2558 children in them We achieved an uptake of 2333 health assessments which is 91% All children entering school in receive a Health Assessment in reception. For this the information from the health visiting service about individual children are collated with a health questionnaire completed by parents / carer of the child. If there are any queries from the information received or concerns raised then the parent will be first called and appropriate advice, referral or if required an appointment will be made for them to meet with the school nurse. This includes the transfer of any safeguarding plans to the school nursing service if the child and family are on a plan. Developmental screening assessments of height,
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weight, communication skills and coordination are assessed according to government guidelines and appropriate advice and health promotion offered. The height and weight measurements contribute data to the National Child Measurement programme if the parents consent for sharing of their information. This programme influences government decisions and actions about childhood obesity. At this assessment the child’s immunisation uptake is assessed and any child with missing immunisations are identified and referred to their GP or the children immunisation clinic. Following on from the assessments and the identification of any areas where there have been a number of concerns, such as overweight children the school nurses and nursery nurses provide health promotion and so contribute to school based PSHE programmes. Actions to improve our performance in 2015/2016 We have recently completed a review of all schools looking at the level of need. The schools that have been identified with high levels of need following the health assessments have school nurse run ‘drop in clinics’. These are weekly clinics that have no appointments so parents can drop in for advice and support. A pilot of these has found that the parents like these clinics and they were well used and avoided many telephone calls and gave parents easier access to Named Nurses and School Nurses. These clinics are help at the start or end of the school day when parents are at the school to meet their children. Parents can also request to see the school nurse at a set time at these clinics or after or before the clinics. How improvement will be measured and monitored We will be monitoring the number of drop-ins offered and the numbers of parents attending the drop in as well as attending as a planned appointment. We can compare directly the numbers seen in one year as compared to the previous year We will be monitoring topic trends, this will enable us to plan and target any additional Public Health initiatives either to parents or within the school
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Part 3: Outline of Quality Improvements in 2014/15 Monitor issued ‘NHS foundation trust annual reporting manual 2014/15’ in December 2014. From 2011/12, all acute trusts are required to have external audit work performed on their Quality Accounts. In March 2015 Monitor published detailed on what was required to be included in the annual quality account. In March 2015 NHS England published guidance on how to report quality accounts. The Royal Marsden chose to include the mandatory (must do) set of quality indicators for requirements for 2014/15. Some of the indicators are not relevant to the trust e.g. ambulance response times, therefore these have been excluded. However, we also felt it was important to consult with our members and council of governors to incorporate their views about ‘quality’ into the quality account. The process for agreeing the quality priorities for 2015/2016 was as follows. October 2014 • Key milestones and a timetable outlined at the Patient Experience and Quality Account
group were agreed. Members of this group that was chaired by the Deputy Chief Nurse were representatives from the council of governors, Healthwatch, Sutton Health and Wellbeing Board, patients and carers, matrons from the hospital and community services.
November 2014 • We reviewed the first draft of the annual Quality Account 2014/2015. • We held a members’ event to discuss progress with developing and choosing quality
priorities. February 2015 • We produced a second draft of the Quality Account 2014/2015. • The Council of Governors chose the quality priorities. • Chief Nurse discussed and agreed measurable targets with relevant staff. • The second draft of the quality account was issued to the Council of Governors,
Healthwatch, Clinical Commissioning Group, the Health and Wellbeing Board and the Patient and Carer Advisory Group for them to provide comments and statements (see appendix 3) about the quality account.
• Second draft of the Quality Account 2014/2015 was sent to Plain English Campaign for comments.
• The second draft of the quality account was issued to staff for comments. March 2015 • The Council of Governors held a meeting to review the second draft and give comments
(see appendix 3). • The second draft was sent to The Medical Advisory Committee, Trust Consultative
Committee and the Nursing, Radiography and Rehabilitation Advisory Committee for review.
April and May 2015 • The Chief Nurse tells the Board about progress to date and gets approval of the quality
priorities and targets for 2015/2016. • Details of progress against the 2014/2015 quality priorities and targets were added to the
final draft of the Quality Account 2014/2015. • A copy of the final draft was sent to the marketing and communications department. • A copy of the final draft was sent to external auditors for review. • The marketing and communications team sent the final copy of the Quality Account
2014/2015 to the designer.
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May and June 2015 • The final copy of the Quality Account 2014/2015 was reviewed at the Audit Committee
meeting. • We published the quality account on NHS Choices website and our website as required. The quality priorities for 2015/16 The quality priorities and targets for 2015/2016 are shown in the table below. The priorities and targets in blue are mandatory (that is, we had to include them) and the priorities and targets in red are the new ones we have set ourselves. Table 1: Quality priorities and targets for 2015/16 Category Quality Priority Target Safe care 1 Reduction in Healthcare
Associated Infections (MRSA bacteraemia and Clostridium difficile infections). Applies to hospital inpatient beds at The Royal Marsden and patients of Sutton and Merton Community Services.
For there to be less than one case of MRSA infection per year. For there to be fewer than 16 cases of Clostridium difficile infection per 100,000 bed days. (A bed day is when a patient is in hospital overnight. It is measured in a large number to spot trends.)
Safe care 2 To reduce the rate of patient-safety incidents and percentage resulting in severe harm or death. (A patient-safety incident is an incident which could have or did lead to harm for a patient.) (In 2013/14 the rate of severe harm or death from incidents per 100 admissions was 0.008 for acute and 0.00 for community). Applies to hospital inpatient beds at The Royal Marsden and patients of Sutton and Merton Community Services.
Reduction in the rate of reported patient safety incidents per 100 admissions that have caused severe harm or death to below 0.01.
Safe care 3 To maintain the percentage of admitted patients assessed for the risk of venous thromboembolism (getting a blood clot in a vein).
For the percentage of patients who have been assessed to stay above 95%.
Effective care
4 To reduce the incidence of emergency readmissions to hospital within 28 days of patients being discharged.
For the number of avoidable readmissions to be below 0.3%.
Effective care
5 To reduce the incidence of category-3 pressure sores (full-thickness skin loss) and
For the percentage of category-3 and category-4 pressure sores arising in patients receiving
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category-4 pressure sores (full-thickness tissue loss) developing in patients while they are receiving community care. Applies to Sutton and Merton Community Services.
community care to be less than 0.2%. For 90% of category-3 and category-4 pressure sores, both already existing and developing while receiving community care, to have healed or improved to category 1 or category 2 within three months.
Patient experience
6 a To make sure that we are responding to inpatients’ personal needs.
b To introduce the ‘friends and family test’ question for patients receiving community care. (The friends and family test question asks people who use NHS services whether they would recommend the services to others.)
For us to still be in the top 20% of trusts for results in the friends and family test for hospital inpatients. For us to set a baseline for our friends and family test results and increase patient satisfaction, using an audit tool called the CARE measure, to over 80% for community services.
Patient experience
7 To increase the percentage of staff who would recommend The Royal Marsden to friends or family needing care.
For more than 87% of surveyed staff to say that they would recommend The Royal Marsden.
Patient experience
8 a To reduce waiting times at chemotherapy appointments and improve patients’ experiences relating to waiting times. b To reduce waiting times in outpatient clinics and improve patient experiences relating to waiting times
For no more than 10% of patients to have to wait more than one hour.
Patient experience
9 To reduce the length of time a patient waits for medicines when they are discharged.
For the number of patients who wait for more than two hours to be reduced by 10%.
Children’s services
10 To ensure that children in Sutton and Merton have high levels of disease protection within the local communities. To measure and report across Merton and Sutton boroughs individually.
For the Children’s Immunisation Team to:- a maintain Human Papilloma Virus (HPV) immunisation uptake above 90% national target for all girls in the target group of year 8 and year 9. b to increase School leavers Booster (SLB) for Diphtheria, Polio and Tetanus uptake from 72% to 80% (national target) across both boroughs by March 2016.
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The table below summarises our quality priorities for the last five years. Priorities for community services are provided from 2011/2012 onwards. Safe care 2009/2010 2010/2011 2011/2012 2012/2013 2013/2014 2014/2015 Reduce the incidence of healthcare-associated infections
Reduce the incidence of healthcare-associated infections
Reduce the incidence of healthcare-associated infections
Reduce the incidence of healthcare-associated infections (mandatory priority)
Reduce the incidence of healthcare-associated infections (mandatory priority)
Reduce the incidence of healthcare-associated infections (mandatory priority)
Reduce the number of medication mistakes
Reduce the number of medication incidents
Reduce the number of medication incidents
Reduce the rate of patient-safety incidents and the percentage resulting in severe harm or death (mandatory priority)
Reduce the rate of patient-safety incidents and the percentage resulting in severe harm or death (mandatory priority)
Reduce the rate of patient-safety incidents and the percentage resulting in severe harm or death (mandatory priority)
Reduce the incidence of falls
Reduce the number of falls
Reduce the number of falls in hospital Increase by 15% increase the number of falls screens (applies to Sutton and Merton Community Services)
---------------- --------------- ----------------
Assess, monitor and treat venous thromboembolism (a blood clot in a vein)
Reduce the incidence of venous thromboembolism (blood clots)
Maintain the percentage of admitted patients assessed for the risk of venous thrombo-embolism (mandatory priority)
Maintain the percentage of admitted patients assessed for the risk of venous thrombo-embolism (mandatory priority)
Maintain the percentage of admitted patients assessed for the risk of venous thrombo-embolism (mandatory priority)
Meet national health-visit targets – new birth visits (applies to Sutton and Merton Community Services)
Meet national health-visit targets – new birth visits (applies to Sutton and Merton Community Services)
---------------
-------------
Meet national guidance and training – safeguarding
----------
---------------
---------------
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children (applies to Sutton and Merton Community Services)
Reduce the mortality rate and the hospital standardised mortality ratio (HSMR)
Reduce the hospital standardised mortality ratio (HSMR)
Reduce the hospital standardised mortality ratio (HSMR)
Reduce the hospital standardised mortality ratio (HSMR)
Reduce the incidence of pressure sores arising in hospital
Reduce the incidence of pressure sores arising in hospital
Reduce the incidence of pressure sores arising in hospital Reduce the incidence of pressure sores especially categories 3 and 4, developing in patients receiving community services (applies to Sutton and Merton Community Services)
Reduce the incidence of category-3 and category-4 pressure sores developing in patients receiving community services
Reduce the incidence of category-3 pressure sores (full-thickness skin loss) and category-4 pressure sores (full-thickness tissue loss) developing in patients while they are receiving community care (applies to Sutton and Merton Community Services)
Reduce the incidence of category-3 pressure sores (full-thickness skin loss) and category-4 pressure sores (full-thickness tissue loss) developing in patients while they are receiving community care (applies to Sutton and Merton Community Services)
---------
--------------
---------------
More than 42% of patients to die where they have chosen to die
Increase the number of patients who die where they have chosen to die
------------
Reduce the length of stay
Reduce the length of stay
Reduce the length of stay
------------
------------
------------
-----------
----------------
-------------
Increase the number of patients offered a holistic needs assessment
Increase the number of patients who have a holistic needs assessment (an assessment that considers all aspects of a person’s needs, such as emotional, social and cultural needs,
Increase the number of patients who have a holistic needs assessment (an assessment that considers all aspects of a person’s needs, such as emotional, social and cultural needs,
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not just their medical needs)
not just their medical needs)
-----------
----------------
-------------
Reduce the number of emergency readmissions to hospital within 28 days of discharge (mandatory priority)
Reduce the number of emergency readmissions to hospital within 28 days of discharge (mandatory priority)
Reduce the number of emergency readmissions to hospital within 28 days of discharge (mandatory priority)
Patients in pain Be in the top 20% of trusts for key areas in the national inpatient survey
Be in the top 20% of trusts for key areas in the national inpatient survey
Improve or maintain a high score in relation to responding to inpatients’ personal needs in the national survey (mandatory priority)
Make sure that we are responding to inpatients’ personal needs (mandatory priority)
Make sure that we are responding to inpatients’ personal needs (mandatory priority)
Treat patients with dignity and respect
Be in the top 20% of trusts for key areas in the national outpatient survey
Be in the top 20% of trusts for key areas in the national outpatient survey
--------
Improve communication, particularly at first appointments
Improve communication, particularly at first appointments
Give patients enough information on discharge
Immediately gather patient feedback throughout the trust
Immediately gather patient feedback throughout the trust
------------
------------
------------
Reduce chemotherapy waiting times Improve patients’ experiences of hospital transport Improve communication at every part of the patient’s experience
Reduce waiting times at chemotherapy appointments and improve patients’ experiences relating to waiting times
Reduce waiting times at chemotherapy appointments and improve patients’ experiences relating to waiting times
Reduce waiting times at chemotherapy appointments and improve patients’ experiences relating to waiting times
-----------
-------------
-------------
Increase the percentage of staff who would recommend
Increase the percentage of staff who would recommend
Increase the percentage of staff who would recommend
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The Royal Marsden to friends or family needing care (mandatory priority)
The Royal Marsden to friends or family needing care (mandatory priority) Introduce a patient experience survey for Sutton and Merton Community Services (mandatory priority)
The Royal Marsden to friends or family needing care (mandatory priority) Introduce a patient experience survey for Sutton and Merton Community Services (mandatory priority)
------------
-------------
Reduce the length of time a patient waits for medicines or equipment when they are discharged
Reduce the length of time a patient waits for medicines or equipment at the point when they are discharged
------------
-------------
Increase the uptake of immunisation, working in partnership with primary care
Improve health outcomes for children in reception class, in line with the ‘Healthy Child Programme 5-19. (This programme sets out a framework for services for children and young people to promote good health and well-being.)
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Statements of assurance from the Board
Review of services
During 2014/2015, we provided or subcontracted comprehensive cancer services and community services. We have reviewed all the information they have on the quality of care provided by all their relevant health services. The income generated by the health services reviewed in 2014/2015 is equal to the total income generated from the relevant health services in 2014/2015. The information provided in part three of this quality account covers the three aspects of quality – patient safety, clinical effectiveness and patient experience. Participation in clinical audits
At The Royal Marsden we carry out many clinical audits for improving quality of care. We take part in all the national cancer audits which apply to us. This allows us to compare our performance against that of other hospitals in England, and sometimes across the world. We also have a comprehensive programme of local audits which healthcare staff, including consultants, junior doctors, nurses and allied health professionals, carry out regularly to improve local areas of care.
During 2014/2015 (April 2014 to March 2015) 18 national clinical audits and three national confidential enquiries covered health services that we provide. National clinical audit and confidential enquiries
National confidential enquiries are “inspections” that are carried out nationally to investigate areas of care where there may have been problems or where the patients may be particularly vulnerable. All hospitals are asked to take part in them so that all care across England can be monitored.
During 2014/2015, we registered for or took part in 19 of the national clinical audits (see table 11) and all national confidential enquiries we were eligible to take part in (see table 13). We cannot take part in many of the national audits performed by other hospitals because we only have cancer patients.
Table 11 below lists the relevant national clinical audits we took part in and the number of relevant cases we included in each audit, as a percentage of the number of cases required under the terms of that audit. Table 11: National clinical audits we took part in during 2014/2015
No National Clinical Audits Participated Cases submitted (%)
1 National Oesophago-Gastric cancer audit (OG) Audit
Yes 100% of cases diagnosed at the Trust
2 National Bowel Cancer Audit (NBOCAP)
Yes 100% of cases diagnosed at the Trust diagnoses
3 National Lung Cancer Audit (LUCADA)
Yes Note: tertiary Trust Standards do not apply as most patients are not ‘first seen’ at
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No National Clinical Audits Participated Cases submitted (%)
tertiary Trusts Treatment data submitted
4 National Head and Neck Cancer (DAHNO)
Yes 100% cases diagnosed at the Trust submitted
5 National Emergency Laparotomy Audit (NELA)
Yes 100%
6 National Prostate Cancer (NPCA) Yes 100%
7 Intensive Care National Audit & Research Centre (ICNARC) Case Mix Programme (CMP)
Yes 100%
8 Sentinel Stroke National Audit Programme (SSNAP)
Yes 100%
9 Audit of Intermediate Care 2014 Yes 100%
Other National Audits
11 National Health Service Cancer Screening Programme (NHSCSP) Audit of Invasive Cervical Cancer
Yes 100%
12
The British Association of Urological Surgeons (BAUS) Nephrectomy audit 2014
16 Royal College Radiologists (RCR) National Re-audit of Adjuvant Breast Radiotherapy Technique and Tumour Bed Boost Practice in Early Breast Cancer after Breast-Conserving Surgery 2014
Yes 100%
17 The iBRA (implant breast reconstruction evaluation) Study: a national audit of practice and outcomes of implant breast reconstruction
Yes 100%
18 Tissue Viability Society (TVS) & NHS Yes 100%
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No National Clinical Audits Participated Cases submitted (%)
England Audit
19 Management of Health at Work Knowledge audit
Yes 100%
The reports of 14 national clinical audits were reviewed by The Royal Marsden in 2014/15. The Royal Marsden will take the following actions (awaiting confirmation of actions) to improve the quality of healthcare provided, where appropriate. Consultant Outcome data based on national audits are published on the NHS Choices: My NHS and The Royal Marsden website. Table 12: National clinical audits reports published and actions taken
No National Clinical Audit reports published in 2014/15
Description of actions
1 National Oesophago-Gastric Cancer Audit Report
Report reviewed
2 National Bowel cancer Audit Report Report reviewed
3 National Lung Cancer Audit (LUCADA) Report disseminated
4 National Head & Neck Cancer Audit Report reviewed
5 Organisational Report of the National Emergency Laparotomy Audit
Report reviewed
6 National Prostate Cancer Audit
7 Sentinel Stroke National Audit Programme (SSNAP):
Report disseminated
8 NHS Blood and Transplant: Red Cell Survey
Report reviewed
9 NHSCSP Audit of invasive cervical cancer National report
Report disseminated
10 RCR National audit of Radiotherapy in the Treatment of Metastatic Spinal Cord Compression and Implications for the Development of Acute Oncology Service
Report disseminated
11 RCR National audit of appropriate imaging
Report disseminated
12 BAUS Analyses of Prostatectomy 2013 dataset
Report reviewed
13 BAUS Analyses of Cystectomy 2013 Report reviewed
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No National Clinical Audit reports published in 2014/15
Description of actions
dataset
14 BAUS Analyses of Nephrectomy 2013 dataset
Report reviewed
Table 13: National confidential enquiries The Royal Marsden eligible to participate in 2014/15
National Confidential Enquiry into Patient Outcome and Death (NCEPOD) studies
Participated % cases submitted
1 Gastrointestinal Haemorrhage Yes Ongoing
2 Sepsis Yes Ongoing
3 Acute Pancreatitis Study Yes Ongoing
The report of 2 national confidential enquiries report was reviewed by The Royal Marsden in 2014/15. The Royal Marsden intends to take the following actions to continue to improve the quality of healthcare provided. Table 14: National Confidential Enquiries reports published and actions
No National Confidential Enquiry into Patient Outcome and Death (NCEPOD) studies
Description of actions (local)
1 Tracheostomy Care: On the Right Trach Recommendations reviewed at the Surgical Audit Group.
2 Subarachnoid Haemorrhage: Managing the Flow
Principal recommendations reviewed at IGRM.
The reports of 48 local clinical audits and local action plans to improve the quality and outcomes of patient care were reviewed by Clinical Audit Committee of The Royal Marsden in 2014/15. The following actions are examples of some of the actions taken. Should you require more information about the local audits please contact the Quality Assurance department on 020 7808 2702 or email [email protected].
Title of local audit Action points from local audit
Audit of the Royal Marsden Hospital’s prescribing adherence to the National Institute for Health and Care Excellence (NICE) clinical guideline regarding opioids in palliative care
SHO and palliative care specialist registrar training. Palliative care team awareness on usage of opioid prescribing leaflet. Re-audit.
A retrospective audit looking at palliative and end of life care practices in medical patients with advanced cancer admitted to the Critical Care Unit (CCU)
Distribution of the prompt sheet for the Principles of Care for the Dying is being reinforced by the palliative care team. A tab with prompts linked to the principles of good end of life care has been created and will be started in the CCU.
Snap-shot endoscopy department patient experience survey
Implementation of a nurse led consent process.
Getting compression garments on prescription for the management of lymphoedema – an audit of the process and outcome
All lymphoedema patients who obtain their compression garments on prescription from their general practitioner (GP) will be asked about the pharmacy that they use and if the compression garments are being accurately provided. The prescription request letter to the GP will be changed. All patients who are new to obtaining their compression garments on prescription and all patients who have had difficulties and delays obtaining their garments will be encouraged to use the postal prescription service whenever possible.
Re-audit of the Surgical Safety Checklist practice at the Royal Marsden Hospital
Establishment of a Theatre Safety and Quality Assurance Committee. Scanning all World Health organisation (WHO) checklists onto the electronic patient record (EPR). Re- audit.
Snap-shot patient experience in Recovery Unit
Best practice confirmed.
Massage therapy in the outpatient waiting area (patient survey and staff survey)
Best practice confirmed.
Patient experience and satisfaction with the gastro-intestinal (GI) and nutrition team outpatient consultation
Best practice confirmed.
Transfer of sentinel lymph node biopsy samples from Sutton theatres to histopathology
Procedures for transfer of specimens from Sutton theatres to Fulham Road have been changed.
Audit to prospectively identify selection criteria for breast cancer patients who will derive most benefit from voluntary deep inspiration breath hold
Audit is required to reassess the time taken for pre-treatment and treatment.
Thromboprophylaxis in the Royal Marsden Hospital Drug Development Unit (DDU)
A flow diagram has been posted on the ward to help remind physicians of thromboprophylaxis considerations for urgent admissions. DDU physician and nurse education to be implemented.
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Title of local audit Action points from local audit
Use of aromasticks to help with sleep problems: Patient experience survey (Rehab48)
Clinical staff will continue to be informed about the use of aromasticks to help with sleep problems as appropriate. Two blends of aromasticks will be used in a forthcoming sleep research study on the Critical Care Unit.
IV Audit (NAR279-14) • Results highlighted at mandatory training and published in IV newsletter
• Extravasation policy in pack updated • Documentation related to care plans and fluid
balance charts improved Labelling of administration sets and CVAD dressings improved
Medical Devices Training and record keeping (NAR185-14)
An annual audit to monitor compliance of staff straining on high and medium risk medical devices planned An annual audit to monitor all staff trained on high risk medical devices have a formal annual assessment planned
Colorectal cancer surveillance post treatment audit (GI149)
A follow-up patient information sheet has been created and rolled out to clinic patients. This information sheet includes colonoscopy requirements.
Snap-shot Private Care Inpatient Experience Survey October to January 2014 (PC1)
Implementation of action plans
Audit of Radiographer led verification of Non Small Cell Lung Cancer (NSCLC) Stereotactic Body Radiotherapy (SBRT), RT54
An annual re audit by lung clinician of 10 radiographer verifications of LINAC based SBRT NSCLC treatments planned.
Brain CNS Doc audits for Peer review: MDT, Keyworker and copy letters to patient
The MDT form has been updated to ensure data capture of the following mandatory information regarding patient management plans. The form changes and completion requirements have been advised to relevant members of the Neuro Oncology Team.
Participation in clinical research The Royal Marsden and The Institute of Cancer Research form the largest centre for cancer research in Europe. This is important because it means that our patients and our staff are always aware of the latest research in treatments, medicines and therapies that make such a major difference to outcomes and the experience of care. If you would like to find out more about our research work please go to our website www.royalmarsden.nhs.uk The number of patients receiving relevant health services provided or subcontracted by The Royal Marsden from April 2014 to March 2015 that were recruited during that period to participate in research approved by a research ethics committee was 4598 patients into 420 different trials.
The trust has made 85 positive recommendations in support of revalidation since April 2014. The medical appraisal policy and related processes for managing the appraisal and revalidation of assigned doctors are supported by a six monthly report at IGRM and annual Board Report. The Board Report incorporates a performance report and an action plan to support continuous improvement. Additional quarterly and annual external reporting / governance arrangements are also in place.
Use of the CQUIN payment framework (as at 25th March 2015)
Commissioning for Quality and Innovation (CQUIN) payments are a mechanism for commissioners to reward quality by linking a proportion of the Trust’s income (2.4% to 2.5% in 2014/2015) to the achievement of quality improvement goals.
Previous year’s achievements
• In 2013/2014 cancer specialist services received 100% of its CQUIN goals. This equated to approximately £3.7 million of income. Sutton and Merton Community Services achieved 94% of its CQUIN goals in 2013/2014, which equated to approximately £800,000 of income.
• In 2012/2013 The Royal Marsden achieved 100% of its CQUIN target which equated to approximately £3 million.
• In 2012/13 Sutton and Merton Community Services achieved 86.7% of its CQUIN target which equated to £712,500.
Goals for 2014/15
Goals for 2014/15 were agreed in the following subject areas for cancer specialist services and for community services.
Cancer specialist services: Friends and Family Test NHS Safety Thermometer – increasing the percentage of harm free care Dementia - identification of patients aged 75 and over who, following emergency
admission, are identified as potentially having dementia, are appropriately assessed and referred on to specialist services; delivery of training programme; audit of carers of patients with dementia to test whether they feel supported.
Specialist Dashboards – Specialised Urology, HPB and Pancreas, Specialised Dermatology, Paediatric Oncology, Adult Critical Care
Patient Held Records – implementation of patient-held records for those patients who have had a VTE to ensure patients and other care providers have key information and contact details to hand
Endocrinology – Scope arrangements for networks in specialised endocrinology to increase national consistency across providers and clarify pathways into specialised services
Improving waiting times through system leadership – focus on tertiary referrals. Develop a South-West London patient tracking list and escalation process to improve the patient experience
Working with primary care to manage increases in breast referrals – carry out a full analysis of breast referrals and work with primary care to implement any actions informed by the analysis
24 hour treatment plan for non-elective admissions Discharge planning – improve the discharge planning process, with particular
focus on TTOs (to take out medications)
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End-of-life care - improving care for patients approaching end-of-life in hospitals by educating the hospital workforce
Develop a join plan, with the LCA, to identify clinical units and to audit review rates, intervals and outcomes. Development of unit-specific metrics
Sutton and Merton Community Services: Reducing Admissions to A&E Departments from Nursing and Residential Homes Implementation of the Friends and Family Test Pressure Ulcers – Data collection and improvement Reducing inequalities in diabetic eye screening services Inter-communicability between Child Health Information Systems (CHIS to CHIS)
Cancer specialist services CQUIN goals – quarters one to three 2014/2015
The Royal Marsden submitted its quarter 1 report to commissioners on 31 July 2014, its quarter 2 report on 31 October 2014, and quarter 3 report on 30 January 2015, all with positions of 100% achievement. All quarter positions have been confirmed by commissioners.
Sutton and Merton Community Services CQUIN goals – quarter one to three 2014/2015
Sutton and Merton Community Services submitted its quarter 1 report to commissioners on 31 July 2014, its quarter 2 report on 31 October 2014 and its quarter 3 report on 30 January 2015, all with positions of 100% achievement. This has been confirmed by commissioners.
What others say about the provider
Statements from the Care Quality Commission (CQC) The Royal Marsden NHS Foundation Trust is required to register with the Care Quality Commission and its current registration status is “registered with no conditions”. To date The Care Quality Commission has not taken enforcement action against The Royal Marsden NHS Foundation Trust during 2014/2015. To date The Royal Marsden has not participated in any investigations by the Care Quality Commission during the reporting period, 2014/2015. Throughout the year at the monthly Integrated Governance and Risk Management committee meetings the trust reviewed the Intelligent Monitoring Reports which show the risk rating that the Care Quality Commission gives the trust based on quality indicators. The Intelligent Monitoring Reports place the trust in Band 6 which is the lowest category of risk. Data quality Good quality information is very important in underpinning the effective delivery of the best patient care. The Royal Marsden NHS Foundation Trust submitted records during 2014/205 to the Secondary Uses service for inclusion in the Hospital Episode Statistics which are included in
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the latest published data. The percentage of records in the published data, which included the patient’s valid NHS number, was 99.92% for admitted patient care, 99.85% for outpatient care, and none for accident and emergency care (specialist cancer trust and community services without an accident and emergency department). See table 1 below. The percentage of records that included the patient’s valid General Medical Practice Code was 99.54% for admitted patient care, 99.64% for outpatient care and none for accident and emergency. Table 15: Data quality - England and Wales
% completeness
NHS number GP practice
2012/13 2013/14
2014/15 Q1
2014/15 Q2
2014/15 Q3
2012/13 2013/14 2014/15 Q1
2014/15 Q2
2014/15 Q3
Inpatient & Day cases
99.9*% 99.9% 99.9% 99.97%
99.92% 99.7*% 99.8% 99.8% 99.72% 99.54%
Outpatients 99.8*% 99.9% 99.8% 99.90%
99.85% 99.7*% 99.8% 99.7% 99.75% 99.64%
*The data shown for NHS number completeness 2012/2013 is different than what was previously reported in the Annual Quality Account for 2012/2013. This is because there was a change in definition between the two periods. The NHS number completeness previously included private patients, where this measure should only apply to NHS patients, as many private patients do not actually have an NHS Number. Although data quality at The Royal Marsden is very good the Trust strives for continual improvement. The Royal Marsden NHS Foundation Trust implements the following actions to improve data quality: 1. A dedicated data quality team are responsible for running routine validation checks and
reports to identify errors and inconsistencies in data entry. 2. In 2013 trust wide monthly communications started promoting the importance of
accurate information and data collection centrally for all trust staff. 3. Trust wide audits of data quality involving key information points are conducted
annually. Information Governance Toolkit attainment levels The Royal Marsden’s Information Governance Toolkit assessment submitted a final score of 89% on the 31st March 2015 for version 12.This is an increase of 1% from the previous score of 88% in version 11.The Information Governance Toolkit is available on the Health and Social Care Information Centre (HSCIC) website https://nww.igt.hscic.gov.uk/ Payment by Results Clinical coding error rate The Royal Marsden was not subject to the Payment by Results clinical coding audit during 2013/2014 by the Audit Commission. However a full coding audit was carried out by a qualified coding auditor to standard coding methodology and the error rates reported for diagnoses and treatment coding are in table 2 below. 200 episodes were reviewed within the sample. These results should not be extrapolated further than the actual sample audited.
* The Trust was not eligible for an Audit Commission Clinical Coding Audit in 2010/11; these figures are therefore based on an audit commissioned by The Royal Marsden in November 2010.
**These figures are taken from the Information Governance Clinical Coding Audit in December 2013, which used the latest version of the NHS Health and Social Care Information Centre audit methodology. Part four Review of quality performance (previous year’s performance) National targets
Cancer waiting times targets
National Target 2014/2015
2014/2015 performance Q1
2014/2015 performance Q2
2014/2015 performance Q3
2014/2015 performance Q4
2014/2015 performance
All urgent GP referrals seen within 14 days
93% 94.3% 97.0% 96.8%
All referrals for breast symptoms seen within 14 days
93% 93.5% 93.3% 96.4%
Treatment within 31 days of decision to treat for first treatment
96% 99.4% 99.7% 99.4%
Subsequent surgical treatment started within 31 days of decision to treat
94% 96.2% 97.5% 99.2%
Subsequent drug treatment started within 31 days of decision to treat
98% 99.6% 99.8% 100%
Subsequent radiotherapy treatment started within 31 days of
94% 98.1% 96.7% 99%
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decision to treat
Treatment started within 62 days of urgent GP referrals *
85% 87.0% 84.2% 86.9%
Treatment started within 62 days of recall date for urgent screening centre referrals*
90% 88.2% 95.5% 91.6%
* Figures include agreed reallocations between trusts NHS 18 week targets
Target/ priority National target 2013/2014
2013/2014 % achieved Q1
2013/2014 % achieved Q2
2013/2014 % achieved Q3
2013/2014 % achieved Q4
2014/2015 % achieved Q1
2014/2015 % achieved Q2
2014/2015 % achieved Q3
National target 2014/2015
Patients requiring admission who waited <18 weeks from referral to treatment (not national targets since 2010)
90% 95.4% 96.1% 94.9% 96.0% 95.9% 95.1% 95.4% 90%
Patients not requiring admission who waited <18 weeks from referral to treatment (not national targets since 2010)
95% 99.0% 99.1% 99.0% 98.5% 97.5% 97.8% 98.2% 95%
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Access targets
Target/ Priority National target 2014/2015
2011/2012 % achieved
2012/2013 % achieved
2014/2015 % achieved
2014/2015 % achieved Q1
2014/2015 % achieved Q2
2014/2015 % achieved Q3
2014/2015 % achieved Q4
Operations cancelled by the Trust at the last minute
Less than 5%
0.3% 0.5% 0.9% 0.5% 0.8%
Last minute cancelled operations not subsequently performed within one month
0% 0% 0% 0% 0% 0%
The Royal Marsden NHS Foundation Trust met all key performance waiting times and access targets in 2012/2013 and 2013/2014 with the exception of the breast symptomatic target during Q2. During the first half of 2014/2015, the Trust failed the 62 day Screening standard in Q1 and failed the 62 day GP standard in Q2.
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Appendix 1: Quality Indicators where national data is available from the health and Social Care Information Centre
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Appendix 2: Trust values The Royal Marsden is shaped by a distinct set of 16 values that define what we are and how we behave. Characteristics (what we are) Attitudes (How we act) Pioneering Determined Aspirational Confident Knowledgeable Open Driven Resilient Relationships (How we relate to others) Emotions (How we feel) Collaborative Compassionate Supportive Positive Trusted Calm Personable Proud Over the last year we have been focusing on a different value each month and exploring how our staff adopt these values in their daily work. Compassion Compassion is the emotion we feel in response to the suffering of others that motivates a desire to help. The Trust prides itself on delivering compassionate care to every patient. Ann Duncan, Matron, Kennaway/Smithers wards, Sutton and Markus/Wilson wards, Chelsea Ann Duncan is matron of Kennaway and Smithers wards at Sutton and Markus and Wilson wards at Chelsea. She said: “I don’t think you could be a good nurse without being compassionate. It’s fundamental to all the care we give, not only to patients but staff as well. “Compassion is the relationship you have with a person – treating them as an individual with dignity, respect and genuine kindness and the way you would want your own family and friends treated. “It’s important to really listen to what the patients and staff are saying to you and then to act on what you are hearing.” Ann has worked at The Royal Marsden for 14 years. “For nurses to give compassionate care they have got to be looked after too. It’s a very stressful job and it’s getting busier so we need to make them feel supported and build team work,” she said.
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Determined We are determined when we are unwilling to let anything prevent us from doing what we have decided to do. Christine Hall, senior physiotherapist, Sutton and Merton Community Services Christine role involves providing support to cancer patients once they have left hospital. She said: “We have to be determined in order to help patients achieve their goals, despite obstacles along the way. Helping someone take their first steps outside or even practising getting in and out of a car can give someone confidence and their independence. Having determination is really important as it motivates the patients and gives them that extra push so they continue with their rehabilitation. “Sometimes we can work with a patient in a challenging environment where there may not be much room. We have to be extremely determined and adaptable to help that person do the best that they can. In the workplace a sense of determination can also act as a role model for other staff in times of challenges and changes.”
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Appendix 3: Statements from key stakeholders (these statements will be added once the draft quality account has been reviewed during the 30 day period).
Statement in response to The Royal Marsden Quality Account, in relation to Sutton and Merton Community Services As the lead commissioner Merton Clinical Commissioning Group (CCG), in partnership with Sutton CCG and Public Health colleagues, has monitored the safety, effectiveness and patient experience of community health services provided by The Royal Marsden through Sutton and Merton Community Services (SMCS) during 2014/15. We monitor the quality of services provided through the Clinical Quality Review Group meetings, and the engagement of SMCS in this process to provide assurance across the full range of community services provides the basis for commissioners to comment on the quality of these services. We thank all the staff for their commitment and participation in these meetings, particularly following the introduction of patient stories and clinical presentations to highlight areas of good practice or improvement. We have reviewed the achievements for The Royal Marsden in respect of community services and acknowledge the aspiration from the organisation to provide high quality and safe care. We have noted the priorities in the Quality Account 2014/15 that relate to community services and would congratulate the organisation in achieving their targets to improve their performance in reducing the incidence of pressure ulcers that have developed whilst in the care of community services, and that have healed or improved. The robust system of identification and challenge through pressure ulcer panels is an example of their commitment to improving quality and safety. We welcome the introduction of patient experience surveys to measure staff empathy during consultations using the CARE tool and note the ongoing commitment to gain feedback from users of the services, identify actions and monitor improvement. We are pleased to note that community services feature in priority areas identified for 2015/16 and look forward to continue working with SMCS during the year to fulfil the ambition to constantly improve patient care. Merton Clinical Commissioning Group Sutton Clinical Commissioning Group April 2015
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From London Borough of Sutton Public Health – Commissioner of Children’s Public Health:
The Royal Marsden Foundation Trust currently manages the Children’s Public Health Nursing workforce and we applaud the inclusion of an indicator in the Quality Account.
The Children’s Public Health Quality Indicator (Priority 12) is yet to formally report and we will hope to use the knowledge in the forthcoming reprocurement.
Sue Levi Consultant in Public Health Medicine, People's Directorate London Borough of Sutton Royal Marsden Quality Account 2014/15 Chair’s statement:- As Chair of Sutton Council’s Scrutiny Committee I am pleased to provide some comments on the Royal Marsden’s Quality Account for 2014/15. As with previous versions, the Account provides a useful overview of the work of the Trust and is improved this year by the inclusion of personal statements from key staff members. This can only help on the journey towards the ambition of providing a document which is both clear and comprehensive and is easy to read for non-clinical experts. Sutton’s Scrutiny Committee looks forward to working more closely with colleagues at the Royal Marsden over the coming year to better understand the priorities and issues covered in the Quality Account and share performance information on a more regular basis. Cllr Alan Salter Chair of the Scrutiny Committee, London Borough of Sutton Statement from Councillor Robert Freeman (Chairman, Adult Social Care and Health Scrutiny Committee, Royal Borough of Kensington and Chelsea) on the Quality Account 2014/15 I am pleased to provide this brief statement for The Royal Marsden’s Quality Account for 2014/15. The Royal Borough of Kensington and Chelsea has an excellent working relationship with The Royal Marsden. The Quality Account gives a useful overview of the work and performance of trusts. The Royal Marsden is a world renowned cancer care organisation. It can be more difficult for a scrutiny committee to scrutinise with a specialist trust, such as The Royal Marsden, because only a small proportion of The Royal Marsden’s patients are from the scrutiny committee’s borough. However, having said this, we are most proud of
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having The Royal Marsden based in the Borough. The Royal Borough’s scrutiny committee, with our scrutiny colleagues from Sutton, have endeavoured to carry out a number of joint public meetings on The Royal Marsden, over the years. These meetings have been successful in engaging the public. At these meetings the Royal Marsden’s Executive have been questioned by both councillors and the public. We look forward to working more closely with colleagues at The Royal Marsden over the coming year to better understand the priorities and issues covered in the Quality Account 14/15. Councillor Robert Freeman Statement from the Council of Governors on the Quality Account 2014/15 In each of its meetings the Council of Governors reviews the Quality Accounts presented by the Chief Nurse, Dr Shelley Dolan, and discusses priority quality issues. A working group of the Council the Patient Experience and Quality Account Group, has also reviewed feedback from patients, including the frequent feedback surveys, and has influenced the questions used in these surveys to reflect patients’ interests. Governors helped agree the process for developing and selecting priorities for quality improvement and have met with patient, carer and public members at Members’ Events, one of these events in particular, in November 2014 which focused on the themes in the Quality Account. These events allowed Governors and members to discuss and challenge the current priorities and to feedback their views on future areas relating to patient safety, clinical effectiveness and patient experience. The Royal Marsden strives to improve the presentation of data each year to make the Quality Account, now in its fifth year of publication, more succinct, interesting and readable by the general public as well as by healthcare professionals. This year Governors have seen a considerable improvement in the layout of the information, making it easier to read and digest. Based on their involvement and the feedback they have received from members and other patients and carers, Governors endorse the key priorities for improvement as set out in the Quality Account. Council of Governors April 2015 The Royal Marsden NHS Foundation Trust 2013-2014 Annual Quality Account Members of the Patient and Carer Advisory Group have considered The Royal Marsden's Quality Account for the Period 2014/15 the sixth such report produced by the Trust. We believe the report clearly demonstrates that the Trust remains focussed on listening to its patient, carer and staff community, and that it has robust arrangements in place to monitor its performance. The objectives set out in the report provide clear evidence that the Trust continues to strive to improve and challenge the quality of care and services it provides, both in the hospital and in community services in Sutton and Merton. We commend this approach.
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We are pleased to note the efforts made by the Trust to reduce the waiting times for chemotherapy and for receipt of take home medicines on discharge, and to improve communications with patients and we also welcome the targets set for further improvement in these areas, in the coming year. We also endorse the continued efforts to improve care for patients in the Sutton and Merton community services, for example the steps taken to prevent and manage pressure ulcers and to improve the health of reception age children. The excellent response to the Friends and Family Test from both the hospital and community services is well deserved by the Trust. The Patient and Carer Advisory Group congratulates the Trust on its Quality Account and its achievements over the year. We look forward to further improvements in the patient experience over the coming year. Anita C. Gray Chairman – the Patient Carer Advisory Group Statement from Healthwatch Merton Healthwatch Merton acknowledge the good work of the Trust over the last year in improving quality of services for patients and its work in engaging a wide range of service users and the public. We would like to congratulate the Trust on once again retaining its Customer Service Excellence Standard and highlight central to achieving this standard is ‘with the citizen always and everywhere at the heart of public services provision’. We note that several of the priority areas in this quality account reflect community issues. Welcoming the addition of ‘Priority 12 - To improve health outcomes for children in Reception year’ and the recognition by the Trust for ‘Priority 9 - Reduction in chemotherapy waiting times and improvement in patient experience related to waiting times: Were you kept informed about your waiting times?’ which as well as raised within our own work, is evidenced within your intelligence gathering and needs improving. We look forward to wherever possible working with the Trust over the next year on continued improvement in these areas. Dave Curtis - Manager Healthwatch Merton Statement from Healthwatch Sutton In general, we have not identified any themes in feedback relating to the services provided by the Royal Marsden NHS Foundation Trust and as such no directly related pieces of work have been carried out by Healthwatch Sutton during 2014/15. We have identified the following positive feedback: 1) We have followed the work of The Royal Marsden NHS Foundation Trust through representation on the Patient Experience Group.
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2) We were pleased to see that community services in general have not featured as one of the main concerns for the people of Sutton. 3) We have participated in the development of the Better Care Fund alongside The Royal Marsden NHS Foundation Trust which has made a valuable contribution towards the development of this programme. 4) We are working with Sutton CCG as part of the re-procurement process of community services in Sutton. Pete Flavell Healthwatch Sutton Manager
Healthwatch Central West London (CWL) response to the Royal Marsden NHS Foundation Trust Quality Account 2014-2015
Healthwatch CWL welcomes the opportunity to comment on the quality account of The Royal Marsden NHS Foundation Trust. We acknowledge the continual work of the Trust in improving quality of services for patients and engaging with a wide range of service users and the public for this purpose.
We commend overall improvements from last year in various quality areas including completing risk assessments, attempts to improve hygiene of patients and the reduction in the number of avoidable readmissions to hospital.
We note that several of the priority areas are key priorities for healthwatch in ensuring that the patient experience, comfort and safety are paramount for all patients using the Chelsea site. In particular we would like to commend the work of the Trust on reducing infection and acknowledge the maintenance of excellent hygiene standards within the hospital and effort to prevent cross infection. The target for the number of MRSA patients was slightly missed; however it was exceeded for C.difficile infections.
In relation to patient safety we are pleased to see improvement in the number of patient incidents as targets were met, with rates in the Royal Marsden falling below national average. Whilst procedures have been put in place for once an incident has happened, members of Healthwatch would like to know more detail about the preventative measures taken by staff in relation to incidents.
We commend the trust for readmission levels of less than 1% within 28 days. Our members would welcome further information about how readmission is managed and some of the common themes of the readmissions.
It is reported that in surveys filled out by non-staff members, complaints were made that acronyms such as DTALD and other medical jargon should be avoided as it is not easy for a lay person to understand, and results in some people not being able to complete the survey.
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In relation to chemotherapy waiting times, our members would welcome further analysis of the situation as the data in Priority 10 shows that patients were not kept well informed about waiting times and in recognising that the survey asks closed questions we would implore the trust to correlate these findings with complaints and data received via PALs and external sources.
Healthwatch looks forward to maintaining our strong working relationship with the Trust in 2015/16 in the delivery of opportunities for patient and public involvement.
For further information please contact Mel Christodoulou Healthwatch CWL, 020 8968 7049 [email protected]
Borough Manager (Kensington and Chelsea) Appendix 4 Statement of director’s responsibilities for the quality report The directors are required under the Health Act 2009 and the National Health Service Quality Accounts Regulations to prepare quality accounts for each financial year. Monitor has issued guidance to NHS foundation trust boards on the form and content of annual quality reports (which incorporate the above legal requirements) and on the arrangements that foundation trust boards should put in place to support the data quality for the preparation of the quality report. In preparing this quality report, directors have taken steps to satisfy themselves that the content of the quality report meets the requirements set out in the NHS Foundation Trust Annual Reporting Manual 2014/15 and supporting guidance. The content of the quality report is not inconsistent with internal and external sources of information including:
• Board minutes and papers for the period April 2014 to March 2015 • Papers relating to Quality reported to the Board over the period April 2014
to March 2015 • Feedback from the commissioners dated 10/04/2015 • Feedback from the governors through the Council of Governors
throughout the year dated 10/04/2015 • Feedback from local Healthwatch organisations dated 02/04/15,
10/04/2015 and 02/04/2015 • Feedback from Overview and Scrutiny Committee dated 10/04/2015 • The Trust’s complaints report published under regulation 18 of the Local
Authority Social Services and NHS Regulations 2009, dated 18/04/2014 • The 2014 national in-patient survey results, dated /02/2015 • The 2014 national staff survey, dated /02/2015 • The Head of Internal Audit’s annual opinion over the Trust’s control
environment dated xx/xx/15 • CQC Intelligent Monitoring Reports from April 2014 to March 2015
- The Quality Report presents a balanced picture of The Royal Marsden NHS
Foundations Trust’s performance over the period covered; - The performance information reported in the quality report is reliable and accurate; - There are proper internal controls over the collection and reporting of the measures
of performance included in the quality report, and these controls are subject to review to confirm that they are working effectively in practice
- The data underpinning the measures of performance reported in the Quality Report is robust and reliable, conforms to specified data quality standards and prescribed definitions is subject to appropriate scrutiny and review; and the Quality Report has been prepared in accordance with Monitor’s annual reporting guidance (which incorporates the Quality Accounts Regulations) as well as the standards to support data quality for the preparation of the quality report.
The directors confirm to the best of their knowledge and belief they have complied with the above requirements in preparing the quality report. By order of the Board
Mr R. Ian Molson Chairman XX 2015
Cally Palmer CBE Chief Executive XX 2015
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Appendix 5: Independent Assurance Report Independent Auditor’s Report to the Council of Governors of The Royal Marsden NHS Foundation Trust on the Quality Report Scope and subject matter Respective responsibilities of the Directors and auditors Assurance work performed Limitations Conclusions
COUNCIL OF GOVERNOR PAPER SUMMARY SHEET
Date of Meeting: 10th June 2015
Agenda item Item 7.2.
Title of Document: Quality and Performance: Quality Accounts for February 2015 – April 2015
To be presented by
Chief Nurse
Executive Summary The monthly Quality Account reports the current Trust performance against the targets for 2014/15 described in the Annual Quality Account (2013/14) under the following three nationally agreed categories:
• Safe care • Effective care • Patient experience
Recommendations The Council is invited to note the performance of the Trust against the agreed national and local quality targets for February 2015 to April 2015, and the actions being taken. Author: Shelley Dolan, Chief Nurse
Contact Number or E-mail: x2121
Date: 28th May 2015
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The Royal Marsden NHS Foundation Trust Quality Account for February, March and April 2015 presented to Council of Governors June 2015
Dr. Shelley Dolan, Chief Nurse
1.0. Introduction
The monthly Quality Account reports the current Trust performance against the targets for 2015/16 described in the Annual Quality Account under the following three nationally agreed categories:
• Safe care • Effective care • Improved Patient experience
1.1. Data Quality Information and data at the Royal Marsden is produced by a centralised dedicated expert team separate from the clinical and operational teams. This separation and expertise is critical to ensure that the data is accurate and is not affected by the operational teams who are trying to comply with local and national improvement targets.
2.0. Safe Care
2.1. Reduction in Healthcare Associated Infections (MRSA bactereamia and C Difficile infections)
Target: <31 C Difficile infections and <1 MRSA bactereamia
• Performance: Table 2.1 shows that the Trust had two attributable C Difficile (CDI) cases in April. As shown in the table below the target this year for the Trust is 31 cases of CDI.
Table 2.1
No. Organism RM attributable February 15
RM attributable March 15
RM attributable April 15
RM Annual Trajectory
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1. MRSA bactereamia
0 0 0 1
2. C.Difficile
2 5 2 31
*MRSA has a target of zero but Monitor has a de minimus of six cases.
2.2. Rate of patient safety incidents and percentage resulting in severe harm or death
To include: • Reduction of severe/moderate risk medication errors • Reduction of harm from falls
Target: Reduction in the rate of patient safety incidents per 100 admissions and the proportion that have resulted in severe harm or death
Performance: 2.2. (1) Reduction in Falls Target: < 0.7 moderate and above (resulting in harm) falls per 1000 bed days Year to date - to the end of April 2015 the Trust has met the target.
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4
5
Severity of Patient Fall incidents:
3 - Severity - Current Period
2014 04
2014 05
2014 06
2014 07
2014 08
2014 09
2014 10
2014 11
2014 12
2015 01
2015 02
2015 03
2015 04 Total
No Harm 18 12 21 23 20 21 26 14 16 21 11 11 17 214 Low / Minor (Minimal harm) 5 11 7 6 3 6 6 4 3 6 9 3 7 70 Moderate (Short term harm) 1 1 0 0 0 0 0 1 0 1 0 0 2 5 Severe / Major (Permanent or long term harm) 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Death / Catastrophic (Caused by the incident) 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Totals: 24 24 28 29 23 27 32 19 19 28 20 14 26 289 % Harm Patient Fall 25% 50% 25% 21% 13% 22% 19% 26% 16% 25% 45% 21% 35% 26% 2.2. (2) Reduction in medication errors Target: To increase the reporting of near misses and decrease the incidents that cause actual harm (low<2 per 1000 bed days and moderate <0.17 per 1000 bed days). N.B. To place medication errors in perspective, annually 0.05% of all medicines administered result in a medication error. For April 2015, the figure is also 0.05%
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7
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Severity of medication incidents:
3 - Severity - Current Period
2014 04
2014 05
2014 06
2014 07
2014 08
2014 09
2014 10
2014 11
2014 12
2015 01
2015 02
2015 03
2015 04 Total
No Harm 51 52 66 49 59 54 63 56 81 58 68 49 43 702 Low / Minor (Minimal harm) 13 8 16 11 8 11 14 11 13 14 7 9 19 144 Moderate (Short term harm) 0 0 0 0 1 1 0 3 0 3 0 0 0 8 Severe / Major (Permanent or long term harm) 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Death / Catastrophic (Caused by the incident) 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2.3 Percentage of admitted patients risk assessed for Venous Thrombo-embolism (VTE)
Target: 95% have completed VTE risk assessments Performance: The Trust consistently achieves >90% compliance with risk assessment (CQUIN target is 90%). All patients with confirmed VTE as reported by radiology undergo a Root Cause Analysis (RCAs). The VTE steering board monitor all confirmed VTE and scrutinise the RCAs.
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3.0 Effective Care
3.2 Incidence of Trust acquired pressure ulcers
3.2.1 The number and severity of healthcare acquired pressure ulcers are used internationally as a proxy for the effectiveness of care provision. Many people with cancer and or co-morbidity are more vulnerable to tissue damage for the following reasons; multiple hospital admissions, frailty, multiple drugs including high dose steroids (decreases skin elasticity), immobility, malnutrition or susceptibility to infection.
3.2.2 Data for this report was taken on 1st May (hospital) and on 1st May (SMCS) 2015 from DATIX. Data may have been updated since. 3.2.3 Total number of patients with the Trust (hospital/community services) attributable pressure ulcers for the month of
April 2015: 54 [Hosp=24, Community services= 30]
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3.2.4 For serious incident reporting to Steis [Strategic Executive Information System] as Hospital/Community Services. Number of patients with Trust attributable pressure ulcers at categories 3 and 4 for the month of April 2015: 4 [Hosp=1, Community services=3]
3.2.5 Number of patients with Trust attributable category 3 and 4 pressure ulcers
Number of patients with Trust attributable category 3 and 4 pressure ulcers,
April 2014- April 2015
hospital
communityservices
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3.2.6 Number of patients with Trust attributable pressure ulcers, all categories
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Description of European Pressure Ulcer Advisory Panel (EPUAP) pressure ulcer classification system. EPUAP Description of Stage
1 Non blanching redness of intact skin 2 Partial thickness skin loss or blister 3 Full thickness skin loss (fat visible) 4 Full thickness tissue loss (muscle/bone visible) 3.3. Emergency re-admissions to hospital within 28 days of discharge Target: Reduction in the number of avoidable re-admissions to hospital within 28 days of discharge Performance: Within 28 days of original admission there were the following emergency admissions:
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4.0 Patient Experience 4.1 Reduction in chemotherapy waiting times and improvement in patient experience related to waiting times
Target: Reduction in chemotherapy waiting times at Sutton/Chelsea and improvement in the patient experience related to waiting times Performance: Data in the following graphs are for all chemotherapy attendances, for NHS and Private Patients.
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Table 1: Chelsea chemotherapy waiting times
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Table 2: Sutton chemotherapy waiting times
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Table 3: Kingston chemotherapy waiting times
Actions to reduce long waiting: The Trust is introducing electronic chemotherapy prescribing (echemo). The existing paper based proforma printing system for chemotherapy requires transfer of paper prescriptions and orders which can be time consuming in peak times and slow down the chemotherapy pathway. E-prescribing of chemotherapy allows decisions to be communicated in real time to all relevant departments so that work can commence in preparing a patient’s chemotherapy as soon as a doctor has assessed them as fit to receive it. This reduces process inefficiencies, lost drug charts as
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well as allowing each step of the pathway to be electronically auditable to facilitate future quality initiatives. The e-prescribing system also aids medical staff in prescribing subsequent cycles of treatment for patients through use of a re-prescribe function, supporting pre-ordering of chemotherapy which has continued to be a challenge in 2014-15. The Trust went live with a pilot with the Lung cancer unit in October 2014 and has since rolled out to introduce ‘e-Chemo’ to the breast unit in January, GI in March, and skin and half of urology at the end of April 2015. The remainder of the solid tumour areas (rest of urology, neuro-onc, gynae, head and neck, and sarcoma) are planned to go live between now and end of June 2015. Haematology and paediatrics are in the process of preparatory work now for projected go lives near end of Summer and end of 2015 respectively. 4.2 Ensure that we are responding to inpatient’s personal needs The Friends and Family Test
The NHS “Friends and Family Test” was announced by the Prime Minister on 25 May 2012. The national mandated question asked is:
“How likely are you to recommend our ward to friends and family if they need similar care or treatment?”
The patients then select their answer from the following Likert Scale:
“beds could be improved a great deal. Some nurses were very helpful and considerate and other had the attitude they couldn’t be bothered”
The only criticism is that extra equipment was stored in the bathroom, which got in the way”
Day case (453)
Day case
Alongside positive comments from day case 62 patients made suggestions for improvement (42 Sutton/20 Chelsea). These were around the following:-
Over twenty of the suggestions for improvement all related to the length of the waiting times and insufficient space for patients and staff from Sutton MDU.
Other suggestions for improvement were:-
“It was a bit confusing over the prescriptions. Now been told to ask my own GP for medication. After 3 months of receiving from chemo clinic”
“Chemotherapy process was not explained fully before my first appointment, I did not know what to expect and this forced me to be very anxious”
Outpatient (97 comments)
Alongside positive comments from outpatient 11 patients made suggestions for improvement. These were around the following:-
“Please make an effort to “speed up” blood taking – one person is not enough”
“Car parking charges that are made worse by time kept waiting for clinics running late and time kept waiting for medicine from the pharmacy. All these delays incur extra cost in an already high cost car park.”
“My initial diagnosis was 5 years ago my outpatient appointments are never on time and I can never get a mobile signal to advise my family”
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National FFT inpatient results reporting:
From November 2014 NHS England will no longer report against a ‘net promoter score’ and instead will report a percentage of those who would recommend the Trust to friends and family. The table below has been updated to reflect this.
Inpatient data was collected for 170 Acute NHS trusts and independent sector providers. Nationally, the overall average inpatient percentage for those who would recommend the service to friends and family was 95% in February.
The table below shows the results for the Trust over each quarter to date. At the time of reporting (30th April 2015) national figures were available up to March 2015.
Q1
‘13-‘14
Q2
‘13-‘14
Q3
‘13-‘14
Q4
‘13-‘14
Q1
’14-‘15
Q2
’14-‘15
Q3 ’14-‘15
Jan ‘15
Feb ‘15
Mar ‘15
The Royal Marsden percentage of inpatients who would recommend
-- -- -- -- -- 94% 97% 99% 100% 98%
National average
-- -- -- -- -- 94% 95% 94% 95% 95%
Response number
585 635 450 711 633 738 425 162 211 228
5.0. Safer staffing
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From June 2014 all Trusts are required by the Department of Health, Monitor and Care Quality Commission to be able to assure their Boards around the provision of nursing care on its wards and units. This new requirement follows the national failings in care at Mid Staffordshire NHS Foundation Trust and other Trusts since put on “special measures”. The final Francis report recommended that Boards regularly check that levels of nurse staffing are appropriate for good quality care. Therefore from June 2014 the RM Board has received a monthly summary of planned numbers of nurses and Health Care Assistants (HCA) during the day and at night, versus the actual numbers. It is also mandated that the Board receive a six monthly report from the Chief Nurse regarding all issues regarding Safe Nurse staffing across the Trust. Such a report has been presented to the June 2014 and January 2015 Board and will be presented again in June 2015. The following data is the planned and actual nurse staffing for April 2015. Overall the percentages are as follows:
Average fill rate for Night staff 101.5% Average fill rate for Day staff 101.3% Average fill rate for Registered staff 99.8% Average fill rate for Care staff 109.3% Average Trust wide fill rate (All staff, night and day) 101.4% 5.1. Nursing Leavers and Starters Report The tables below show the number of nurse starters and leavers over a two year period. In the financial year 2013/14 the number of nurse leavers equated to 12 nurses per month on average. For the current financial year more nurses have been recruited at this point than in the last financial year however the Trust still continues to lose more nurses than recruited. In November the Chief Nurse began a monthly recruitment meeting to address the issues around recruitment and retention of nurses. The RM is keen to improve recruitment and retention of nurses particularly at bands 5 and 6 (junior and senior Staff Nurses). The new recruitment group is facilitating HR, senior nursing, marketing and communications to work together and look at innovative solutions. In April as illustrated below the Trust had six new starters but there were 15 leavers (nine from SMCS). There are in total 62 nurses in the recruitment pipeline who have been recruited and are due to start as soon as possible. The recruitment team are focusing on improving the interview to start time.
Band 5 - 7 Nurses April 2014 to Date
Apr-
14 May-
14 Jun-
14 Jul-14
Aug-14
Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr -15 Total
6.0. Governors are invited to note the performance of the Trust against the agreed national and local quality targets for February, March and April 2015 and the actions being taken.
Apr May Jun July Aug Sep Oct Nov Dec Jan Feb March Average TotalStarters 16 8 8 5 4 13 20 8 8 10 4 16 10 120Leavers 9 8 14 13 17 18 11 13 13 14 6 6 12 154Balance +7 0 -6 -8 -13 -5 +9 -5 -5 -4 -2 +10 -2 -34
Band 5-7 Nurses April 2013/ March 2014
COUNCIL OF GOVERNOR PAPER
SUMMARY SHEET
Date of Meeting: 10th June 2015
Agenda item 7.3.
Title of Document: Quality and Performance: CQC Inpatient Survey
To be presented by
Chief Nurse
Executive Summary To improve the quality of services the NHS delivers it is important to understand what people think about their care and treatment. This is the twelfth survey of adult inpatients and 154 acute and specialist NHS trusts participated in 2014. The Care Quality Commission will use the results to assist in their regulation, monitoring and inspection of NHS acute trusts in England. Recommendations The Survey of Adult Inpatients 2014 provides essential feedback that must be used to ensure continuous improvement. The Royal Marsden has demonstrated that it can make improvements using the 2013 results and will continue the cycle of continuous improvement in 2015. Governors are invited to discuss this paper and this important patient feedback. Author: Shelley Dolan, Chief Nurse
Contact Number or E-mail: x2121
Date: 27th May 2015
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Report for the Board on The Survey of Adult Inpatients 2014
May 2015 1.0. Introduction to the Survey of Adult Inpatients
To improve the quality of services the NHS delivers it is important to understand what people think about their care and treatment. This is the twelfth survey of adult inpatients and 154 acute and specialist NHS trusts participated in 2014. The Care Quality Commission will use the results to assist in their regulation, monitoring and inspection of NHS acute trusts in England. They use the data from the survey in their system of Intelligent Monitoring. This provides inspectors with an assessment of risk within NHS trusts that may require follow up. NHS England will use the results to check progress and improvement against the objectives set out in the NHS mandate. 2.0. Survey method The survey included all patients aged 16 years or older who had spent at least one night in a hospital between June and August 2014. Patients eligible for the survey were taken from Trust patient administration systems. During September to December 2014 postal surveys were sent to patients’ home addresses following their discharge. Up to two reminders were sent to non-responders. A freepost envelope was included for replies. Patients could call a free telephone line to ask questions, complete the questionnaire verbally, or access an interpreting service. 2.1. Response rate national and Royal Marsden The national response rate was 47% (59,000 patients). The Royal Marsden (RM) achieved a higher response rate of 59% with responses returned from 468 patients who had received treatment during June to August 2014 (n=850).. 3.0. The Royal Marsden NHS Foundation Trust 2014 results 3.1 Patient responses placed The Royal Marsden in the best performing trusts in all ten relevant
sections (waiting list and planned admissions, waiting to get a bed on a ward, hospital and ward, doctors, nurses, care and treatment, operations and procedures, leaving hospital, overall views of care and services and overall experience).
3.2 There were 58 questions that were relevant to the trust. There were two questions that were not
relevant and these related to Accident and Emergency departments. 3.3 The responses showed that for ‘overall experience’ the trust was rated very highly by patients at
9.1/10 (highest score nationally, 9.2/10). 3.4 When asked if ‘patients felt they had been treated with respect and dignity while in
hospital’ responses rated the trust 9.8/10 which was the highest score achieved by trusts nationally.
3.5 Patient responses also placed the trust in the best performing trusts for 50 out of 58 of individual
questions. For example, • ‘being given answers from doctors’ 9.4/10 (highest score nationally 9.4/10)
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• ‘getting answers you could understand from nurses to questions they had’ 9.3/10 (highest score nationally 9.3/10)
• ‘having confidence in the decisions being made about their condition or treatment’ 9.3/10 ( highest score nationally 9.4/10)
• ‘staff explained about the purpose of medications they were taking in a way they could understand’ 9.5/10 (highest score nationally 9.7/10)
3.6 For the other 8 out of 58 questions the trust performed about the same as other trusts. These areas will be focussed on in the action plan.
• ‘bothered by noise at night from other patients’ 7.0/10 (highest score nationally 8.9/10) • ‘did staff discuss if additional equipment was needed in your home’ 9.0/10 (highest score
nationally 9.3/10 3.7 There were no questions that the trust was in the lowest category ‘worst performing trusts’.
3.8 There were three questions that the trust decreased scores from last year; however the trust
results still remained in the best performing trusts. • ‘length of time on waiting list’ 9.3/10, (highest score nationally 9.5/10) • ‘Were you offered a choice of food’ 9.5/10, (highest score nationally 9.6/10) • ‘Were there enough nurses to care for you’ 8.8/10, (highest score nationally 9.5/10)
4.0 Action plan 4.1 In 2014 following receipt of the 2013 survey results an action plan was developed. In the areas
identified and acted upon all the results had improved in the 2014 survey. 4.2 Appendix 1 shows the action plan that has been developed following the results of the 2014
survey. 5.0. Conclusion The Survey of Adult Inpatients 2014 provides essential feedback that must be used to ensure continuous improvement. The Royal Marsden has demonstrated that it can make improvements using the 2013 results and will continue the cycle of continuous improvement in 2015. The Trust is grateful to all of its patients who took the time to complete the survey. Governors are invited to discuss this paper and this important patient feedback.
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Appendix 1 KEY (Change Status)
1 Recommendation agreed but not yet actioned 2 Action in progress 3 Recommendation fully implemented 4 Recommendation never actioned (state reasons) 5 Other (please provide supporting information)
ACTION PLAN Please complete and return this action plan to Head of Quality Assurance within six months. Project title National Inpatient Survey 2014 results (May 2015) Action plan lead Name: Sarah Rushbrooke Title: Deputy Chief Nurse Contact: 2175 Question Actions required (specify “None”
if none required) Action by date
Person responsible (name and grade)
Comments/action status (Provide examples of action in progress, changes in practices, problems encountered in facilitating change, reasons why recommendation has not been actioned etc.)
Change stage (see Key)
Q11. Hospital and ward: Did you ever share a sleeping area with patients of the opposite sex?
1) Raise awareness among staff about the issues surrounding shared accommodation. 2 Review of clinical areas (including radiology) to identify areas that may be at risk of breaching this.
Q15. Hospital and ward: Were you ever bothered by noise at night from other patients?
On admission nursing staff to encourage patients – 1) To speak to nurse in charge to ascertain causes in order to deal with noise. 2) To play games on phone with volume turned down.
June 2015 Divisional Clinical Nurse Director Common Cancers, Matrons.
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3) Use ear phone when watching television or watch in dayroom. 4) Minimise phone calls made after 10pm.
Q23 Hospital and ward: Did you get enough help from staff to eat your meals.
Raise awareness among nursing staff on the wards about overseeing meal times and ensure protected mealtimes are in place.
June 2015 Divisional Clinical Nurse Directors
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Q32 Care and treatment: Were you involved as much as you wanted to be in decisions about your care and treatment?
Raise awareness with staff about including patients and documenting on the electronic patient records.
July 2015 Divisional Clinical Nurse Directors
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Q53 Leaving hospital: Discharge delayed due to wait for medicines/to see doctor/for ambulance.
1) Review qualitative comments from patients to identify which particular area is of more concern. 2) Actions related to delays raised following review.
June 2015 1) Head of Quality Assurance 2) Discharge and Vulnerable adult Lead
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Q64 Leaving hospital: Did hospital staff discuss with you whether additional equipment or adaptations were needed in your home?
Review current practice and identify areas for improvement on both sites.
June 2015 Discharge and Vulnerable adult Lead
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COUNCIL OF GOVERNOR PAPER SUMMARY SHEET
Date of Meeting: 10th June 2015
Agenda item 7.4.
Title of Document: Quality and Performance: Staff Survey
To be presented by
Chief Operating Officer
Background The annual NHS Staff Survey provides an important source of feedback from staff about their jobs, their colleagues and the organisation and is used to shape the Trust’s workforce strategy. Staff survey ratings are also used by the CQC as part of the Quality and Risk Profile.
Executive Summary The findings from both the national NHS staff survey and the Staff Friends and Family Test show a broadly positive message with the majority of staff reporting good working experiences. However, the Trust’s drive for excellence applies as much to the working lives of staff as to patient experience and outcomes and there is room for improvement. Key findings:
• Overall similar position to last year, with eight areas above average for acute specialist Trusts
• Staff report the highest rate nationally for feeling secure in raising concerns about unsafe practice
• We continue to perform well on support from immediate manager • There has been an improvement in the percentage of staff able to contribute towards
improvement at work • There continues to be evidence of working excessive hours and some evidence or
work related stress • The findings of subtle bullying and harassment have not changed from last year • Staff consistently feel they can make a positive contribution to patient care and
would recommend this organisation if friend/relative required treatment
Key actions: • Conduct a series of listening events with staff to explore what excellence looks like
for The Royal Marsden as an employer • Support health and wellbeing of staff through a programme of events and continued
staff support services, as well as support to find more efficient ways of working • Improve the appraisal rate and ensure quality appraisals • Consistently reinforce expectations about behaviours and requirements of all staff
and support those who experience harassment and bullying • Continue to support training and development and explore further with staff how it
is accessed and experienced, to better understand the apparent mismatch between availability of education and development opportunities and staff perceptions, particularly when we know that the opportunities at RMH are greater than in other teaching hospitals.
Continue to conduct the national survey and Friends and Family Test, seeking an improved response rate and explore with staff other means of them providing feedback.
Recommendations The Council is asked to:
1. Note the findings from the surveys
2. Review actions for appropriateness and relevance and make any further recommendations
Author: Assistant Director of Workforce
Contact Number or E-mail:
Date: 27th May 2015
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National Survey Results – Staff Survey
1. Background The Royal Marsden recognises the strong association between aspects of staff engagement and indicators of the quality and costs of care, as evidenced by the research findings summarised in the Point of Care Foundation report, Staff Care 2014. The annual NHS Staff Survey provides an important source of feedback from staff about how they are currently feeling about their jobs, their colleagues and the organisation and as such informs the Trust’s workforce strategy.
The Trust attracts the highest calibre workforce who work hard to provide an excellent service to patients. Our ambition is to be recognised as an excellent employer, as well as an excellent service provider and to achieve this we need to maintain and improve staff engagement and morale, so that we can together respond to the demands and challenges we face.
Whilst not the only way in which the Trust gains an understanding of staff’s experience, the annual survey does provide a useful indicator of staff engagement. Staff survey ratings are also used by the CQC as part of the Quality and Risk Profile. The results and action plan for the annual staff survey and the staff friends and family test were reported to QAR in May 2015.
It is important that the Board both demonstrates an understanding of how staff are currently feeling against the key indicators contained within the report and endorses the improvement plan in response.
2. Survey Findings The staff survey is structured around the NHS staff pledges, with many key findings linked to them. The pledges are made by all NHS employers to all NHS staff as a commitment to provide high-quality working environments for staff.
Overall, the staff survey results are positive. It is recognised that there is scope for further improvement if the Trust is be regarded as an excellent employer for staff engagement. This section describes the key findings from the 2014 staff survey results.
Appendix 1 shows the results of this year’s survey for each of the 29 Key Findings and shows how this compares to the previous year’s results, those of all acute specialist trusts and the national average. It also provides internal comparators by Division and staff group. Table 1 shows the number of staff by division.
Table 1: Number of by Division / Directorate as at March 2015 Division / Directorate Total Clinical Services Division 1254 Cancer Services Division 1160 Community Services Division 848 Facilities Directorate 216 Private Care Division 218 Corporate Services - Management, Performance and Communications 164 Workforce and Corporate Affairs 105 Finance, Estates and Capital Projects 103 Nursing, Risk & Quality Assurance 69 Grand Total 4137
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Note – this figure is higher than the number who were eligible for the staff survey due to exclusions including maternity leave and new starters since Sept 2014.
The results for The Royal Marsden continue to be positive:
29 Key Findings
Improvement
No significant change
Deteriorated
Comparison to previous year 3 22 2
(2 Key Findings cannot be compared due to changes in questions)
29 Key Findings
Better than average
Average
Worse than average
Comparison to acute specialist Trusts
8 16 5
Of these five worse than average, there is only a marginal variance from the national average for three of them.
The aim this year is to drive improvements to minimise the indicators where there is a negative variance from the national average.
Highlights from the findings:
Response rate:
All eligible staff (3,589) were invited to complete the survey and 1,957 responded. The number of respondents is the highest of all acute specialist trusts.
55% (from 51%)
(national response rate 42%
Highest ranking nationally:
Staff agreeing that they would feel secure raising concerns about unsafe clinical practice
81%
(national average 68%)
Largest improvement from last year:
% staff able to contribute towards improvements at work
76% (from 69%)
Other significant improvements:
% staff witnessing potentially harmful errors, near misses or incidents
25% (from 30%)
% staff experiencing physical violence from patients, relatives or the public in the last 12 months
4% (from 6%)
Other findings – areas for improvement
This section outlines the areas for improvement and section 4 sets out the Trust action plan.
Appraisals: 84% staff reported having had an appraisal in the last 12 months. This is higher than the Trust’s reported appraisal rate (77% as at end March 2015) which reinforces the need for the current work to improve reporting and recording of appraisals and aim towards achieving an appraisal completion rate of over 90%.
There has been a slight increase in the work pressure felt by staff from 2.82 to 2.91 and those suffering work-related stress remains steady at 36%. However, The
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Trust rates better than average for acute specialists for support from immediate managers. Notwithstanding the increase in work pressures, overall staff motivation and satisfaction have remained largely the same, whereas the national picture shows both have fallen. The overall staff engagement indicator also remains the same.
Levels of training reported by staff have remained the same as last year and are in line with the average for acute specialist trusts. This is disappointing as one of the most frequent reasons provided by staff for why they would recommend The Royal Marsden as a place to work is the opportunities for staff development. Questions in the survey related to training include if staff have received training on how to deliver a good patient / service user experience, mandatory training and other training and development. We know that we need to further improve mandatory training rates; however support for continuing professional development is good. We want to explore this finding further to understand how staff perceive the training they are accessing and where there may be gaps. In line with national responses, the survey again shows a poorer reported experience for BME staff and those with a disability in a number of key findings. This has previously been identified and is being monitored through the Trust’s Equality, Diversity and Inclusion Strategy Group.
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3. Other sources of feedback - Staff Friends and Family Test (SFFT) The Staff Friends and Family Test is a national NHS survey that has been run for the first time in 2014/15. Implementation of the survey is a CQUIN target. The survey has been run in the three quarters of 2014/15, with the annual staff survey being run in quarter three. The requirement is that all staff should be asked to participate in the SFFT at least once over the year. The Royal Marsden has invited all staff to participate each time the survey was run in 2014/15.
The responses for each of the tests run in the last financial year are shown below. Further detail on the comments and findings by Division are provided to Directors for local action planning and are used to inform Trust actions.
Responses for SFFT for 2014/15
Question: How likely are you to recommend this organisation to friends and family … as a place to receive care or treatment (‘care’) … as a place to work (‘work’) Q1 2014 Q2 2014 Q4 2014 Recommend – Care 95% 96% 96%
Not recommend – Care 1% 1% 1%
Recommend – Work 73% 73% 74%
Not recommend – Work 9% 10% 11%
Response rate (%) 49% 49% 34%
Response rate (number of respondents) 1786 1798 1359 Note the annual staff survey was run in quarter 3 in place of the SFFT.
NHS England publishes the results of the SFFT in the quarter after the last survey closed. This provides some opportunity for benchmarking, although with a caution that standardisation techniques have not been applied to control the differences in numbers of respondents between quarters or organisations. A summary of this benchmarking comparison for quarter two results is provided here:
Benchmark data for SFFT for quarter two
How likely are you to recommend this organisation to friends and family … as a place to receive care or treatment (‘care’) … as a place to work (‘work’) RM National
London area
Ranking out of all Trusts' responses - %
Recommend – Care 96% 77% 77% 14/242
Not recommend – Care 1% 8% 8% 10/242
Recommend - Work 73% 61% 63% 42/242
Not recommend - Work 10% 19% 19% 31/242
The results for quarter four have not yet been published.
4. Action plan
From an analysis of these survey results and previous feedback from staff, the actions below have been identified in relation to emerging themes and in response to key findings. The restraints of the NHS context within which we work mean that it will not be possible to respond to all of the points made by staff in relation to resources and the physical working environment, particularly in the short term. As well as helping staff to understand the reasons for this, it is even more important that we
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optimise the opportunities we do have to improve working lives through ensuring that staff feel valued and involved and are aware of and make the most of the support and opportunities available to them. Many of the actions set out below build on work in progress. Actions:
- Hold listening events with staff through June, to identify changes that will have the biggest impact and as a further way of involving staff in planning for improvement.
- Strengthen local accountability – Fundamental to improving staff survey results is creating a greater ownership of the workforce agenda at local level. The Divisions have been provided with their own results and we aim to strengthen accountability by:
o Ensuring that there a formal action plan in place for each by 12 June 2015
- Support health and wellbeing – These actions relate in particular to key findings (KFs) 3, 5, 11. The aim here is to develop a programme of health and wellbeing events throughout the year to support staff and increase skills development related to resilience by:
o Promoting staff support services already available through the weekly bulletin on a quarterly basis starting in June 2015.
o Promoting participation in Schwartz rounds.
o Further reducing vacancies, particularly in the hard to fill areas. The aim this year would be to reduce vacancies to 5% or below by March 2016.
o Developing different ways of working through the work of the Transformation Board and Continuous Improvement Group.
o Developing a health and wellbeing programme by the end of quarter 1 and implementation of the programme by the end of quarter 2
o Developing an employee proposition that helps to differentiate us from other NHS employers and allows us to recruit and retain high calibre staff. In order to do this in a way which takes us above and beyond the usual NHS practices, we will be applying to The Royal Marsden Cancer Charity for funding support in June 2014 for a range for workforce programme to enable us to:
recruit and retain the brightest and best
implement a range of recognition schemes
continue to support our staff in their demanding roles through the Staff Support team
o Driving improvement of the appraisal completion rate with an aim to get to 90% or above by 31 March 2016
o Driving improvement of mandatory and statutory training compliance to 90% or above by 31 March 2016 focusing on the five strands of training that apply to all staff, with a communication plan in place by July 2015.
o Implementing a new e-learning system by October 2015
- Consistently reinforce expectations about behaviours and requirements of all staff, including treating each other with dignity and respect - (KFs 19, 27, 28) by:
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o Establishing a mediation service
o Promoting the Workplace Adviser service to those who do experience harassment and bullying from June onwards.
- Encourage incident reporting and maintain high rates of confidence in raising concerns. The Trust scored the highest in the country in relation to staff feeling secure raising concerns about unsafe practice (KF15). However, those reporting potential incidents that they had witnessed reduced from 97% to 94% (KF12). Further analysis indicates that this relates to a small reduction in the number of administrative staff not reporting observed incidents and work is ongoing to review and address this issue.
o Focus improvement work on the administrative and clerical staff group to bring reporting up the levels of other staff groups
- Continue to support and promote workforce development (KF6), specifically we will:
o Explore, through the Listening Events, how staff perceive the training they are accessing and where there may be gaps. Continue to monitor and improve the effectiveness of training. The Listening Events are scheduled for June/July 2015
o Promote workforce development opportunities and how these benchmark against other organisations
o Raise profile of education and training through development of a multi-professional strategy by January 2016
- In the last year there was a significant improvement in staff’s ability to contribute to improvements in work (KF 22). The plan is to build on this and other staff engagement work to improve team working and more effective ways of working by:
o Reviewing team meetings by end of quarter 2
o Continuing to develop forums for staff engagement and involvement in quality improvements through Transformation programme
The current NHS environment in which we are working and the already positive results means that it will continue to be a challenge to see significant improvements in staff survey responses. However, with the actions above and the work already underway we are aiming to move from average to better than average on a number of key indicators. We will also ensure that staff can access high quality support when they need it.
We will continue to conduct the national survey and Friends and Family Test, to seek an improved response rate and explore with staff other means of them providing feedback. The GMC (General Medical Council) trainee survey is another source of feedback from our doctors in training and when the results of this survey are published in the summer, the improvement plan will be reviewed to incorporate these as appropriate.
5. Monitoring improvements Progress with local action plans and findings from the Listening Events will be monitored at the newly proposed Workforce Committee. The feasibility of adapting the local Staff Family and Friends to include questions on the areas outlined above is being explored. This would enable the Trust to assess if the actions described above
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have had a positive impact. It would also help would provide valuable local data ahead of the national survey. Whilst the actions described above are intended to have an impact on 2015 staff survey results, it should be recognised that impact from some of the actions will require a longer timescale. 6. Conclusions and Recommendations
The Council is asked to:
1. Note the findings from the surveys
2. Review actions for appropriateness and relevance and make any further recommendations
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Appendix 1
Staff survey 2014 – key findings compared with previous year, acute specialist trusts and national average and Divisions
Key findings by Staff Group
See spreadsheet appendices
Staff Pledge
HCC Key Score No. Description
Staff Survey Question Nos %14/15 %13/14
Statistically significant change since 13/14
Average for Acute Specialist Trusts %
Ranking Compared with all Specialist Trusts in 2013 %
Best for Acute Specialist Trusts %
National average %
Clinical Services
Cancer Services
Community Services
Private Patients Division
KF1% feeling satisfied with the quality of work and patient care they are able to deliver Q6d Q9a Q9c 83 82
=84% average 92% 76% 84 87 73 89
KF2% agreeing that their role makes a difference to patients Q9b 92 93 = 92% average 95% 89% 92 95 91 91
KF3* Work pressure felt by staff Q7e to Q7g 2.91 2.82 - 2.91 average 2.61 3.02 2.89 2.85 3.27 2.69
KF4 Effective Team Working Q4a toQ4d 3.78 3.87 = 3.83 average 3.95 3.79 3.80 3.80 3.71 3.85
KF5* % Working extra hours Q25b to Q25c 76 77 = 72%worse than average 62% 72% 80 81 74 73
KF6% receiving job-relevant training, learning or development in last 12 months
Q1a to Q1g, Q2a to Q2c 80 81
=81% average 86% 81% 83% 80% 85% 86%
KF7 % appraised in last 12 months Q3a 84 86 = 84% average 92% 84% 86% 80% 89% 88%
KF8% having well structured appraisals in last 12 months Q3a to Q3d 43 42 = 42% average 49% 40% 43% 41% 45% 48%
KF9 Support from immediate managers Q10a to Q10e 3.81 3.75 = 3.78better than average 4.02 3.74 3.75 3.81 3.89 3.88
KF10% receiving health and safety training in last 12 months Q1a 78 73 = 78% average 92% 75% 82% 79% 82% 88%
KF11* % suffering work-related stress Q16 36 37 = 35%worse than average 27% 38% 38% 38% 34% 35%
KF12* % witnessing potentially harmful errors, near misses or incidents in last month Q17a to Q17b 25 30
+29%
better than average 20% 28% 33% 30% 24% 23%
KF13% reporting errors, near misses or incidents witnessed in last month Q17a to Q17c 89 93 = 92%
worse than average 96% 90% 92% 86% 91% 96%
KF14Fairness and effectiveness of incident reporting procedures
Q17a and/or Q17b and Q17c 3.70 3.77 - 3.63
better than average 3.72 3.54 3.77 3.78 3.58 3.76
KF15 % agreeing that they would feel secure raising concerns about unsafe clinical practice Q18a to Q18g 81 -
N/A70%
better than average 81% 70% 79% 84% 85% 85%
KF16*% experiencing physical violence from patients, relatives or the public in last 12 months Q20a 4 6
+6%
better than average 2% 13% 4% 3% 7% 8%
KF17*% experiencing physical violence from staff in last 12 months Q20b 1 1 = 1%
better than average 1% 2% 1% 1% 0% 1%
KF18*
% experiencing harassment, bullying or abuse from patient, relatives or the public in last 12 months Q21a 19 20
=22% average 11% 25% 18% 25% 24% 29%
KF19*% experiencing harassment, bullying or abuse from staff in last 12 months Q21b 24 25 = 23% average 16% 22% 30% 24% 19% 19%
KF20*% feeling pressure in last 3 months to attend work when feeling unwell Q15a to Q15c 18 20 = 23%
better than average 18% 23% 22% 17% 16% 21%
2014 Staff Survey Results including Divisional Breakdown - Clinical
Sta
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and
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: Hea
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, wel
l-b
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Staff Pledge
HCC Key Score No. Description
Staff Survey Question Nos %14/15 %13/14
Statistically significant change since 13/14
Average for Acute Specialist Trusts %
Ranking Compared with all Specialist Trusts in 2013 %
Best for Acute Specialist Trusts %
National average %
Clinical Services
Cancer Services
Community Services
Private Patients Division
KF21% reporting good communication between senior management and staff Q11a to Q11d 36 33 = 37% average 44% 34% 33% 39% 32% 31%
KF22 % able to contribute towards improvements at work # Q7a Q7b Q7d 76 69 + 71%
better than average 80% 70% 74% 77% 76% 79%
KF23 Staff job satisfaction Q8a to Q8g 3.73 3.66 = 3.72 average 3.94 3.66 3.62 3.80 3.77 3.78
KF24Staff recommendation of the Trust as a place to work or receive treatment # Q12a Q12c Q12d 4.12 4.15 = 4.14 average 4.28 3.70 4.12 4.24 3.79 4.31
KF25 Staff motivation at work # Q5a to Q5c 3.94 3.86 = 3.9 average 4.06 3.85 3.87 4.04 3.97 4.14
KF26% having equality and diversity training in last 12 months Q1b 68 69 = 68% average 75% 65% 72% 70% 63% 81%
KF27% believing Trust provides equal opportunities for career progression or promotion Q22 86 90
=90%
worse than average 95% 87% 83% 89% 91% 88%
KF28*% experiencing discrimination at work in last 12 months Q23a Q23b 10 11 = 9%
worse than average 4% 11% 12% 10% 9% 12%
Ad
dit
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al
Th
eme:
P
atie
nt
Exp
erie
nce
M
easu
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KF29
% agreeing feedback from patients/service users is used to make informed decisions in their directorate/department Q13a Q13c 62 -
Number of respondents (1,957 out of 3,589) 55 51 + 55% average - 42 633 488 355 111
KeyBest in division
RMH is classified as an acute specialist in the survey
Ad
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al
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eme:
E
qu
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D
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Sta
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Ple
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4:
En
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st
aff
in
dec
isio
ns
Ad
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ion
al
Th
eme:
S
taff
S
atis
fact
ion
Key
- No figures provided
Improvement from last year + 3/29
(2/28 in 2013/14)
* measure is 1 – 5
# contribute to overall indicator for staff engagement
No significant change from last year
= 22/29 (25/28 in 2013/14) 8/29 Better than average for acute specialist trusts
16/29 Average for acute specialist trusts
Worse than last year
- 2/29 (0/28 in 2013/14)
5/29 Worse than average for acute specialist trusts
Staff Pledge
HCC Key Score No. Description
Staff Survey Question Nos %14/15 %13/14
Statistically significant change since 13/14
Average for Acute Specialist Trusts %
Ranking Compared with all Specialist Trusts in 2013 %
Best for Acute Specialist Trusts %
National average % Facilities
Corporate Services - Management, Performance and Communications
Workforce & Corporate Affairs
Nursing Risk & Quality Assurance
Finance, Estates and Capital Projects
KF1% feeling satisfied with the quality of work and patient care they are able to deliver Q6d Q9a Q9c 83 82
=84% average 92% 76% 93 72 71 85 77
KF2% agreeing that their role makes a difference to patients Q9b 92 93 = 92% average 95% 89% 95 83 83 87 88
KF3* Work pressure felt by staff Q7e to Q7g 2.91 2.82 - 2.91 average 2.61 3.02 2.60 2.83 3.10 3.00 2.63
KF4 Effective Team Working Q4a toQ4d 3.78 3.87 = 3.83 average 3.95 3.79 3.61 4.02 3.56 3.73 3.75
KF5* % Working extra hours Q25b to Q25c 76 77 = 72%worse than average 62% 72% 56 73 71 62 56
KF6% receiving job-relevant training, learning or development in last 12 months
Q1a to Q1g, Q2a to Q2c 80 81
=81% average 86% 81% 80% 63% 78% 79% 68%
KF7 % appraised in last 12 months Q3a 84 86 = 84% average 92% 84% 72% 79% 78% 88% 89%
KF8% having well structured appraisals in last 12 months Q3a to Q3d 43 42
=42% average 49% 40% 50% 42% 45% 38% 43%
KF9 Support from immediate managers Q10a to Q10e 3.81 3.75=
3.78better than average 4.02 3.74 3.63 3.96 3.67 3.68 3.94
KF10% receiving health and safety training in last 12 months Q1a 78 73 = 78% average 92% 75% 57% 57% 57% 73% 77%
KF11* % suffering work-related stress Q16 36 37 = 35%worse than average 27% 38% 30% 35% 44% 38% 32%
KF12* % witnessing potentially harmful errors, near misses or incidents in last month Q17a to Q17b 25 30
+29%
better than average 20% 28% 8% 9% 7% 6% 15%
KF13% reporting errors, near misses or incidents witnessed in last month Q17a to Q17c 89 93 = 92%
worse than average 96% 90% - - - - 75%
KF14Fairness and effectiveness of incident reporting procedures
Q17a and/or Q17b and Q17c 3.70 3.77
-3.63
better than average 3.72 3.54 3.69 3.51 3.45 3.88 3.48
KF15 % agreeing that they would feel secure raising concerns about unsafe clinical practice Q18a to Q18g 81 -
N/A70%
better than average 81% 70% 74% 81% 69% 80% 73%
KF16*% experiencing physical violence from patients, relatives or the public in last 12 months Q20a 4 6
+6%
better than average 2% 13% 2% 1% 0% 0% 0%
KF17*% experiencing physical violence from staff in last 12 months Q20b 1 1 = 1%
better than average 1% 2% 3% 1% 2% 0% 0%
KF18*
% experiencing harassment, bullying or abuse from patient, relatives or the public in last 12 months Q21a 19 20
=22% average 11% 25% 18% 7% 5% 10% 5%
KF19*% experiencing harassment, bullying or abuse from staff in last 12 months Q21b 24 25
=23% average 16% 22% 27% 18% 23% 30% 14%
KF20*% feeling pressure in last 3 months to attend work when feeling unwell Q15a to Q15c 18 20
=23%
better than average 18% 23% 13% 13% 20% 22% 18%
2014 Staff Survey Results including Divisional Breakdown - Corporate
Sta
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sup
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taff
Ple
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3: H
ealt
h, w
ell-
bei
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and
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ety
Staff Pledge
HCC Key Score No. Description
Staff Survey Question Nos %14/15 %13/14
Statistically significant change since 13/14
Average for Acute Specialist Trusts %
Ranking Compared with all Specialist Trusts in 2013 %
Best for Acute Specialist Trusts %
National average % Facilities
Corporate Services - Management, Performance and Communications
Workforce & Corporate Affairs
Nursing Risk & Quality Assurance
Finance, Estates and Capital Projects
KF21% reporting good communication between senior management and staff Q11a to Q11d 36 33 = 37% average 44% 34% 47% 45% 28% 34% 40%
KF22 % able to contribute towards improvements at work # Q7a Q7b Q7d 76 69 + 71%
better than average 80% 70% 72% 83% 75% 66% 76%
KF23 Staff job satisfaction Q8a to Q8g 3.73 3.66 = 3.72 average 3.94 3.66 3.69 3.93 3.58 3.59 3.78
KF24Staff recommendation of the Trust as a place to work or receive treatment # Q12a Q12c Q12d 4.12 4.15 = 4.14 average 4.28 3.70 4.36 4.28 3.98 4.21 4.11
KF25 Staff motivation at work # Q5a to Q5c 3.94 3.86 = 3.9 average 4.06 3.85 4.22 3.85 3.72 3.73 3.73
KF26% having equality and diversity training in last 12 months Q1b 68 69 = 68% average 75% 65% 63% 50% 63% 53% 72%
KF27% believing Trust provides equal opportunities for career progression or promotion Q22 86 90
=90%
worse than average 95% 87% 84% 88% 80% 83% 80%
KF28*% experiencing discrimination at work in last 12 months Q23a Q23b 10 11 = 9%
worse than average 4% 11% 16% 6% 10% 2% 6%
Ad
dit
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al
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eme:
P
atie
nt
Exp
erie
nce
M
easu
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KF29
% agreeing feedback from patients/service users is used to make informed decisions in their directorate/department Q13a Q13c 62 -
KF24Staff recommendation of the Trust as a place to work or receive treatment # Q12a Q12c Q12d 4.12 4.15 = 4.14 average 4.28 3.70 4.27 4.06 4.04 4.25 3.94 3.85 4.11 4.01 4.09 4.19 4.30
KF25 Staff motivation at work # Q5a to Q5c 3.94 3.86 = 3.9 average 4.06 3.85 4.10 4.03 3.98 4.13 4.14 4.06 3.87 3.79 3.86 3.65 4.01
KF26% having equality and diversity training in last 12 months Q1b 68 69 = 68% average 75% 65% 78 65 70 66 76 67 64 74 63 62 76
KF27% believing Trust provides equal opportunities for career progression or promotion Q22 86 90 = 90%
worse than average 95% 87% 85 91 73 90 97 98 89 78 86 82 87
KF28*% experiencing discrimination at work in last 12 months Q23a Q23b 10 11 = 9%
worse than average 4% 11% 11 9 29 11 3 5 13 16 8 8 5A
dd
itio
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T
hem
e:
Equ
alit
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D
iver
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2013 Staff Survey Results including Occupational Group BreakdownSt
aff P
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Staf
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Staf
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Ad
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Sta
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Sati
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tion
Staff Pledge
HCC Key Score No. Description
Staff Survey Question Nos %13/14 % 12/13
Statistically significant change since 12/13
Average for Acute Specialist Trusts %
Ranking Compared with all Specialist Trusts in 2013 %
Best for Acute Specialist Trusts %
National average %
Adult/ General Nurses
Other Registered Nurses
Nursng / Healthcare Assistants
Medical / Dental
Occupational Therapy
Physiotherapy Radiography
Other Scientific & Technical
Admin & Clerical
Central Functions/Corporate Services
Maintenance/Ancillary
KF29
% agreeing feedback from patients/service users is used to make informed decisions in their directorate/department Q13a Q13c 62 -
Number of respondents (1,957 out of 3,589) 55 51 + 55% average - 42 388 135 52 105 37 73 92 121 321 94 57
RMH is classified as an acute specialist in the survey
Key
Best in division
Key
- No figures provided
Improvement from last year + 2/28
(2/38 in 2012/13)
* measure is 1 – 5
# contribute to overall indicator for staff engagement
No significant change from last year
= 25/28 (13/38 in 2012/13) 7/28 Better than average for acute specialist trusts
17/28 Average for acute specialist trusts
Worse than last year
- 0/28 (6/38 in 2012/13)
4/28 Worse than average for acute specialist trusts
COUNCIL OF GOVERNOR PAPER SUMMARY SHEET
Date of Meeting: 10th June 2015
Agenda item Item 8.
Title of Document: Items from Governors
To be presented by
Governors to lead discussion
Background At the Governor’s request, the following items will be discussed; 8.1 Pharmacy Waiting Times (requested by Governor, Vikki Orvice) 8.2 Surgical Strategy (requested by Governor, Duncan Campbell) 8.3 IT Strategy (requested by Governor, Duncan Campbell) Recommendations All Governors are invited to discuss the relevant matters.
COUNCIL OF GOVERNOR PAPER SUMMARY SHEET
Date of Meeting: 10th June 2015
Agenda item Item 9.
Title of Document: Governor’s Register of Interests – For information
To be presented by
Executive Summary The requirements of the NHS Act 2006, Health and Social Care Act 2012 and Trust Constitution require the Governors of the Council to declare their interests to the Trust in order to avoid a conflict of interest. The Register is formally checked on an annual basis, although Governors are obliged to notify the Trust of any changes in their interests during the year. The Trust’s current Register of Interest is enclosed for the Council of Governor’s information. Recommendations 1) The Council of Governors are asked to note the enclosed Register and inform the Trust
Secretary of any necessary additions / amendments.
2) The Council of Governors is also asked to note that in line with the NHS Act 2006, the Register of Interests is available for inspection by members of the public.
Author: Rey Aziz, Corporate Governance Manager Rebecca Hudson, Member and Governor Lead
Contact Number or E-mail: Ext. 8239
Date: 15th May 2015
Governors Register of Interests June 2015
Name Date Directorships/ Positions of Authority and Remunerated Work
Significant Shareholdings
Grants from RMCC*
Unremunerated Work
Membership Family Interests
Patient Governors
Maggie Harkness, Kensington & Chelsea and Sutton & Merton
14/05/15 Nil Nil Nil Nil Nil Nil
Joyce Herve, Kensington & Chelsea and Sutton & Merton
23/05/15 Nil Nil Nil Nil Nil Nil
Colin Peel, Kensington & Chelsea and Sutton & Merton
24/05/15 Nil Nil Nil Nil Nil Nil
Fiona Stewart, Elsewhere in London
1/06/15 Nil Nil Nil Nil Nil Nil
Dr Peter Lewins, Elsewhere in London
14/05/15 Nil Nil Nil Charity Ambassador, The Royal Marsden Cancer Charity
Nil Nil
Vikki Orvice, Elsewhere in England
26/05/15 Nil Nil Nil Nil Nil Nil
Simon Spevack, Elsewhere in England
02/06/15 Nil Nil Nil Nil Nil Nil
Lesley-Ann Gooden, Carer
13/05/15 Nil Nil Nil Nil Nil Nil
Duncan Campbell, Carer
16/05/15 Director of Domaine de Bussas Ltd and Chateau Bussas Ltd – close companies
Nil Nil Nil Nil Nil
Public Governors
Dr Carol Joseph, Kensington & Chelsea
17/05/15 Nil Nil Nil Nil Nil Nil
Janet Mountford, Sutton & Merton
14/05/15 Chair of Sutton Homestart Charity
Nil Nil Nil Member of Fitness to Practice Panel at Nursing & Midwifery Council
Nil
Ann Curtis, Elsewhere in England
14/05/15 Nil Nil Nil Nil Nil Nil
Robert Shearer, Elsewhere in England
13/05/15 Nil Nil Nil Nil Member National Health Action Party
Nil
Staff Governors
Richard Keane, Clinical Professionals
02/06/15 Nil Nil Nil Nil Nil Nil
Dr Claire Dearden, Doctor
03/06/15 Trustee on the UK CLL Forum
Member of the Medical Advisory Panel for Leukaemia and Lymphoma Research
