Northampton General
Hospital NHS Trust
(RNS)
Data Pack
10th January 2014
CQC │
If you have 5-10 minutes ‘At a glance’: 3-15
Context: 16
Safe: 30-31
Effective: 45-47
Caring: 54-55
Responsive: 72-73
Well-led: 78-80
If you have 2-3 hours All of the report
At a glance
To help you navigate
through the report,
here is some
guidance on which
sections of the report
you should read
depending on the
time you have
available.
Reading this report
Northampton General Hospital NHS Trust Page 2
CQC │
Executive Summary Northampton General Hospital NHS Trust (RNS) has been selected as one of the first trusts to be inspected under the CQC’s revised inspection approach. The trust was selected for inspection as an example of a ‘high risk’ trust.
This data pack is designed to provide the CQC’s inspection team with an overview of the trust in order to guide their investigation.
Context Northampton General Hospital NHS Trust is an acute trust with 800
consultant led beds. It provides general acute services to a population of 380,000, and hyper-acute stroke, vascular and renal services to people living throughout whole of Northamptonshire, covering a population of 691,952.
The trust’s main hospital site is based at Northampton General Hospital, which is located close to Northampton town centre. The trust also provides services at the following sites in the county: Corby Community Hospital, Danetre Hospital in Daventry, Isebrook Hospital, Hazelwood Ward and Weston Favell Health Centre.
Approximately half of the Executive Directors, as well as the Chairman and Chief executive, are fairly new, having been appointed to these positions in the last few months. Many posts are interim and there are two Chief Operating Officers.
Northampton General Hospital NHS Trust Page 3
Source: Office for National Statistics; 2011 Census for England and Wales; Public
Health Observatories – Area Health Profiles
Context Safe Effective Caring Responsive Well-led
Trust overview
Sites 1 main site plus several satellite sites all over
Northamptonshire
Beds 800
Population Served 684,00
Actual Net Surplus (Deficit) £0.4m (2012/13) £0.5m (2011/12)
Source: NHS Choices; Bed Availability and Occupancy, Department of Health
Transparency Website, Jul 2013 - Sep 2013; Trust Website; Trust Annual
Reports, 2012/13
Source: HES data, 2010-11 and 2012-13
Note: The HES A&E data is experimental data
Area overview Northamptonshire
Population 691,952
GP Registered 97%
Deprivation (Out of 326 LAs) 119
Ethnicity (Non-white minority) 8.55%
Life Expectancy Worse than average or average
Urban/Rural Urban
Activity Type 2010-11 2011-12 2012-13
Inpatient N/A 95,691 96,237
Outpatient 323,748 331,114 356,320
Accident & Emergency 83,187 91,283 N/A
CQC │
Safe Never Events
A serious incident known as a Never Event is classified as such because they are so serious that they should never happen. There were no never events reported by the trust between 1 December 2012 and 31 November 2013.
Serious Incidents
Between December 2012 and November 2013, 104 Serious Incidents occurred at the trust. Ward areas accounted for 85.5% of the serious incidents reported – a total of 89 incidents. A&E was second with five incidents reported.
Incident reports to the NRLS
An analysis of the number of patient safety incidents reported to the NRLS, against the number of incidents expected to occur at a trust, based on the number of bed days, can indicate any potential under-reporting. The largest number occurred in medical specialties , which accounted for 57% of all incidents. Surgical specialties had the second most amount of incidents reported along with A&E third.
Northampton General Hospital NHS Trust Page 4
Source: Strategic Executive Information System (STEIS) Data,
Dec 2012 – Nov 2013
Context Safe Effective Caring Responsive Well-led
Source: National Reporting Learning System (NRLS) July 2012 – June 2013
Specialty Moderate Severe Abuse Death Total
Medical specialties 129 16 36 8 189
Surgical specialties 41 7 7 5 60
Accident and
Emergency (A) 22 1 4 2 29
Anaesthesia Pain
Management and
Critical Care
21 1 0 2 24
Obstetrics and
gynaecology 7 0 4 3 14
Diagnostic services 4 0 0 1 5
Other specialties 1 0 0 0 1
Other 5 0 2 3 10
Grand total 230 25 53 24 332
CQC │
Safety thermometers
Often the safety thermometer measures are good indicators of how nursing staff are performing. It is also worth exploring how the trust uses the patient safety thermometer to support the provision of safe care.
The proportion of patients with new pressure ulcers has fluctuated throughout the year with a sharp increase in September 2013. The trust also reported double the England average for people over 70 in November 2013. This requires investigation to ensure the trust has measures in place to reduce levels.
The Safety Thermometer data shows that the trust reported no new
cases of VTE since March 2013, but the trust have confirmed that this is because they do not collect this data.
The proportion of patients suffering from UTIs on the date of a monthly survey among patients with a catheter has been consistently above the England average.
The proportions of patients suffering from falls with harm , including patients over 70, are below the England average for most of the period.
The trust’s infection rates for C. diff and MRSA lie within a statistically acceptable range after taking into account the trust’s size and the national level of infections.
It must be noted that caution should be used when comparing trust Safety Thermometer results to the national average as this does not account for trust-to-trust variation in the demographic make-up of the population, though they may be an area for further investigation.
Infection rates for both C.difficile and MRSA are both within a statistically acceptable range.
Northampton General Hospital NHS Trust Page 5
Safety Thermometer Trust median National median
New pressure
ulcers
All patients 1.3% 1.2%
Patients over 70 1.6% 1.4%
New VTEs All patients 0.0% 2.5%
Catheter and
New UTIs
All patients 0.9% 0.5%
Patients over 70 1.3% 0.6%
Falls with Harm All patients 0.3% 0.9%
Patients over 70 0.5% 1.2%
Source: Safety Thermometer November 2012 – November 2013
Context Safe Effective Caring Responsive Well-led
Bacterial indicators Total Range
C. difficile 32 Within acceptable
MRSA 1 Within acceptable
MSSA 10 N/A
Source: Health Protection Agency (HPA) data August 2012 – July 2013
CQC │
Effective Tier 1 Indicators
There were 4 Tier 1 indicators flagged as ‘risk’ or ‘elevated risk’.
Mortality
The mortality indicators flagged above have been refined to include ‘Composite Indicators’.
In-hospital mortality-Gastroenterological and hepatological conditions and procedures is a ‘Composite Indicator’ formed of 14 sub-indicators. Of the 14 sub-indicators, 1 sub-indicator is rated as a ‘risk’:
Composite indicator: In-hospital mortality - Gastroenterological and hepatological conditions and procedures
Maternity
Maternity and women's health is a ‘Composite Indicator’ formed of 3 sub-indicators. Of the 3 sub-indicators, 1 sub-indicator is rated as an ‘elevated risk’:
Maternity outlier alert: Elective Caesarean section
The table below shows the total number of deliveries at Northampton General Hospital NHS trust compared to the total number of deliveries in England:
Northampton General Hospital NHS Trust Page 6
Context Safe Effective Caring Responsive Well-led
Framework section RAG
Summary Hospital-level Mortality Indicator
Composite indicator: In-hospital mortality - Gastroenterological and
hepatological conditions and procedures
Maternity outlier alert: Elective Caesarean section
The number of cases assessed as achieving compliance with all nine
standards of care measured within the National Hip Fracture Database.
England Northampton General
Hospital NHS trust
Total number of deliveries 695,378 4,576 (0.65%)
Elevated risk Risk
CQC │
Sources: NHS Friends and Family Survey, July 2013 – Oct 2013. Cancer Patient
Experience Survey, National Cancer Intelligence; NHS Choices Network, Oct 2008 and
Nov 2013
Caring The trust has no risks or elevated risks in this domain.
Friends and Family Test
The overall performance for the trust is in line with the England score. A&E performance is higher than the England score. Response rates for A&E are higher than the England response rate and inpatient areas are in line with the England figure.
Cancer Patient Experience Survey
Out of 70 questions the trust was in the bottom 20% nationally on five questions.
The main issues are around pain control, choice of treatment and patients who would give a rating of care of excellent or very good.
NHS Choices
The trust has an overall score of 3.5 stars out of 5 stars. The main positives are excellent care, professional staff and being treated with respect and dignity. The issues raised are waiting times, communication, and misdiagnosis.
CQC’s Adult Inpatient Survey 2012
From the Adult Inpatient Survey the trust performed ‘About the same’ as other trusts for all 10 areas of questioning.
There are 2 questions where the trust is in the worst 20% nationally:
• Were you ever bothered by noise at night from other patients?
• Were you ever bothered by noise at night from hospital staff?
Northampton General Hospital NHS Trust Page 7
Area of questioning RAG
The Emergency/A&E Department
Waiting List and Planned Admissions
Waiting to Get to a Bed on a Ward
The Hospital and Ward
Doctors
Nurses
Care and Treatment
Operations and Procedures
Leaving Hospital
Overall Views and Experiences
Context Safe Effective Caring Responsive Well-led
Source: CQC Adult Inpatient Survey 2012
Better than other trusts
About the same as other trusts
Worse than other trusts
CQC │
Responsive Accident and Emergency
Trusts in England are tasked by the government with admitting, transferring or discharging 95% of patients within four hours of their arrival in the A&E department. Northampton General Hospital NHS Trust is consistently failing to meet this target, dropping to 76% in April 2013. In the last few months their performance has improved but they remain below the target.
Cancelled Operations
Delayed Discharges
The trust was rated as ‘low amber’ or ‘medium risk’ for access to secondary care through A&E, and ‘low green’ or ‘low risk’ for access to elective secondary care (diagnostics and treatment) from general practice.
There are three areas where the trust shows to be worse than others. All are questions taken from the A&E survey:
• percentage of admitted patients who wait in A&E less than 4 hours
• percentage of non-admitted patients who wait in A&E less than 4 hours
• transitions from the ambulance to A&E
Northampton General Hospital NHS Trust Page 8
Framework sections RAG
Number of patients not treated within 28 days of last minute cancellation
due to non-clinical reason
The proportion of patients whose operation was cancelled
Source: Cancelled Operations: DoH QMCO January 2013 – March 2013
Framework sections RAG
The proportion of respondents to the adult inpatient survey who stated they
were not given enough notice about when they were to be going to be
discharged
The proportion of respondents to the adult inpatient survey who stated that
their discharge was delayed for more than four hours, due to waiting for
medicine, to see a doctor or for an ambulance
Source: CQC Analysis of Secondary Care – February 2013
Context Safe Effective Caring Responsive Well-led
Better than expected
Similar to expected
Worse than expected
75%
80%
85%
90%
95%
100%
Ap
r-12
Jun
-12
Au
g-1
2
Oct-
12
Dec-1
2
Fe
b-1
3
Ap
r-13
Jun
-13
Au
g-1
3
Oct-
13
% of A&E attendances less than 4 hours from arrival to admission, transfer or discharge
Englandaverage
Trust
CQC │
Well-led Number of staff
Overall sickness
Sickness absence rates
Agency spend
FTE nurses per bed day
Audit Commission - Payment by Results Data (PbR) Assurance 2011/12
Payment by Results aims to support NHS modernisation by paying hospitals for the work they do, rewarding efficiency and quality. It also carries risks that need to be managed effectively both locally and nationally. Since 2007, the Audit Commission has delivered an assurance programme for Payment by Results looking at the quality of clinical coding.
For the 2011/12 financial year, there were a number of indicators and items of qualitative intelligence for the trust from this audit:
Northampton General
Hospital NHS Trust
East Midlands SHA
average National average
4.5% 4.5% 4.2%
Northampton General Hospital NHS Trust Page 9
Northampton General Hospital NHS Trust National average
Medical Staff 1.5 1.1
Nursing Staff 4.4 4.0
Midwife Staff 4.4 4.3
Other Staff 4.1 3.9
Trust agency spend (£m) As % of total staff cost Median within EM SHA
£7m 4.3% 4.2%
Source: Health and Social Care Information Centre (HSCIC), Apr 12 – Mar 13
Source: Acute Trust Quality Dashboard, Methods Insight, Autumn 2013/14
RAG NGH NHS Trust National
FTE Nurses per Bed Day 1.6 1.9
Total staff 4,200
Source: Trust website
Source: Monitor, Expenditure on Agency Staff in Acute Trusts, 2011-12
Source: Acute Trust Quality Dashboard, Methods Insight, Autumn 2013/14
Indicator RAG
8.5% of primary diagnoses were recorded incorrectly in the period. Against
an expected rate of 9%.
13.2% of secondary diagnoses were recorded incorrectly in the period.
Against an expected rate of 8%.
6.3% of primary procedures were recorded incorrectly in the period.
Against an expected rate of 7%.
12.2% of secondary procedures were recorded incorrectly in the period.
Against an expected rate of 7%.
Source: Audit Commission - Payment by Results Data (PbR) Assurance (2011/12)
Context Safe Effective Caring Responsive Well-led
Better than expected
Tending towards better than expected
Within expectations
Tending towards worse than expected
Risk or elevated risk
CQC │
Well-led NHS Staff Survey
The results of the 2012 NHS Staff Survey are organised into 28 key findings.
Twenty four of the 28 key findings were placed within the bottom 20% of trusts nationally, including the percentage of staff feeling satisfied with the quality of work and patient care they are able to deliver.
Northampton General Hospital NHS Trust Page 10
Context Safe Effective Caring Responsive Well-led
*Note: Because of changes to the format of the survey questions, comparisons with 2011
scores are not possible in all cases. These are denoted by ‘-’
Indicators RAG Trust National* vs. 2011*
Percentage of staff having equality and diversity training in last 12 months 62% 55% Percentage of staff saying hand washing materials are always available 60% 60% -
Staff motivation at work 3.84 3.84 -
Percentage of staff reporting errors, near misses or incidents
witnessed in the last month 90% 90%
Percentage of staff working extra hours 76% 70% -
Percentage of staff experiencing physical violence from patients,
relatives or the public in last 12 months 18% 15%
Percentage of staff witnessing potentially harmful errors, near misses or incidents in last month 42% 34% -
Percentage of staff appraised in last 12 months 73% 84% -
Percentage of staff experiencing harassment, bullying or abuse from patients, relatives or the public in last 12 months 38% 30% N/A
Percentage of staff experiencing harassment, bullying or abuse from staff in last 12 months 31% 24% N/A
Percentage of staff feeling satisfied with the quality of work and patient care they are able to deliver 72% 78% -
Percentage of staff agreeing that their role makes a difference to patients 87% 89% -
Work pressure felt by staff 3.34 3.07 N/A
Percentage of staff experiencing physical violence from staff in last 12 months 4% 3% N/A
Better than expected (within top 20% of trusts nationally
Tending towards better than expected
Within expectations
Tending towards worse than expected
Risk or elevated risk (within bottom 20% of trusts nationally)
Direction of change from previous year
Source: NHS Staff Survey 2012
CQC │
Well-led NHS Staff Survey
Staff at Northampton General Hospital NHS Trust are less likely to recommend the trust as a place to work or receive treatment, and report lower levels of fairness and effectiveness of incident reporting procedures or good communication with senior managers.
Northampton General Hospital NHS Trust Page 11
Context Safe Effective Caring Responsive Well-led
Indicators RAG Trust National* vs. 2011*
Percentage of staff able to contribute towards improvements at work 58% 68% -
Staff job satisfaction 3.40 3.58 -
Percentage of staff experiencing discrimination at work in last 12 months 17% 11% -
Effective team working 3.53 3.72
Percentage of staff having well structured appraisals in last 12 months 23% 36% -
Support from immediate managers 3.26 3.62
Percentage of staff suffering work-related stress in last 12 months 43% 37%
Percentage of staff feeling pressure in last 3 months to attend work when feeling unwell 35% 29% -
Percentage of staff believing the trust provides equal opportunities for career progression or promotion 79% 88% -
Percentage of staff receiving job-relevant training, learning or development in last 12 months 76% 81% N/A
Percentage of staff receiving health and safety training in last 12 months 63% 74%
Fairness and effectiveness of incident reporting procedures 3.41 3.50 -
Percentage of staff reporting good communication between senior management and staff 20% 27% N/A
Staff recommendation of the trust as a place to work or receive treatment 3.37 3.57 -
Better than expected (within top 20% of trusts nationally
Tending towards better than expected
Within expectations
Tending towards worse than expected
Risk or elevated risk (within bottom 20% of trusts nationally)
Direction of change from previous year
*Note: Because of changes to the format of the survey questions, comparisons with 2011
scores are not possible in all cases. These are denoted by ‘-’
Source: NHS Staff Survey 2012
CQC │
Well-led General Medical Council – National Training Scheme Survey 2013
The trust performed worse than expected in the GMC National Training Scheme Survey in two or more areas in clinical oncology, GP programme (medicine) and respiratory medicine. Measures that the trust did well in include access to educational resources, local teaching and feedback.
Northampton General Hospital NHS Trust
Context Safe Effective Caring Responsive Well-led
Page 12
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GP Prog - Paediatrics and Child
Health
GP Prog - Surgery
General Practice F2
Medicine F1
Obstetrics and gynaecology
Paediatrics
Respiratory medicine
Urology
Better than expected
Similar to expected
Worse than expected
No Data
Source: gmc-uk.org
CQC │
CQC Framework Key
Northampton General Hospital NHS Trust Page 13
Safe Page 30
Effective Page 45
Caring Page 54
Responsive Page 72
Well-led Page 78
CQC │ Northampton General Hospital NHS Trust
Key facts
Northampton General
Hospitals NHS Trust
RNS Inspection pack prepared:
December 2013
Reason for inspection:
The trust was selected for inspection as an
example of a ‘high risk’ trust.
Page 14
What is a Tier 1 Indicator?
Tier 1 Indicators are the key metrics the CQC uses to help decide where and what to inspect. These Tier 1 indicators have been selected on the basis of statistical robustness, ability to identify poorly performing trusts, and their ability (as a group) to cover multiple dimensions of quality, and are constantly being refined as we learn more.
Within each of the five domains (Safe, Effective, Caring, Responsive and Well-led), there are a number of indicators (items) that have been assessed for each trust. For each indicator, the trust will be rated as ‘within expectations’, ‘risk’ or ‘elevated risk’. A summary of the ‘risks’ and ‘elevated risks’ for Northampton General Hospital NHS Trust are on the following page.
.
0
2
4
6
8
10
12
14
16
18Risks and Elevated Risks for all trusts
Northampton General Hospital NHS Trust Elevated RisksNorthampton General Hospital NHS Trust RisksElevated RisksRisks
CQC │
Safe Effective Caring Responsive Well-led Total
Number of Items 8 76 8 10 10 112
Number of Risks 0 2 0 1 1 4
Number of Elevated risks 0 2 0 0 2 4
Domain risk rating 0 6 0 1 5 12
Tier 1 Risks by Domain (Trust level)
Northampton General Hospital NHS Trust Page 15
CQC │
Context
Northampton General Hospital NHS Trust Page 16
Bed occupancy between July and
September 2013
84%
Population for
Northamptonshire
is 691,952
Northamptonshire is
the 119th most
deprived area out of
326 local
authorities.
97% of the population
of Northamptonshire
is registered to a GP
CQC │
Trust Profile Northampton General Hospital NHS Trust is an acute trust with 800 consultant led beds, and provides general acute services for a population of 380,000. It also provides hyper-acute stroke, vascular and renal services to people living throughout the whole of Northamptonshire, which has a population of 691,952. The trust was registered with the CQC on 1 April 2010, and the latest certificate of registration was generated on 9 August 2011. It has had no enforced conditions applied to it. The trust is registered to provide the following regulated activities:
• Accommodation for persons who require nursing or personal care
• Assessment or medical treatment for persons detained under the
MHAC 1983
• Diagnostic and screening procedures
• Maternity and midwifery services
• Surgical procedures
• Termination of pregnancies
• Treatment of disease, disorder or injury
In addition to the main hospital site, which is located close to Northampton town centre, the trust also provides services at the following sites in the county:
• Corby Community Hospital: In-patient rehabilitation services
• Danetre Hospital in Daventry: Diagnostic and/or screening
services, Services for everyone and Surgical procedures
• Isebrook Hospital Hazelwood Ward: Dementia, Diagnostic and/or
screening services, Learning disabilities, Caring for adults under
65 years of age and Caring for adults over 65 years of age
• Northampton General Hospital: Diagnostic and/or screening
services, Maternity and midwifery services, Services for everyone,
Surgical procedures and Termination of pregnancy
• Weston Favell Health Centre: Diagnostic and/or screening
services and Services for everyone
The trust is also an accredited cancer centre and provides cancer
services to a wider population of 880,000 who live in
Northamptonshire and parts of Buckinghamshire.
A list of services provided by Northampton General Hospital NHS Trust can be found in the appendix.
Northampton General Hospital NHS Trust Page 17
Finance information 2011-12 2012-13
Actual Net Surplus (Deficit) £0.5m £0.4m
Source: Trust Annual Reports, 2011/12 and 2012/13
Context Safe Effective Caring Responsive Well-led
Source: HES data, 2010-2011 to 2012-2013.
Note: The HES A&E data is experimental data
Activity Type 2010-11 2011-12 2012-13
Inpatient N/A 95,691 96,237
Outpatient 323,748 331,114 356,320
Accident & Emergency 83,187 91,283 N/A
CQC │
Bed Occupancy Between July and September 2013 the trust’s bed occupancy was 83.92%, compared to the England average of 85%. It is generally accepted that, when occupancy rates rise above 85%, it can start to affect the quality of care provided to patients and the orderly running of the hospital. The Department of Health also publishes separate occupancy rates for critical care beds, the results of which are detailed in the table below:
The graph below details the bed occupancy as a percentage of available beds occupied overnight for the time period between April 2011 and Sept 2013. Over the two year period, 2011 to 2013, the trust’s average has been above the England average with few exceptions. However, there has been a downward trend since the start of 2013 with the July to September 2013 figure below the England average.
CQC view
The trust’s bed
occupancy has often
been above the
England average in
the past, but more
recent levels (July to
September 2013)
are below the
England average.
Occupancy of adult
critical care beds
slightly exceeds that
of the national
average.
Neonatal critical care
beds seem to be
under utilised, with a
bed occupancy of
26.7%.
Northampton General Hospital NHS Trust Page 18
Source: NHS England Unify2 Data Collection, Apr 11 – Sept 13
Context Safe Effective Caring Responsive Well-led
Source: Critical Care Bed Capacity and Urgent Operations Cancelled,
Department of Health Transparency Website, (Aug 13 – Oct 13)
75%
80%
85%
90%
95%
100%
Ap
r-Jun 1
1
Jul-S
ep 1
1
Oct-
De
c 1
1
Jan
-Mar
12
Ap
r-Jun 1
2
Jul-S
ep 1
2
Oct-
De
c 1
2
Jan
-Mar
13
Ap
r-Jun 1
3
Jul-S
ep 1
3
Bed
oc
cu
pa
ncy %
Average total daily percentage of available beds occupied overnight
Northampton General Hospital NHS Trust England average
Source: Bed Availability and Occupancy, Department of Health
Transparency Website, (Jul 13 – Sep 13)
Service area
Beds
available
Percentage
occupied National average
Total 811 83.9% 85.2%
General and Acute 742 86.5% 86.4%
Maternity 69 55.9% 58.7%
Service area
Beds
available
Percentage
occupied
National
average
Adult critical care 16 83.3% 82.1%
Paediatric intensive care N/A N/A 75.3%
Neonatal critical care 5 26.7% 71.5%
CQC │
Trust board and organisation structure The trust board is accountable for setting the strategic direction, monitoring of performance against objectives and ensuring high standards of corporate governance as well as helping to promote links between the trust and the local community. Approximately half of the Executive Directors, as well as the Chairman and Chief executive, are fairly new, having been appointed to these positions in the last few months. The following pages detail the members of the trust board and their roles, while the table to the right lists the trust’s Clinical Directors, as detailed on the trust’s website. The Appendix provides detail on the non-
executive directors.
Chair and Chief Executive
Chairman – Paul Farenden Paul Farenden was appointed as Chairman on 1 March 2012, and is a local man who was previously chief executive at the Dudley Group of Hospitals NHS Foundation Trust. He has some 40 years of experience in healthcare finance, management and leadership. A qualified accountant, he has been chief executive in three NHS trusts over the last 20 years, where he has led large scale organisational change. His experience has provided him with an in-depth understanding of both the NHS and the wider healthcare system.
Chief Executive – Dr Sonia Swart
Dr Sonia Swart was appointed as Chief Executive on 20 September 2013, having been the trust's Medical Director since September 2007, and acting Chief Executive since June 2013. Dr Swart
qualified from the University of Cambridge and went on to train in general medicine and clinical haematology. She worked as a consultant haematologist in North Warwickshire before joining Northampton General Hospital in 1994. Prior to becoming Medical Director, Dr Swart combined an active clinical role with a number of managerial activities, including head of pathology, clinical director for diagnostics and clinical lead for the foundation trust application.
Northampton General Hospital NHS Trust
Source: Trust website
Page 19
Context Safe Effective Caring Responsive Well-led
Clinical Area Clinical Director
Nursing, midwifery and patient services Suzie Loader
Medical Mike Wilkinson
CQC │
Trust board and organisation structure continued… Executive Directors
Director of Nursing, Midwifery and Patient Services – Suzie Loader
Suzie Loader is responsible for providing professional nursing & midwifery advice to the board, and for the facilitation of quality management issues, patient and public involvement and ensuring effective complaints systems are in place. She is also the Director of Infection Prevention and Control and provides the board with regular updates in this area. She also shares responsibility for clinical governance.
Suzie Loader joined the trust in April 2012 from the United Lincolnshire Hospitals NHS Trust, where she was interim Nurse Advisor leading the turnaround in the quality of nursing care following regulator inspections. Previously she has been Head of Case Management at the Nursing and Midwifery Council relating to fitness to practice, joint lead in support of the Prime Ministers Commission on the Future of Nursing and Midwifery, Project Director for Modernising Nursing Careers at the Department of Health and Director of Nursing at Heatherwood and Wexham Park NHS Foundation Trust. Acting Director of Finance – Andrew Foster
Andrew Foster is a qualified accountant who has worked for 25 in the NHS in a range of finance roles, and joined the trust in 2006 as Deputy Director of Finance. Prior to this he held senior positions at the Strategic Health Authority and Birmingham Women's Hospital.
Interim Chief Operating Officer – Deborah Needham
Deborah Needham trained as a Registered General Nurse in Lancashire where she held positions in both respiratory and emergency medicine units, before moving to London in 1998 as a ward manager. Moving from Nursing into Management in 1999, she has experience in operational and strategic management. Deborah Needham joined the trust in 2008 as a Directorate Manager and has held the posts of Deputy Director of Operations, Acting Operations Director and most recently Medical Care Group Director within the trust.
Interim Chief Operating Officer – Rebecca Brown
Rebecca Brown has 24 years operational and strategic experience in the NHS, starting as a nurse in 1989 before moving into general management in 2001. Since then she has worked in many different specialities and led some large scale service reconfigurations. She was awarded an MBE for her services to nursing in 2000. She began working at the trust in 2010 when she was appointed as deputy director of operations. Subsequently she was appointed to the role of care group director, before taking up the role of acting chief operating officer in October 2013.
Acting Medical Director – Mike Wilkinson
No biography from trust’s site
Northampton General Hospital NHS Trust Page 20
Context Safe Effective Caring Responsive Well-led
Source: Trust website
CQC │
Trust board and organisation structure continued… Executive Directors
Director of Facilities and Capital Development – Charles Abolins
Charles Abolins is responsible for the trust’s estates and facilities, capital development, purchasing and supply. After graduating in hospitality management from Birmingham College of Food and Tourism, Charles has held a number of facilities management posts in the NHS. Since joining trust, Charles has been responsible for leading and implementing complex, major capital building programmes and managing a wide range of facilities support
services.
Director of Strategy and Partnerships – Chris Pallot
Chris Pallot came to work for the trust in January 2010, initially on secondment from NHS Northamptonshire, before being appointed as the trust's director of planning and performance in September 2010. Chris Pallot has held positions at Kettering General Hospital, the NHS Modernisation Agency and NHS Northamptonshire. In previous roles, Chris Pallot has been responsible for operational management, service improvement and commissioning and contracting.
Director of Workforce and Transformation – Janine Brennan
Janine Brennan was on 2nd April 2013, having worked previously as director of workforce and organisational development at Royal Berkshire NHS Foundation Trust. Janine Brennan qualified in law and human resources management and has worked in a number of acute trusts, as well as the public sector and not-for-profit
organisations.
Northampton General Hospital NHS Trust Page 211
Context Safe Effective Caring Responsive Well-led
Source: Trust website
CQC │ Page 22
Trust board structure
Non-Executive Directors
Nicholas
Robertson Phil Zeidler
Graham
Kershaw
Chief Executive
Dr Sonia Swart
Chairman
Paul Farenden
Elizabeth Searle
Appointed Sep 2013
Appointed Mar 2012
Executive Directors
Acting Medical
Director
Mike Wilkinson
Acting Director
of Finance
Andrew Foster
Interim Chief
Operating Officer
Deborah
Needham
Interim Chief
Operating Officer
Rebecca Brown
Appointed Oct 2013 Appointed 2008 Appointed 2006
David Noble
Source: Trust website
Northampton General Hospital NHS Trust
Context Safe Effective Caring Responsive Well-led
Director of Nursing,
Midwifery and
Patient Services
Suzie Loader
Appointed Apr 2012
Director of Facilities
and Capital
Development
Charles Abolins
Director of Strategy
and Partnerships
Chris Pallot
Appointed Sep 2010
Director of
Workforce and
Transformation
Janine Brennan
Appointed Apr 2013
CQC │
Area overview Northampton is a non-metropolitan district of Northamptonshire in the East Midlands region of England. The 2010 Indices of Deprivation showed that Northampton was the 127th most deprived local authority (out of 326 local authorities, with 1st being the most deprived). There has been an increase of deprivation for all of Northamptonshire districts in national terms than previously.
Census data shows an increasing population for both the district and county, and a lower than average proportion of Black, Asian and Minority Ethnic (BAME) residents.
Life expectancy is 10.5 years lower for men and 6.4 years lower for
women in the most deprived areas of Northampton than in the least deprived areas.
Area demographics
The area demographic pyramid below details the combined population distribution for Northamptonshire. It has an evenly distributed population, but has a larger proportion of the population found between the age group 40 – 49 similar to the England averages.
Northampton General Hospital NHS Trust Page 23
Fact box
Population According to the 2011 census, the population of Northampton
is 212,100 (Northamptonshire is 691,952) with 97% of the
overall population that are registered with a GP.
The Royal College of Surgeons recommend that the "...catchment population size...for an
acute general hospital providing the full range of facilities, specialist staff and expertise for
both elective and emergency medical and surgical care would be 450,000 - 500,000."
Index of Multiple
Deprivation
Of 326 local authorities, Northampton is the 127th most
deprived (with 1st being the most deprived).
Ethnic Diversity In Northampton, 15.4% belong to non-White minorities. Of
these, Black African constitutes the largest ethnic group with
3.1% of the population.
Rural or Urban Region Northampton is a largely urban region.
Disease and Poor Health In Year 6, 18.4% of children are classified as obese. Levels of
teenage pregnancy and smoking in pregnancy are worse than
the England average. An estimated 23.3% of adults smoke
and 24.1% are obese. Rates of hip fractures and smoking
related deaths are worse than the England average.
Life Expectancy and
Causes of Death Life expectancy for both men and women is lower than the
England average. The early death rate from heart disease
and stroke has fallen but is worse than the England average.
Sources: Office for National Statistics, statistics.gov.uk, Royal College of Surgeons, data.gov.uk;
2011 Census for England and Wales, Public Health Observatories – area health profiles
Context Safe Effective Caring Responsive Well-led
10% 8% 6% 4% 2% 0% 2% 4% 6% 8% 10%
0-9
10-19
20-29
30-39
40-49
50-59
60-69
70-79
80 and over
England Male England FemaleNorthamptonshire Male Northamptonshire Female
CQC │
Area overview continued… The map on this page shows the location of Northampton General Hospital NHS Trust, the main hospital of the trust. In addition, hospitals from other trusts (Northamptonshire Healthcare NHS Foundation Trust) within a 5 mile radius are also shown.
Northampton General Hospital NHS Trust
Source: © Google Maps
Trust Sites
Other NHS Hospitals
Northampton
General Hospital
The Sett
Page 24
Context Safe Effective Caring Responsive Well-led
Berrywood
Hospital
CQC │
CQC inspection history Northampton General Hospital NHS Trust has had four inspections since registration and these include three inspections at Northampton General Hospital and one inspection at Isebrook Hospital, Hazelwood Ward.
The locations that have been inspected since registration are listed below along with their level of compliance.
Northampton General Hospital (RNS01)
Three inspections, including a ‘themed’ inspection, have been carried out in July 2011, March 2012 and July 2012. The site is found to be compliant for some outcomes with no further action needed, requires improvements for other outcomes which were found compliant and non-compliant in other outcomes.
Isebrook Hospital, Hazelwood Ward (RNS7M)
One inspection has been carried out at this location in January 2012, and the location was found to be compliant for the outcomes but with minor concerns for one of the outcomes.
Northampton General Hospital NHS Trust Page 25
Context Safe Effective Caring Responsive Well-led
CQC │
CQC inspection history continued… The current compliance of Northampton General Hospital NHS Trust by outcome is detailed in the table below:
Northampton General Hospital NHS Trust
Location Outcome Latest judgement Date of judgement
Isebrook Hospital, Hazelwood
Ward (RNS7M)
Outcome 1 (R17) Respecting and involving people who use services Compliant 14/03/2012
Outcome 4 (R9) Care and welfare of people who use services Compliant 14/03/2012
Outcome 7 (R11) Safeguarding people who use services from abuse Compliant 14/03/2012
Outcome 10 (R15) Safety and suitability of premises Compliant but with minor
concerns 14/03/2012
Outcome 13 (R22) Staffing Compliant 14/03/2012
Outcome 16 (R10) Assessing and monitoring the quality of service provided Compliant 14/03/2012
Northampton General Hospital
(RNS01)
Outcome 1 (R17) Respecting and involving people who use services Compliant 04/09/2012
Outcome 2 (R18) Consent to care and treatment Compliant 04/09/2012
Outcome 4 (R9) Care and welfare of people who use services Compliant 04/09/2012
Outcome 7 (R11) Safeguarding people who use services from abuse Compliant but requires
improvement 04/09/2012
Outcome 9 (R13) Management of medicines Non-compliant 04/09/2012
Outcome 13 (R21) Staffing Non-compliant 04/09/2012
Outcome 16 (R10) Assessing and monitoring the quality of service provided Compliant 04/09/2012
Outcome 4 (R9) Care and welfare of people who use services Compliant with minor concerns
09/08/2011
Outcome 7 (R11) Safeguarding people who use services from abuse Compliant 09/08/2011
Outcome 16 (R10) Assessing and monitoring the quality of service provided Compliant 09/08/2011
Page 26
Context Safe Effective Caring Responsive Well-led
CQC │
CQC inspection comments The tables on the following pages detail the comments relating to each of the inspections of Northamptonshire General hospital NHS Trust.
Northampton General Hospital NHS Trust
Section Outcome name Hospital Comment Nature of
comment
Date of
comment
Section 1:
Involvement
and
information
Outcome 1 (R17)
Respecting and
involving people
who use services
Isebrook
Hospital,
Hazelwood
Ward
On inspection day, CQC observed that staff spoke to patients in a respectful way and gave explanations
when assisting people. One patient said, "the rehabilitation is very good" saying that the staff "explain
things and work with you.“ One relative said that staff had asked her for information about her family
member when he was first admitted to the ward so that they were aware of his needs and preferences.
She explained that she was also involved in planning for her family members future care arrangements
with hospital staff.
31/01/2012
Outcome 2 (R18)
Consent to care
and treatment
Northampton
General
Hospital
Before people received any care or treatment they were asked for their consent and the
provider acted in accordance with their wishes.
Seven people were spoken to about the process for consenting to their care and
treatment. CQC found that all had been aware of the implications of any tests or
treatment before giving their consent. The majority were satisfied that their treatment
and any tests had been fully explained by staff and the risks and benefits had been
discussed and that their wishes followed.
04/09/2012
Section 2:
Personalised
care
Outcome 4 (R9)
Care and welfare
of people who use
services
Isebrook
Hospital,
Hazelwood
Ward
One patient spoken to during inspection said that she, "had nothing to complain about" since being
admitted to the ward. She told us that "the rehabilitation is very good.“ Another patient who was
transferred from one of the acute hospitals mentioned that, he was being kept informed about his
treatment. He said that, staff had explained the reasons for the transfer to him and that he was
expecting to see the doctor that morning and they would explain his treatment plan.
31/01/2012
Northampton
General
Hospital
During inspections CQC spoke with patients and/or their relatives about their experiences in the
accident and emergency (A&E) department, emergency assessment unit and wards. One patient and
their relative said that there had been a real improvement in A&E since their last visit earlier in the year.
The relative said, "The care has been excellent this time, staff have communicated with me every step
of the way, we have not been left alone for very long".
04/07/2012
Northampton
General
Hospital
During the inspection 10 wards were visited patients, some of their family members and staff providing
care were spoken to. Patients made a lot of positive comments to us about their care and treatment. For
example, one patient said that they had been dealt with promptly on arrival in the accident and
emergency department and had confidence in the doctors who they described as "knowing what they
were doing".
04/07/2011
Page 27
Context Safe Effective Caring Responsive Well-led
Positive Comment Negative Comment
CQC │
CQC inspection comments
Northampton General Hospital NHS Trust
Section Outcome name Hospital Comment Nature of
comment
Date of
comment
Section 3:
Safeguarding
and safety
Outcome 7 (R11)
Safeguarding
people who use
services from
abuse
Isebrook
Hospital,
Hazelwood
Ward
One relative spoken to during inspection said that she felt her family member was safe on the ward and
that she had no concerns about his care. She explained that if she did have concerns she could
approach staff. 31/01/2012
Staff were aware of the different types of abuse and were able to discuss how they would manage a
safeguarding vulnerable adults' allegation. They were aware that they had an individual
responsibility to report any allegations and that there was a safeguarding lead within the
trust that they could contact if necessary for advice.
31/01/2012
Northampton
General
Hospital
One person spoken to during inspection said, they had raised a concern about a member of staff and
that this had been dealt with appropriately and to their satisfaction. Another person said, they had talked
about a safeguarding concern with one of the staff on the ward and that the way the team responded to
the concerns was excellent and prompt.
16/07/2012
Outcome 16 (R10)
Assessing and
monitoring the
quality of service
provided
Isebrook
Hospital,
Hazelwood
Ward
During CQC’s inspection visit, staff were asked about the quality assurance systems.
Staff said that staffing levels had been increased as a result of them raising concerns
that there were not enough staff to meet the needs of patients. 31/01/2012
Northampton
General
Hospital
During the inspection it was found that comprehensive systems were in place to assess and monitor the
quality of care and services. Speaking to a member of staff in the complaints department and reviewing
complaint and quality assurance documentation, it was found that appropriate systems were in place to
identify and address recurring themes or concerns regarding patient care. Systems were also in place
to help ensure that lessons were learnt from things that went wrong.
16/07/2012
Page 28
Context Safe Effective Caring Responsive Well-led
Positive Comment Negative Comment
CQC │
CQC inspection comments
Northampton General Hospital NHS Trust
Section Outcome name Hospital Comment Nature of
comment
Date of
comment
Section 4:
Suitability of
staffing
Outcome 13 (R22)
Staffing
Isebrook
Hospital,
Hazelwood
Ward
Two relatives spoken to during inspection said that, the staff were "very busy" particularly at weekends.
One relative said that sometimes when her family member rang their call bell "nothing happens." She
explained that the ward used several temporary staff from an agency. One patient told us that staff
"may take longer to get to you when they are busy.“ Another patient said she was very happy with her
care but hated having to wait for assistance to go to the toilet. She said that when she asks for help
"there is always something else having to be done."
31/01/2012
Northampton
General
Hospital
During inspection some patients and their relatives on each of the nine wards and departments visited
were spoken to . All the patients commented how busy staff were and said they thought there was not
enough staff. Comments included; "Getting washed and dressed can be a bit of a rush in the morning,
they are very busy especially for the first hour. Staff have to leave you and attend to others. I have a call
bell but can wait a long time if staff are busy". "I rang my bell because I was feeling sick but had a long
time to wait".
07/2012
Section 5:
Quality and
management
Outcome 16 (R10)
Assessing and
monitoring the
quality of service
provided
Isebrook
Hospital,
Hazelwood
Ward
Minutes from clinical governance meetings showed that quality issues were discussed and monitored at
different levels within the trust. These included learning from incidents. An example was the minutes of
a meeting attended by ward managers and matrons throughout the trust. It was agreed that part of that
meeting would be used to share experiences and learn from complaints and incidents.
31/01/2012
Northampton
General
Hospital
During inspection patients said that they are asked for their views about their care and treatment during
their stay in hospital. They are asked to answer a set of questions generated on a hand
held electronic device which is left with a sample of patients. This is referred to as a
patient tracker system and provides senior managers with an overview of patients'
experiences on the wards.
04/07/2011
Page 29
Context Safe Effective Caring Responsive Well-led
Positive Comment Negative Comment
CQC │
60%
65%
70%
75%
80%
85%
90%
95%
100%
Ea
st M
idla
nds
Ea
st of E
ngla
nd
Isle
of W
ight
London
Nort
h E
ast
Nort
h W
est
So
uth
Centr
al
So
uth
East C
oast
So
uth
Weste
rn
West M
idla
nds
Yo
rksh
ire
Category A (Red 2) incidents: Presenting conditions which may be life threatening but less
time-critical - National Target 75%
Aug-13 Sep-13 Oct-13 Target
Performance of local health care providers To give an informed view of trust’s performance it is important to consider the service levels of non-acute local providers. For example, slow ambulance response times will greatly increase the risk of mortality. NHS England collects data on three key performance indicators for England’s Ambulance services. These are:
• Category A (Red 1) incidents: presenting conditions, which may be immediately life threatening. National target 75%
• Category A (Red 2) incidents: presenting conditions, which may be life threatening but less time-critical. National target 75%
• Category A calls (Red 1 and Red 2) resulting in an ambulance arriving at the scene of the incident within 19 minutes. National target 95%
The graph to the right shows the performance of ambulance services in England over a three month period (Aug 2013 – Oct 2013, for the percentage of Category A (Red 1) incidents responded to within eight minutes. Between Aug 2013 – Oct 2013 the proportion of Red 1 calls resulting in an emergency response within 8 minutes was less than the national target of 75%. Graphs representing the further two indicators, for which the East Midlands Ambulance Service did not meet the national targets, can be found in the Appendix.
Northampton General Hospital NHS Trust Page 30
Context Safe Effective Caring Responsive Well-led
Source: NHS England
CQC │
Safe
Northampton General Hospital NHS Trust Page 31
0 Never Events reported by the trust
between December 2012 and November
2013
Four questions in the
staff survey are in the
bottom 20% of all trusts
Infection rates are
within statistically
acceptable limits
Catheter and new
UTIs are above
England average for all
patients and those over
70 for most of the
period
New pressure ulcer
proportions are above
England average for all
patients and patients
over 70
CQC │
Framework section Tier 1 Indicator RAG
Deaths in low risk
diagnosis groups
Dr Foster: Deaths in low risk diagnosis groups
(April 2012 – March 2013)
Never Events Never Event Incidence (July 2013 – September 2013)
Venous
Thromboembolism
Proportion of patients risk assessed for Venous
Thromboembolism (VTE) (April 2013 – June 2013)
Avoidable
infections
Incidence of Clostridium difficile (C. difficile)
(August 2012 – July 2013)
Incidence of Meticillin-resistant Staphylococcus aureus
(MRSA) (August 2012 – July 2013)
Patient safety
incidents
Proportion of reported patient safety incidents that are
harmful (July 2012 – June 2013)
Potential under-reporting of patient safety incidents
resulting in death or severe harm
(July 2012 – June 2013)
Potential under-reporting of patient safety incidents
(July 2012 – June 2013)
Additional information Additional information has been included in this domain to provide a more holistic view of the trust’s performance. These are listed below:
Safe Dashboard
Northampton General Hospital NHS Trust Page 32
Additional information
STEIS Never Events
STIES Serious Incidents
NRLS notifications
Pressure ulcers
VTE
Catheter and UTI Infections
Falls
Staff survey
Complaints Handling
Schedule 5
Context Safe Effective Caring Responsive Well-led
Elevated Risk
Risk
Within expectations Source: CQC Intelligent Monitoring Report, Oct 2013
CQC │
The following pages detail indicators related to patient safety, including the prevalence of Never Events and Serious Incidents, patient safety incidents reported to the National Reporting and Learning System (NRLS), type of incident harm and infection rates.
STEIS data Never Events
A serious incident known as a Never Event is classified as such because they are so serious that they should never happen.
The trust reported no Never Events between December 2012 and December 2013.
The table to the right details the number of Never Events that occurred at trusts of similar size (with respect to number of bed days) to the Northampton General Hospital NHS Trust between November 2012 and December 2013. As can be seen, the trust, with no Never Events, has not reported noticeably more or less than trusts of a similar size (in regard to number of bed days). It is crucial to note that Never Events are not acceptable.
Northampton General Hospital NHS Trust
Safety indicators
Page 33
Trust name Number of Never
Events reported
Bed days
Trust A 1 270,073
Trust B 2 268,861
Trust C 3 268,793
Trust D 4 268,694
Trust E 0 266,370
Trust F 0 264,396
Trust G 4 263,854
Trust H 1 256,339
Trust I 3 256,146
Northampton General Hospital NHS Trust 0 255,044
Trust J 0 251,028
Trust K 0 251,027
Trust L 1 250,474
Trust M 2 250,369
Trust N 4 249,599
Trust O 0 247,447
Trust P 2 243,816
Trust Q 4 242,149
Trust R 3 241,408
Trust S 2 241,266
Trust T 4 240,573
Trust U 3 239,062
Trust V 3 235,879
Trust W 2 232,191
Trust X 2 232,111
Context Safe Effective Caring Responsive Well-led
Source: Strategic Executive Information System (STEIS) Data,
Dec 2012 – Nov 2013
CQC │
STEIS data continued… Never Events continued…
No Never Events have occurred at the trust in the last 12 months. The graph below details the number of Never Events reported versus trust size (with respect to number of bed days), for the time period December 2012 to November 2013.
Between December 2012 and November 2013, a total of 355 Never Events occurred at 150 trusts in England.
Northampton General Hospital NHS Trust Page 34
Context Safe Effective Caring Responsive Well-led
Source: Strategic Executive Information System (STEIS) Data,
Dec 2012 – Nov 2013
31
61
49
26
6 6
2 2 0 0 1
0
10
20
30
40
50
60
70
0 1 2 3 4 5 6 7 8 9 10
No
. o
f T
rusts
No. of Never Events
Distribution of Never Events across England trusts
0
1
2
3
4
5
6
7
8
9
10
0 100 200 300 400 500 600 700
Co
un
t o
f N
ever
Even
ts
Estimated bed days (thousands)
Never Events compared with trust size
Other acute trusts Statistical outliers Northampton General Hospital NHS Trust
CQC │
STEIS data continued… Serious Incidents
The Strategic Executive Information System (STEIS) records Serious Incidents and Never Events. Serious Incidents are those that require an investigation. Never Events are incidents that should never occur, and there is a defined list of 28 incidents which are classified as Never Events.
Since 2004, trusts have been encouraged to report all patient safety incidents to the NRLS. The notifications of patient safety incidents are classified by the degree of
harm: no actual harm, low, moderate, severe, abuse and death. Since 2010, it has been mandatory for trusts to report all death or severe harm incidents to the CQC via the NRLS.
If a trust is accurately reporting, a single incident will be reported via both NRLS and STEIS (assuming the incident was a Serious Incident/Never Event).
Between December 2012 and November 2013, 104 Serious Incidents occurred at the trust. The table to the right details the location of the Serious Incidents that occurred at the trust. Ward areas accounted for 85.5% of the serious incidents reported.
CQC view
There were 104
Serious Incidents
that were reported at
the trust between
December 2012 and
November 2013.
These occurred in
eight different areas,
with the majority on
wards.
Northampton General Hospital NHS Trust Page 35
Location of incident Number of serious incidents
Ward areas 89
Accident and emergency 5
Outpatient department 4
Operating theatre 2
Radiology department 1
Labour ward and delivery 1
Laboratory 1
Patient's home 1
Total 104
Context Safe Effective Caring Responsive Well-led
Source: Strategic Executive Information System (STEIS) Data,
Dec 2012 – Nov 2013
CQC │
Incident reports to the NRLS Since 2004 trusts have been encouraged to report all patient safety incidents to the NRLS and since 2010, it has been mandatory for them to report all death or severe harm incidents to the CQC via the NRLS. An analysis of the number of incidents reported to the NRLS, against the number of incidents expected to occur at a trust, based on the number of bed days, can indicate any potential under-reporting.
There were 332 incidents reported by the trust to the NRLS between July 2012 to June 2013:
Incidents reported between July 2012 to June 2013
NRLS z-score analysis
For any set of values, a z-score is a measure of how far any single value is from the mean of all of the values. It is expressed in standard deviations, with zero indicating a value equal to the mean, a negative z-score indicating a value less than the mean, and a positive z-score indicating a value greater than the mean.
The NRLS z-score analysis in this data pack is based on three indicators proposed and defined by NHS England.
The indicators are:
• Death and Severe Harm notifications as a rate per bed days, used to identify potential under-reporting
• All incidents (including low and no harm) as a rate per bed days, used to identify potential under-reporting
• Proportion of low, moderate, severe and death incidents out of all incidents reported, used to identify trusts with high proportions of harmful events
The table below details the trust’s NRLS z-scores and corresponding RAG rating.
Analysis of the NRLS notification z-scores (time period July 2012 to June 2013) across all specialties indicates that the trust’s reporting is within statistically acceptable limits.
Northampton General Hospital NHS Trust Page 36
Abuse Moderate Severe Death Total No. of
Incidents
53 230 25 24 332
NRLS z-score indicator type Z-score value RAG
Death & severe harm – under reporting -0.4 All incidents (including low and no harm) – under reporting -0.1 Low, moderate, severe death incidents – high proportions of
harmful events -0.4
Context Safe Effective Caring Responsive Well-led
H Significantly high number of notifications
L Significantly low number of notifications
Within expectations Source: National Reporting Learning System (NRLS) July 2012 – June 2013
CQC │
Incident reports to the NRLS continued… Death
Between July 2012 and June 2013, the trust submitted 24 patient safety alerts which were classified as deaths. There were 17 of the 24 deaths which took place in inpatient areas of acute / general hospitals. Seven of the deaths were categorised as ‘implementation of care and on-going monitoring / review’, of which six were subcategorised as ‘other’. Four deaths were categorised as ‘treatment / procedure’. The categories of ‘access, admission, transfer, discharge’, ‘clinical assessment’ and ‘other’ accounted for three deaths each.
In addition, ‘patient accident’, ‘medication’, ‘medical device / equipment’ and ‘documentation’ accounted for the remaining four deaths.
Severe Harm
The majority (72%) of the 25 severe incidents occurred in inpatient areas of an acute hospital setting with the remaining 28% split between four hospital locations including three in support services and two in the outpatient department. There were 52% categorised as ‘patient accident’. The remaining 48% of incidents were split between four different categories including four in ‘clinical assessment’, four in ‘implementation of care’ and ‘ongoing monitoring / review’, three in ‘treatment / procedure’ and the remaining incident in ‘medical device / equipment’.
Medical specialties made up 64% of the 25 severe incidents and surgical specialties made up 28%. Of the severe incidents categorised as medical specialties, five were subcategorised as occurring in the cardiology department. There were three severe incidents each in general medicine and care of older people.
Three of the seven incidents in the surgical specialty were subcategorised as trauma and orthopaedics with the others split between four different subcategories including urology, vascular surgery, ophthalmology and general surgery.
Moderate harm
The majority (72%) of the 230 moderate harm incidents occurred in inpatient areas of general / acute hospital settings.
Medical specialties was the most common location for moderate harm incidents - accounting for 56% of the 129 moderate incidents reported. Of these, 57% were attributed to general medicine and 17% were care of older people with cardiology and gastroenterology
making up the majority of the remaining moderate harm medical incidents.
Surgical specialties was the next highest specialty with 18% of moderate incidents (41), of which general surgery accounted for 38% and trauma and orthopaedics accounted for 32%.
Accident and Emergency (22) and anaesthesia pain management and critical care (21) made up the majority of the remaining incidents, however the subcategories were either ‘other’ or un-coded.
Abuse
Of the 53 incidents reported as abuse, 41 (77%) resulted in no harm to the patient with the remaining 10 (13%) causing a low level of harm. The majority of incidents occurred in medical specialties (68%) whilst there were also seven incidents in surgical specialties. The remaining incidents were split between three different specialties at the trust.
Northampton General Hospital NHS Trust Page 37
Context Safe Effective Caring Responsive Well-led
Source: National Reporting Learning System (NRLS) July 2012 – June 2013
CQC │
Incident reports to the NRLS continued… Specialty in which incidents occurred
The table below details the specialties in which the 332 incidents reported to the NRLS took place. The largest number occurred in medical specialties, which accounted for 57% of all incidents.
Location of incidents
The graph below shows that the vast majority of the incidents reported to the NRLS by the trust occurred in inpatient areas. The remaining incidents were distributed between eight other locations with A&E coming second.
CQC view
The majority of
incidents were
classified as
occurring in medical
specialties, surgical
specialties, accident
and emergency and
anaesthesia pain
management and
critical care.
Medical specialties
had the most
moderate, abuse,
deaths and severe
harm incidents.
Northampton General Hospital NHS Trust Page 38
Context Safe Effective Caring Responsive Well-led
Source: National Reporting Learning System (NRLS)
July 2012 – June 2013
Specialty Moderate Severe Abuse Death Total
Medical specialties 129 16 36 8 189
Surgical specialties 41 7 7 5 60
Accident and
Emergency (A) 22 1 4 2 29
Anaesthesia Pain
Management and
Critical Care
21 1 0 2 24
Obstetrics and
gynaecology 7 0 4 3 14
Diagnostic services 4 0 0 1 5
Other specialties 1 0 0 0 1
Other 5 0 2 3 10
Grand total 230 25 53 24 332
2
1
1
1
8
13
48
258
0 50 100 150 200 250 300
(blank)
Private house / flat etc.
General areas
Day care services
Outpatient department
Support services
Accident (A) / minor injury unit /medical assessment unit
Inpatient areas
CQC │
New pressure ulcers This page outlines the percentage of patients in hospital on the date of a monthly survey who acquired a pressure ulcer after their admission to the trust. Due to the effects of seasonality on hospital acquired pressure ulcers, the England averages have been included.
All patients and patients over 70
The proportion of all patients with new pressure ulcers and those for patients over 70 show a similar pattern with regular spikes and fluctuations above the England average. The recent rise in percentages for both
categories must be investigated. In November 2013 the proportion of patients over 70 with new pressure ulcers was more than double the England average at 3%.
CQC view
The proportion of
patients with new
pressure ulcers has
fluctuated with a
sharp rise from
September 2013 and
double the England
average reported for
people over 70 in
November 2013.
This requires
investigation to
ensure the trust has
measures in place to
reduce this increase
and stabilise levels.
Caution should be
used when
comparing trust
Safety Thermometer
results to the
national average as
this does not
account for trust-to-
trust variation in the
demographic make-
up of the population,
though they may be
areas for further
investigation.
Northampton General Hospital NHS Trust Page 39
Context Safe Effective Caring Responsive Well-led
Source: Safety Thermometer Nov 2012 – Nov 2013
New pressure ulcers
(All)
New pressure ulcers
(Patients over 70)
Month Trust
(%)
National Avg.
(%)
Trust
(%)
National Avg.
(%)
Nov-12 1.0 1.2 1.6 1.5
Dec-12 1.7 1.1 2.0 1.4
Jan-13 0.7 1.3 1.3 1.6
Feb-13 0.7 1.3 1.3 1.6
Mar-13 1.8 1.3 2.2 1.6
Apr-13 1.5 1.3 1.8 1.6
May-13 1.2 1.2 1.6 1.5
Jun-13 1.3 1.2 1.0 1.4
Jul-13 1.0 1.2 1.8 1.4
Aug-13 1.5 1.1 1.5 1.3
Sep-13 0.9 1.1 0.9 1.3
Oct-13 2.0 1.1 2.9 1.3
Nov-13 1.9 1.0 3.1 1.2
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
Nov-1
2
Dec-1
2
Jan
-13
Fe
b-1
3
Ma
r-13
Ap
r-13
Ma
y-1
3
Jun
-13
Jul-1
3
Au
g-1
3
Se
p-1
3
Oct-
13
Nov-1
3
Perc
en
tag
e o
f P
ati
en
ts
New pressure ulcers All patients
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
Nov-1
2
Dec-1
2
Jan
-13
Fe
b-1
3
Ma
r-13
Ap
r-13
Ma
y-1
3
Jun
-13
Jul-1
3
Au
g-1
3
Se
p-1
3
Oct-
13
Nov-1
3
Perc
en
tag
e o
f P
ati
en
ts
New pressure ulcers Patients over 70
Northampton General Hospital NHS Trust England average
CQC │
New Venous Thromboembolisms (VTEs) This page outlines the percentage of patients suffering from new VTEs on the date of a monthly survey. A case of new VTE is considered such if the case of VTE started after the patient was admitted.
All patients
The proportion of patients with new VTE was above the England average between November 2012 and March 2013, after which there are no cases of new VTE on the particular day of the monthly VTE survey. The trust
report that this is because they do not collect this data.
CQC view
The trust report that
that they do not
collect data on new
VTEs for the Safety
Thermometer and
this is why their
figures are zero from
April 2013 to
November 2013.
Northampton General Hospital NHS Trust Page 40
Context Safe Effective Caring Responsive Well-led
Source: Safety Thermometer Nov 2012 – Nov 2013
0.0%
0.2%
0.4%
0.6%
0.8%
1.0%
1.2%
1.4%
Nov-1
2
Dec-1
2
Jan
-13
Fe
b-1
3
Ma
r-13
Ap
r-13
Ma
y-1
3
Jun
-13
Jul-1
3
Au
g-1
3
Se
p-1
3
Oct-
13
Nov-1
3
Perc
en
tag
e o
f p
ati
en
ts
New VTE
Northampton General Hospital NHS Trust England average
New VTE
Month Hospital (%) National Avg. (%)
Nov-12 0.6% 0.7%
Dec-12 1.0% 0.7%
Jan-13 0.7% 0.7%
Feb-13 0.7% 0.7%
Mar-13 1.3% 0.7%
Apr-13 0.0% 0.7%
May-13 0.0% 0.7%
Jun-13 0.0% 0.6%
Jul-13 0.0% 0.6%
Aug-13 0.0% 0.6%
Sep-13 0.0% 0.6%
Oct-13 0.0% 0.6%
Nov-13 0.0% 0.6%
CQC │
Catheters and New Urinary Tract Infections (UTIs) This page outlines the proportion of patients suffering from new urinary tract infections on the date of a monthly survey among patients with a catheter.
All patients and patients over 70
The proportion of patients with a catheter who suffered from a UTI at the trust has been above the England average for the majority of the period between November 2012 and November 2013. There are noticeable spikes in percentages during January, March
and September 2013 for all patients. UTI infections in patients over 70 show a similar pattern of proportions above the England average for most of the period.
CQC view
The trust ‘s total
percentage of
patients suffering
from UTIs on the
date of a monthly
survey among
patients with a
catheter has been
consistently above
the England
average.
An investigation is
required to
understand what
measures the trust
has in place to
reduce the high
proportions and
stabilise for both
patient groups.
Northampton General Hospital NHS Trust Page 41
Context Safe Effective Caring Responsive Well-led
Source: Safety Thermometer Nov 2012 – Nov 2013
Catheter and New UTIs
(All patients) Catheter and New UTIs
(Patients over 70)
Month Trust
(%)
National Avg.
(%)
Trust
(%)
National Avg.
(%)
Nov-12 0.3 0.5 0.5 0.6
Dec-12 0.4 0.5 0.5 0.6
Jan-13 1.0 0.5 1.8 0.6
Feb-13 0.3 0.5 0.5 0.6
Mar-13 1.7 0.5 1.4 0.6
Apr-13 1.2 0.5 1.3 0.6
May-13 0.9 0.5 1.6 0.6
Jun-13 0.6 0.5 1.0 0.6
Jul-13 0.4 0.5 0.5 0.6
Aug-13 1.0 0.5 1.5 0.5
Sep-13 1.3 0.5 0.9 0.6
Oct-13 1.0 0.4 1.6 0.5
Nov-13 0.9 0.4 1.3 0.5
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
1.6
1.8
2.0
Nov-1
2
Dec-1
2
Jan
-13
Fe
b-1
3
Ma
r-13
Ap
r-13
Ma
y-1
3
Jun
-13
Jul-1
3
Au
g-1
3
Se
p-1
3
Oct-
13
Nov-1
3
Perc
en
tag
e o
f P
ati
en
ts
Catheters and new UTIs All patients
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
1.6
1.8
2.0
Nov-1
2
Dec-1
2
Ja
n-1
3
Fe
b-1
3
Ma
r-13
Ap
r-13
Ma
y-1
3
Ju
n-1
3
Jul-1
3
Au
g-1
3
Se
p-1
3
Oct-
13
Nov-1
3
Perc
en
tag
e o
f P
ati
en
ts
Catheters and new UTIs Patients Over 70
Northampton General Hospital NHS Trust England average
CQC │
Falls with harm Each month the trust records the number of harmful falls within a three day period – this page details the corresponding data.
All patients
A pattern of below England average proportions is visible in all falls with harm with a slight peak in percentages in May 2013.
Patients over 70
Falls with harm in patients over 70 have remained below
the England average for almost all of the period, following a similar pattern to all patients.
CQC view
For both categories
of patients, the
proportions of
patients suffering
from falls with harm
are below the
England average for
most of the period.
Northampton General Hospital NHS Trust Page 42
Context Safe Effective Caring Responsive Well-led
Source: Safety Thermometer Nov 2012 – Nov 2013
Falls with Harm
(All patients) Falls with Harm
(Patients over 70)
Month Trust
(%)
National Avg.
(%)
Trust
(%)
National Avg.
(%)
Nov-12 0.4 1.0 0.3 1.3
Dec-12 0.3 1.0 0.5 1.3
Jan-13 0.1 0.9 0.0 1.2
Feb-13 0.3 1.0 0.5 1.2
Mar-13 0.4 0.9 0.5 1.2
Apr-13 0.6 1.0 0.8 1.2
May-13 1.0 0.9 1.4 1.4
Jun-13 0.3 0.9 0.5 1.2
Jul-13 0.4 0.9 0.8 1.2
Aug-13 0.3 0.9 0.3 1.2
Sep-13 0.6 0.8 0.9 1.1
Oct-13 0.0 0.8 0.0 1.0
Nov-13 0.2 0.8 0.0 1.0
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
1.6
Nov-1
2
Dec-1
2
Jan
-13
Fe
b-1
3
Ma
r-13
Ap
r-13
Ma
y-1
3
Jun
-13
Jul-1
3
Au
g-1
3
Se
p-1
3
Oct-
13
Nov-1
3
Perc
en
tag
e o
f P
ati
en
ts
Falls with harm All patients
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
1.6
Nov-1
2
Dec-1
2
Jan
-13
Fe
b-1
3
Ma
r-13
Ap
r-13
Ma
y-1
3
Jun
-13
Jul-1
3
Au
g-1
3
Se
p-1
3
Oct-
13
Nov-1
3
Perc
en
tag
e o
f P
ati
en
ts
Falls with harm Patients Over 70
Northampton General Hospital NHS Trust England average
CQC │
Infection control data
MRSA infections
During the 12 months from August 2012 to July 2013, the trust reported one case of MRSA infection.
Statistical analysis of MRSA infection data over the period August 2012 to July 2013 indicates that the number of infections reported by the trust lies within a statistically acceptable range relative to the trust’s size and the national level of infections.
MSSA infections
During the 12 months from August 2012 to July 2013, the trust had a total of 10 MSSA infections, seven of which occurred in January 2013.
It should be noted that MSSA is a relatively new infection control indicator, for which the relationship to the quality of care is yet to be fully established. Statistical analysis has therefore not been carried out to determine the statistically acceptable range of performance for this indicator.
C. difficile infections
During the 12 months from August 2012 to July 2013, the trust reported 32 cases of C. difficile infections. The
month with the highest number of cases (seven) was April 2013.
Statistical analysis of C.diff infection data over the period August 2012 to July 2013 shows that the number of infections reported by the trust is within a statistically acceptable range, taking into account the trust’s size and the national level of infections.
CQC view
The trust’s infection rates for C. diff and MRSA lie within a statistically acceptable range after taking into account the trust’s size and the national level of infections.
Northampton General Hospital NHS Trust Page 43
Bacteria 2012 2013
Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul
C. difficile 0 2 1 2 4 2 2 5 7 2 4 1
MRSA 0 1 0 0 0 0 0 0 0 0 0 0
MSSA 1 0 2 2 1 1 0 0 1 0 1 1
Context Safe Effective Caring Responsive Well-led
Source: Health Protection Agency (HPA) data August 2012 – July 2013
CQC │
Staff survey data items relevant to the safe domain The 2012 Department of Health NHS staff survey was open to 202,000 NHS staff and had a response rate of 50%. The results are primarily intended for use by NHS organisations to help them review and improve staff experience so that staff can provide better patient care.*
The General Medical Council National Training surveys asked 54,000 doctors in training in the UK to give their opinions on the quality of the training they received.
The results of questions relating to patient safety from these two surveys are displayed below.
CQC view
The trust scored in
the bottom 20% of
all trusts for four of
the six questions in
the staff survey
relating to safety.
Northampton General Hospital NHS Trust Page 44
Data item source Data item RAG
Picker Institute
Europe on behalf of
the Department of
Health, NHS Staff
Survey 2012*
58% of staff said hand washing materials were always available
75% of staff worked extra hours
41% of staff witnessed potentially harmful errors, near misses or incidents in the last month
72% of staff felt satisfied with the quality of work and patient care they are able to deliver
The proportion of staff who would recommend the trust as a place to work or receive treatment
89% of staff reported errors, near misses or incidents witnessed in the last month
General Medical
Council, National
Training Surveys
(Mar 13 – May 13
Trainees rated their clinical supervisor on whether they felt forced to cope with clinical problems beyond their
competence or experience
This measures the quality of educational supervision by asking trainees about the support and management they
were getting in their training from their educational supervisor
This asked trainees to assess their overall workload to establish how appropriate it was to learning and developing
experience and skills during their training
*More detail on these staff survey questions can be found in the ‘Well-led’ section.
Context Safe Effective Caring Responsive Well-led
Better than expected
Tending towards better than expected
Within expectations
Tending towards worse than expected
Worse than expected Sources: NHS Staff Survey, 2012;
GMC National Training Surveys, Mar 13 – May 13
CQC │
Medication Errors Data held about the trust shows that they are performing similar to expected:
:
Complaints handling Data returns to the Health and Social Care Information
Centre showed 538 written complaints were submitted to the trust in 2012-13, however no data is available on the number that were upheld. This was a 4.1% increase from the 517 complaints in 2011-12. The number of complaints is not necessarily an indicator of poor performance, as the best trusts may encourage comments from patients.
Schedule 5 (formerly Coroner’s Rule 43) Every six months, the Ministry of Justice publishes a summary of Schedule 5 recommendations which have been made by the local coroners with the intention of learning lessons from the cause of death and preventing deaths.
No reports were present for Northampton General Hospital NHS Trust.
CQC view
The trust received
538 written
complaints in the
2012-13 time period,
representing an
increase of 4.1%
from the 2011-12
period.
Medication errors
per 1,000 were
within statistically
acceptable limits.
Northampton General Hospital NHS Trust Page 45
Context Safe Effective Caring Responsive Well-led
RAG Northampton General Hospital
NHS Trust
National
Mean
Medication errors
per 1,000 7.7 7.2
Source: Acute Trust Quality Dashboard, Apr 2012 – Sep 2012
Source: HSCIC, 2011-12 and 2012-13
Source: Schedule 5 (formerly Summary of Reports and Responses
under Rule 43 of the Coroners Rules), October 2012 – March 2013
Better than expected
Tending towards better than expected
Within expectations
Tending towards worse than expected
Worse than expected
CQC │
Effective
Northampton General Hospital NHS Trust Page 46
4 Tier 1 indicators identified
as being a ‘risk’ or ‘elevated
risk’
Elevated Risk:
Summary Hospital-
level Mortality Indicator
Risk:
The number of cases
assessed as achieving
compliance with all
nine standards of care
measured within the
National Hip Fracture
Database.
Elevated Risk:
Maternity outlier alert:
Elective Caesarean
section
Risk:
Composite indicator:
In-hospital mortality -
Gastroenterological
and hepatological
conditions and
procedures
CQC │
Framework section Tier 1 Indicator RAG
Maternity and
women’s health
Maternity outlier alert: Elective Caesarean section
Maternity outlier alert: Emergency Caesarean section
Maternity outlier alert: Puerperal sepsis and other
puerperal infections
Re-admissions
Maternity outlier alert: Maternal readmissions
Maternity outlier alert: Neonatal readmissions
Emergency readmissions following an elective admission
Emergency readmissions following an emergency
admission
PROMs
(EQ-5D score)
Groin Hernia Surgery
Hip Replacement
Knee Replacement
Varicose Vein Surgery
Audit
The number of cases assessed as achieving compliance
with all nine standards of care measured within the
National Hip Fracture Database.
Key Indicator 1: Number of patients scanned within 1
hour of arrival at hospital
Key Indicator 8: Number of potentially eligible patients
thrombolysed
Surgical revisions
outlier alert
Hip revisions N/A
Knee revisions N/A
Effective Dashboard
Northampton General Hospital NHS Trust Page 47
Context Safe Effective Caring Responsive Well-led
Elevated risk
Risk
No evidence of risk
Source: CQC Intelligent Monitoring Report, Nov 2013
CQC │
Additional Information Additional information has been included in the pack to provide a more holistic view of the trust’s performance. These are listed below:
Framework section Tier 1 Composite Indicator RAG
Mortality: Trust
level
Summary Hospital-level Mortality Indicator
Dr. Foster: Composite of Hospital Standardised Mortality
Ratio indicators
Mortality
(Composite
indicator: In-
hospital mortality)
Cardiological conditions and procedures
Cerebrovascular conditions
Dermatological conditions
Endocrinological conditions
Gastroenterological and hepatological conditions and
procedures
Genito-urinary conditions
Haematological conditions
Infectious diseases
Conditions associated with Mental health
Musculoskeletal conditions
Nephrological conditions
Neurological conditions
Paediatric and congenital disorders and perinatal
mortality
Respiratory conditions and procedures
Trauma and orthopaedic conditions and procedures
Vascular conditions and procedures
Effective Dashboard continued…
Northampton General Hospital NHS Trust Page 48
Context Safe Effective Caring Responsive Well-led
Additional Information
Mortality Indicators
Maternity Indicators
Source: CQC Intelligent Monitoring Report, Nov 2013
Elevated risk
Risk
No evidence of risk
CQC │
S
um
ma
ry H
osp
ital-le
ve
l Mo
rtality
Ind
ica
tor
D
r. Fo
ste
r: Com
po
site
of H
osp
ital
Sta
nd
ard
ise
d M
orta
lity R
atio
ind
ica
tors
Va
scu
lar c
on
ditio
ns a
nd
pro
ce
du
res
Tra
um
a a
nd
orth
op
ae
dic
co
nd
ition
s a
nd
p
roce
du
res
Resp
irato
ry c
on
ditio
ns a
nd
pro
ce
du
res
Resp
irato
ry c
on
ditio
ns a
nd
pro
ce
du
res
Pa
ed
iatric
an
d c
on
ge
nita
l dis
ord
ers
an
d
pe
rina
tal m
orta
lity
Nep
hro
log
ica
l co
nd
ition
s
Mu
scu
loske
leta
l co
nd
ition
s
Infe
ctio
us d
ise
ase
s
Hae
ma
tolo
gic
al c
on
ditio
ns
Ge
nito
-urin
ary
co
nd
ition
s
Ga
stro
en
tero
logic
al a
nd
he
pa
tolo
gic
al
co
nd
ition
s a
nd
pro
ce
du
res
En
do
crin
olo
gic
al c
on
ditio
ns
Derm
ato
log
ical c
on
ditio
ns
Ce
reb
rova
scu
lar c
on
ditio
ns
Cere
bro
Co
nd
itions a
sso
cia
ted
with
M
en
tal h
ea
lth v
ascu
lar c
on
ditio
ns
Card
iolo
gic
al c
on
ditio
ns a
nd
pro
ce
du
res
Mortality tree This page shows the revised Tier 1 Mortality Indicators within the CQC Surveillance Programme.
Composite indicators are indicators that are formed of multiple sub-indicators. Further details of the composite indicator measures can be found in the Appendix.
CQC view
The SHMI was
flagged as an
Elevated Risk while
Gastroenterological
and hepatological
conditions and
procedures was
flagged as a Risk -
both would require
further investigation.
Northampton General Hospital NHS Trust Page 49
Mortality
Overall trust
Composite
indicator
SHMI HSMR In-hospital mortality
Context Safe Effective Caring Responsive Well-led
Elevated risk Risk No evidence of risk
CQC │
Mortality sub-tree Gastroenterological and Hepatological conditions and procedures was flagged as a Risk.
In-hospital mortality: Gastroenterological and hepatological conditions was flagged as a Risk.
CQC view
The Composite
Indicator
Gastroentological
and hepatological
conditions was
flagged as a Risk
and should be
investigated further.
Northampton General Hospital NHS Trust Page 50
Context Safe Effective Caring Responsive Well-led
Mortality
Overall trust
Composite
Indicator
Gastroenterological and
hepatological conditions and
procedures
Indicator RAG
In-hospital mortality: Gastroenterological and
hepatological conditions
Mortality outlier alert: Liver disease, alcohol-related Mortality outlier alert: Biliary tract disease Mortality outlier alert: Gastrointestinal haemorrhage Mortality outlier alert: Noninfectious gastroenteritis Mortality outlier alert: Intestinal obstruction without hernia Mortality outlier alert: Other gastrointestinal disorders Mortality outlier alert: Other liver diseases Mortality outlier alert: Operations on jejunum Mortality outlier alert: Peritonitis and intestinal abscess Mortality outlier alert: Therapeutic endoscopic procedures
on biliary tract
Mortality outlier alert: Therapeutic endoscopic procedures
on lower GI tract
Mortality outlier alert: Therapeutic endoscopic procedures
on upper GI tract
Mortality outlier alert: Therapeutic operations on jejunum
and ileum
Elevated risk Risk No evidence of risk
CQC │
Mortality The table below details the mortality related data items that were rated as comparatively ‘better’ or ‘worse’.
Northampton General Hospital NHS Trust Page 51
Data item source Data item Comparison with expected
Information Centre for Health & Social Care
(IC), Hospital Episode Statistics (HES)
(1 January 2011 to 31 December 2012)
Total 30 day mortality rates by Health Resources Group chapters: C - Mouth, head, neck,
and ears Better than expected
Total 30 day mortality rates by Health Resources Group chapters: M - Female
reproductive system
Tending towards better
than expected
Total 30 day mortality rates by Health Resources Group chapters: B - Eyes and periorbital Tending towards worse
than expected
Total 30 day mortality rates by Health Resources Group chapters: G - Hepato-biliary &
pancreatic system
Tending towards worse
than expected
Total 30 day mortality rates by Health Resources Group chapters: D - Respiratory system Much worse than
expected
Information Centre for Health & Social Care
(IC), Hospital Episode Statistics (HES)
(1 January 2011 to 31 December 2011)
Standardised in-hospital mortality rates by CCS diagnosis group: Paediatrics and
congenital disorders
Much better than
expected
Standardised in-hospital mortality rates by CCS diagnosis group: Musculoskeletal Tending towards better
than expected
Standardised in-hospital mortality rates by CCS diagnosis group: Endocrinology Tending towards worse
than expected
Standardised in-hospital mortality rates by CCS diagnosis group: Dermatology Tending towards worse
than expected
Standardised in-hospital mortality rates by CCS diagnosis group: Gastroenterology and
hepatology Worse than expected
Context Safe Effective Caring Responsive Well-led
Much better/better than expected
Tending towards better than expected
Tending towards worse than expected
Much worse/worse than expected
CQC │
Overview of Maternity Indicators The analysis within this report, is based on births that took place in-hospital. Home births are excluded, as the level of information recorded in HES for these births is not detailed enough to be used in our analysis.
Deliveries that are privately funded but take place in an NHS setting are included in this analysis.
Please note that the analysis of perinatal mortality and caesarean sections includes discharges up until July 2013. However, the analysis of neonatal readmissions only includes discharges up until June 2013. Discharges in July 2013 cannot be analysed, as data is
not yet available.
The analysis of the maternal readmissions and puerperal sepsis and other puerperal infections indicators will only look at discharges up until May 2013 as this is the latest available.
Level of Neonatal Unit at the trust
Northampton General Hospital NHS Trust has a Local Neonatal Unit (LNU). This type of unit was previously called a Level 2 unit.
LNUs provide neonatal care for their own catchment population, except for the sickest babies. They provide all categories of neonatal care, but they transfer babies who require complex or longer-term intensive care to a Neonatal Intensive Care Unit as they are not staffed to provide longer-term intensive care. The majority of babies over 27 weeks of gestation will usually receive their full care, including short periods of intensive care, within their Local Neonatal Unit. Some networks have agreed variations on this policy, due to local requirements. Some Local Neonatal Units provide high
dependency care and short periods of intensive care for their network population. Local Neonatal Units may receive transfers from other neonatal services in the network if they fall within their agreed work pattern.
Deliveries at the trust per Quarter
The graph below shows the numbers of deliveries by quarter at the trust between April 2010 and June 2013.
Northampton General Hospital NHS Trust Page 52
Context Safe Effective Caring Responsive Well-led
Source: Royal College of Paediatrics and Child Health
940
960
980
1,000
1,020
1,040
1,060
1,080
1,100
1,120
1,140
Ap
r-Ju
n 1
0
Jul-S
ep 1
0
Oct-
Dec 1
0
Jan
-Mar
11
Ap
r-Ju
n 1
1
Jul-S
ep 1
1
Oct-
Dec 1
1
Jan
-Mar
12
Ap
r-Ju
n 1
2
Jul-S
ep 1
2
Oct-
Dec 1
2
Jan
-Mar
13
Ap
r-Ju
n 1
3
Nu
mb
er
of
de
liveri
es
CQC │
Proportions of delivery methods
The table below shows the profile of delivery methods at the trust between July 2012 and July 2013, as derived from the recorded primary procedure. The trust had a slightly lower normal delivery rate (58.8%) when compared to the national rate (60.9%).
Profile of deliveries
The table below shows the profile of all deliveries at the trust between July 2012 and July 2013.
This analysis shows that the trust has a broadly similar profile of deliveries compared to the national profile.
Northampton General Hospital NHS Trust
Delivery method England
deliveries (%)
Trust
deliveries (%)
Trust
deliveries (n)
Elective caesarean delivery 10.7% 13.8% 631
Other/Emergency caesarean delivery 14.5% 14.6% 668
Breech Extraction delivery 0.0% 0.2% 10
Other Breech delivery 0.4% 0.2% 7
Low Forceps cephalic delivery 3.2% * *
Other Forceps Delivery 3.6% 5.8% 264
Ventouse (Vacuum) delivery 5.9% 6.5% 297
Spontaneous other delivery 0.4% * *
Normal delivery (Spontaneous vertex) 60.9% 58.8% 2,690
Other/unrecorded method of delivery 0.5% 0.2% 7
Total deliveries 100% 100% 4,576
England
deliveries (%)
Trust
deliveries (%)
Trust
deliveries (n)
Births Single 98.5% 98.5% 4,506
Multiple 1.5% 1.5% 70
Gestation
period
Under 24 weeks 0.6% 0.2% 8
Pre term 24-36
weeks 7.4% 6.4% 282
Term 37-42 weeks 91.8% 93.2% 4,119
Post Term >42
weeks 0.3% 0.2% 9
Mother’s age
Under 20 4.5% 4.8% 218
20-34 76.1% 77.3% 3,539
35-39 15.5% 14.6% 670
40+ 3.9% 3.3% 149
*Note: Delivery methods are derived from primary procedure. For reasons of
confidentiality, low numbers and their associated proportions have been removed and
replaced with ‘*’.
Context Safe Effective Caring Responsive Well-led
England Trust
Median length of stay 2 days 2 days
Total number of deliveries 695,378 4,576
Source: Hospital Episode Statistics
Page 53 Page 53
CQC │
Cross-sectional analysis of standardised maternity indicators at Northampton General Hospital NHS Trust
Below shows the outcomes of cross-sectional standardised analysis for each of the indicators used as part of the maternity outlier surveillance programme. The table on this page shows the outcomes of cross-sectional standardised analysis for each of the indicators used as part of the maternity outlier surveillance programme.
The trust’s elective caesarean section rates were significantly higher than expected. Please note that the trust has alerted as part of the
maternity outlier surveillance programme for significantly high rates of elective caesarean sections using CUSUM time series analysis.
This was the second alert for this indicator at the trust and therefore our initial questions to the trust asked for an explanation for why
elective caesarean section rates have remained significantly higher than expected. We did not ask the trust to carry out a case note review, but asked for an update on the actions put in place following the earlier alert.
The trust reported that they had implemented all NICE guidance and carry out regular quality audits but that their elective caesarean section rate remains high. The trust stated that exclusion of home births from our analysis may raise their rate as the trust has a higher proportion of these compared to nationally. In March 2013, the trust
had an external review conducted by the Royal College of Obstetricians and Gynaecologists that concluded that the trust’s maternity services complied with the majority of the standards they were assessed against. The trust’s current action plan was also reviewed and evidenced during this visit; this includes several measures, including the development of a Birth Centre, which the trust is taking to reduce their elective caesarean rate.
The trust response was considered by the maternity outliers panel on 27 November 2013. The panel decided that this case could now be passed to the local compliance team for follow-up of progress against their action plan.
The trust’s perinatal mortality rate was also significantly higher than expected, however it did not meet the criteria for an outlier using time series analysis. The trust’s maternal readmission rate was
significantly lower than expected.
The table below shows the outcomes of cross-sectional standardised analysis for each of the indicators used as part of the maternity outlier surveillance programme.
Northampton General Hospital NHS Trust Page 54 Source: NHS Neonatal Networks website
Context Safe Effective Caring Responsive Well-led
Indicator Time period Observed
number
Expected
number
Standardised
Ratio (SR)
Maternal readmissions July 2012 to
May 2013 49 87.8 55.8 (z = -2.6)
Perinatal mortality
July 2012 to
July
2013
49 25.9 189.1 (z = 2.7)
Emergency caesarean
sections
July 2012 to
July
2013
668 661.0 101.1 (z = 0.1)
Elective caesarean
sections
July 2012 to
July
2013
631 481.5 131.0 (z = 2.4)
Neonatal readmissions July 2012 to
June 2013 205 188.2 108.9 (z = 0.4)
Puerperal sepsis and
other puerperal infections
July 2012 to
May 2013 38 77.7 48.9 (z = -1.5)
CQC │
Caring
Northampton General Hospital NHS Trust Page 55
The trust performs
“within the expected range” for
10 of the 10 Adult Inpatient Survey domains
A&E scores from the
friends and family
test have exceeded
the England average
for three out of the past
four months
Significantly
decreased on five
questions compared to
the 2011 CQC Adult
Inpatient Survey
In the top 20% in
England for eight
questions from the
cancer patient survey,
but the worst 20% for
five questions
In the bottom 20% for
seven questions from
the bereavement
survey
CQC │
Framework section Tier 1 Indicator RAG
Compassionate
care
“Did you find someone on the hospital staff to talk to
about your worries and fears?”
(CQC Adult Inpatient Survey 2012)
“Do you feel you got enough emotional support from
hospital staff during your stay?”
(CQC Adult Inpatient Survey 2012)
Meeting physical
needs
“Did you get enough help from staff to eat your meals?”
(CQC Adult Inpatient Survey 2012)
“Were you involved as much as you wanted to be in
decisions about your care and treatment?”
(CQC Adult Inpatient Survey 2012)
“Do you think the hospital staff did everything they could
to help control your pain?”
(CQC Adult Inpatient Survey 2012)
Overall experience
“Overall…”(I had a very poor/good experience)
(CQC Adult Inpatient Survey 2012)
NHS England inpatients score from Friends and Family
Test (CQC Adult Inpatient Survey 2012)
Treatment with
dignity and respect
“Overall, did you feel you were treated with respect and
dignity while you were in hospital?”
(CQC Adult Inpatient Survey 2012)
Trusting
relationships
"Did you have confidence and trust in the doctors treating
you?“(CQC Adult Inpatient Survey 2012)
"Did you have confidence and trust in the nurses treating
you?“(CQC Adult Inpatient Survey 2012)
Additional information
Additional information has been included in this domain to provide a more holistic view of the trust’s performance. These are listed below:
Caring Dashboard
Page 56
Additional information
Friends and Family Test
Cancer Patient Experience Survey
Further Sources (Qualitative Information)
National Bereavement Survey
Context Safe Effective Caring Responsive Well-led
Source: CQC Intelligent Monitoring Report, December 2013 –
CQC Adult Inpatient Survey 2012
Elevated risk Risk No evidence of risk
Northampton General Hospital NHS Trust
CQC │
CQC’s Adult Inpatient Survey 2012 Analysis of data from the CQC’s Adult Inpatient Survey 2012 shows that the trust scored about the same as other trusts in all 10 areas of questioning.
Comparison with 2012 results
Compared to results from 2011, the trust’s performance has significantly decreased on five questions, as shown in the table below.
CQC view
The trust has
performed similarly
to other trusts on all
of the CQC Adult
Inpatient Survey
questions.
However, the trust
has shown a
significant decrease
on five questions
compared to 2011.
Northampton General Hospital NHS Trust Page 57
Source: CQC Adult Inpatient Survey 2011, 2012
Context Safe Effective Caring Responsive Well-led
Area of questioning RAG
The Emergency/A&E Department
Waiting List and Planned Admissions
Waiting to Get to a Bed on a Ward
The Hospital and Ward
Doctors
Nurses
Care and Treatment
Operations and Procedures
Leaving Hospital
Overall Views and Experiences
Better than other trusts
About the same as other trusts
Worse than other trusts
Direction of change from previous year
Question 2012 2011 Trend
3. While you were in the A&E
Department, how much information
about your condition or treatment was
given to you?
7.9 8.5
9. From the time you arrived at the
hospital, did you feel that you had to
wait a long time to get to a bed on a
ward?
7.3 7.9
53. How long was the delay? 7.1 7.7
67. Overall, did you feel you were
treated with respect and dignity while
you were in the hospital?
8.6 9.0
69. During your hospital stay, were
you ever asked to give your views on
the quality of your care?
1.2 1.7
CQC │
CQC’s Adult Inpatient Survey 2012 The full results of the CQC Adult Inpatient Survey 2012 are shown below. For each question in the survey, the standardised responses are converted into a scale from 0 to 10, with a higher score representing better performance.
Northampton General Hospital NHS Trust Page 58
Area of questioning Question RAG Trust 2012 Trust 2011
The Emergency/A&E
Department
While you were in the A&E Department, how much information about your condition or treatment was given to
you? 7.9 8.5
Were you given enough privacy when being examined or treated in the A&E Department? 8.7 8.80
How do you feel about the length of time you were on the waiting list? 8.3 8.4
Was your admission date changed by the hospital? 9.2 9.4
Had the hospital specialist been given all necessary information about your condition/illness from the person
who referred you? 9.7 -
From the time you arrived at the hospital, did you feel that you had to wait a long time to get to a bed on a
ward? 7.4 7.9
The Hospital and Ward
Did you ever share a sleeping area with patients of the opposite sex? 9.5 9.3
Did you ever use the same bathroom or shower area as patients of the opposite sex? 9.0 9.3
Were you ever bothered by noise at night from other patients? 5.1 5.0
Were you ever bothered by noise at night from hospital staff? 7.3 7.2
In your opinion, how clean was the hospital room or ward that you were in? 8.6 8.7
How clean were the toilets and bathrooms that you used in hospital? 8.3 8.4
Did you feel threatened during your stay in hospital by other patients or visitors? 9.6 9.6
Were hand-wash gels available for patients and visitors to use? 7.9 8.5
How would you rate the hospital food? 9.6 9.7
Were you offered a choice of food? 4.7 4.8
Did you get enough help from staff to eat your meals? 8.6 8.8
Context Safe Effective Caring Responsive Well-led
Source: CQC Adult Inpatient Survey 2011, 2012 Better than other trusts ‘About the same’ as other trusts Worse than other trusts
CQC │
CQC’s Adult Inpatient Survey 2012 This page further details the results of the CQC Adult Inpatient Survey 2012.
Northampton General Hospital NHS Trust Page 59
Area of questioning Question RAG Trust 2012 Trust 2011
Doctors
When you had important questions to ask a doctor, did you get answers that you could understand? 8.0 8.0
Did you have confidence and trust in the doctors treating you? 8.7 8.9
Did doctors talk in front of you as if you weren't there? 8.5 8.3
Nurses
When you had important questions to ask a nurse, did you get answers that you could understand? 8.1 8.1
Did you have confidence and trust in the nurses treating you? 8.6 8.8
Did nurses talk in front of you as if you weren't there? 8.8 8.7
In your opinion, were there enough nurses on duty to care for you in hospital? 7.2 7.1
Care and Treatment
Did a member of staff say one thing and another say something different? 7.8 7.7
Were you involved as much as you wanted to be in decisions about your care and treatment? 7.2 7.1
How much information about your condition or treatment was given to you? 7.8 7.9
Did you find someone on the hospital staff to talk to about your worries and fears? 5.6 6.2
Do you feel you got enough emotional support from hospital staff during your stay? 7.0
Were you given enough privacy when discussing your condition or treatment? 8.4 8.3
Were you given enough privacy when being examined or treated? 9.5 9.5
Do you think the hospital staff did everything they could to help control your pain? 8.0 8.1
After you used the call button, how long did it usually take before you got help? 5.9 6.1
Context Safe Effective Caring Responsive Well-led
Source: CQC Adult Inpatient Survey 2011, 2012 Better than other trusts ‘About the same’ as other trusts Worse than other trusts
CQC │
CQC’s Adult Inpatient Survey 2012 This page further details the results of the CQC Adult Inpatient Survey 2012.
Northampton General Hospital NHS Trust Page 60
Area of questioning Question RAG Trust 2012 Trust 2011
Operations and
Procedures
Did a member of staff explain the risks and benefits of the operation or procedure? 8.8 8.9
Did a member of staff explain what would be done during the operation or procedure? 8.4 8.4
Did a member of staff answer your questions about the operation or procedure? 8.5 8.5
Were you told how you could expect to feel after you had the operation or procedure? 6.7 7.1
Did the anaesthetist or another member of staff explain how he or she would put you to sleep or control your
pain? 9.0 9.2
Afterwards, did a member of staff explain how the operation or procedure had gone? 7.6 7.6
Leaving Hospital
Did you feel you were involved in decisions about your discharge from hospital? 6.6 -
Were you given enough notice about when you were going to be discharged? 6.8 -
Discharge delayed due to wait for medicines/to see doctor/for ambulance. 5.9 6.3
How long was the delay? 7.1 7.7
Before you left hospital, were you given any written or printed information about what you should or should
not do after leaving hospital? 6.6 6.4
Did a member of staff tell you about medication side effects to watch for when you went home? 8.0 8.1
Were you told how to take your medication in a way you could understand? 4.3 4.8
Were you given clear written or printed information about your medicines? 8.1 8.3
Did a member of staff tell you about any danger signals you should watch for after you went home? 7.5 -
Did a member of staff explain the purpose of the medicines you were to take at home in a way you could
understand? 5.3 5.0
Did hospital staff take your family or home situation into account when planning your discharge? 7.3 -
Did the doctors or nurses give your family or someone close to you all the information they needed to care
for you? 5.5 5.7
Context Safe Effective Caring Responsive Well-led
Source: CQC Adult Inpatient Survey 2011, 2012 Better than other trusts ‘About the same’ as other trusts Worse than other trusts
CQC │
CQC’s Adult Inpatient Survey 2012 This page further details the results of the CQC Adult Inpatient Survey 2012.
Northampton General Hospital NHS Trust Page 61
Area of questioning Question RAG Trust 2012 Trust 2011
Leaving Hospital
Did hospital staff tell you who to contact if you were worried about your condition or treatment after you left
hospital? 8.5 -
Did hospital staff discuss with you whether additional equipment or adaptations were needed in your home? 8.4 -
Did hospital staff discuss with you whether you may need any further health or social care services after
leaving hospital? 8.1 8.2
Did you receive copies of letters sent between hospital doctors and your family doctor (GP)? 8.7 8.7
Were the letters written in a way that you could understand? 8.6 9.0
Overall Views and
Experiences
Overall, did you feel you were treated with respect and dignity while you were in the hospital? 7.6 -
Overall impression of stay 1.2 1.7
During your hospital stay, were you ever asked to give your views on the quality of your care? 1.8 -
Did you see, or were you given, any information explaining how to complain to the hospital about the care you
received? 8.5 -
Context Safe Effective Caring Responsive Well-led
Source: CQC Adult Inpatient Survey 2011, 2012 Better than other trusts ‘About the same’ as other trusts Worse than other trusts
CQC │
Friends and Family Test Since April 2013, patients have been asked whether they would recommend hospital wards to their friends and family if they required similar care or treatment, the results of which have been used to formulate NHS Friends and Family Tests for Accident & Emergency and Inpatient admissions.
Scores are calculated as follows:
• The proportion of respondents who state that they would be “extremely likely” to recommend the service to their friends and family, minus those who
responded “neither likely or unlikely,” “unlikely,” or “extremely unlikely” to do so.
• Scores can range from -100 to 100, with a higher score indicative of better performance. It should be noted that this score is not a percentage.
Further guidance is available via NHS England.
It should be noted that response rates can be influenced by many factors and are provided here for context only. Hence, low response rates are common across the country for both A&E and Inpatient Friends and Family Tests.
Overall Performance
The tables on the following pages detail the performance of the trust in the A&E and Inpatient Friends and Family Tests for July 2013 - October 2013.
As the table below shows, the trust scored 67 overall in the October Inpatient Friends and Family Test, which is in line with the England average.
The trust scored 67 for the A&E department and 68 for inpatient areas.
CQC view
The Friends and
Family Tests have
been introduced to
give patients the
opportunity to give
feedback on the
quality of care they
receive. The trust
can be seen to be
performing below the
England average for
the inpatient average
component of the
test, whilst the A&E
score is significantly
above the England
average.
Northampton General Hospital NHS Trust Page 62
Source: NHS Friends and Family Survey, July 2013 – October 2013
Context Safe Effective Caring Responsive Well-led
England Northampton
General Hospital
Inpatient response rates 33.6% 32.1%
Inpatient scores 74.1 68.0
A&E response rates 14.0% 18.5%
A&E scores 56.4 67.0
Overall response rate 23.9% 22.2%
Overall score 68.5 67.0
CQC │
Friends and Family Test Inpatient performance
In August, 454 people completed the test. 96.4% of patients asked were either ‘likely’ or ‘extremely likely’ to recommend the ward they stayed in to friends or family.
Inpatient Friends and Family Test, July 2013 – October 2013
Accident and Emergency performance
In August 346 people completed the test. 93.3% of patients asked were either ‘likely’ or ‘extremely likely’ to recommend the trust’s A&E department to friends or family.
A&E Friends and Family Test, July 2013 – October 2013
CQC view
The trust has
consistently scored
below the England
average for the
Inpatient test from
July onwards.
However, the trust’s
A&E scores have
exceeded the
England average for
three of the four
months since the
Friends and Family
Test's began.
Northampton General Hospital NHS Trust Page 63
Source: NHS Friends and Family Survey, July 2013 – October 2013
Indicator Month
July Aug Sept Oct
Score Trust 55 61 55 67
England 55 54 54 56
Response Rate Trust 12.9% 6.2% 13.1% 18.5%
England 10.3% 11.3% 13.0% 14.0%
Indicator Month
July Aug Sept Oct
Score Trust 69 70 74 68
England 72 72 71 74
Response Rate Trust 25.2% 17.1% 27.3% 32.1%
England 31.0% 32.1% 32.1% 33.6%
Context Safe Effective Caring Responsive Well-led
CQC │
Friends and Family Test Wards and specialties
In the October 2013 inpatient survey, 30 wards at Northampton General Hospital were included. Response rates within wards varied between 0% and 107.7%. There were 19 wards that scored less than the trust average of 65, these wards are detailed in the table below and are continued overleaf. Creaton Ward scored the least of all wards. There were two wards where people would be extremely unlikely to recommend them. These were Creaton and Dryden.
Wards that scored below trust average in the August 2013 inpatient Friends and Family Test
CQC view
Out of 30 inpatient
wards there were 19
wards that scored
less than the trust
average of 65.
Creaton Ward
scored the least of
all wards with a
score of 18. 18% of
people questioned
would be extremely
unlikely to
recommend this
ward.
Northampton General Hospital NHS Trust Page 64
Source: NHS Friends and Family Survey, October 2013
Context Safe Effective Caring Responsive Well-led
Ward Name
Res
po
ns
es
Eli
gib
le
Res
po
ns
e
Rate
Sc
ore
Ex
’ L
ike
ly
Lik
ely
Neit
he
r
Un
lik
ely
Ex
’
Un
lik
ely
Do
n't
Kn
ow
First specialty Second specialty
Creaton ward 11 54 20.4% 18 5 3 1 0 2 0 General Medicine
Abington ward 16 48 33.3% 25 6 8 1 1 0 0 Trauma &
Orthopaedics
Emergency assessment
unit 20 186 10.8% 45 11 7 0 2 0 0 General Medicine
Dryden ward 27 112 24.1% 52 18 5 3 0 1 0 General Medicine
Holcot stroke unit 15 17 88.2% 53 10 3 2 0 0 0 General Medicine
Victoria ward 17 67 25.4% 56 10 5 1 0 0 1 General Medicine
Allebone ward 14 54 26.0% 57 9 4 0 1 0 0 General Medicine Cardiology
Compton ward 14 13 107.7% 57 8 6 0 0 0 0 Geriatric Medicine
Finedon ward 15 56 26.8% 57 9 4 1 0 0 1 Nephrology
Spencer ward 31 133 23.3% 57 19 9 1 1 0 1 Gynaecology
Brampton ward 12 40 30.0% 58 8 3 1 0 0 0 Geriatric Medicine
Rowan ward 43 182 23.6% 58 27 14 2 0 0 0 General Surgery
CQC │
Friends and Family Test
Wards that scored below trust average in the August 2013 inpatient Friends and Family Test
CQC view
Out of 30 inpatient
wards there were 19
wards that scored
less than the trust
average of 65.
Creaton Ward
scored the least of
all wards with a
score of 18. 18% of
people questioned
would be extremely
unlikely to
recommend this
ward.
Northampton General Hospital NHS Trust Page 65
Context Safe Effective Caring Responsive Well-led
Source: NHS Friends and Family Survey, October 2013
Ward Name
Re
sp
on
se
s
Eli
gib
le
Re
sp
on
se
Ra
te
Sc
ore
Ex
’ L
ike
ly
Lik
ely
Ne
ith
er
Un
lik
ely
Ex
’
Un
lik
ely
Do
n't
Kn
ow
First specialty Second specialty
Benham Ward 50 125 40.0% 60 34 12 2 2 0 0 General Medicine
Cedar Ward 9 69 13.0% 63 5 3 0 0 0 1 Trauma &
Orthopaedics
Corby Community 8 8 100.0% 63 5 3 0 0 0 0 Geriatric Medicine
DISNEY WARD
(Aged 16yr & Over) 0 8 0% NA 0 0 0 0 0 0 Paediatrics
Emergency Observation
Area 0 30 0% NA 0 0 0 0 0 0 General Medicine
High Dependency Unit 0 2 0% NA 0 0 0 0 0 0 General Surgery
PADDINGTON
(Aged 16yr & Over) 0 5 0% NA 0 0 0 0 0 0 Paediatrics
CQC │
Cancer Patient Experience Survey The Cancer Patient Experience Survey (CPES) is designed to monitor national progress on cancer care. 155 acute hospital NHS trusts took part in the 2012/13 survey, which comprised of a number of questions across 13 different cancer groups. Of the 70 questions for which the trust had a sufficient number of survey respondents on which to base findings, Northampton General Hospital NHS Trust was rated by patients as being in the bottom 20% of all trusts nationally for five of the 70 questions. The results of the questions are displayed over the following pages.
CQC view
The trust performed
‘Better than other
trusts’ nationally for
eight of the
questions in the
2012/2013 Cancer
Patient Experience
Survey. There were
six questions where
the trust performed
‘worse than other
trusts’ nationally.
These were around
communication
between staff and
patients, hospital
staff and community
staff working
together, and the
number of people
who would rate the
treatment as
‘excellent or very
good.
Northampton General Hospital NHS Trust Page 66
Question RAG Trust 2013 (%) National Average
2013 (%) Trust 2012 (%)
Saw GP once/twice before being told had to go to hospital 74.8% 73.8% 73.8%
Patient thought they were seen as soon as necessary 85.9% 83.3% 84.2%
% ans. less than 12 months 96.4% 95.7% 94.5%
Patient's health got better or remained about the same while waiting 82.1% 80.0% 82.9%
% ans. they've had diagnostic tests for cancer in last 12 months 88.8% 88.1% 85.7%
Staff gave complete explanation of purpose of test(s) 83.9% 83.1% 85.6%
Staff explained completely what would be done during test 86.8% 86.5% 85.2%
Given easy to understand written information about test 89.6% 86.4% 86.2%
Given complete explanation of test results in understandable way 81.6% 77.8% 77.8%
% ans. that they were first told by a doctor (incl GP) or nurse 96.4% 95.8% 97.7%
Patient told they could bring a friend when first told they had cancer 79.3% 73.2% 68.3%
Patient felt they were told sensitively that they had cancer 84.0% 83.7% 85.3%
Patient completely understood the explanation of what was wrong 72.4% 73.3% 72.8%
Patient given written information about the type of cancer they had 76.5% 70.7% 76.7%
Patient given a choice of different types of treatment 77.1% 84.1% 82.2%
Patient’s views definitely taken into account by doctors and nurses discussing
treatment 68.3% 70.8% 68.6%
Source: Cancer Patient Experience Survey, National Cancer Intelligence
Network, 2011/12 and 2012/13
Context Safe Effective Caring Responsive Well-led
Better than other trusts About the same as other trusts
Worse than other trusts
CQC │
Cancer Patient Experience Survey
The following table further details the trust’s performance on the Cancer Patient Experience Survey.
Northampton General Hospital NHS Trust
Source: Cancer Patient Experience Survey, National Cancer Intelligence Network, 2011/12 and 2012/13
Question RAG Trust 2013 (%) National Average 2013 (%) Trust 2012 (%)
Possible side effects explained in an understandable way 77.4% 74.3% 73.8%
Patient given written information about side effects 87.0% 80.2% 84.5%
Patient definitely told about treatment side effects that could affect them in the future 53.2% 54.8% 71.3%
Patient definitely involved in decisions about care and treatment 70.7% 72.1% 84.6%
Patient given the name of the CNS in charge of their care 90.8% 87.1% 75.1%
Patient finds it easy to contact their CNS 72.5% 75.5% 91.0%
CNS definitely listened carefully the last time spoken to 90.7% 91.0% 89.5%
Get understandable answers to important questions all/most of the time 91.9% 90.5% 79.0%
Hospital staff gave information about support groups 81.8% 81.0% 58.5%
Hospital staff gave information about impact cancer could have on work/education 73.6% 73.1% 78.9%
Hospital staff gave information on getting financial help 65.0% 52.6% 22.5%
Hospital staff told patient they could get free prescriptions 85.9% 75.2% 95.5%
Patient has seen information about cancer research in the hospital 94.8% 83.6% 53.8%
Taking part in cancer research discussed with patient 24.6% 28.9% 60.9%
Patient has taken part in cancer research 54.6% 59.8% 90.9%
% ans. they've had an operation in last 12 months 64.0% 57.8% 83.6%
Staff gave complete explanation of what would be done 83.8% 87.0% 76.9%
Patient given written information about the operation 74.5% 72.9% 71.8%
Staff explained how operation had gone in understandable way 73.0% 76.7% 71.2%
% ans. they've stayed overnight for cancer care in last 12 months 73.5% 67.4% 79.2%
Got understandable answers to important questions all/most of the time 85.1% 82.1% 83.7%
Page 67
Context Safe Effective Caring Responsive Well-led
Better than other trusts
About the same as other trusts
Worse than other trusts
CQC │
Cancer Patient Experience Survey
The following table further details the trust’s performance on the Cancer Patient Experience Survey.
Northampton General Hospital NHS Trust
Source: Cancer Patient Experience Survey, National Cancer Intelligence Network, 2011/12 and 2012/13
Question RAG Trust 2013 (%) National Average 2013 (%) Trust 2012 (%)
Patient had confidence and trust in all doctors treating them 84.3% 84.5% 82.1%
Doctors did not talk in front of patient as if they were not there 83.0% 82.7% 63.0%
Patient’s family definitely had opportunity to talk to doctor 65.7% 66.4% 71.4%
Got understandable answers to important questions all/most of the time 79.9% 73.9% 67.8%
Patient had confidence and trust in all ward nurses 66.1% 68.5% 79.7%
Nurses did not talk in front of patient as if they were not there 81.0% 83.8% 56.0%
Always / nearly always enough nurses on duty 60.1% 60.7% 85.4%
Patient did not think hospital staff deliberately misinformed them 90.1% 87.3% 77.5%
Patient never thought they were given conflicting information 80.3% 79.5% 54.6%
All staff asked patient what name they preferred to be called by 54.2% 56.4% 83.2%
Always given enough privacy when discussing condition/treatment 83.9% 84.2% 96.0%
Always given enough privacy when being examined or treated 93.3% 93.6% 61.4%
Patient was able to discuss worries or fears with staff during visit 67.4% 63.8% 80.3%
Hospital staff did everything to help control pain all of the time 79.9% 84.1% 80.6%
Always treated with respect and dignity by staff 81.1% 82.5% 81.8%
Given clear written information about what should / should not do post discharge 84.2% 83.3% 90.5%
Staff told patient who to contact if worried post discharge 93.2% 92.7% 63.1%
Family definitely given all information needed to help care at home 60.4% 60.5% 61.1%
Patient definitely given enough care from health or social services 64.1% 58.3% 75.8%
Staff definitely did everything to control side effects of radiotherapy 78.2% 78.6% 80.9%
Staff definitely did everything to control side effects of chemotherapy 78.7% 81.2% 81.4%
Staff definitely did everything they could to help control pain 78.2% 80.9% 68.0%
Page 68
Context Safe Effective Caring Responsive Well-led
Better than other trusts
About the same as other trusts
Worse than other trusts
CQC │
Cancer Patient Experience Survey
The following table further details the trust’s performance on the Cancer Patient Experience Survey.
Northampton General Hospital NHS Trust
Source: Cancer Patient Experience Survey, National Cancer Intelligence Network, 2011/12 and 2012/13
Question RAG Trust 2013 (%) National Average 2013 (%) Trust 2012 (%)
Hospital staff definitely gave patient enough emotional support 68.4% 70.2% 94.5%
% ans. they've had an OP appt with a cancer doctor in last 12 months 95.2% 92.8% 77.9%
Doctor had the right notes and other documentation with them 94.7% 95.4% 95.1%
GP given enough information about patient`s condition and treatment 95.1% 94.2% 95.1%
Practice staff definitely did everything they could to support patient 68.8% 67.8% 95.9%
Hospital and community staff always worked well together 60.6% 64.3% 67.8%
Given the right amount of information about condition and treatment 89.3% 87.7% 60.3%
Patient offered written assessment and care plan 23.1% 22.3% 89.1%
Patient did not feel that they were treated as a `set of cancer symptoms` 81.3% 80.4% 27.0%
Patient`s rating of care `excellent`/ `very good` 85.7% 87.5% 78.4%
Page 69
Context Safe Effective Caring Responsive Well-led
Better than other trusts
About the same as other trusts
Worse than other trusts
CQC │
Further sources Patient opinion
Patient Opinion is an independent non-profit feedback platform for health services, which aims to facilitate honest and meaningful conversations between patients and providers.
There are 337 comments on the trust’s section of the Patient Opinion website; there is some overlap with the comments on the NHS Choices website.
The service has scores of
• 3.7 stars out of 5 stars ‘cleanliness’ (126 ratings) • 5 stars out of 5 stars ‘environment’ (3 ratings) • 4.3 stars out of 5 stars ‘information’ (3 ratings) • 3.9 stars out of 5 stars ‘involved’ (128 ratings) • 4.3 stars out of 5 stars ‘listening’ (3 ratings) • 4.1 stars out of 5 stars ‘medical’ (127 ratings) • 4 stars out of 5 stars ‘nursing’ (127 ratings) • 2.7 stars out of 5 stars ‘parking’ (124 ratings) • 4 stars out of 5 stars ‘respect’ (130 ratings) • 3.7 stars out of 5 stars ‘timeliness’ (129 ratings) Good things patients are saying about the hospital relate to Cleaners, Healthcare assistants, Medical care, Nurses and Staff. What could be improved about the hospital includes A&E and care in general.
Share your experience
Share Your Experience is a service organised by the Care Quality Commission, whereby patients are asked to provide feedback on the standard of care they have received.
There were eight Your Experience comments for this trust, of which all were negative.
The eight negative comments cover the following themes; Poor care, Waiting times, Staff levels, Cancelled surgeries and Food.
The National Bereavement Survey 2011
The National Bereavement Survey 2011 was collected at Primary Care Trust cluster-level. Northampton General NHS Trust formed part of the Milton Keynes and Northamptonshire PCT cluster.
The Milton Keynes and Northamptonshire PCT cluster can be seen to be performing in the bottom 20% for seven indicators, these can be found in the appendices. The results for Hospital Nurses and Doctors are shown below.
The full results for the National Bereavement Survey 2011 can be found in the appendices.
CQC view
Comments and
reviews posted via
Patient Opinion and
share your
experience highlight
a number of areas
for further review
including poor care
and waiting times.
Northampton General Hospital NHS Trust Page 70
Staff Respect and Dignity Quality of Care
Hospital Nurses
Hospital Doctors
Context Safe Effective Caring Responsive Well-led
Sources: Patient Opinion; NHS Share Your Experience;
National Bereavement Survey 2011 Top 20% of PCT clusters Middle 60% of PCT clusters
Bottom 20% of PCT clusters
CQC │
Further sources NHS Choices
Northampton General Hospital has 249 ‘reviews’ on the NHS Choices website. 10 of these reviews are included in the analysis below dated Jan 2013 to Dec 2013.
There were 25 positive comments rated 5 stars. Themes included excellent A&E Care, professionalism, waiting times, respect & dignity and cleanliness. There were six negative comments rated 1 star. Themes from this included: communication, lack of care & treatment, mis-diagnosis, waiting times and unprofessional staff.
The stars ratings on the NHS Choices website give Northampton General Hospital a score of 3.5 stars out of 5 overall with the following:
• 4 stars for ‘cleanliness’ (based on 60 ratings) • 4 stars for ‘staff co-operation’ (59 ratings) • 4 stars for ‘dignity and respect’ (62 ratings) • 4 stars for ‘involvement in decisions’ (61 ratings) • 4.5 stars for ‘same-sex accommodation’ (48 ratings)
CQC view
Comments and
reviews via NHS
Choices praise
excellent care
received in A&E.
However reviews
also flag lack of care
and treatment as a
concern.
Northampton General Hospital NHS Trust Page 71
Source: NHS Choices
Context Safe Effective Caring Responsive Well-led
CQC │
Further sources Patient-Led Assessments of the Care Environment (PLACE)
The 2013 Patient-Led Assessments of the Care Environment (PLACE) programme replaced the former Patient Environment Action Team (PEAT) programme from April 2013.
These self-assessments are undertaken by teams of NHS and private/independent health care providers and for the first time include at least 50% members of the public (known as patient assessors). They focus on the
environment in which care is provided, as well as supporting non-clinical services such as cleanliness, food, hydration, and the extent to which the provision of care with privacy and dignity is supported.
The table below depicts Northampton General Hospital’s PLACE scores in the four metrics that were assessed:
CQC view
Patient-Led
Assessments of the
Care Environment
(PLACE)
Assessment scored
Northampton
General above 90%
for three out of the
four metrics -
Cleanliness, Privacy,
dignity and wellbeing
& Facilities.
However the trust
only scored 89.6%
for Food.
Northampton General Hospital NHS Trust Page 72
Source: Sources: Patient-Led Assessments of the Care Environment (PLACE),
England – 2013 (Experimental statistics published)
PLACE metric Northampton
General
Hospital
Scores (%)
Cleanliness 99.4%
Food 89.6%
Privacy, dignity and
wellbeing 94.1%
Facilities 95.3%
Context Safe Effective Caring Responsive Well-led
CQC │
Responsive
Northampton General Hospital NHS Trust Page 73
CQC analysis rated the trust as
‘medium risk’ for access to secondary care
through A&E
The trust is failing to
meet A&E targets for
95% of patients being
seen within 4 hours
The trust is worse than
average for unplanned
re-admittance and
patients leaving A&E
without being seen
The trust performed
within expectations
for cancelled
operations
Transitions from the
ambulance to A&E are
‘worse than
expected’
CQC │
Additional information Additional information has been included in this domain to provide a more holistic view of the trust’s performance. These are listed below:
Responsive Dashboard
Northampton General Hospital NHS Trust Page 74
Framework section Tier 1 Indicator RAG
Access Measures
A&E waiting times under 4 hours (January 2013 – March
2013)
Referral to treatment times under 18 weeks: admitted
pathway (April 2013)
Referral to treatment times under 18 weeks: non-admitted
pathway (April 2013)
Diagnostics waiting times: patients waiting over 6 weeks
for a diagnostic test (April 2013)
All cancers: 62 day wait for first treatment from urgent GP
referral (January 2013 – March 2013)
All cancers: 62 day wait for first treatment from NHS
cancer screening referral (January 2013 – March 2013)
All cancers: 31 day wait from diagnosis (January 2013 –
March 2013)
The proportion of patients whose operation was cancelled
(January 2013 – March 2013)
The number of patients not treated within 28 days of last
minute cancellation due to non-clinical reason (January
2013 – March 2013)
Proportion of ambulance journey where the ambulance
vehicle remained at hospital for more than 60 minutes N/A
Discharge and
Integration
Ratio of the total number of days delay in transfer from
hospital to the total number of occupied beds (January
2013 – March 2013)
Additional information
A&E wait from decision to admit to being admitted
Distribution of A&E wait times (within 4 hours)
Cancelled Operations
Delayed Discharges
CQC Analysis of Secondary Care
Context Safe Effective Caring Responsive Well-led
Elevated risk Risk No evidence of risk
Source: CQC Intelligent Monitoring Report, October 2013.
CQC │
A&E wait times A&E wait times and referral to treatment (RTT) times may indicate the effectiveness with which demand is managed. Trusts in England are tasked by the government with admitting, transferring or discharging 95% of patients within four hours of their arrival in the A&E department.
The chart below shows Northampton General Hospital NHS Trust’s performance in meeting this four hour target, it looks at wait times between 08 April 2013 and 08 October 2013. The trust is persistently failing to meet
the national target and is well below the England average. The 2013 summer months showed some improvement however attendances with less than 4 hours from arrival to admission, transfer or discharge with still fell below target during that period.
Last year the trust was performing better than the England average in relation to patients waiting between four and twelve hours to be admitted. However since January 2013 their performance has decreased and in April around 12% of patients were waiting over four hours to be admitted.
CQC view
The trust is regularly
not meeting the four
hour target in A&E.
Their performance
has improved since
it’s lowest A&E
attendances in April
but is still below
95%. The trust
should be taking
steps to alleviate
increased pressures
over winter to ensure
their performance
continues to
improve.
A large proportion of
patients are waiting
over four hours from
the decision to admit
until being admitted.
This is often higher
than the national
average.
Northampton General Hospital NHS Trust Page 75
Source: NHS England, April 2012 – October 2013
Context Safe Effective Caring Responsive Well-led
75%
80%
85%
90%
95%
100%
Ap
r-12
Jun
-12
Au
g-1
2
Oct-
12
Dec-1
2
Fe
b-1
3
Ap
r-13
Jun
-13
Au
g-1
3
Oct-
13
% of A&E attendances less than 4 hours from arrival to admission, transfer or discharge
Englandaverage
Trust
0.0%
3.0%
6.0%
9.0%
12.0%
15.0%
Ap
r-12
Jun
-12
Au
g-1
2
Oct-
12
Dec-1
2
Fe
b-1
3
Ap
r-13
Jun
-13
Au
g-1
3
Oct-
13
% of emergency admissions via A&E waiting 4-12 hours from the decision to admit until
being admitted
England average Trust
CQC │
Distribution of A&E waiting times Whilst the national target is that all patients be admitted or discharged within four hours of arriving at A&E, it is important to see how long patients are waiting within this target time.
The percentage of patients still waiting in A&E at the trust is in line with the national average, until between three and five hours when they perform worse than the average. The graph to the right shows the percentage of patents leaving A&E, this increases after the four hour target.
The trust is performing worse than the average in relation to patients leaving A&E without being seen, the highest percentage occurred in
March 2013 with 5% of patients not being seen. Since last November the trust has been worse than the national average for unplanned re-admittance.
Northampton General Hospital NHS Trust Page 76
Source: CQC analysis, February 2013
Source: CQC analysis, February 2013
Source: Health & Social Care Information Centre (HSCIC) September 2012 – August 2013
Context Safe Effective Caring Responsive Well-led
0%
20%
40%
60%
80%
100%
0 1 2 3 4 5 6 7 8 9 10 11
% o
f p
ati
en
ts s
till
wait
ing
in
A&
E
Time waited (hours)
Percentage of patients still waiting in A&E
Northampton General Hospital NHS Trust England average
-20
-10
0
10
20
30
0 1 2 3 4 5 6 7 8 9 10 11
-ve v
alu
es =
lo
wer
tha
n
avera
ge
+ve v
alu
es =
hig
he
r th
an
avera
ge
Time to depart A&E (hours)
Number of patients departing A&E at each time Interval, compared to the national average
0.0%1.0%2.0%3.0%4.0%5.0%6.0%7.0%8.0%9.0%
Se
p-1
2
Oct-
12
Nov-1
2
Dec-1
2
Jan
-13
Fe
b-1
3
Ma
r-13
Ap
r-13
Ma
y-1
3
Jun
-13
Percentage of patients that left A&E before being seen for treatment
0.0%1.0%2.0%3.0%4.0%5.0%6.0%7.0%8.0%9.0%
10.0%
Se
p-1
2
Oct-
12
Nov-1
2
Dec-1
2
Jan
-13
Fe
b-1
3
Ma
r-13
Ap
r-13
Ma
y-1
3
Jun
-13
Percentage of unplanned re-admittance within seven days of a previous attendance at A&E
Northampton General Hospital NHS Trust England average
CQC │
Cancelled operations The Department of Health monitor the proportion of cancelled elective operations. This can be an indication of the management, efficiency and the quality of care within the trust. The trust performed similar to expected in comparison to other similar trusts.
.
Delayed discharges The ability for a trust to conduct safe and timely discharges is important for the overall patient flow through the hospital. Patients need to be discharged when ready and any information and support provided to ensure the patient does not need to be re-admitted into hospital.
Within the Adult Inpatient Survey, there are two questions that refer to the process of discharge. The trust was rated as similar to expected in comparison to other similar trusts for both.
CQC view
The trust is
performing similarly
to expected in
relation to cancelled
operations and
delayed discharge
information is not
applicable, therefore
the trust is not
considered to be at
risk in this area.
Northampton General Hospital NHS Trust Page 77
Framework sections RAG
Number of patients not treated within 28 days of last minute
cancellation due to non-clinical reason
The proportion of patients whose operation was cancelled
Framework sections RAG
The proportion of respondents to the adult inpatient survey who
stated they were not given enough notice about when they were
to be going to be discharged
The proportion of respondents to the adult inpatient survey who
stated that their discharge was delayed for more than four hours,
due to waiting for medicine, to see a doctor or for an ambulance
Better than expected
Similar to expected
Worse than expected
Source: Cancelled Operations DoH QMCO January 2013 – March 2013
Source: Delayed discharges CQC Survey of Adult Inpatients June 2012
– March 2012
Context Safe Effective Caring Responsive Well-led
Better than expected
Similar to expected
Worse than expected
CQC │
CQC analysis of secondary care February 2013
Northampton General Hospital NHS Trust was rated as ‘low amber’ or ‘medium risk’ for access to secondary care through A&E and ‘low green’ or ‘low risk’ for access to elective secondary care (diagnostics and treatment) from general practice.
The ratings are based on aggregate z-scores to identify the risk bands. Low green ratings are given to measures with a low z score and therefore no/very low risk and vice versa for high red.
The table below provides a summary for individual measures for the trust. It shows that the trust scored ‘worse than expected’ in regards to three questions about waiting times in the NHS A&E survey.
These are Percentage of admitted and non-admitted patients who wait in A&E less than 4 hours and transitions from the ambulance to A&E.
Measure topic Measure name RAG
Ambulance handover Percentage of patients whose ambulance handover time is more than 30 minutes
A&E wait time
Percentage of admitted patients who wait in A&E less than 4 hours
Percentage of non-admitted patients who wait in A&E less than 4 hours
Leaving A&E without being seen Percentage of patients who leave A&E without being seen
Unplanned re-attendances to A&E Percentage of patients with unplanned re-attendance at A&E within 7 days of original attendance
Waiting times in NHS A&E survey
First conversation with a doctor or nurse
Being examined
Information about waiting for an examination
Length of time in A&E
Transitions from the ambulance to A&E
CQC view
The trust is
performing within
expectations for
most areas relating
to waiting times.
However the
transitions from the
ambulance and the
percentage of
admitted and non-
admitted patients
waiting less than
four hours is worse
than expected.
Waiting times within
A&E are a risk for
this trust and their
winter planning
should ensure they
maintain and ideally
improve their
performance without
affecting patient
care.
Northampton General Hospital NHS Trust Page 78
Source: CQC analysis, February 2013
Context Safe Effective Caring Responsive Well-led
Better than expected Tending towards better than expected Within expectations Tending towards worse than expected Worse than expected
CQC │
Well-led
Northampton General Hospital NHS Trust Page 79
The trust’s sickness
absence rates and
agency staff spending
are higher than the
those for the East
Midlands SHA
Three Tier 1 indicators
are flagged as a risk or
elevated risk for the
trust
The trust performed
worse than expected
for 24 of the 28 key
findings from the 2012
NHS Staff survey
The trust took part in all
of the clinical audits it
was eligible for
CQC │
Framework section Indicator RAG
Reporting Culture
Consistency of reporting to the National Reporting and
Learning System (NRLS) (October 2012 – March 2013)
Data quality of trust returns to the HSCIC
(April 2013 – June 2013)
Inpatients response rate from NHS England Friends and
Family Test (April 2013 – August 2013)
Partners
Monitor – Governance risk rating (as on 30/09/2013) N/A
TDA – Escalation score (as on 3/10/2013) GMC National Training Survey – Trainee’s overall
satisfaction (March 2013 – May 2013)
Staffing
Composite
risk rating
of ESR
items
relating to:
Staff sickness rates
(August 2012 – July 2013)
Staff registration (as on 31/07/2013) Staff turnover (August 2012 – July 2013)
Staff stability (August 2012 – July 2013)
Staff support/ supervision
(as on 31/07/2013)
Ratio: Staff vs bed occupancy
(September 2012 – January 2013)
Healthcare Worker Flu vaccination uptake (September
12 – January 13)
Framework section Indicator RAG
Staff Survey
(NHS Staff Survey
2012)
Percentage of staff who would recommend the trust as a
place to work or receive treatment
(September 2012 – December 2012)
Percentage of staff appraised in last 12 months
(September 2012 – December 2012)
Support from immediate managers
(September 2012 – December 2012)
Percentage of staff receiving health and safety training in
last 12 months (September 2012 – December 2012)
Fairness and effectiveness of incident reporting
procedures (September 2012 – December 2012)
Percentage of staff reporting good communication
between senior management and staff
(September 2012 – December 2012)
Qualitative
Intelligence
Serious Education concerns
(November 2011 – August 2013)
Safeguarding concerns
(September 2012 – September 2013)
Your Experience
(September 2012 – August 2013)
NHS Choices (July 2012 – July 2013)
Patient Opinion (August 2012 – August 2013)
CQC complaints (September 2012 – September 2012)
Provider complaints (April 2012 – March 2013)
Well-led Dashboard
Northampton General Hospital NHS Trust Page 80
Context Safe Effective Caring Responsive Well-led
Elevated risk Risk No evidence of risk
Source: CQC Intelligent Monitoring Report, October 2013
CQC │
Well-led Dashboard
Northampton General Hospital NHS Trust Page 81
Context Safe Effective Caring Responsive Well-led
Elevated risk Risk No evidence of risk
Additional information
Audit Data
NHS Staff Survey
Other External Reviews
Source: CQC Intelligent Monitoring Report, October 2013
Additional Information Additional information has been included in the pack to provide a more holistic view of the trust’s performance. These are listed below:
CQC │
Workforce Staff sickness
The trust’s staff sickness absence rates are broadly in line with the England average for the majority of the time period between April 2011 and March 2013. Between February and October 2012 the trust’s staff sickness absence rates were above the England average, with a noticeable peak around May 2012.
The overall sickness for the trust between April 2012 and March 2013 is the same as for the East Midlands SHA area, but slightly above the national average.
In Autumn 2013/14 the trust’s sickness rates by staff group are all slightly above their respective national averages.
Number of staff
Overall sickness
Sickness absence rates
Agency spend
FTE nurses per bed day
CQC view
Apart from a period
between February
and October 2012,
the trust’s staff
sickness absence
rates are mostly in
line with the England
average between
April 2011 and
March 2013.
In Autumn 2013/14
the trust’s sickness
rates by staff group
are all slightly above
their respective
national averages.
Agency spend by the
trust in 2011/12 was
in line with the East
Midlands SHA
median.
Nurses per bed day
are lower than the
national average, but
within a statistically
acceptable range.
Northampton General Hospital NHS Trust Page 82
Northampton General Hospital
NHS Trust (%)
National
average (%)
Medical Staff 1.5 1.1
Nursing Staff 4.4 4.0
Midwife Staff 4.4 4.3
Other Staff 4.1 3.9
Trust agency spend
(£m)
As % of total staff
cost
Median within East
Midlands SHA
£7m 4.3% 4.3%
Source: Health and Social Care Information Centre (HSCIC), Apr12 – Mar 13
Source: Acute Trust Quality Dashboard, Methods Insight, Autumn 2013/14
RAG Northampton General
Hospital NHS Trust
National
FTE nurses per
bed day 1.6 1.9
Total staff 4,200
Source: Trust website
Source: Monitor, Expenditure on Agency Staff in Acute Trusts, 2011/12
Source: Acute Trust Quality Dashboard, Methods Insight, Autumn 2013/14
Northampton General
Hospital NHS Trust (%)
East Midlands
SHA average (%)
National average
(%)
4.5 4.5 4.2
Source: NHS England, Apr 11 – Mar 13
Context Safe Effective Caring Responsive Well-led
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
Ap
r-11
Jun
-11
Au
g-1
1
Oct-
11
Dec-1
1
Fe
b-1
2
Ap
r-12
Jun
-12
Au
g-1
2
Oct-
12
Dec-1
2
Fe
b-1
3
Sic
kn
ess a
bs
en
ce r
ate
Staff sickness absence rates
Northampton General Hospital NHS Trust England average
CQC │
NHS Staff Survey The results of the 2012 NHS Staff Survey are organised into 28 key findings.
The following details trust’s rating for each of these key findings, as well as noting where there has been a significant change in performance from the 2011 survey.
CQC view
There were only two
key findings in the
2012 NHS Staff
Survey where the
trust performed
within expectation or
better:
• Percentage of
staff having
equality and
diversity training
in last 12 months
• Percentage of
staff saying hand
washing materials
are always
available
Northampton General Hospital NHS Trust Page 83
Indicators RAG Trust National* vs. 2011
Percentage of staff having equality and diversity training in last 12 months 62% 55% Percentage of staff saying hand washing materials are always available 60% 60% -
Staff motivation at work 3.84 3.84 -
Percentage of staff reporting errors, near misses or incidents witnessed in the last month 90% 90%
Percentage of staff working extra hours 76% 70% -
Percentage of staff experiencing physical violence from patients, relatives or the public in last 12 months 18% 15%
Percentage of staff witnessing potentially harmful errors, near misses or incidents in last month 42% 34% -
Percentage of staff appraised in last 12 months 73% 84% -
Percentage of staff experiencing harassment, bullying or abuse from patients, relatives or the public in last
12 months 38% 30% N/A
Percentage of staff experiencing harassment, bullying or abuse from staff in last 12 months 31% 24% N/A
Percentage of staff feeling satisfied with the quality of work and patient care they are able to deliver 72% 78% -
Percentage of staff agreeing that their role makes a difference to patients 87% 89% -
Work pressure felt by staff 3.34 3.07 N/A
Percentage of staff experiencing physical violence from staff in last 12 months 4% 3% N/A
Note: Because of changes to the format of the survey questions, comparisons with 2011 scores are not possible in all cases. These are denoted by ‘N/A’
Context Safe Effective Caring Responsive Well-led
Source: NHS 2012 Staff Survey
Better than expected (within top 20% of trusts nationally
Tending towards better than expected
Within expectations
Tending towards worse than expected
Risk or elevated risk (within bottom 20% of trusts nationally)
Direction of change from previous year
CQC │
Indicators RAG Trust National* vs. 2011
Percentage of staff able to contribute towards improvements at work 58% 68% -
Staff job satisfaction 3.40 3.58 -
Percentage of staff experiencing discrimination at work in last 12 months 17% 11% -
Effective team working 3.53 3.72 Percentage of staff having well structured appraisals in last 12 months 23% 36% -
Support from immediate managers 3.26 3.62
Percentage of staff suffering work-related stress in last 12 months 43% 37%
Percentage of staff feeling pressure in last 3 months to attend work when feeling unwell 35% 29% -
Percentage of staff believing the trust provides equal opportunities for career progression or promotion 79% 88% -
Percentage of staff receiving job-relevant training, learning or development in last 12 months 76% 81% N/A
Percentage of staff receiving health and safety training in last 12 months 63% 74%
Fairness and effectiveness of incident reporting procedures 3.41 3.50 -
Percentage of staff reporting good communication between senior management and staff 20% 27% N/A
Staff recommendation of the trust as a place to work or receive treatment 3.37 3.57 -
NHS Staff Survey
The following table further details the trust’s performance on the NHS Staff Survey.
CQC view
The trust performs
within the bottom
20% of trusts for 24
of the 28 key
findings. It is strongly
recommended that
there is a line of
enquiry around what
action the trust is
taking around these
results.
Northampton General Hospital NHS Trust Page 84
Source: NHS 2012 Staff Survey
Context Safe Effective Caring Responsive Well-led
Note: Because of changes to the format of the survey questions, comparisons with 2011 scores are not possible in all cases. These are denoted by ‘N/A’
Better than expected (within top 20% of trusts nationally
Tending towards better than expected
Within expectations
Tending towards worse than expected
Risk or elevated risk (within bottom 20% of trusts nationally)
Direction of change from previous year
CQC │
General Medical Council – National Training Scheme Survey 2013 The table summarises the output from the General Medical Council National Training Scheme 2013 Survey Results. Given the volume of data, only specialties with red and green outliers are noted. Grey dots note results not published.
Ove
rall
Sa
tis
fac
tio
n
Cli
nic
al
Su
pe
rvis
ion
Han
do
ve
r
Ind
uc
tio
n
Ad
eq
ua
te
ex
pe
rie
nc
e
Wo
rklo
ad
Ed
uc
ati
on
al
Su
pe
rvis
ion
Ac
ce
ss
to
Ed
uc
ati
on
al
Res
ou
rce
s
Fe
ed
ba
ck
Lo
ca
l
tea
ch
ing
Reg
ion
al
tea
ch
ing
Stu
dy l
ea
ve
Anaesthetics
CMT
CST
Cardiology
Clinical oncology
GP Prog - Emergency Medicine
GP Prog - Medicine
GP Prog - Paediatrics and Child
Health
GP Prog - Surgery
General Practice F2
Medicine F1
Obstetrics and gynaecology
Paediatrics
Respiratory medicine
Urology
CQC view
The trust performed
worse than expected
in two or more areas
in Clinical oncology,
GP Prog – Medicine
and Respiratory
medicine
The trust performed
worse than expected
in two or more
clinical specialties in
the following areas:
• Overall
satisfaction
• Clinical
supervision
• Induction
• Workload
• Access to
educational
resources
• Local teaching
• Study leave
Northampton General Hospital NHS Trust Page 85
Source: gmc-uk.org
Context Safe Effective Caring Responsive Well-led
Better than expected Similar to expected Worse than expected No Data
CQC │
Eligible / Did participate Not Eligible / Not Applicable Did not participate Data not available
Clinical audit participation For the 2012/2013 quality reports, trusts were required to report on participation/eligibility for 45 national clinical audits and confidential enquiries (selected by the Department of Health) that were conducted during that year. These, along with the trust’s participation and eligibility status are detailed below and on the following pages.
Northampton General Hospital NHS Trust
Indicators Eligibility Participation
Acute coronary syndrome or Acute myocardial infarction (MINAP) Adult asthma (British Thoracic Society) Adult bronchiectasis (British Thoracic Society) Adult cardiac surgery audit (ACS) Adult community acquired pneumonia (British Thoracic Society) Adult critical care (Case Mix Programme – ICNARC CMP) Bowel cancer (NBOCAP) Cardiac Arrest Audit (NCAA) Cardiac arrhythmia (HRM) Carotid interventions audit (CIA) Child health programme (CHR-UK) Comparative Audit of Blood Transfusion programme Congenital heart disease (Paediatric cardiac surgery)
Coronary angioplasty Dementia (NAD) Diabetes (Adult) ND(A) (NADIA) Elective surgery (National PROMs Programme) Emergency use of oxygen (British Thoracic Society) Epilepsy 12 audit (Childhood Epilepsy) Fractured neck of femur Heart failure (HF)
Context Safe Effective Caring Responsive Well-led
Source: Trust Website: Quality Account 2012/13
CQC view
The trust took part in
all of the clinical
audits it was eligible
for. There was
however not data
available for nine of
these audit.
Page 86
CQC │
Clinical audit participation continued… CQC view
(As per previous
slide) The trust took
part in all of the
clinical audits it was
eligible for. There
was however not
data available for
nine of these audit.
Northampton General Hospital NHS Trust Page 87
Indicators Eligibility Participation
Head and neck oncology (DAHNO) Hip fracture database (NHFD) Inflammatory bowel disease (IBD) Intra-thoracic transplantation (NHSBT UK Transplant Registry)
Joint Registry (NJR) Maternal, infant and newborn programme (MBRRACE-UK)
Lung cancer (NLCA) National Vascular Registry Neonatal intensive and special care (NNAP) Non-invasive ventilation - adults (British Thoracic Society) Oesophago-gastric cancer (NAOGC) Paediactric bronchiectasis (British Thoracic Society)
Paediatric asthma (British Thoracic Society) Paediatric fever (College of Emergency Medicine) Paediatric intensive care (PICANet)
Paediatric pneumonia (British Thoracic Society) Pain database Parkinson's disease (National Parkinson's Audit) Patient Outcome and Death (NCEPOD) Potential donor audit (NHS Blood & Transplant) Psychological therapies (NAPT) Pulmonary hypertension (Pulmonary Hypertension Audit)
Context Safe Effective Caring Responsive Well-led
Source: Trust Website: Quality Account 2012/13
Eligible / Did participate Not Eligible / Not Applicable Did not participate Data not available
CQC │
Clinical audit participation continued… CQC view
As per previous
slide, the trust took
part in all of the
clinical audits it was
eligible for. There
was however not
data available for
nine of these audit.
Northampton General Hospital NHS Trust Page 88
Indicators Eligibility Participation
Renal colic (College of Emergency Medicine) Renal replacement therapy (Renal Registry) Renal transplantation (NHSBT UK Transplant Registry)
Review of Asthma Deaths (NRAD)
Sentinel Stroke National Audit Programme (SSNAP)
Severe trauma (Trauma Audit & Research Network, TARN)
Suicide and Homicide for people with Mental Illness (NCISH)
Context Safe Effective Caring Responsive Well-led
Source: Trust Website: Quality Account 2012/13
Eligible / Did participate Not Eligible / Not Applicable Did not participate Data not available
CQC │
National Clinical Audit Support Programme National Bowel Cancer Audit Project
The National Bowel Cancer Audit Project aims to improve the quality of care and survival of patients with bowel cancer, and meets the requirements as set out in the NHS cancer plan, NICE guidelines and the report of the Bristol Royal Infirmary inquiry. Information in the audit includes audit participation by NHS trusts and data completeness for key fields, measures about the process of care given to patients and information about care outcomes and treatment.
The results presented in the National Bowel Cancer Audit 2013 are based upon patients diagnosed with bowel cancer between 1 April 2011 and 31 March 2012.
Providers must ensure that service users are protected against risks of unsafe or inappropriate care and treatment arising from a lack of proper information about them, by maintaining accurate and complete records.
CQC view
The trust performed
within expectations
for all five of the
indicators from the
National Bowel
Cancer Audit
Project.
Northampton General Hospital NHS Trust Page 89
Indicators RAG
97% of cases reported to the audit were discussed at
multidisciplinary team (MDT) meetings. The national level was
97%.
90% of cases had a CT scan reported. The national rate was
83%.
145 cases were identified in HES, meaning a case ascertainment
rate of 85%. The national rate was 95%.
There were 70 cases having major surgery. For these cases, the
level of data completeness was 88%. This is considered ‘good’.
The national level was 71%.
87% of patients were seen by a clinical nurse specialist. The
national rate is 82%.
Source: National Clinical Audit Support Programme - National Bowel
Cancer Audit Project 2013
Context Safe Effective Caring Responsive Well-led
Better than expected
Tending towards better than expected
Within expectations
Tending towards worse than expected
Worse than expected
CQC │
National Institute for Clinical Outcomes Research - Myocardial Ischaemia (MI) National Audit Project
The Myocardial Ischaemia National Audit Project (MINAP) began in late 1998 when a broadly based Steering Group developed a dataset for acute myocardial infarction. The dataset has been further expanded to cover the management of other acute coronary syndromes. The Steering group represents key stakeholders including professional bodies, national government and patient representation, in conjunction with the British Cardiovascular Society. It is the long term aim of the project to continue to provide, for all interested groups, including patients, commissioning bodies, cardiac networks of care, and academic researchers, first class data on the care for acute coronary syndromes within England and Wales.
Data held about trust for the 2011/12 financial year is shown in the table to the right.
CQC view
The trust performed
within expectations
for four of the five
Myocardial
Ischaemia National
Audit Project
indicators.
For the fifth, ‘the
proportion of eligible
patients with an
initial diagnosis of
nSTEMI who receive
primary angiography
within 150 minutes
of calling for
professional help’,
there was no data
available.
Northampton General Hospital NHS Trust Page 90
Indicator Performance RAG
The proportion of eligible patients with a
discharge diagnosis of nSTEMI (non-ST
segment elevation myocardial infarction) who
were seen by a cardiologist or member of their
team
Northampton
General
Hospital
The proportion of eligible patients with a
discharge diagnosis of nSTEMI who were
admitted to a cardiac unit or ward
Northampton
General
Hospital
The proportion of eligible patients with a
discharge diagnosis of nSTEMI who were
referred for or had angiography
Northampton
General
Hospital
The proportion of eligible patients with an initial
diagnosis of nSTEMI who receive primary
angiography within 150 minutes of calling for
professional help
Northampton
General
Hospital
No
data
Proportion of eligible patients with an initial
diagnosis of STEMI who receive primary
angioplasty within 90 minutes of arrival at the
Heart Attack Centre
Northampton
General
Hospital
Source: National Institute for Clinical Outcomes Research - Myocardial
Ischaemia National Audit 2011/12 Project
Context Safe Effective Caring Responsive Well-led
Better than expected
Tending towards better than expected
Within expectations
Tending towards worse than expected
Worse than expected
CQC │
Royal College of Physicians - Audit of Falls & Bone Health in Older People
The national audit of falls and bone health was a programme of work which examined the organisation and commissioning of service provided to older people for falls prevention and bone health, the clinical care delivered to people that have fallen and fractured a bone and patients’ experiences of fall services.
In 2010 both an organisational and clinical audit were performed together as part of the falls and bone health audit programme. Data for the overall trust shows:
CQC view
The trust was found
to be performing
within expectations
for all but three of
the indicators from
the Royal College of
Physicians Audit of
Falls & Bone Health
in Older People
2010.
For the remaining
three indicators, the
trust was rated as
tending towards
worse than
expected.
Northampton General Hospital NHS Trust Page 91
Indicator RAG
Was adequate analgesia administered within 60 minutes of
hospital attendance, or prior to attendance by ambulance
personnel (Hip)?
Is it documented within medical/nursing/therapist notes that
written falls prevention information has been given to the patient
or their carer (Hip)?
Was the patient prescribed bisphosphonate or other appropriate
anti-resorptive therapy for osteoporosis (Hip)?
Was the patient prescribed bisphosphonate or other appropriate
anti-resorptive therapy for osteoporosis (Non-Hip)?
Has trust calculated its serious injuries in-patient falls rate
against activity (e.g. per admission or occupied bed day)?
Is there a mechanism to record patients’ views of the falls and
bone health service using questionnaires and/or interviews?
Indicator RAG
Was home hazard assessment performed in the patient's own
environment (Hip)?
Was home hazard assessment performed in the patient's own
environment (Non-Hip)?
Was a formal assessment of cognitive function, including where
indicated a delirium screen (performed within 72 hours of surgery
(Hip)?
Is it documented within medical/nursing/therapist notes that
written falls prevention information has been given to the patient
or their carer (Non-Hip)?
Are older people who fall and attend EDs or MIUs routinely
screened for risk of future falls?
Is there further assessment and management of all appropriate
fracture patients coordinated by a fracture liaison nurse/similar
designated person?
Does an occupational therapist routinely assess for potential
hazards within the patient's home?
Are evidence based therapeutic exercise programmes (Otago or
FaME) used for falls prevention, with standard duration of 12
weeks+?
Was an attempt made within 24 hours of surgery to mobilise the
patient (Hip)?
Are there documented lying and standing blood pressure
readings (Hip)?
Are there documented lying and standing blood pressure
readings (Non-Hip)?
Did the patient attend an exercise programme within 12 weeks of
the fall (Hip)?
Did the patient attend an exercise programme within 12 weeks of
the fall (Non-Hip)?
Source: Royal College of Physicians - Audit of Falls & Bone Health in Older
People, 2010
Context Safe Effective Caring Responsive Well-led
Better than expected Tending towards better than expected
Within expectations
Worse than expected Tending towards worse than expected
CQC │
UK National Screening Committee - Antenatal and New-born Screening Education Audit
The Trust Education & Training For Screening Annual Audit Tool 2011/12 was developed by the National Screening Committee’s (NSC) Regional Screening Teams assist Trust Screening Coordinator’s (LCO) to assess the appropriateness, effectiveness, and accessibility of locally held educational initiatives pertaining to antenatal and the new-born screening programmes. This audit tool assists in the continuing development of quality evidence-based training initiatives and feeds into regional and national education
and training strategy for screening.
Data held for the 2011/12 audit shows the trust to be performing within expectations for the following indicators:
• Does the trust have a named individual responsible for (antenatal and new-born) screening education and audit?
• Does the trust use the National Screening Committee antenatal and new-born induction resource for all relevant new staff?
• Does the trust have a designated person responsible for co-ordination and education regarding antenatal screening programmes?
Audit Commission - Payment by Results Data (PbR) Assurance 2011/12
Payment by Results aims to support NHS modernisation by paying hospitals for the work they do, rewarding efficiency and quality. It also carries risks that need to be managed effectively both locally and nationally. Since 2007, the Audit Commission has delivered an assurance programme for Payment by Results looking at the quality of clinical coding.
For the 2011/12 financial year, there were a number of indicators and items of qualitative intelligence for trust
from this audit:
CQC view
The trust was found
to be performing
within expectations
for all three of the
indicators from the
Antenatal and New-
born Screening
Education Audit.
The trust was found
to be performing
within expectations
for all four of the
indicators from the
Audit Commission
Payment by Results
Data (PbR)
Assurance 2011/12.
Northampton General Hospital NHS Trust Page 92
Indicator RAG
8.5% of primary diagnoses were recorded incorrectly in the
period. Against an expected rate of 9%.
13.2% of secondary diagnoses were recorded incorrectly in the
period. Against an expected rate of 8%.
6.3% of primary procedures were recorded incorrectly in the
period. Against an expected rate of 7%.
12.2% of secondary procedures were recorded incorrectly in the
period. Against an expected rate of 7%.
Source: UK National Screening Committee – Antenatal and Newborn
Screening Education Audit
Source: Audit Commission - Payment by Results Data (PbR) Assurance
(2011/12)
Context Safe Effective Caring Responsive Well-led
Tending towards worse
than expected
Worse than expected
Better than expected
Tending towards better than expected
Within expectations
Appendices
CQC │ Northampton General Hospital NHS Trust
Map of Northampton General Hospital
Page 94
Source: Trust website
Context Safe Effective Caring Responsive Well-led
CQC │
Trust profile continued…
Northampton General Hospital NHS Trust
Departments and services at Northampton General Hospital NHS Trust
Northampton General Hospital NHS Trust provides the following services:
• Accident and emergency services
• Cardiology
• Children's & Adolescent Services
• Diagnostic Physiological Measurement
• Disability services
• Dentistry and Orthodontics
• Dermatology
• Diabetic Medicine
• Ear, Nose & Throat
• End of life care services
• Endocrinology and Metabolic Medicine
• Gastrointestinal and Liver services
• Genetics
• Geriatric Medicine
• Gynaecology
• General Surgery
• Haematology
• Maternity service
• Minor injuries unit
• Minor Injuries Unit - Northampton -
• Neurology
• Nephrology
• Neurosurgery
• Ophthalmology
• Orthopaedics
• Oral and Maxillofacial Surgery
• Plastic surgery
• Pain Management
• Respiratory Medicine
• Rheumatology
• Surgery - Vascular
• Sleep Medicine
• Surgery – Breast
• Urology
Source: Trust website
Context Safe Effective Caring Responsive Well-led
Page 95
CQC │
Trust board and organisation structure continued… Non-Executive Directors
Nicholas Robertson
Nicholas Robertson left Royal Dutch Shell in 2009 after 32 years, in which he worked in many countries, mainly in finance roles but also in general management and human resources. From 2000 he was Vice President of Group Risk Management and Insurance. He is now acting as a consultant on risk management for industrial companies and on finance for smaller oil and gas companies. He is a trustee director of Mental Health Matters, which is a charity. Nicholas Robertson has a degree in engineering and economics, is
a chartered accountant and chairs the audit committee.
Phil Zeidler (Vice Chairman)
Phil Zeidler had a successful career as an entrepreneur in financial services, building three business, the most recent of which became the largest independent outsourced distributor of general insurance in the UK. Currently Chairman of an insurance business, a music fund and board member of the charity Pilotlight, his core skills lie in strategic planning, innovation and developing strategic relationships.
Graham Kershaw (Senior Independent Director)
Graham Kershaw holds a first class honours degree in business from Leeds Metropolitan University and has an MBA. He is a fellow of the Chartered Institute of Secretaries and Administrators and a fellow of the Chartered Institute of Personnel and Development. Graham Kershaw also holds a professional marketing qualification, and has been a main board director of a number of major UK retail
companies including: Lloyds Pharmacy, Capio UK and Joshua Tetley’s. He is currently managing director of Cogniscence Ltd, a business mainly providing change management and business turnaround input to the public sector.
Elizabeth Searle
After qualifying as a nurse and working in cancer and palliative care, Elizabeth Searle held posts in higher education developing palliative care courses, with Macmillan as Director of Education Development and Support and at Sue Ryder Care as Head of Palliative Care, working with their hospices.
David Noble
David Noble’s career has been in finance covering both the public and private sectors. Most recently David Noble has spent nine years as Finance Director of the Equipment Procurement and Support sector of the Ministry of Defence, leading change programmes to improve the performance of the organisation.
Northampton General Hospital NHS Trust Page 96
Source: Trust website
Context Safe Effective Caring Responsive Well-led
CQC │
Area overview continued… Health profiles are designed to help local government and health services identify problems in their areas and decide how to tackle these issues. They provide a snapshot of the overall health of the local population and highlight potential differences against regional and national averages.
The tables below outline Northamptonshire’s health profile information in comparison with the rest of England.
CQC view
Northamptonshire’s
deprivation is
significantly worse
than the England
average in nine out
of 32 area measures
for the health profile
of an area.
Northampton General Hospital NHS Trust
Source: Public Health Observatories – Area Health Profiles
Page 97
Context Safe Effective Caring Responsive Well-led
CQC │
Area overview continued… The table below further details the health profile information for Northamptonshire.
CQC view
Northamptonshire’s
deprivation is
significantly worse
than the England
average in nine out
of 32 area measures
for the health profile
of an area.
Northampton General Hospital NHS Trust
Source: Public Health Observatories – Area Health Profiles
Page 98
Context Safe Effective Caring Responsive Well-led
CQC │
60%
65%
70%
75%
80%
85%
90%
95%
100%
Ea
st M
idla
nds
Ea
st of E
ngla
nd
Isle
of W
ight
London
Nort
h E
ast
Nort
h W
est
So
uth
Centr
al
So
uth
East C
oast
So
uth
Weste
rn
West M
idla
nds
Yo
rksh
ire
Category A calls (Red 1 and Red 2) resulting in an ambulance arriving at the scene of the incident
within 19 minutes - National Target 95%
Aug-13 Sep-13 Oct-13 Target
60%
65%
70%
75%
80%
85%
90%
95%
100%
Ea
st M
idla
nds
Ea
st
of
En
gla
nd
Isle
of W
ight
London
Nort
h E
ast
Nort
h W
est
So
uth
Centr
al
So
uth
East C
oast
So
uth
Weste
rn
West M
idla
nds
Yo
rksh
ire
Category A (Red 2) incidents: Presenting conditions which may be life threatening but less
time-critical - National Target 75%
Aug-13 Sep-13 Oct-13 Target
Performance of local health care providers continued…
Northampton General Hospital NHS Trust Page 99
Source: NHS England
Context Safe Effective Caring Responsive Well-led
CQC │
Media reports The hospital trusts that pose a 'high risk' 24 October 2013
In a new report the Care Quality Commission (CQC) have categorised trusts across England according to the risk they pose, here is the list of how different trusts fared…
The trusts were placed into six bands - band 1 is considered the highest risk and band 6 the lowest. Northampton general hospital NHS trust featured in Band 1. Source: The Telegraph
Northampton General Hospital midwife-led maternity unit opens 24 October 2013
Northamptonshire's first midwife-led maternity unit has opened as part of a £480,000 project. The four-room Barrett Birth Centre at Northampton General Hospital includes three birthing pools, kitchenettes and en-suite bathrooms. The hospital said it provides an alternative for women who do not want home births and do not require consultant-led care. It is predicted about 1,000 babies will be born in the new centre each year. Source: BBC
Hospital staff in Northampton raise concerns about child abuse ‘four times a day’ 15 November 2013
Abuse alerts about children are being spotted by staff at Northampton General Hospital at a rate of more than four a day. A report from the hospital showed that in 2012/13, staff raised the alarm over concerns about babies and unborn children 887 times and 648 times about other children. It resulted in 51 unborn children being placed on child protection plans.
In all, 12 babies were removed from their parents at birth.
The report gave some details of three anonymous case studies of
children whose abuse was spotted at NGH and turned out to be serious case reviews. Source: Northampton Chronicle
Legal high’ cases on the rise at Northampton General Hospital 21 November 2013
One person a week is being taken to Northampton General Hospital suffering from the effects of ‘legal highs’, an accident and emergency consultant has warned. Source : Northampton Chronicle
Northampton General Hospital NHS Trust Page 100
Context Safe Effective Caring Responsive Well-led
CQC │
STEIS Serious Incidents Definition A serious incident requiring investigation is defined as an incident that occurred in relation to NHS-funded services and care resulting in one of the following:
• Unexpected or avoidable death of one or more patients, staff, visitors or members of the public;
• Serious harm to one or more patients, staff, visitors or members of the public or where the outcome requires life-saving intervention, major surgical/medical intervention, permanent harm or will shorten life expectancy or result in prolonged pain or psychological harm (this includes incidents graded under the
NPSA definition of severe harm);
• A scenario that prevents or threatens to prevent a provider organisation’s ability to continue to deliver healthcare services, for example, actual or potential loss of personal/organisational information, damage to property, reputation or the environment, or IT failure;
• Allegations of abuse;
• Adverse media coverage or public concern about the organisation or the wider NHS;
• One of the core set of ‘Never Events as updated on an annual basis.
Northampton General Hospital NHS Trust Page 101
Source: National Framework for Reporting and Learning from Serious Incidents Requiring
Investigation, NHS National Patient Safety Agency, 2010
Context Safe Effective Caring Responsive Well-led
CQC │ Northampton General Hospital NHS Trust Page 102
Composite indicator Tier 1 Indicator RAG
Cardiological
Conditions and
Procedures
(April 2008 – March
2011)
In-hospital mortality Cardiological conditions
Mortality outlier alert
Acute myocardial infarction
Cardiac arrest and ventricular
fibrillation
CABG (isolated first time)
CABG (other)
Adult cardiac surgery
Coronary atherosclerosis and
other heart disease
Congestive heart failure;
nonhypertensive
Cardiac dysrhythmias
Heart valve disorders
Pulmonary heart disease
Cerebrovascular
conditions
Cerebrovascular
conditions
(February 2012-
January 2013)
In-hospital mortality Cerebrovascular conditions
Mortality outlier alert Acute cerebrovascular disease
Dermatological
Conditions
(February 2012-
January 2013)
In-hospital mortality Dermatological conditions
Mortality outlier alert
Skin and subcutaneous tissue
infections
Chronic ulcer of skin
Composite indicator Tier 1 Indicator RAG
Endocrinological
Conditions
(1 April 2012 - 31
March 2013)
In-hospital mortality Endocrinological conditions
Mortality outlier alert
Diabetes mellitus with
complications
Diabetes mellitus without
complications
Fluid and electrolyte disorders
Gastroenterological
and Hepatological
Conditions and
Procedures
(1 April 2012 – 31
March 2013)
In-hospital mortality Gastroenterological and
hepatological conditions
Mortality outlier alert
Liver disease, alcohol-related
Biliary tract disease
Gastrointestinal haemorrhage
Noninfectious gastroenteritis
Intestinal obstruction without
hernia
Other gastrointestinal disorders
Other liver diseases
Operations on jejunum
Peritonitis and intestinal abscess
Therapeutic endoscopic
procedures on biliary tract
Therapeutic endoscopic
procedures on lower GI tract
Context Safe Effective Caring Responsive Well-led
Composite Mortality Indicators The tables over the next few pages list the indicators used to produce the composite mortality indicators contained in the Effective domain.
Source: CQC Intelligent Monitoring Report, Nov 2013 Elevated risk Risk No evidence of risk
CQC │
Composite Mortality Indicators continued…
Northampton General Hospital NHS Trust Page 103
Composite indicator Tier 1 Indicator RAG
Gastroenterological
and Hepatological
Conditions and
Procedures
(continued)
Mortality outlier alert
Therapeutic endoscopic
procedures on upper GI tract
Therapeutic operations on
jejunum and ileum
Genito-Urinary
Conditions
(February 2012 –
January 2013)
In-hospital mortality Genito-urinary conditions
Mortality outlier alert Urinary tract infections
Haematological
Conditions
(February 2012 –
January 2013)
In-hospital mortality Haematological conditions
Mortality outlier alert Deficiency and other anaemia
Infectious Diseases
(February 2012 –
January 2013)
In-hospital mortality Infectious diseases
Mortality outlier alert Septicaemia (except in labour)
Conditions
Associated With
Mental Health
(February 2012 –
January 2013)
In-hospital mortality Conditions associated with
Mental health
Mortality outlier alert Senility and organic mental
disorders
Musculoskeletal
Conditions
(February 2012 –
January 2013)
In-hospital mortality Musculoskeletal conditions
Mortality outlier alert
Pathological fracture
Spondylosis, intervertebral disc
disorders, other back problems
Nephrological
Conditions
(February 2012-
January 2013)
In-hospital mortality Nephrological conditions
Mortality outlier alert
Acute and unspecified renal
failure
Chronic renal failure
Composite indicator Tier 1 Indicator RAG
Neurological
Conditions
(February 2012 –
January 2013)
In-hospital mortality Neurological conditions
Mortality outlier alert Epilepsy, convulsions
Paediatric and
Congenital
Disorders and
Perinatal Mortality
(February 2012-
January 2013)
In-hospital mortality Paediatric and congenital
disorders
Maternity outlier
alert Perinatal mortality
Respiratory
Conditions and
Procedures
(1 April 2011 – 31
March 2013)
In-hospital mortality Respiratory conditions
Mortality outlier alert
Asthma
Acute bronchitis
Chronic obstructive pulmonary
disease and bronchiectasis
Pleurisy, pneumothorax,
pulmonary collapse
Pneumonia
Trauma and
Orthopaedic
Conditions
(February 2012 –
January 2013)
In-hospital mortality Trauma and orthopaedic
conditions
Mortality outlier alert
Craniotomy for trauma
Fracture of neck of femur (hip)
Head of femur replacement
Hip replacement
Intracranial injury
Other fractures
Context Safe Effective Caring Responsive Well-led
Elevated risk Risk No evidence of risk Source: CQC Intelligent Monitoring Report, Nov 2013
CQC │ Northampton General Hospital NHS Trust Page 104
Composite indicator Tier 1 Indicator RAG
Trauma and
Orthopaedic
Conditions
(continued)
(February 2012-
January 2011)
Mortality outlier alert
Reduction of fracture of bone
Reduction of fracture of bone
(upper/lower limb)
Reduction of fracture of neck of
femur
Shunting for hydrocephalus
Vascular Conditions
and Procedures
(January 2012-
February 2013)
In-hospital mortality Vascular conditions
Mortality outlier alert
Amputation of leg
Aortic, peripheral, and visceral
artery aneurysms
Clip and coil aneurysms
Other femoral bypass
Peripheral and visceral
atherosclerosis
Repair of abdominal aortic
aneurysm (AAA)
Transluminal operations on the
femoral artery
Dr. Foster: Hospital
Standardised
Mortality Ratio
(1 April 2011 – March
2012)
Hospital Standardised Mortality Ratio
Hospital Standardised Mortality Ratio (Weekday)
Hospital Standardised Mortality Ratio (Weekend)
Context Safe Effective Caring Responsive Well-led
Composite Mortality Indicators continued…
Elevated risk
Risk
No evidence of risk
Source: CQC Intelligent Monitoring Report, Nov 2013
CQC │
Definitions of Mortality Indicators Hospital Standardises Mortality Ratio (HSMR)
What is the HSMR?
The Hospital Standardised Mortality Ratio (HSMR) is an indicator of healthcare quality that measures whether the mortality rate at a hospital is higher or lower than you would expect.
How does HSMR work?
The HSMR is a ratio of the observed number of in-hospital deaths at the end of a continuous inpatient spell to the expected number of in-
hospital deaths (multiplied by 100) for 56 specific CCS groups; in a specified patient group. The expected deaths are calculated from logistical regression models taking into account and adjusting for a case-mix of: age band, sex, deprivation, interaction between age band and co-morbidities, month of admission, admission method, source of admission, the presence of palliative care, number of previous emergency admissions and financial year of discharge.
How should HSMR be interpreted?
Care is needed in interpreting these results. Although a score of 100 indicates that the observed number of deaths matched the expected number in order to identify if variation from this is significant confidence intervals are calculated. A Poisson distribution model is used to calculate 95% and 99.9% confidence intervals and only when these have been crossed is performance classed as higher or lower than expected.
Summary Hospital-level Mortality Indicator
What is the SHMI?
The Summary Hospital-level Mortality Indicator (SHMI) is a high level hospital mortality indicator that is published by the Department of Health on a quarterly basis. The SHMI follows a similar principle to the general standardised mortality ratio; a measure based upon a nationally expected value. SHMI can be used as a potential smoke alarm for potential deviations away from regular practice.
How does SHMI work?
1. Deaths up to 30 days post acute trust discharge are considered in
the mortality indicator, utilising ONS data.
2. The SHMI is the ratio of the Observed number of deaths in a Trust
vs. Expected number of deaths over a period of time.
3. The Indicator will utilise 5 factors to adjust mortality rates by: the
primary admitting diagnosis; the type of admission; a calculation
of co-morbid complexity (Charlson Index of co-morbidities); age;
and sex.
4. All inpatient mortalities that occur within a Hospital are considered
in the indicator.
How should SHMI be interpreted?
Due to the complexities of hospital care and the high variation in the
statistical models used all deviations from the expected range are
highlighted using a Random Effects funnel plot.
Northampton General Hospital NHS Trust Page 105
Context Safe Effective Caring Responsive Well-led
Source: NHS Neonatal Networks website
CQC │
Definitions of Maternity Indicators The indicators used as part of the maternity outliers surveillance programme are defined as follows:
A maternal non-elective readmission is defined as a woman who is readmitted to any acute trust within 42 days of the start of their delivery episode. The woman may have been readmitted via either the Emergency or Maternity departments. The indicator only counts readmissions where there was a length of stay of at least a day, or where the readmission resulted in a death. In addition, the indicator excludes women recorded with primary diagnoses on readmission in ICD-10 Chapter Z (Factors influencing health status and contact with
health services). This is because our analysis of previous maternal readmission cases has found that high numbers of women recorded with these primary diagnoses on readmission have tended to be related to data recording issues, for example healthy mothers accompanying their unwell babies back to hospital. Any women still in hospital within 42 days of the start of their delivery episode are excluded from the analysis. The readmission is assigned to the trust at which the delivery occurred.
Perinatal mortality is any in-hospital death within seven days of birth. It includes both stillbirths and neonatal deaths. Neonatal deaths that occur in any hospital within seven days are included in this indicator. Therefore, this will include babies readmitted to hospital, either as a planned admission or as an emergency, and babies transferred from their birth episode to a different trust for neonatal care. It does not include deaths which occur out of hospital. The death is assigned to the hospital at which the birth occurred.
Rates of emergency caesarean sections. Emergency caesareans
are identified by a primary procedure code of R18 (other caesarean delivery) within a delivery episode.
Rates of elective caesarean sections. Elective caesareans are identified by a primary procedure code of R17 (elective caesarean delivery) within a delivery episode.
A neonatal non-elective readmission is defined as a baby who is readmitted to any acute trust within 28 days of birth. The babies may have been readmitted via either the Emergency or Maternity departments. The indicator only counts readmissions where there was a length of stay of at least a day, or where the readmission resulted in a death. Any babies aged over 28 days at discharge from
the birth episode are excluded from the analysis. The readmission is assigned to the trust at which the birth occurred.
Puerperal sepsis (ICD-10 O85) and other puerperal infection (ICD-10 O86) within 42 days of the start of the delivery episode. This indicator looks for puerperal sepsis and/or other puerperal infection recorded within the delivery spell, or in any subsequent hospital admission
Additional Information
Indirect standardisation is carried out for the perinatal mortality indicator to adjust for the highest level of neonatal unit at the trust.
Indirect standardisation for the readmission, caesarean and puerperal sepsis indicators is carried out to adjust for differences in the age of women delivering at the trust
Northampton General Hospital NHS Trust Page 106
Context Safe Effective Caring Responsive Well-led
CQC │
Definitions of Maternity Indicators Continued… The indicators detailed on the previous page, and the analysis within this report, is based on births that took place in-hospital. Home births are excluded, as the level of information recorded in HES for these births is not detailed enough to be used in our analysis.
Deliveries that are privately funded but take place in an NHS setting are included in this analysis.
Please note that the analysis of perinatal mortality and caesarean sections includes discharges up until April 2013. However, the analysis of neonatal readmissions only includes discharges up until March 2013. Discharges in April 2013 cannot be analysed, as data is
not yet available to look at the 28-day period following delivery needed for this indicator.
The analysis of the maternal readmissions and puerperal sepsis and other puerperal infections indicators will only look at discharges up until March 2013. Discharges in April 2013 cannot be analysed, as data is not yet available to look at the 42-day period following delivery needed for this indicator.
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Context Safe Effective Caring Responsive Well-led
CQC │
The National Bereavement Survey 2011 CQC view
The Milton Keynes &
Northamptonshire
PCT cluster can be
seen to be
performing in the top
20% of all PCT
clusters nationally
for two of the 26
indicators. However
they can be seen to
be performing in the
bottom 20% of PCT
clusters nationally
for seven of the 26
indicators including
three of the six in the
‘Quality of Care’.
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Area Question RAG Question RAG
Respect and
Dignity Shown
Always
District & Community Nurses GPs
Care Home Hospital Doctors
Hospital Nurses
Patient Care and
Support
Enough Help Available with Personal Needs Enough Help with Nursing Needs
Bed Area had Adequate Privacy Relief of Pain Completely, While at Home in
Last 3 Months
Relief of Pain Completely, While in Hospital in Last 3
Months Relief of Other Symptoms in Last 2 Days
Spiritual Support Excellent in Last 2 Days Emotional Support in Last 2 Days
Support to Stay Where She/he Wanted to be in Last
2 Days
Patient Preferences
and Support of the
Bereaved
No Decision Made About Care Patient Would Not
Have Wanted
Patient Had Enough Choice About Where
They Died
Respondent Involved in Decisions as Much as
Wanted Sufficient Help and Support for Family at
Time of Death
Staff Dealt with Family Sensitively After Patient Died Has Respondent Talked to Anyone Since
Patient’s Death
Quality of Care
Out of Hours District & Community Nurses
GPs Care Home
Hospital Doctors Hospital Nurses
Source: National Bereavement Survey 2011
Context Safe Effective Caring Responsive Well-led
Top 20% of PCT Clusters
Middle 60% of PCT Clusters
Bottom 20% of PCT Clusters
CQC │
NHS LA Risk Management Standards continued…
The NHS Litigation Authority (NHS LA) is a Special Health Authority responsible for handling negligence claims made against NHS bodies in England. A key function for the NHS LA is to contribute to the incentives for reducing the number of negligent or preventable incidents. They aim to achieve this through an extensive risk management programme. Healthcare organisations are regularly assessed against risk management standards which have been specifically developed to reflect issues which arise in the negligence claims reported to the NHS LA.
The tables below document the compliance of the trust.
Northampton General Hospital NHS Trust – Level 1
In November 2011 the NHS Litigation Authority (NHS LA) conducted a Level 1 assessment of the trust. The results of this assessment are displayed below.
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Domain Compliant? Score
Governance Compliant 10/10
Competent & Capable Workforce Compliant x/10
Safe Environment Compliant 10/10
Clinical Care Compliant 10/10
Learning from Experience Compliant 10/10
Overall Compliance Compliant 49/50
Context Safe Effective Caring Responsive Well-led
CQC │
Trust Quality Account The following key points were taken from the trust’s 2012/13 Quality Report:
• In 2010 the ‘Aspiring to Excellence’ programme was introduced to help junior doctors understand their role in affecting change impacting on patient safety.
• The number of patients seen in A&E in 2012/13 was 96,180, which was a 10% increase from 2011/12.
• Around 2,000 patients receiving NHS services provided by the trust between April 2012 to March 2013 were recruited to
participate in research approved by a research ethics committee.
• During the 2012/13 reporting period, the trust investigated a Never Event related to wrong site vascular surgery. Following the event, a number of actions were implemented to reduce the risk of re-occurrence, as well as a review of practices and procedures relating to the WHO surgical checklist.
• The trust has launched a specialist multi-disciplinary team that provides care and support for stroke patients in their own home, with said care being tailored to the needs of each individual.
• In March 2013 staff carried out the first treatment in the country to target early stage lung cancer with a technique called ‘Stereotactic Radiotherapy’.
• One of the trust’s healthcare assistants, Chris Head, has been presented with the Hand Hygiene Champion of 2012 national award by the Infection Prevention Society for his proactive and
enthusiastic teaching of effective hand hygiene.
• The trust is a recognised National Cancer centre, and provides care to a wider population of 880,000 people living in Northamptonshire, North Buckinghamshire and South Leicestershire.
• The 2012 National Cancer patient experience survey showed the trust improved across 64% of standards in comparison to their 2010 results.
• The trust has put the following four ‘Quality Priority Actions’ in place to improve the quality and cost effectiveness of care
2013/14:
• Re-designing the emergency Care Pathway – using best practice standards.
• Caring for Vulnerable Adults – aims to continue care given to people with dementia and/or learning disabilities.
• Patient Safety Programme – high level aim is to save 300 lives over the next 3 years and to reduce avoidable harm by 50% over the same period.
• Patient Experience – aims the trust will achieve 20% response rate in the Friends and Family Test, and 10% increase in their scores.
Northampton General Hospital NHS Trust Page 110
Context Safe Effective Caring Responsive Well-led
CQC │
Glossary Cross-sectional analysis
The cross-sectional analysis measures the standardised ratio (SR) for a chosen single period and the extent to which it deviates from the norm. SRs are presented on a funnel plot. The control limits, with their distinctive funnel shape, represent a specified significance level.
CUSUM
This technique identifies persistent deviations from expected values over time. If outcomes are lower than the national average plus a predefined tolerance level then the plot will stay at zero. If higher, the
CUSUM plot will move upwards. If a significant run of high values is detected, the plot crosses a fixed ‘control limit’ and the plot is then reset to zero. Resetting the plot after an alert allows for further runs of high values to be detected.
Expected deaths
Expected numbers of deaths are calculated by comparing rates at a given trust to national rates on a quarterly basis. Within this comparison, indirect standardisation is carried out to adjust for the sex of the babies born at the trust and the highest level of neonatal unit at the trust. Please note that home births are excluded from the analysis.
Expected caesareans
Expected numbers of caesareans are calculated by comparing rates at a given trust to national rates on a quarterly basis. Within this comparison, indirect standardisation is carried out to adjust for differences in the age of women delivering at the trust. Please note that home births are excluded from the analysis.
Expected readmissions
Expected numbers of readmissions are calculated by comparing rates at a given trust to national rates on a quarterly basis. Within this comparison, indirect standardisation is carried out to adjust for differences in the age of women delivering at the trust. Please note
that home births are excluded from the analysis.
Expected puerperal sepsis and other puerperal infection rates
Expected numbers are calculated by comparing rates at a given trust to national rates on a quarterly basis. Within this comparison, indirect standardisation is carried out to adjust for differences in the age of women delivering at the trust. Please note that home births are excluded from the analysis.
HES data
Hospital Episode Statistics (HES) is a data warehouse containing details of all admissions to NHS hospitals in England. It includes private patients treated in NHS hospitals, patients who were resident outside of England and care delivered by treatment centres (including those in the independent sector) funded by the NHS. HES also contain details of all NHS outpatient appointments in England.
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Glossary continued… Outlier status
An outlier is a trust performing significantly differently than expected on a given measure - here this generally relates to standardised rates in comparison to national levels. The method used to identify outliers among the basket of maternity indicators was a type of statistical process control (a methodology that is used to identify significant deviations from a predefined standard) called CUSUM (short for Cumulative Sum).
Spells
A spell of treatment is a continuous period of treatment within a
single hospital provider (a period commencing with admission to hospital and ending on discharge) and can be made up of a number of care episodes.
Statistical process control
Statistical process control (SPC) is a methodology that uses control charts to identify significant deviations from a predefined standard. These methods originated in manufacturing industry and are now regularly applied to the monitoring of healthcare.
Z-score
The z-scoring approach enables us to measure outcomes on a common scale. The z-score measures the number of standard deviations away from the mean, preceded by a plus or minus depending on whether it is respectively above or below the mean (the mean value is commonly the average value for all trusts, or all trusts of a specific type). High z-scores indicate worse outcomes and low z-scores good outcomes. Z-scores correspond to p-values in that a p-value of 0.01 is equal to a z-score of 2.3 and a p-value of 0.001 matches a score of 3.0.
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