Board: 29 th March 2018 Attachment K0 1 TRUST BOARD Meeting Date: 29 th March 2018 Title: Supporting Papers Available electronically on the website at https://www.hct.nhs.uk/about-us/our-board/meeting-papers/ Executive Lead: Various Author(s): Various For: Noting The Board is requested to note the following supporting papers which are for information only and which are referenced in Executive Directors’ Reports. Lead Agenda Link Title & Category Attachment Clinical Services & Healthcare Governance TrW AM (C) 2 (C) 3 Quality Report Q3. Minutes of the Healthcare Governance Committee meeting held on 22nd January 2018. K1 K2 Performance & Operations KC (D) 2 Integrated Board Performance Report (February 2018). K3 Strategy, Resources and Engagement KC (E) 2 Month 11 Finance Report (February 2018). K4
Transcript
Board: 29th March 2018 Attachment K0
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TRUST BOARD Meeting Date: 29th March 2018 Title: Supporting Papers Available electronically on the website at https://www.hct.nhs.uk/about-us/our-board/meeting-papers/ Executive Lead: Various Author(s): Various For: Noting The Board is requested to note the following supporting papers which are for information only and which are referenced in Executive Directors’ Reports. Lead Agenda
Link Title & Category Attachment
Clinical Services & Healthcare Governance
TrW AM
(C) 2 (C) 3
Quality Report Q3. Minutes of the Healthcare Governance Committee meeting held on 22nd January 2018.
Care Quality Commission .............................................................................................................................................. 6
Serious Incidents and Local Investigations ............................................................................................................... 12
Safer Care ...................................................................................................................................................................... 14
Mortality Review Group ............................................................................................................................................... 17
Medical Revalidation .................................................................................................................................................... 17
Infection Prevention and Control ............................................................................................................................... 17
Children and Adult Safeguarding ............................................................................................................................... 18
Looked After Children and Care Leavers ................................................................................................................... 21
Freedom To Speak Up Guardian ................................................................................................................................ 22
Friends and Family Test ............................................................................................................................................... 24
Complaints and Compliments .................................................................................................................................... 24
2017 PLACE Programme .............................................................................................................................................. 27
Public Health Metrics ................................................................................................................................................... 35
Achievements • There was an overall reduction in the number of avoidable category 2, 3 and 4 pressure
ulcers. • There was also a reduction in the number of injurious falls despite an increase in the
number of falls in inpatient units overall. In line with national audit of inpatient fall results, action has been taken to commence lying and standing blood pressure monitoring.
• Four of the seven cases of C.difficile reported since April 2017 have been successfully appealed at the Herts CDI Appeals Panel meaning that HCT remains within the monthly trajectory.
• The Paediatric Liaison IT solution went live in November 2017, and subsequent dip sample audit provided assurance that the IT solution is working and supporting the safeguarding of children and families who attend A&E.
• The HSAB SAFA app was launched during Q3; the content of this app was led by HCT’s Named Nurse for Safeguarding Adults.
• HCT launched its ‘Partnership in Care’ pilot in two community hospital wards, extending visiting hours to enable patients’ carers to be involved in their care.
• All NICE guidance is now circulated to services via the General Manager to provide a strategic view of which services the guidance applies to.
Challenges • There was an increase in the number of medication incidents resulting in low (6) or
moderate (4) harm; 2 of the incidents resulting in moderate harm were attributed to non-HCT services. There were no specific service trends noted.
• Reduction in the percentage of the complaints responded to within timescales due to staffing capacity. Where initially agreed timescales were unable to be met, an agreement was reached with the complainant regarding a reasonable revised timescale.
• There was an increase in the number of SIs reported in Q3 linked to an increase in avoidable pressure ulcers; all SIs will be investigated through the Trust’s SI process and evidence of changes made following learning will be overseen by SI assurance Panel.
• There was one outbreak of norovirus reported at Danesbury Rehabilitation Unit in December. The outbreak was appropriately managed and did not meet the criteria requiring escalation as an SI.
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Quality Dashboard
5
QUALITY ASSURANCE
CQUINs/Quality Priorities
CQUINs
Title of CQUIN
On trajectory / not on trajectory /
met / not met Q1 Q2 Q3
Improving staff health and wellbeing On trajectory On trajectory On trajectory1
Supporting proactive and safe discharge
On trajectory On trajectory Partially met2
Preventing ill health by risky behaviours – alcohol and tobacco
On trajectory Partially met On trajectory
Improving the assessment of wounds
On trajectory On trajectory On trajectory
Personalised care and support planning
On trajectory On trajectory On trajectory 1 Whilst the staff health and wellbeing CQUIN is currently on trajectory there is a risk that HCT will not meet Part 1 of this CQUIN, which relates to staff giving positive responses to specific questions in the Annual Staff Survey, due to the current high level of organisational change. 2HCT awaiting agreement of trajectory data following freeze data review by E&NHT. Quality Priorities
Title of Quality Priority Met / partially met / not met
Q1 Q2 Q3 Supporting people with health conditions and disabilities to manage their own care as far as possible
Met (on trajectory) Met (on trajectory) Partially met1
Supporting the population by developing patient-focussed outcomes to improve their health and wellbeing.
Met (on trajectory) Met (on trajectory) Partially met2
Supporting Integrated Community Team patients with complex needs to be involved in their personalised care planning through the effective use of S1 care plans
Partially met Partially met Partially met3
Improving the safety of patients in our care by reducing avoidable pressure damage
Partially met Met (on trajectory) Partially met4
1 68.5% of patient facing staff have completed the generic e-Learning module against a Q3 target of
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75%. All other metrics on trajectory. 2 Three additional teams identified to pilot PROMS during Q3, due to staff changes and system pressures pilots will now be undertaken in Q4. Dashboard remains in development phase - anticipated completion by end Q4 with pilot either in Q4 or Q1 2018/19. 3 Patient experience survey data shows that responses for the percentage of patients who report they feel supported by staff in their personalised care planning has not met agreed measure. Staff to be reminded to ask this question of patients when carrying out the survey. All other metrics on trajectory. 4 The number of avoidable category 3 and 4 pressure ulcers is higher than target whilst the number of avoidable category 2 pressure ulcers is lower. TVN Lead scrutiny of Datix incidents has continued and RCA is requested. The overall number of pressure ulcer incidents has reduced compared to 2016/17 with 42% being HCT acquired. Of these 8% are deemed to be avoidable. Risk Register
Risks are routinely reviewed at Senior Management team meetings with key risks and their management brought to the attention of the Executive team following Business Unit Performance Reviews. Risk owners review and update their risks at least every month, and the High-Level Risk Register is reviewed by the Executive Group on a monthly basis. At the end of Q3, there are 6 risks on the High Level Risk Register; 5 operational risks and 1 corporate risk. Themes identified are similar to those reported in Q2 and relate to staffing levels and vacancy rates and re-commissioning of specialist services. Care Quality Commission
Registration • The current registration status is ‘good’. • The Statement of Purpose has been amended to include diagnostic screening for HMP The Mount
and HCT await receipt of the updated certificate. • HCT has advised the CQC of temporary changes to CEO to recognise current acting arrangements. CQC Quality Improvement Plan • Assurance checks for each area continue and there is an improvement in consistency in practice;
these are supported by BUPR • The Simpson Ward Improvement Plan has been completed with staff reporting full support and
leadership enabling safe effective practice. • Quality Assurance Visits continue to provide assurance of current care delivery. Quality Assurance Visits
External Quality Assurance Visits, internal peer reviews and Keeping in Touch (KiT) visits undertaken by HCT staff, stakeholders and Board members provide vital information about the quality of our services,
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identify any areas for improvement, and are an opportunity to engage with our staff and patients. Internal peer review visits Non-Executive Directors participated in 4 internal peer review visits undertaken in Q3 in the following locations: • Potters Bar community Hospital • St Peters Ward • Herts & Essex Oxford and Cambridge Wards • Stort Valley and Villages ICT Team Staff engagement events • A Listening Event with the Director of HR & OD was held at Sandridge Gate • Afternoon Tea event was held on 10th October 2017 to provide support to newly appointed staff
Band 6 and above to understand their experience of working within the Trust three months after appointment and seek opinions on what works well and explore potential opportunities for improvement.
A full narrative relating to these visits and events is attached as Appendix 1. External Quality Assurance Visits 3 external visits were undertaken in HCT services during Q3. • The CQC completed their thematic review into the PALMS service (Positive Behaviour, Autism,
Learning Disability and Mental Health Service for children and young people) in the first week of October
• E&N CCG also carried out a visit to Danesbury Neurological Centre in Welwyn in October. • HV CCG carried out a visit to Dacorum Integrated Community Team (ICT) in November. Areas of good practice
Service Areas of good practice PALMS Service – Formal report not published, but main themes received
• The inspectors were very impressed with the passion, drive and enthusiasm of everyone they came into contact with throughout the visit
• Progress recognised since 2015 & the CAMHS transformation plan; strategy and agreed approaches clear with a recognisable strong emphasis on early intervention
• Effective management of wait times, joint assessments, trusted assessment processes & the targeted interventions for young men
Danesbury Neurological Unit
• Good interactions observed between staff and patients • Good MDT working observed. • Physio and OT photos displayed in patient’s room showing how to move
patients safely and to use support aids appropriately. • Patient’s rooms displayed weekly plans for example, physio, OT, SLT and
Goal planning meetings for patients and relatives. Dacorum ICT
• HVCCG was assured that the service is safe, effective, responsive, caring and well led and has acquired engagement from all levels of staff
• The nursing staff exhibited a good rapport with patients • The Occupational Therapist demonstrated an extensive knowledge of
navigating services
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Area requiring improvement identified / actions taken
Service Areas requiring improvement identified / actions taken PALMS Service
• Clarity of care for children and young people awaiting ADD-vance assessment
• PALMS to provide IHCCT with procedure for risk assessments. • Reduce waiting times for initial intervention • Develop assurance process for quarterly reporting of activity • Improvements for communication and liaison with GPs • PALMS to continue working with adult services for transitional planning
Danesbury Neurological Unit
• NEWs triggers to be escalated and acted upon as per policy. • Ensure ENHT medication charts are archived once transferred to HCT
medication chart. • Patient experience boards to be kept up to date. • Sharps bin to be removed from clean utility. • Comfort Round documentation to have the date clearly documented. • VTE on the medication chart to be completed and undertaken 24 hours
after admission as per policy. Dacorum ICT • HCT is currently liaising with HV CCG regarding recommended actions
The QAV Action Plan for Danesbury Neurological Unit is attached as Appendix 2. Internal Peer Reviews During Q2 and Q3 HCT has carried out internal peer review visits to all eight of our Community Hospital Wards. Seven of the visits took place in Q3. Areas of good practice • All staff on all wards were welcoming, respectful, caring and discreet • Drug storage across all units • All relevant staff were compliant with ‘bare below the elbows’ policy Areas requiring improvement identified / actions taken • NEWS observation charts and related escalations being managed by ward managers • Catheter Passports consistency of reporting of passport, some inconsistency in practice being
followed up • Falls Pathways – review of pathway being undertaken to include national advice for lying and
standing Blood Pressure. Please note the Clinical Professional Lead for in-patient units is following up with site visits to support consistency in practice. Assurance has been received during Q4 that consistency is improved. A summary report is attached as Appendix 3.
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CONSISTENT AND IMPROVING PATIENT SAFETY
Patient Safety Incidents
Incidents During Q3 1262 patient safety incidents were reported, which represents 81.2% of all incidents reported. 545 incidents resulted in harm and are broken down as follows:
Q1 Q2 Q3 Low harm 692 500 522 Moderate harm 59 57 21 Severe harm 0 2 2 Death 1 - This incident occurred at
HMP The Mount 0
0
Total number of incidents resulting in harm
752 (57%) 559 (44%)
545 (43.1%)
Total number of incidents reported 1308 1243 1262
Themes and trends of all incidents The 10 most-reported types of all incidents reported during Q3 are illustrated below:
444
161
93 86 48 48 46 44 38 35
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Equality characteristic group information The percentage of Datix incidents which include equality characteristic group information is outlined below:
Medication incidents During Q3 there were 97 medication-related incidents reported. • During Q3 there were 4 medication incidents resulting in moderate harm, 2 of which were attributed
to HCT services and 2 to non-HCT services. • Details of the 2 HCT moderate harm incidents are as follows:
− A child under the care of Children’s Continuing Care services was under-dosed on their antiepileptic medicine by HCT carers for a number of days. The child was subsequently admitted into A&E for seizure control and returned home in a stable condition. A&E doctors did not think the cause of the seizures was due to the under-dosing.
− The dose of antipsychotic medicine for a child was incorrectly advised by an HCT PALMS consultant psychologist when the patient was accessing respite services. The child received a higher dose of their medicine in respite care. Parents of the child have reported a change in behaviour since the increase in dose.
• The 2 non-HCT moderate harm incidents are as follows: − A patient in a private care home had received an incorrect opioid patch (Buprenorphine
5microgram per hour). The patch which had been applied was much weaker than Fentanyl 50microgram per hour, which was the correct patch. This resulted in patient experiencing pain. HCT nurses promptly sought advice from specialist palliative care and applied the correct
100% 100.0% 100% 100%
57%
Gender Race Age Disability Religion or belief(only recorded
where it is relevantto the incident)
119
11 0 0
111
2 2 0
97
6 4 0
Total number ofmedicationincidents
Total number ofmedication
incidents resultingin low harm
Total number ofmedication
incidents resultingin moderate harm
Total number ofmedication
incidents resultingin severe harm
Q1
Q2
Q3
11
patch. − A patient was admitted into A&E with hypoglycaemia. The patient may have self-administered
an incorrect dose of insulin following a missed visit by HCT community nurses for insulin administration.
Central Alert System During Q3 a total of 31 CAS alerts were received within HCT; 20 of these were not applicable to HCT, 11 were applicable to HCT, of which 6 were cascaded for information only. Q1 Q2 Q3 Total number of CAS alerts applicable to HCT 3 6
11
Number of CAS alerts disseminated, actions completed and alert closed
2 Closed within
timescales 6
Closed within
timescales 9
Closed within
timescales
Number disseminated, actions on going and alert remains open 1
On trajectory to close within
timescales
0 2
On trajectory to close within
timescales Triangulation of quality team information • The Quality Team was piloting a tracker to triangulate quality information but this was not an
effective tool. • The tracker is being redesigned as an action tracker, with themes and owners for actions being
identified at the Quality Triangulation Forum. • The Quality Triangulation Forum met in Q3 and debated themes around patient experience, serious
incidents, risks, and audits. Amongst the themes discussed: − Some serious incidents had highlighted an issue around the lack of professional curiosity and
critical skills demonstrated by some staff. They were demonstrably doing their best to alleviate patient discomfort in difficult circumstances, but looking at the root causes of the patient’s symptoms rather than the symptoms themselves would have been more beneficial.
− Training is sometimes cited as the lesson to be learned from some events but training is freely available – it is how that training is implemented by staff that is key to preventing further recurrence.
− Serious incidents and audits have picked up recurring issues around the lack of consistent National Early Warning Score (NEWS) assessments.
• Actions will be developed around each item, and future forums will aim to include operational representation to make the embedding of learning that much easier.
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Serious Incidents and Local Investigations Serious incidents There were a total of 7 SIs reported in Q3: SIs are detailed by category below:
Incident type Q1 Q2 Q3
Slips/trips/falls meeting SI criteria 2 2 0 Death in custody 1 0 0 Treatment delay 0 1 0 Sub-optimal care 0 0 1 Information Governance 0 0 1 Pressure ulcers meeting SI criteria 0 1 2 Safeguarding adults (neglect- acts or omissions) 0 0 2 Safeguarding adults (neglect- acts or omissions)/ Pressure ulcer
0 0 1
Total 3 4 7 On completion, each SI report will be reviewed at the Serious Incident Assurance Panel to provide assurance of evidence of actions taken to address concerns identified and that changes have been embedded in practice. Themes and learning from SIs
Theme Commentary Outcomes/Learning Holistic assessment and care planning
1. Staff did not identify the correct sites or categories of wounds for a patient with a category 4 pressure ulcer, meaning care planning was not specific to the patient’s needs 2. The falls care plan was not implemented as expected and which may have prompted the use of more effective preventative measures being put in place for a patient who fell 3. A patient who fell had not had a lying and standing blood pressure check to identify or rule out postural hypotension, which may have led to effective management to reduce
1. Caseload reviews to be undertaken immediately to identify patients not fully assessed, Team Manager developing a process to ensure completion of these as per HCT guidelines, pressure ulcer management training and competency reviews will be completed. 2. Ward Manager to complete dip test of records to identify areas of concern and create plan to address these 3. A process is being implemented to ensure all patients on the ward have lying and standing blood pressure checks at the point of admission, Ward Manager will provide assurance of implementation thorough 3
3
4
7
Total
Q1
Q2
Q3
13
Theme Commentary Outcomes/Learning the risk of falls 4. A prisoner did not receive medication as prescribed due to the electronic clinical records system not having the ability to flag to staff prisoners with high risk medications that need follow up, nor a system to support staff to identify appropriate and timely follow up when appointments were missed.
monthly spot check of the clinical records 4. A pathway is being developed to support the identification of prisoners with high risk medication and systems to be put in place within SystmOne to support staff to assess the level of clinical risk for patients who do not attend appointments. Staff will have refresher training regarding the use of medication charts within SystmOne and the records will be dip tested for compliance.
Completion and escalation of risk assessments
1. A patient developed a category 4 pressure ulcer: risk assessments were not completed as expected. When staff were unable to complete these it was not escalated nor mitigating actions taken 2. NEWS scores were not always escalated as per guidelines or expected actions to repeat observations carried out.
1. Refresher training and reviews of competency will be implemented and assurance gathered through dip tests of clinical records 2. Dip test of records will be undertaken to identify staff who need targeted support to improve practice. The dip test will be repeated for 3 months to provide assurance of improvements
Communication with other providers
A patient was inappropriately referred to the ICT 2 weeks before planned surgery by an acute hospital. The patient was not triaged correctly and missed his initial visit
Learning will be shared with the acute hospital with regard to inappropriate referral processes and systems put in place within the team to reject referrals sent inappropriately prior to surgery taking place
Record keeping Staff documentation in the electronic records was sparse however the paper records contained more information- full records should be in the ECR and minimal information on the paper records
Record keeping guidance will be reissued and shared at Ward meetings. Dip testing of the clinical records will identify where there are concerns to be actioned.
Mental capacity assessments
A patient who fell who had some cognitive impairment did not have a MCA completed which may have prompted the use of increased supervision
MCA training will be delivered to Ward staff, a dip test of the clinical records will be undertaken to support the identification of staff who may need more targeted support to complete assessments and identify when they are needed
Equality characteristic group information
Gender Age Disability Ethnicity/group Religion Sexual orientation
Female 80-84 Long standing
health condition White British Not recorded Not recorded
Male 70-74 Long standing
health condition White other Not recorded Heterosexual/straight
Female 85-89 Long standing
health condition White British Not recorded Not recorded
Male 55-59 Physical disability White British None Heterosexual
Male 80-84 Long standing
health condition White British Not known Not recorded
Male 80-84 Not recorded White Irish Not recorded Not recorded
N.B. not applicable to Information Governance incident
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Local investigations There were a total of 4 locally investigated incidents reported in Q3: Locally investigation incidents are detailed by category below:
Incident Type Q1 Q2 Q3 Information governance 1 0 0 Safeguarding allegations of neglect 2 1
1
Sub-optimal care 1 3 1 Medication error 0 2 1 Treatment delay 0 2 0 Medical devices 0 0 1
Total 4 8 4 Themes and learning from locally investigated incidents
Theme Commentary Outcomes/Learning Communication with other providers
Staff did not communicate effectively with care home staff delivering care to an end of life patient
Link staff will be allocated for all care homes on Herts Valleys to improve communication and continuity of care
Communication with patients and their families
The family of an end of life patient in a care home were not communicated with directly by HCT staff with regard to end of life care planning
The Care Home Agreement template will be updated to ensure that HCT staff contact relatives of patients throughout any period of care and have contact details of services visiting their relatives
Safer Care
4
8
4
Total
Q1
Q2
Q3
97.34% 97.85% 97.81%
90.00%
95.00%
100.00%
Harm free care in HCT
Safety Thermometer - average harm free care
Q1
Q2
Q3
National benchmark - 95%
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Falls in community hospitals
During Q3 three falls were classified as severe or moderate harm: two fractured neck of femurs at PBCH and Langley House both of which were classified as severe harm, and one fractured wrist on Simpson Ward which was classified as moderate harm. National Benchmarking • Rate of falls per 1000 Occupied Bed Days (OBD) April to November 2017: HCT reported an average
of 8.13 falls per 1000 OBD against a national benchmark of 7.97 falls per 1000 OBD. • Rate of injurious falls per 1000 OBD April to November 2017: HCT reported an average of 1.91
injurious falls per 1000 OBD against a national benchmark of 2.48 injurious falls per 1000 OBD. Based on data available from NHS Benchmarking for 6 months ending November 2017 Achievements • There is continued strengthening of the collaboration between HCT, ENHHT, HPFT and WHHT which
includes: − Review of recommendations from the National Audit of Inpatient Falls (2017)
86
30
3 0
87
37
3 1
113
34
1 2
Total number of falls incommunity hospitals
Total number of injuriousfalls in community hospitals
Number of falls categorisedas resulting in moderate
harm
Number of falls categorisedas resulting in severe harm
Q1
Q2
Q3
0.81%
1.03%
0.61%
0.20%
0.84%
0.64% 0.68%
0.43%
1.15%
0.50% 0.48% 0.53%
New pressure ulcers Falls with harm New catheter-associatedUTIs
New VTEs in a communityhospital
Safety Thermometer - average 'new' harms
Q1
Q2
Q3
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− Agreement to standardise information provided to patients Areas requiring improvement identified / actions taken • Following its success in 2017, a date for Falls Champion Training Day has been scheduled in March
2018. Falls assessment compliance (Q3 falls spot check audit findings – if available) • Monthly falls monitoring report undertaken and shared with Falls Champions and key stakeholders • Completion of Falls Review at Potters Bar Community Hospital following an increase in number of
falls with moderate and severe harm over Q1 and Q2. • A Spot check of falls assessment compliance was undertaken at all community hospitals during Q3;
results and learning will be shared with Falls Champions during January 2018. Pressure ulcers There were 379 category 2 to 4 pressure ulcer incidents reported in Q3, representing 30% of all patient safety incidents reported in quarter. Of these, 8 were deemed to be avoidable. Avoidable pressure ulcers
Achievements • A deeper understanding of the root cause of avoidable pressure ulcers • Guidance for managing patients who are non-concordant with pressure relieving advice has been
implemented along with a visual guide. Areas requiring improvement identified / actions taken • 75% of patients with avoidable pressure ulcers are receiving care from another provider.
Communication between HCT staff and the care provider needs to improve. The care home agreement form is being promoted and staff are being educated about home care providers.
2
12
1
8
1
7
Avoidable category 2 PUs Avoidable category 3 and 4 PUs
Q1
Q2
Q3
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Mortality Review Group
There were a total of 10 patient deaths reported in Q3. • Nine deaths were expected and occurred in patients who were admitted to a community hospital. • One death occurred in an acute hospital but has been reviewed as it followed a number of
admissions to and from a community hospital. The death was unexpected but was not avoidable and learning will be considered at the next Mortality Review panel.
• The Mortality Panel met once during Q3 • No avoidable deaths have been reported during 2017/18, Q1 to Q3 • The Mortality Review policy became available to staff from 1 October 2017 • Information has been communicated to staff via Noticeboard (Trust communication) to raise
awareness of the new policy and information has also been communicated to community service managers and ward managers.
Medical Revalidation
• A further meeting of the HCT Decision Making Group took place in October 2017. From January 2018
meetings will be increased to every 2 months. • The Responsible Officer continues to receive advice at the Decision Making Group on concerns and
the relevant system issues are being addressed. • Relevant policies have been updated to reflect Medical Revalidation. • An audit of HR information held about doctors has been undertaken and gaps are being addressed. Infection Prevention and Control
Healthcare Associated Infections (HCAI)
6
0
2
0
9
1
Number of expected deaths inquarter
Number of unexpected deaths inquarter
Q1
Q2
Q3
3
0 0
1
0
1
3
0
2
Clostridium difficileinfections (CDI)
MRSA blood streaminfections (BSI)
E.coli blood streaminfections
Q1
Q2
Q3
18
• Three cases of C.difficile reported in Q3 taking the annual total to 7 cases notified since April 2017.
Root cause analysis (RCA) to be undertaken to identify learning and good practice. • Two cases of E.coli were reported in Q3. RCA to be undertaken to identify learning and good
practice. Outbreaks of HCAI • There was one outbreak of norovirus reported at a community hospital in Q3. This did not meet the
definition requiring escalation as a serious incident. Achievements • Four of the 7 cases of C.difficile reported since April 2017 were successfully appealed at the Herts CDI
Appeals panel meaning that HCT remains within the monthly trajectory. • No cases of MRSA bloodstream infection were reported in Q3. • Four infection prevention and control policies reviewed. • 100% of eligible patients screened for MRSA on admission to community hospitals. Areas requiring improvement identified / actions taken • Two cases of C.difficile occurring in Q3 to be presented at the Herts CDI Appeals panel. Children and Adult Safeguarding
Safeguarding Children Training and supervision Achievements • Domestic Abuse Policy for Children and Vulnerable adults was updated and ratified in December
2017 • Safeguarding supervision policy was updated and ratified in October 2017 • The Second Child Sexual Exploitation (CSE) audit and the use of the CSE template and questionnaire
was undertaken. The Q2 data used for the audit indicated that the CSE template was being used correctly. An area for improvement identified from the audit is to improve the sharing of the
96%
99%
97% 98%
97% 98%
90%
95%
100%
Percentage of staff who are compliant with SGCtraining
Percentage of staff who are compliant with SGCsupervision
Q1
Q2
Q3
Trust target - 95%
19
information to the child’s GP when the template is used. This is being shared widely through meetings, supervision and the various communication platforms. The audit will be repeated using Q3 data.
• The Paediatric liaison IT solution went live in November 2017, using a bulk-upload and e-mail alert solution. The model was developed in partnership with Acute Trust, IT, C&YP, CHIS and safeguarding partners. Since the model went live IT has been monitoring data compliance. In December 2017, the first dip sample audit of 19 A&E attendance was undertaken to give assurance that the bulk-uploads was working. The results of the audit indicated a 100% compliance which also included the ambulance icon being uploaded as part of the IT solution process
• 2 Safeguarding Children Nurse Specialists have completed and passed the Mary Seacole training • We have appointed to the MASH (1WTE) vacancy with the nurse specialists first employment day
3/1/2018. • A Safeguarding Children Nurse Specialist has been appointed as Named Nurse for East & North Herts
NHS Trust • We have appointed to the vacant safeguarding nurse specialist post within the team and aim to have
the nurse in post by 1/4/2018. Areas requiring improvement / actions taken • Continue to raise the profile to the use of Graded Care Profile assessments when neglect is a
concern.
The Safeguarding Children dashboard for Q3 is attached as Appendix 4.
Safeguarding Adults Training During Q3 training targets have been achieved as measured against contract standards
Achievements • Face to face training for managing LD patients delivered to 5 out of 8 community In Patient Units • HSAB SAFA app launched, app content lead by HCT Named Nurse Safeguarding Adults • Participated in the facilitation of the HSAB MCA conference in Hertfordshire
98% 98%
100%
97%
98%
100%
97% 97%
98%
90%
95%
100%
Percentage of staff who arecompliant with safeguarding
adults training
Percentage of staff who arecompliant with MCA training
Percentage of staff who arecompliant with DoLS training
Q1
Q2
Q3
Trust target - 95%
20
• Developed and launched new MCA template and revised Safeguarding Adults template for Systm1 • Staff intranet page revised and relaunched
Areas requiring improvement identified / actions taken • Policies for Safeguarding Adults, Allegations of Abuse by HCT staff and Prevent have been updated
and are awaiting final approval at next Safeguarding Adults Forum and Healthcare Governance Committee’s
• Safeguarding Adult Champions are receiving a modified service via telephone due to sickness/capacity within the SAFA team
The Safeguarding Adult dashboard for Q3 is attached as Appendix 5.
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Looked After Children and Care Leavers
Achievements • 100% Review Health Assessments (RHAs) in County completed within time scale by Specialist LAC
nurses. Specialist LAC Nurses complete RHAs for those young people who are either in College, employment, or not in either.
• 100% Out of County Review Health Assessments completed within time scale by Specialist LAC nurses.
• HCT LAC GPs completed 100% of Initial Health Assessments within timescale. • Health Visitors and School Nurses completed 94% of Review Health Assessments within timescale. • Joint Safeguarding Supervision with the Specialist LAC nurses and LAC GPs. Positively evaluated. • 40 young people attended the Care Leavers Event in October 2017. Joint working with the Child in
Care Council (CHICC). Positively evaluated from young people and staff. • Joint information sharing protocol ratified by Hertfordshire Partnership Foundation Trust and HCT to
improve communication between the two agencies. • 4 training sessions delivered across the County by the Specialist LAC Nurses to Foster Carers on
“What is good health?” This was evaluated positively with a request from the carers for further training.
Areas requiring improvement identified / actions taken • Completion of Personal Health Information Plans for all 18 year olds continues to be a challenge. No
national guidance or templates. Working closely with Designated Nurse and Doctor to resolve this. • The voice of the child and young person. Pilot SMS text service for 16+. • Reporting on health outcomes for LAC and Care Leavers. The team are working with Luton who have
a good reporting mechanism via SystmOne. • Identified sexual health work required for unaccompanied asylum seeker children (UASC). Joint
working workshops to be discussed with Hertfordshire County Council UASC team as Specialist Nurses have heard from UASC
• Specialist training for professionals working with UASC has been requested to the Hertfordshire Safeguarding Children’s Board.to improve knowledge and skill set.
• Continued joint working with School Nurses. Specialist LAC Nurses to deliver bespoke training in 2
90%
93% 93%
89%
92%
94%
88%
89%
90%
91%
92%
93%
94%
Percentage of all LAC Initial HealthAssessments referred to HCT staff completed
within agreed timescales
Percentage of all Review Health Assessments oflooked after children referred to HCT staff
completed with time scales
Q1
Q2
Q3
Trust target - 90%
22
workshops across the County as quality issues have been reported. Interactive training to be delivered to provide assurance to our Commissioners that the quality improvements will be maintained.
Freedom To Speak Up Guardian
During Q3: • 1 whistleblowing event was raised via the CQC process. This has been investigated and is being
actively managed. There is no enablement to provide feedback directly. • 2 concerns were raised – 1 relating to systems and process, and 1 relating to quality and patient
safety. Both are under review at the time of the report. • The Trust’s Whistleblowing Policy has been revised in line with the latest Freedom To Speak Up
Guardian guidance.
0
1
0
2
1
2
Number of whistleblowing events Number of raising concerns events
Q1
Q2
Q3
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AN OUTSTANDING PATIENT EXPERIENCE Patient Surveys
The information below summarises Q3community hospital inpatient survey results. A snapshot of patient comments received is detailed below:
Were you treated with Dignity and Respect? • “All the time” • “Given extra time to make my wishes known” • “Always, the staff were very polite and friendly”
Overall, how would you rate the quality of care received?
• “Nothing but thanks and more thanks for the staff at Langley House, from the Cleaners, Canteen Staff, HCA, Nurses and Doctors. Love you all”
• “Was well treated and the staff were very kind and helpful”
Areas of improvement
• “Feel that not given enough Physio to get over chest infection before coming to QVM so wasn't able to participate in Rehab Physio as much as could have done”
• “Some patients could be noisy” Patient Stories
There were no patient stories shared at Board in Q3.
98% 98% 98% 98%
99% 99%
Percentage of patients who told us they weretreated with dignity and respect
Percentage of patients who told us that the overallquality of care was good or better than good
Q1
Q2
Q3
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Friends and Family Test
*The percentage of patients who would recommend Trust services to friends and family if they needed similar care or treatment. • Overall 97% of patients’ would recommend the Trusts services to friends and family if they needed
similar care or treatment. This score exceeds the Trust performance target of 95%. • The services that have underperformed in this area are exception reported in the BUPR. Complaints and Compliments
The information below provides a summary of all contacts received by the Patient Experience Team in Q3; this includes complaints, PALS enquiries and compliments. Complaints Q1 Q2 Q3 Number of complaints received
38 37 37
Percentage of complaints acknowledged responded to within agreed timescales
100% 98% 100%
Percentage of complaints responded to within agreed timescales
100% 100% 82%
Number of complaints received graded as category 3
2 0 0
Number of complaints referred to the Parliamentary and Health Service Ombudsman
0 1 0
Number of local resolution meetings held
2 1 0
• A total of 37 complaints were received in quarter three and all complainants were offered the
opportunity to meet with staff to discuss their concerns in line with Being Open Guidance. • 100% of all complaints were acknowledged within 3 days.
98% 98% 97%
90%
95%
100%
FFT score*
Q1
Q2
Q3
Trust target - 95%
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• 82% of all complaints were responded to within agreed timescales; complainants were contacted in those instances where we were unable to meet the initial timescale to agree a reasonable extension.
• The number of complaints received in the quarter were attributed as follows: − 54% Adult Services in East and North Hertfordshire and Herts Valley − 46% Children’s Specialist, Children’s Therapies & Children’s Universal Services − Children’s Universal Services (Step 2 and PALMS services) received 39% of these complaints
contributing to the increase. However, they have been no special cause events to explain the increase.
Trends and themes identified The top three issues raised were: • Clinical treatment (24% of all complaints received), • Date for appointment (16% of all complaints received) • Standards of care (14% of all complaints received) Examples of organisational learning and improvement from complaints
Theme Commentary Outcomes/Learning Communication and process
The relative of a patient who had been under the care of an Integrated Community Team (ICT) raised a concern regarding equipment, including a hospital bed, that had been left in their home for several weeks following the patient’s death, causing distress to the patient’s spouse and child. Whilst investigating it became apparent that the process for the removal of equipment had not been discussed with the family when the patient first began to receive palliative care or after the patient’s death.
• Staff must ensure that the patient’s paperlite notes includes contact details for a named person within the service to ensure that the family knows who to contact to arrange removal of equipment
• Any plans agreed with the family regarding bereavement visits must be clearly recorded in the patient’s notes so that all visiting staff are also aware of plans that have been agreed.
Communication Standards
A patient contacted the Patient Experience Team as they felt they were not given enough information regarding treatment options available or risks involved before a procedure was undertaken. The patient felt that if they had been made aware of the possible outcomes, they would not have gone ahead with the treatment.
• At assessment staff must discuss all possible options and the potential risks of proposed treatment or procedures with the patient and note the discussion, the patient’s preference and the agreement reached in the patient’s clinical records.
• Staff must ensure that if any changes are made to treatment plans that have been discussed and agreed that this is fully explained to the patient and the reasons for any changes recorded in the patient’s notes.
Medication administration
A complaint was made regarding an incident involving the accidental administration of insulin to a non-diabetic patient, which occurred because Trust policy regarding the identification of patients was not correctly followed. The patient was taken to hospital for observation and returned home the next day. The nurse concerned also called a senior
• Staff must check each patient’s records thoroughly and administer insulin in line with the care plan
• All staff must be mobile working wherever possible to ensure that they have available to them up-to-date records
• Before administering medication staff must confirm the identity of the person, they should ask the patient (or their relative or carer) to confirm their full name and date of birth and then check this against the record.
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Theme Commentary Outcomes/Learning nurse, who attended immediately, discussed the incident and reviewed the competency of the nurse before allowing her to continue with further visits. The nurse reported the incident through the Trust’s incident reporting system.
• Staff must describe the medication to the patient and tell them the reason for its administration so that informed consent to be given.
• If consent is not given, staff must carry out mental capacity assessment.
• If the treatment is withheld because consent cannot be obtained, the GP must be informed immediately.
Equality characteristic group information The Patient Experience Team captures evidence to demonstrate equal access to all groups of people who wish to make a complaint in line with the national directives to ensure equality for people in the 9 protected characteristics groups. • The majority of complaints received in Q3 were related to patients aged 0-15 years of age (41%), 35
years of age or over (41%) and unknown (18%). This can partly be explained by the increase in complaints received from Children’s Universal Services as previously detailed.
• Complaints raised by the person affected (i.e. the patient) continue to account for the majority of Q3 and total 64% of all complaints received. In comparison 54% of all complaints received in quarter two were raised by the person affected.
Compliments
Q1 Q2 Q3 Number of compliments received
2841 1335 3239
Number of compliments per 1000 patient contacts
3.93 3.08 9.34
PALS contacts Informal patient and carer feedback is received by the Patient Experience Team via the PALS function and the team aims to respond to these informal concerns and enquiries in an expedient manner. The top two (HCT related) PALS issues raised in Q3 were: • Standard of communication (including oral and written communication) – 39% • Date for appointment – 25% A further breakdown of all PALS contacts received is detailed below.
Q1 Q2 Q3 Number of PALS contacts received
197 100 139
Percentage of PALS contacts received that were HCT-related
59% (118) 53% (53) 58% (81)
Number of MP enquiries received 6 11 1
Enhanced PALS contacts • An enhanced PALS enquiry is one that cannot be answered immediately and requires further
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investigation or action by the Trust service/s concerned and the PALS team. • Enhanced PALS contacts have been introduced on a trial basis providing further evidence of
partnership work carried out between Trust services and PALS to resolve more enhanced concerns that sit outside of the formal complaints process, as agreed with the individual contacting the service.
• A total of 67 enhanced PALS contacts have been recorded to date since this type of contact was introduced in Q2 on a trial basis.
The top three enhanced PALS contacts to date are: • Communication (including oral and written communication) – 22% • Clinical treatment – 15% • Date for appointment – 15% 2017 PLACE Programme
Action plan updates Individual action plans have been shared with each community hospital ward and this work is being led by Clinical Services with support from the Patient Experience Team and Estates & Facilities Teams. The followings actions have been, or are in the process of being, implemented following the assessments.
Site Domain Action Progress Completion
Simpson Ward Condition, Appearance & Maintenance
Window blinds in need of maintenance and repair. Many windows have no blades, or just one or two and some hanging off.
Blinds now removed and replaced with disposal curtains
Complete
Simpson Ward Dementia Friendly Environment
Consistent flooring, matt, non-reflective and non-patterned.
This has been completed, new flooring in situ.
Complete
Potters Bar Community Hospital
Internet access Patients’ do not have internet access
Tender out to supplier, x3 companies expressed interest. Presentations due on Monday 4th and 5th December 2017. Shortly after the presentations, the supplier will be chosen and it is expected that implementation will commence early in the new year.
Ongoing
Potters Bar Community Hospital
Lighting Light not working in the gym
Light replaced Completed 29/11/17
Langley House Privacy, Dignity & Not all patients have Audit to be carried Ongoing
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Site Domain Action Progress Completion
(Midway Unit) Wellbeing access to lockable storage space
out on the number of bedside units that are not lockable. Request made on 27.11.17 for locks to be fitted to unlockable cabinets/lockers.
Herts and Essex Hospital
Ward food Clear information at ward level advising patients’ how to obtain advice on food allergens
From January 2018 the provision of meals will be changing to give patients more choice on meals and portion sizes and the menu cards will have clearer dietary advice to ensure patients’ are informed.
Expected January 2018
Next steps Monitoring of actions plans will continue to ensure implementation; a pre-meet will be arranged in January 2018 with Clinical Services, Patient Experience Team, and Estates & Facilities Team to begin PLACE 2018 assessment planning. A programme of pre-PLACE assessments will take place at each site ahead of the actual assessments to ensure staff are prepared and to continue with overall PLACE improvements made. Learning Disabilities
Q1 Q2 Q3 Number of LD patients attending HCT services
339 380 737
Number of LD patients flagged on S1 (open referrals)
1925 1217 1284
Carers A carer is described as someone who provides help and support, unpaid, to a family member, friend or neighbour who would otherwise not be able to manage. Carer’s strategic plan • A carer’s strategic plan from 2018 is being developed for health and social care services across
Hertfordshire. • Feedback has been collated from focus groups with carers, and following consultation with carer’s
leads and other stakeholders • A draft will be circulated in the New Year. Partnership in Care • Partnership in Care (PIC) is a new way of working with patients and carers. It involves extending
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visiting hours to enable the patient’s carer to be involved with their care. • PIC was launched as a pilot on St Peters ward and at Danesbury on 20th November. Carers are
offered the option of wearing a yellow lanyard to identify them to all the ward staff. • During January, PIC will be evaluated through a staff survey and a carer’s survey as well as interviews
with staff, carers and patients on the ward. A rollout to the other wards is planned in February 2018. Partnership working with other NHS organisations • The Carers leads in ENHT, WHHT, HPFT and HVCCG have been working together with Carers in
Herts to ensure a consistent approach to supporting carers. • A new group, Supporting Carers across the NHS in Hertfordshire, held an initial meeting with carers
in November. The group membership has been extended to include the Carers Lead for social care in Hertfordshire County Council, Healthwatch Hertfordshire and representatives from the Herts Parent Carer Involvement Group (HPCI) and will meet quarterly. There will be an initial focus on the transition between acute and community care and discharge.
Co-production with carers • NHS England funding is enabling the production of a Carers handbook for ENHT and WHHT. • A focus group took place in December with carers, carer’s leads from across Hertfordshire NHS
organisations and voluntary sector organisations including Carers in Herts. • The carer’s handbooks produced by HCT and HPFT and the Luton & Dunstable hospital were used as
references to inform its development.
CCG/GP Hotline Enquiries
Q1 Q2 Q3 Proportion of urgent ENHCCG hotline enquiries responded to within 5 working days
There were no urgent hotline enquiries
received in Q1
There were no urgent hotline enquiries
received in Q2
There were no urgent hotline enquires received in Q3
Proportion of routine ENHCCG hotline enquiries responded to within 20 working days
92% (11 out of 12) 83% (10 out of 12) 85% (23 out of 27)
The above figures relate to ENHCCG hotline enquiries only as specified in the Quality Schedule 2017/19.
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EXCELLENT CLINICAL EFFECTIVENESS National Institute for Health and Care Excellence (NICE) Quality Standards (QS) and Guidance
The NICE Working Group (NWG) reviewed NICE guidance (NG) and quality standards (QS) released at the end of each month by the NICE. Where the guidance is found to be applicable to HCT commissioned services, action plans are reviewed at the NWG and an update is provided to the Clinical Effectiveness Group (CEG) meeting to provide assurance of clinical compliance of meeting evidenced-based practice standards.
Month Assessed Total NICE assessed
Applicable Total NICE applicable Q3 NG QS NG QS
October 12 1 13 10 1 11
November 21 2 23 4 2 6
December 12 1 13 * * *
Total 49 17* *December guidance - awaiting assessment of applicability New NICE guidance released at the end of every month is now circulated to Services via the General Managers who will have the strategic view of which services that guidance applies to. This will facilitate the inclusion of NICE guidance within existing service operational work plans to support service development. NICE guidance implemented across HCT Quality Standard, QS128, Early years: promoting health and well-being in under 5’s -Health Visiting Service. • HCT delivers a high standard of care to universal and vulnerable children/families who may need
extra support. HCT has effective links with GP and midwifery services who highlight any concerns identified in the antenatal period ensuring Health Visitor involvement.
• The service has reviewed skill mix in order to offer 5 contacts in the antenatal period. • The commissioner specification and changes in KPI requirements from March 2018 for antenatal
contacts will enable the service implement 5 face to face universal contacts. Clinical Guideline, CG127, Hypertension in Adults: Diagnosis and Management • Health Care Assistants complete competency logs before undertaking blood pressure recordings.
Discussions take place at Inpatient Ward Manager meetings and will improve the way blood pressure is measured and help healthcare professionals to diagnose hypertension accurately and treat it effectively. There have been no complaints or serious incidents involving the recording of blood pressure.
NICE Guideline, NG15 – Antimicrobial stewardship systems and processes for effective antimicrobial medicine use
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• 50 recommendations were found to be relevant for HCT. Many of the recommendations are regularly audited in Community Hospitals, including quarterly prescribing medication audits. These audits highlight any discrepancies from the guidelines regarding antibiotics. The audits have demonstrated compliance with the recommendations.
Quality Standard, QS121, Antimicrobial stewardship • Clinicians update patient’s charts as well as the review date, so that nurses can see what they are
treating. This is to ensure that the patient is not given antibiotics for longer than needed. This will minimise the risk of antibiotic resistance developing. Quarterly audits have been implemented for the last two years with results fed back to Clinicians, Nurses and Ward Managers to ensure continuous quality improvement.
Quality Standard, QS132, Social care for older people with multiple long-term conditions • Home First work in partnership with voluntary services; namely Age UK and Crossroads, both of
whom have representatives liaising with Home First on a weekly basis. Home First work in partnership with social care providers (Goldsborough) and demonstrates a multi-disciplinary approach to care provision. All clients will have a physical health and mental health assessment, if deemed appropriate and an agreed care plan with goals jointly identified. All clients have access to a Social worker and Voluntary Services staff who will assess for all available services. Documentation is collated on SystmOne and Acsis (Voluntary Services system).
Quality Standard, QS142, Learning disabilities: identifying and managing mental health • Community Paediatric Service do not routinely follow up children who have only learning difficulties.
These children are followed up by the GP. When mental health issues are suspected in this group of children they are appropriately referred to CAMHS and follow ups (including managing medication for mental health issues) are undertaken by CAMHS.
NICE Guideline, NG19. Diabetic foot problems: prevention and management - Update. • East & North Hertfordshire CCG and Herts Valley CCG (following funding from NHS England) have
commissioned an increased Diabetes Multi-Disciplinary Foot Clinic. Initially this will be funded for 1 year, and will ensure adherence to NICE guidance by allowing 24 hours access to the Podiatry Team. Recruitment to extra posts is currently underway in East & North Herts and should be in place by early 2018. Herts Valley is due to undertake recruitment
Significant progress has been made with the support of HCT’s Performance & Information Team to help support NICE Guidance implementation and availability of information for each service within the Trust. This will ensure accurate NICE guidance reporting via the development of the NICE guidance database on the Business Intelligence platform. Clinical Audit
Learning from Local Clinical Audit Catheter Passport Audit in Community Hospitals – CEG, October 2017. RED ASSURANCE The audit forms part of HCT’s quality contract and assessed catheter passport use in community hospitals. 68% of patients with an indwelling catheter had a catheter passport against a Trust target of 100%. 100% of the patients had a catheter care pathway in place. However, 37% of patients had a date for the changing their catheter completed in their catheter passport. Actions include:
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• Immediate verbal feedback at the time of audit to highlight anomalies and immediate follow up by
the Clinical Quality Lead at all units to ensure that plans are in place to address concerns. • Results shared at the Quality Contract Review meeting. • The assurance was rated as red by CEG members when the catheter audit results were shared in
October 2017. A re-audit was undertaken in December and the findings will be reported at the CEG meeting in February 2018 to ensure that improvement actions have been undertaken.
Audit of the Delivery of Care against the Mental Health and Learning Disability Provision Guidelines at HMP (Her Majesty’s Prison) The Mount as required by NHS England. – CEG, December 2017. AMBER / GREEN ASSURANCE An Independent audit was undertaken to seek assurance of the application of the mental health guidelines for patients within the prison health service. SystmOne Electronic Clinical Records (ECR) and PARIS (Primary Access Regional Information System) ECR were assessed. Overall the audit demonstrated that there was excellent provision of health and rehabilitative care provided within Prison Services and good compliance and high quality care delivery in line with the service specification commissioned by NHS Health and Justice. The audit provides evidence of care delivered according to NICE guidelines. Actions include: • Results presented at Healthcare Governance Committee and the CEG. • Prison Healthcare Service Manager to attend the next CEG meeting in February to discuss the
identification and recording of patients with learning disabilities. • Review local HCT ‘Guideline for the Mental Health and Learning Disability Provision at HMP, The
Mount’ in line with the policy revision date (March 2018). Clinical Effectiveness Forum Update on Audits Education Health Care Plan (EHCP) Reports Re-Audit EHCP assessment process was identified as a way of bringing a child/young person’s education, health and social care needs into a single, legal document. An audit was undertaken to assess the quality of the content of EHCP reports written by Health Professionals. On the whole the reports were well written, concise and relevant. The reports contained accurate patient details, diagnosis and included the child’s strengths and needs. Actions include: • Report shared with Children’s Therapists and Community Medical Team via Team Leads including
information on lessons learnt and how to complete the EHCP. • Re-audit in 1 year (included in the 2018/19 audit plan). Not Brought In (NBI) for Children, Young People and Adults at Risk Audit: In December 2016 the Not Brought In for Children, Young People and Adults at Risk Policy was ratified and launched within HCT. The aim of the audit was to evidence that the policy was being followed by staff working in HCT Children’s services and to seek assurance 6 months post launch of the policy. The audit demonstrated areas of good practice and evidence of good documentation. The NBI policy is being followed by staff working in children’s services, with the exception of notifying GP’s when children fail to be taken to their second appointment. Actions include: • Report shared at the Children’s Safeguarding Forum. • Raise awareness of Healthcare Professionals’ responsibilities and expectations to adhere to the NBI
policy. • The Safeguarding Children’s Team to re-audit in 6 months’ time. Looked after Children Quality Dip Audit of records
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HCT is required to provide quarterly audits to look at record keeping as part of the Quality Schedule agreed with the Commissioners and to provide assurance that Health Visitors (HV), School Nurses (SNs) and Specialist Looked after Children (LAC) nurses within HCT are compliant with the record keeping policy and are documenting correctly on the Review Health Assessment (RHA) paperwork. The results showed 80% of the paperwork was satisfactory. Actions include: • “Top 10 Tips” relating to RHAs shared with Children’s Universal Services (CUS) staff to use as an aid
to improve quality. Advertised on Noticeboard and shared at the SNs development day (September 2017). Positive feedback received from SNs.
• Audit shared with CUS Senior Management Team, the LAC Operational meeting, HCT Safeguarding Children Forum.
• Re-audit in December 2017.
School Nursing Audiology (Hearing) Screening Audit 2017 The aims of the audit were to ensure that all reception children receive or are offered an audiology screen and to ensure that all children who fail screening are re-tested and referred to audiology if the second screen is failed. In the 2016-17 cohort (14,728) 14,573 children had a hearing test (98.95%) [Last year’s figures for HCT = 98.66%]. Actions include: • All children who have not received an audiology screen or those children that failed an initial
audiology screen and were not re-screened, or referred, will be identified and investigated and re-screened in line with current guidelines.
• SystmOne change request for children with learning difficulties to ensure these children can take part in the test.
• Lessons from the audit shared at team meeting identifying areas for improvement. • Re-audit on an annual basis for the next reception cohort (2018).
School Nursing Vison Screening Audit 2017 The aims of the audit were to ensure that all reception aged children are screened for Vision, and the children who fail vision screening are referred in line with current guidelines. In the 2016-17 cohort (14,728) 14,530 children had a vision test (98.66%). [Last year’s figures for HCT = 98.09%]. Actions include: • All children who have not received a vision screen will be identified and screened or offered a
screen, in line with current guidelines. Those children that failed a vision screen and not referred will be identified, parents will be contacted and an appropriate referral made (action completed).
• Revise standard operating procedure for ‘Testing vision using kay picture crowded logmar test for school screening’ due by September 2018.
• Re-audit on an annual basis for the next reception cohort (2018). Local Improvement to seek better Engagement with Trust Staff We sought feedback from our clinical staff, following which we made improvements to our clinical audit registration form to ensure that the form is user-friendly and easy for HCT staff to complete as shown in the example below.
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Medicines Management
Review of NICE Technology Appraisals • During Q3 NICE published 23 TAs; all 23 were reviewed and found to be not applicable to HCT
commissioned services. Antibiotic prescribing audit Community hospitals Point prevalence audit was undertaken in October 2017: • 31 patients were prescribed oral/IV antibiotics/antifungals/antivirals • In 15 of the patients prescribed antibiotics/antifungals/antivirals, the prescription was initiated by
HCT doctors • 14 out of these 15 (93%) patients were prescribed antibiotics/antifungal/antiviral in line with pan-
Herts or primary care guidance or HCT guidelines. In one case the correct antibiotic was prescribed but the duration of treatment exceeded the recommended treatment course.
• 15 out of 15 of these (100%) had a clear antibiotic indication documented in the patient’s notes or medication chart.
Community district nursing teams • Prescribing data is not currently available for Q3 as ePACT prescribing data is provided by CCG. • There were 72 prescriptions for antibiotics by the Community district nurses in Q2. There were 6
prescriptions for antibiotics which were not first line treatment within the Trust’s antibiotic formulary. Four of these were prescribed based on recommendation (microbiology approval or sensitivities). For two prescriptions there is not clear communication from the nurse for antibiotics chosen.
• HCT pharmacy team continue to liaise with the prescribing nurses to ensure they are prescribing to the Trust’s formulary.
MHRA Medicines Related Patient Safety Alerts • During Q3 16 MHRA updates have been received and 9 applicable updates have been circulated to
all HCT medical and non-medical prescribers for information.
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Public Health Metrics
Make Every Contact Count (MECC) Training
Q1 Q2 Q3 Number of eligible staff 2194 2190 2236 Number of eligible staff who have received MECC training 986 980 1040 Percentage of eligible staff who have received MECC training 45% 45% 47% Patient Advice Regarding Alcohol Consumption
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Weight Management
37
Smoking status and advice given
Percentage of patients with a smoking status recorded
Q1 Q2 Q3
Adult Specialist Services 89.87 89.28 90.61
Children's and Young People's Services 88.40 88.29 89.95
East & North Herts ICT 94.21 94.45 96.31
Herts Valley ICT 93.72 94.51 94.70
Inpatients 90.60 50.51 100
Percentage of people who smoke
Q1 Q2 Q3
Adult Specialist Services 38.28 38.26 32.93
Children's and Young People's Services 9.98 10.33 5.3
East & North Herts ICT 2.2 2.27 2.33
Herts Valley ICT 6.61 6.50 12.76
Inpatients 1.89 6.53 4.89
Percentage of smokers given brief intervention advice
Q1 Q2 Q3
Adult Specialist Services 55.39 56.74 58.02
Children's and Young People's Services 68.37 70.33 58.03
East & North Herts ICT 66.03 65.77 70.75
Herts Valley ICT 54.83 55.22 72.15
Inpatients 50 62.5 100
Number of smokers referred to HSSS (as reported by HSSS)
Q1 Q2 Q3
Total 46 51 38
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LEARNING FROM CLAIM AND LITIGATION Claims
Clinical negligence claims
One new clinical negligence claim has been received during Q3. This concerns alleged failure to pursue treatment in 2015 for what transpired to be a fractured arm (HMP The Mount). A number of other prisons are also named defendants. Note: Any new claims reported are claims received and advise of allegations. They do not necessarily confirm that the Trust has admitted liability. In some cases of new claims reported, the Trust may not be the correct defendant and further investigation is underway.
Other claims New Employer‘s Liability
Claims New Third Party Liability Claims Claims closed
0
2 2 unrelated claims received in Q3, each
alleging breach of the Data Protection Act. (1 x Health Visiting; 1 x School Nursing)
0
Trends in claims There are no discernible trends. Claims are few in number, tend to be of low value and are widely spread in terms of services, geography and the nature of claim.
Coroners’ Inquests
There have been no Coroner’s Inquests during Q3.
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Appendix 1: Visits undertaken by Board members in Q3
Service Examples of Good Practice Main Themes ( Opportunities / Challenges) Recommended Actions
Potters Bar Hospital Internal Quality Assurance peer review
• Staff were welcoming and very helpful whilst checking identity and reason for visit.
• Staff had participated in a recent fire drill
• Good system in place for checking Controlled drugs
• Green stickers for antibiotics not being used.
• Whilst HCA very clear about SAFA escalation process, not all staff are clear.
• A flow chart clearly visible to all staff regarding the SAFA escalation process and telephone number to call would be useful.
St Peters Ward Internal Quality Assurance Visit
• This process – it is very thorough and constructive
• The Ward has a positive atmosphere • Staff were friendly and knew patients
well and were interacting in a professional and friendly manner
• Patients were all very pleased with their care, enjoyed the food and were very complimentary about the ward and the staff.
• The Sister in charge is well respected by staff and patients. She shows positive leadership
• Three beds had been opened in the Day Room to alleviate pressure at Watford General.
• System flow is impeded by lack of notes, prescriptions and other details arriving with patients from the acute Trust. Some concerns were raised regarding the unacceptable condition in which some patients are received from the Acute Trusts.
• The long awaited SystmOne is expected to be rolled out in March.
• Delays in discharges are frustrating, there are sometimes personal difficulties and increasingly the CCG question the referral and recommendations from the ward which results in delays and duplication.
• Staff were unclear on the escalation process or name the Speak Up Champion
Listening Event at Sandridge Gate
• Very pleasant working environment • Example of well-established multi-
disciplinary team co-location • Staff appeared to be engaged and
• Admin hub had been recently been introduced and staff reported that there had been implementation problems. Head of Communications was in attendance and as he had previous involvement, he was able to sit with staff to
• Admin hub – various implementation problems being addressed by Locality Manager
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Service Examples of Good Practice Main Themes ( Opportunities / Challenges) Recommended Actions
motivated • Evidence of visible and engaged
leadership • One member of the therapy team
ran a 20 min relaxation session for staff in her own time/during lunch period once a week to support staff health and wellbeing
capture concerns. • Request that System One trainer remain at Sandridge for a longer period to resolve teething problems and discrepancies
• Hardship difficulty allegedly due to Trust delay in request for travel expenses
• Access to car park for those with staff with mobility difficulties
Herts & Essex Hospital Oxford and Cambridge Wards
• First impressions were very good with welcoming staff and a calm environment.
• Ward was clean, uncluttered and appropriate safeguards were in place
• Ward is prepared to support the winter pressure capacity when required.
• Worked well to reduce Delayed transfers of Care (DToC) which are significantly reduced.
• New Ward Manager has made a significant impact on recruitment and cultural change.
• Staff are new but developing well into an effective team, demonstrating good team working.
• HCA on apprenticeship scheme, good advocate for the scheme.
• Activity lead is fully engaged, innovative and committed to
• Transfers of care have been delayed due to care provider capacity.
• Staff could benefit from updates in respect of the newer whistleblowing guidance and role of the Freedom to Speak up Guardian.
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Service Examples of Good Practice Main Themes ( Opportunities / Challenges) Recommended Actions
improving the activities and entertainment for patients.
Herts & Essex Hospital - ICT
• The team leader is inspirational. She has developed and promoted integration of her team with CCG GPs, Age UK and the other emergency services.
• Online handbook/tool being developed to support team, partners and public in promoting self-management
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Appendix 2: Quality Assurance Visit Action Plan – Danesbury Neurological Unit
Action Plan
Area visited Danesbury Date of visit 20.10.2017
Issue Action Required Assigned Person
Timeframe for Completion
Completion progress
NEWS triggers to be escalated and acted upon as per policy
• Audits to be increased to weekly (currently fortnightly)
• Band 6 staff to spot check when on shift • Highlight in staff meeting minutes
Rachael Ellis Band 6 nursing staff
February 2018 Not yet consistent. NEWS scores now being checked daily by Ward Manager and B6 Sisters
ENHT medication charts to be archived once HCT meds chart written
• Ward clerk to check end of bed folders day after admission to check and remove any ENHT paperwork following transfer to HCT prescription chart
• Highlight in staff meeting minutes
Ward Clerk- TL Rachael Ellis
From 06.11.17 Complete Dec 2017 Complete Dec 2017
Embedded in ward routine Noted in minutes 03.11.17
Patient experience boards to be kept up to date – (this was concerning the infection control audit results)
• Infection control champion who completes audits to fill out white board
• Nurse in charge to complete staffing board
Infection control link champions -AH and SA Nurse in charge
From 06.11.17 Complete Dec 2017 Complete Dec 2017
Now embedded in ward routine Note minutes circulated 6.11.2017
Sharps bin to be removed from clean utility
• Completed • Highlight in staff meeting minutes
Rachael Ellis Completed 06.11.17
As above
Comfort round documentation to have date clearly documented
• Weekly spot checks until embedded • Highlight in staff meeting minutes
Rachael Ellis Complete Dec 2017
Now being consistently recorded
VTE to be marked as completed on medication chart
• Doctor to mark on drug chart when VTE completed
• Audit new patients until compliance • Highlight in staff meeting minutes
Dr O’Flynn Rachael Ellis
February 2018 Being recorded consistently on admission to the ward, but not for 24 hour review. Ward Manager continuing to work on this.
43
Appendix 3: Internal Peer Review Results Q3
44
Appendix 4: Safeguarding Children Dashboard Q3
45
Appendix 5: Safeguarding Adult Dashboard Q3
Board: 29th March 2018 Attachment K2
1
Healthcare Governance Committee Monday 22 January 2018 11.00 – 1.00
Boardroom, Howard Court
Key Points for the Board and Audit Committee to note: RED
• None AMBER/RED
• Nascot lawn Update • Watford ICT update • End of Life progress report • Risk management Strategy Public Summary • Safe Staffing in ICTs • Patient Safety & Experience Group Assurance Report
AMBER/GREEN
• Whistleblowing and Raising Concerns Policy • Complaints Report Q3 • Serious Incident report Q3 • Safe Staffing in Community Hospitals • Infection control and prevention Forum Assurance Report • Clinical Effectiveness Assurance Report
GREEN
• Simpson Ward Update • Mortality and Morbidity Standard Operating Procedure (SOP) • Mortality and Morbidity Q3 Report
1. Present & Apologies Present:
Anne McPherson Tricia Wren Tracey Westley Andy Nuckcheddee Linda Sheridan Dr John Omany Marion Dunstone Alan Russell
AMc PW TW AN LS JO MD AR
Non-Executive Director (Chair) Acting Director of Nursing & Quality Assistant Director Risk & Quality Assurance Interim Deputy Director of Quality & Governance Non-Executive Director Medical Director Director of Operations Non-Executive Director
In Attendance:
Declan O’Farrell Jane Lawson Rowena Sebastian
DOF JL RS
Trust Chair Deputy General Manager PA to Acting Director of Nursing & Quality and Medical Director (minutes)
Apologies: David Law Debbie Eyitayo Clare Hawkins Marina Sweatman Jeff Philips
DL DE CH MS JP
Chief Executive Interim Director of HR & OD Acting CEO, Director of Quality &Chief Nurse Board Support Officer Non-Executive Director
Board: 29th March 2018 Attachment K2
2
Item Action Date 1a Introduction and Apologies The chair opened the meeting and observers were welcomed.
Apologies were noted.
2. Declaration of Interests No declarations or conflicts of interest were recorded.
3. Previous Minutes and Tracker Progress
The minutes of meeting on 21st November 2017 were received and accepted as correct. Tracker The completed (blue) and in progress actions (green) were
acknowledged. All other actions have been completed. Confidential note - Part II minute: The committee had received an update to the confidential part II.
4. Assurance 4.1 Nascot Lawn Update It was noted that:
(i) A Nascot Lawn Task & Finish Working Group has been put in place,
to ensure safe and effective transfer of children until closure. This will be chaired by AM, deputy chair will be PW. The group is meeting fortnightly and includes, the Medical Director, Director of Operations, Head of Children’s Services, key safeguarding staff and the lead for Nascot Lawn. Terms of reference for the T&F Working Group have been agreed and initial meetings have taken place.
(ii) A strategic group is in place, working with HCT and commissioners
on the transfer of CYP to the new providers. A detailed list of approx. 50 children to be transferred has been created. Provider units have been identified, but capacity is limited.
(iii) A quality framework is in place to ensure safe transfer of children.
This is supported by a HCT clinical group meeting weekly to ensure the unit is safely staffed and managed until closure. Additional pharmacy support is currently being sourced to support the nurses in management of complex medication.
Challenge, Observations & Questions a) It was recognised that there will be a financial obligation from
commissioners to maintain the service going forward. Contingencies measures will be identified, should there be a delay in the transfer of care.
b) Generic training has been carried out in all the units, but bespoke
training can only be delivered when the child is in the unit. This
Board: 29th March 2018 Attachment K2
3
Item Action Date concern has been raised and will be discussed at the HCT/ Commissioners meetings. Delayed transfer may incur additional cost pressures. Some HCT staff have raised concern about the competency of new provider staff. This has been raised as concern with commissioners but support will be put in place if required.
c) HCT need to be prepared for the outcome of the pending judicial
review and be clear about our approach, whatever the outcome. It was recognised that there was tension between the financial
obligations and maintaining the service going forward, this has been raised with the CCG.
d) CQC have been advised of the impending difficulties.
e) HGC are confident that HCT has put in place a robust approach for
the transfer of care and engagement with families. Decisions and Actions 1. Robust Approach put into place to ensure safe and effective transfer
of children. Parents to be kept informed. 2. Task and Finish group to provide update reports to all concerned. 3. Nascot Lawn to remain on the agenda until the result of the judicial
review is known. Risk Rating: Amber/Red
MD PW MS
To note To note To note
4.2 Simpson Ward Action Plan TW The Simpson Ward action Plan update was received and discussed.
It was noted that: (i) There was a minor typo under 2.3 CQC Simpson ward action plan
paper4.2-2.3 should read “and” and not “nad” (ii) WHHT have confirmed that the ward now belongs to HCT. The
operational team were commended for the way they have made dramatic improvements.
(iii) The CQL monitors the unit on a weekly basis and reported
positively on a patient resuscitation carried out in the unit, which was well managed by all staff involved.
(iv) A leadership programme is in place to support development of the
ward manager. The leads have been trained in their appropriate areas
Challenge, Observations & Questions a) The staff toilet still needs repair and HCT are unable to undertake
the work and charge WHHT. Finance team is chasing payment for the work to be completed. Signs will be put up to explain that the ward is under HCT care. Issues with electrical wiring have been
Board: 29th March 2018 Attachment K2
4
Item Action Date resolved, but there are some outstanding IT issues.
b) HGC agreed if paper records are being maintained correctly this is
acceptable until the IT issues have been resolved. Staff Wi-Fi – The Workspace on wheels programme is being rolled out next week. Staff will have Wi-Fi, once this is in place. Patient access to Wi-Fi is still to be resolved.
Decisions and Actions 1. The Simpson Ward action plan update was noted. TW to follow up
on maintenance issues and report back. Contact to be maintained. 2. AR requested a KIT visit to Watford with a ‘randomly’ chosen nurse. 3. TW to investigate and update on the IT situation Risk Rating: Amber/Green
TW TW
Mar 18 To note
4.3 Watford ICT update JL The Watford ICT update was received and discussed.
JL gave an update on the continuing staffing issues at Watford. It was noted that: (i) Work is taking place to improve staff turnover and maintain staff
already in place. Issues are due to the location of the service and its proximity to WHHT and other areas which offer a higher financial reward for staff. There will be an increasing number of band 4 staff to free up Band 5 staff.
(ii) The team are reviewing the level of induction support received by
new staff. Quality leads are looking at how to support staff to manage caseloads and increase capacity. A specialist clinical network is to be put in place to ensure senior (band 6) support. This will lessen the strain on the senior staff to support new staff.
(iii) Identifying what specialist skills are required, using Watford as a
blueprint, due to the current challenges faced in this area. All qualified staff have been mapped to see who is lacking they are competent sign off.
(iv) Key lead members of staff have been asked to free up a period of
time to look at the key areas of concern to enable us to come up with a tailored programme to enable us to direct the staff in the direction that they want to go.
(v) Create bespoke training for staff to gain some of the clinical skills (vi) The nurse retention programme has been looking at buddying
systems, using senior buddies, both external and internal. (vii) Plans are also being made to put career coaching in place, which
Board: 29th March 2018 Attachment K2
5
Item Action Date will be launched in Watford. Regular meetings will take place with the member of staff as they join, to find out what their future plans are, which area they want to specialise in, etc to provide support and encouragement. This will not be carried out using the appraisal structure already in place, as a mentor, rather than a line manager will be carrying out these meeting.
Challenge, Observations & Questions a) Appraisals should be the vehicle to enable staff to move forward in
their careers, so will need to be treated separately from mentoring. b) There is a focus on using paramedics in a different ways, when
recruiting. c) There will be regular 3-monthly meetings to take place once staff
are in place.
d) Only 9% of staff left Watford for a better financial package. Decisions and Actions 1. Watford ICT update was noted 2. NEDs to join the staff for visits. JL to check with staff on how they
want to the visits facilitated 3. AM to attend a team meeting during the next month to help prepare
staff for CQC inspection. Risk Rating: Red/Amber
4.4 Whistleblowing and Raising Concerns Policy PW Whistleblowing and Raising Concerns Policy update was received and
discussed. It was noted that: (i) AMc and TW added more detail to the policy to reflect the role of the
guardian. DE is working on the promotion of this. (ii) AMc stated that a NED would be supporting the guardian. FTSU
ambassadors will be identified from across HCT services. Managers will be trained to differentiate a freedom to speak up issue from a daily issue.
Challenge, Observations & Questions a) AMc queried if people were actually using this system to raise
concerns. How are they being supported when they do? b) Can management differentiate between a daily issue and freedom
to speak up issues? Do members of staff actually know what this is and who to go to if they need to raise a concern?
c) Deputy FTSU guardian to be identified, preferably a NED to
Board: 29th March 2018 Attachment K2
6
Item Action Date maintain a degree of impartiality
d) There is another route for Doctors to take for concerns, but they can
also use this route. Decisions and Actions 1. Update on FTSU to be added to the Board report. 2. JL to put a brief synopsis onto team agendas to aid the promotion. 3. Agreed to source more ambassadors in the field. Identify a deputy
in post, so there is always someone available during times of annual leave, etc.
4. Anonymous issues will also be investigated, although there is no
individual to give updates to, the outcomes will be logged. It was decided to keep the monitoring process as it is.
Risk Rating: Amber/Green
PW PW
Jan 18 To note
4.5 End of Life Care Progress Report update MD/ JL End of Life Care Progress Report update was received and discussed
It was noted that: (i) All of the audits are in place or underway. The syringe driver re-
audits are due for completion this week. Opioid audit is due for completion this week. Local audits are awaiting collation and will be ready in time for CQC inspection. The monthly audit review has been amended and any issues to go to the LMs.
(ii) Peer review internal dip test is under review. The findings of this
will be shared and acted upon if improvement is needed. (iii) SPC leads are working on how to support the cultural shift. The
recording of practice is proving a challenge. Localities are being given additional support where there are gaps. There will be diverted resource for those who want extra shifts.
(iv) Data dashboard is now functioning. Available in all the localities to
understand the data and look at the variance to work through. The place of death/ place of care must be recorded. JL to review the dashboard at next operational group. Focussing on headlines and simplifying the information.
Challenge, Observations & Questions a) Do we have enough SPC support? How do we use our SPC team?
How do we support our SPC nurses? b) There is a shortage of SPC nurses and they are difficult to recruit. c) Some Trusts have reduced the number of patients to be seen by
Board: 29th March 2018 Attachment K2
7
Item Action Date specialists and train other staff to see these patients. Need to ask the question “Would this patient benefit from palliative care?”, rather than put them into a specific category. Identified extra resource from the Macmillan education team and ensure that each bed-base unit has a visit.
d) Need to ensure that the SPC nurses are prepared for CQC
inspection. e) Once audits are completed, risk to be lowered to Amber/Green Decisions and Actions 1. End of Life Care Progress Report update was approved. Watford
ICT downgraded from red to amber. 2. Peer Review to focus on 5 things that need to be completed 3. Need to ensure evidence is clearly labelled as to exactly what is
being audited. Audit results to be presented to next HGC 4. If someone is in their last year of life, need to make this clear so that
suitable care can be administered, rather than avoiding the classification.
Risk Rating: Amber/Red
JL JL JL
To note March 18 To note
4.6 Risk Management Strategy Public Summary The Risk Management Strategy Public Summary was received and
discussed It was noted that: (i) The formal review will be on the SRC agenda. There is a need to
produce something to explain that this is an ongoing strategy (ii) Need to reference that we work with the wider organisations Challenge, Observations & Questions a) The benefits are not made clear in the strategy b) The chart is clear, but the summary may need more attention c) AM thanked TW for producing the document Decisions and Actions 1. Recommended this is presented to the Board for further discussion
and agreement. Risk Rating: Amber/Red
TW
Jan 18
4.7 Quality Report Contributory Documents AN
Board: 29th March 2018 Attachment K2
8
Item Action Date 4.7i Complaints Q3 The Complaints Q3 report was received and discussed. There were 37
complaints in total. It was noted that: (i) There has been a positive contribution from PALS where they have
been discussed at formal stage. Information around the enhanced PALs contact has been produced in the report. Complaints were continuing to reduce in numbers. Three complaints were re-opened in quarter 3
(ii) 82% of complaints were responded to within the agreed time frames
and within target. There had been a recent drop in response rate from business services, due to winter pressures.
(iii) To have a summary version of complaints, in future, unless
committee would like an added appendix with the full details. Report to go to Board.
(iv) 3,239 compliments received in Q3. Challenge, Observations & Questions a) No challenges, observations or questions were received. Decisions and Actions 1. Complaints Q3 report was noted 2. Condolences must be included to any deceased patients’ families. Risk Rating: Amber/Green
AP
To note
4.7ii Serious Incident Q3 PW The Serious Incident Q3 was received and discussed.
It was noted that: (i) 7 serious incidents were reported during this quarter including; 3
pressure ulcers, 1 sub-optimal care, 1 IG incident and 3 Safeguarding concerns (Report to be submitted)
(ii) 3 Pressure Ulcer issues occurred in Watford ICT and this is being
managed via the focused work on the team led by the DGM. Challenge, Observations & Questions a) There are good escalation processes in place. Decisions and Actions 1. Serious Incident Q3 update was noted
Board: 29th March 2018 Attachment K2
9
Item Action Date 2. AM to see the last 10 completed SIs to aid with the audit for CQC
and governance Risk Rating: Amber/Green
PW
4.7iii Safe Staffing in Summary PW
The Safe Staffing Community Hospitals Q3 was received and discussed. It was noted that: (i) All wards are meeting national safe staffing requirements apart from
Herts & Essex hospital in October where average staffing fell to 78.8%. Risks were mitigated by additional HCA support and the ward manager offering support.
(ii) All community hospitals wards continue to provide care for a high number of patients with complex needs.
(iii) Vacancy levels were above the Trust’s target of 10% on all bed
based units in Q3 mitigated by high use of bank and agency staff. (iv) Vacancy rates reduced at Herts and Essex following targeted work
to recruit additional staff and retain existing staff as part of the Nurse Retention programme.
(v) PW stated that the monthly deep dive of wards creates a lot of
additional work for staff and questioned the viability of continuing this approach as other measures are now in place to identify red flags on wards which instigate internal investigation,
Challenge, Observations & Questions a) It was noted that St Peters ward continued to use a high number of
bank and agency staff. b) Monthly deep dives are time consuming and not adding value. c) Staff sickness at H&E was high due to flu outbreak. 6 of the 8 staff
currently off sick received the flu vaccination. Need to check if flu vaccination is still available to unvaccinated staff, despite reaching the target?
Decisions and Actions 1. Safe Staffing Community Hospitals report Q3 was noted 2. It was agreed to stop the deep dives as a routine. Specific concerns
will be investigated and deep dives carried out where themes and trends emerge. Any serious staffing issues to be escalated immediately as per escalation policy.
3. DO’F requested an example of how the escalation process worked.
PW will ensure an example is presented to next HGC.
PW PW
To note Mar 18
Board: 29th March 2018 Attachment K2
10
Item Action Date 4. Medical staffing report and issues concerning Doctor vacancies to
be brought to HGC. Risk Rating: Amber/Green
JO
To note
4.7iv Interim Staffing update Report for ICTs PW The Staffing update report for ICTs for Q3 was received and discussed.
It was noted that: (i) The report covered October and November only as December data
for Q3 was not available at the time of reporting.
(ii) Vacancy levels remain above HCT target of 9%. Active recruitment continues. Bank and agency staff remains high to fill vacant posts.
(iii) Watford and Welwyn and Hatfield were noted as ‘hot spots’ Challenge, Observations & Questions a) Focused support and deep dives are being undertaken in Watford
and Welhat ICT supported by the DGM b) Active recruitment continues across all ICTs supported by a variety
of advertising and promotion campaigns. c) The Trust continues to take part in the National Nurse Retention
programme. A workshop for nurses is taking place in February to identify key measures that will improve the nurses’ working day.
Decisions and Actions 1. Staffing update report for ICTs was noted. Risk Rating: Amber/Red
4.8 High Level Risk Register TW
High Level Risk Register as at 14th November 2017 was received and discussed. It was noted that: (i) There are 7 risks currently on the register, 2 risks regarding staffing
in the Specialist Palliative Care service and Integrated Community Teams in E&N Herts have been escalated.
(ii) 2 existing risks have been de-escalated (512, 576) Risk 576* closed (iii) A new risk regarding the overall procurement process and the
financial implications for potential loss of Adult Services in Herts Valleys has been added.
(iv) 4 high-level risks have not changed risk score and the
Board: 29th March 2018 Attachment K2
11
Item Action Date decommissioning of MSK risk has been closed
Challenge, Observations & Questions a) Need to agree the top 3 risks as an organisation. b) Retendering of CUS is not included on the risk register. Need to add
and outline the risks related to patient safety and delivery of quality care.
Decisions and Actions 1. The High Level Risk Register was noted 2. Health Visitor and school nursing procurement to be returned to the
high level RR and BAF. Patient-focussed elements of safety and quality to be included in the risks.
Risk Rating: Not Applicable
MD
Jan 18
5.0 Patient Safety & Experience 5.1 Patient Safety & Experience Group Assurance Report and Minutes PW
The Patient Safety & Experience Group Chair’s Assurance Report and the minutes for the meeting held on 14th December 2017 were received. It was noted that: (i) The group felt that all topics were covered and investigated
appropriately in meetings. The committee is working well and challenging relevant patient safety concerns. Critical analysis of gaps and deep dives continue as required to capture data.
(ii) Insulin incidents reviewed in detail, process issues i.e. allocation on
S1 and scheduling are causing concern and resulting in missed visits. No serious patient harm, but delay in insulin administration.
(iii) A working group has been formed to help resolve the process issue.
Work is being carried out to improve the functionality of S1 and the allocation of work. The HCA insulin administration is working well and no incidents have occurred in this service.
Challenge, Observations & Questions a) Missed insulin administration visits were the main issue, higher than
they should be and plans in place to address concerns. b) The process of allocation and scheduling to individual clinicians
must be improved to avoid any further incidents of missed visits. Decisions and Actions 1. The Patient Safety & Experience Group Chair’s Assurance Report
Board: 29th March 2018 Attachment K2
12
Item Action Date and the minutes for the meeting held on 14th December 2017 were noted.
Risk Rating: Amber/Red
5.2 Infection Control Forum Chair’s Assurance report and minutes from 16th November 2017
PW
The Infection Control Forum Chair’s Assurance report and minutes from 16th November 2017 were received and discussed It was noted that: (i) Assurance that all IPC measures have now been put in place on
Simpson Ward except for the toilet (flooring). This has been escalated to Estates and discussions are taking place with WHHT as owners of the unit to carry out repairs.
Challenge, Observations & Questions a) The previous issue with sharps boxes not been used correctly has
improved. Decisions and Actions 1. Infection Control Forum Chair’s Assurance report and minutes from
16th November 2017 were noted. Risk Rating: Green
6.0 Clinical Effectiveness 6.1 Mortality and Morbidity Standard Operating Procedure JO The Mortality and Morbidity Standard Operating Procedure was received
and discussed Decisions and Actions 1. The Mortality and Morbidity (interim) SOP was accepted. This has
been aligned with the policy now in place. 2. Trusts around the country are working together to create a
community SOP. Risk Rating: Green
6.2 Mortality and Morbidity Q3 JO
Mortality and Morbidity Q3 report was received and discussed. It was noted that: (i) It was reported that there were 10 deaths – 9 were expected. There
was no evidence of any lapses in quality. (ii) Full report to be presented to the next Trust Board meeting.
Board: 29th March 2018 Attachment K2
13
Item Action Date Decisions and Actions 1. The Mortality and Morbidity Q3 was reviewed and approved. Risk Rating: Green
6.3 Clinical Effectiveness Group Chair’s Assurance Report and Minutes from the Meeting held on 7th December 2017.
JO
The Clinical Effectiveness Group Chair’s Assurance Report and Minutes from the Meeting held on 7th December 2017 were received. Challenge, Observations & Questions a) Some of the policies were out of date and may no longer be
relevant. Working on reviewing policies to identify those that need updating or removal.
Decisions and Actions 1. Clinical Effectiveness Group Chair’s Assurance Report and Minutes
from the Meeting were noted 2. To review policies and identify amendments that need to be made Risk Rating: Amber/Green
TW
Mar 18
7. Key Items for Noting 8. Date of Next Meeting(s)
20 March 2018 2.00 – 5.00 Boardroom, Howard Court
HCT INTEGRATED BOARD PERFORMANCE
REPORT February 2018
1
HCT IBPR February 2018 Final
Board 29th March 2018 K3
Section
1 Trust Scorecard
2 Key Messages
3 Quality KPIs
4 Performance KPIs Inc. National & Local indicators
5 Learning & Development KPIs
6 Workforce & Finance KPIs
Appendix 1. Safe Staffing Report
2
3
Indicator
2017/18
Target /
Threshold
Current period
performance
Current
Period
RAG
YTD RAG
Trend from
previous
month
Trend over time
HCT
Benchmarking
Rank
Trusts
Participating
Quality
% of patients receiving harm free care (New Harms only) Compliant �
G G �
C.difficile cases occurring post 3 days following admission into HCT bed based facilities (i.e.
acquired in our facility)
Friends and Family test 90%
Full Year 6
monthly
trajectory
0 - Feb
�G
97.0% G G
Number of complaints received in month
1 R
6 14
For information 12 � 12
98% 6
�
Community Hospitals - Average length of stay in HCT community hospital - Non Stroke (Rehab
Pathway)19 days 21.8
No of avoidable category 2 pressure ulcers acquired in HCT care
30% reduction
on baseline from
2016/2017
2 R G
34.6 �
�
G G
Perform
ance
Community Hospitals - Average length of stay in HCT community hospital - ALL Stroke (Rehab
Pathway)42 Days
R R
Community Hospitals - % of NHS (health) bed days lost due to delayed transfers of care
5%
for health delays
4% by Mar 18
Total 17.7%
(Health 12.8%
HCS 4.9%
Both 0.0)
R R �
�All data entered on S1 within 24 hours of contact >=90% 91.1% G G
G �Patient waiting list (including Consultant & Non-consultant led services) 92.0% 95.9% G
% of eligible staff trained at appropriated level of safeguarding children in accordance with IC
document Level 1, Level 2, Level 395%
9
L & D
% staff who have undertaken mandatory training 90.0% 92.6% G G �
% of staff who have undertaken level 1 / 2 safeguarding adults training every 3 years 90% 97.6%
97.0% G G �% of all clinical and medical relevant staff (all clinical staff including staff in supervisory roles
requiring a clinical registration) will undertake
Level 2 safeguarding adults
90% 96.7% G G �
�
% of staff completing Information Governance training (Rolling Year) 95% 92.6% A A
Workforce &
Finance
% of staff who have received an appraisal in the last 12 months 90% 90.3%
�
G G �
% posts vacant
(vacant WTE/budgeted WTE).10% 11.6% A A
12% 14.6% A
�
�
A �
Absence Rate 3.6% 3.93% A A
Underlying Staff turnover (Voluntary resignations excluding retirements, redundancy and the end of
FTCs)
7
11
16
(Overall Turnover)
4
18
17
18
16
15
17
(Overall
Turnover)
17
TRUST SCORECARD 17/18
G G
Scorecard Key Messages Quality KPIsPerformance
KPIsL&D KPIs
Workforce & Finance KPIs
Appendices
February 2018 Key Messages
Performance highlights
• 97.0% of patients receiving harm free care (new harms).
• Stroke LOS within rehab pathway thresholds.
• Looked after children initial health and review assessments above target.
• 1 and 2.5 year children's health reviews on target.
• 95.8% of patients waiting within 18 weeks for their initial appointment.
• Trust achieving over 90% for data entry within 24 hours.
• Childrens safeguarding training levels above target.
• Staff Mandatory training figures above target with 92.6% in February
• HCT achieving staff appraisal compliance with 90.3% in February
Areas for Board review
• One C.Diff cases acquired in HCT care reported in February.
• DTOC rate above the 5% threshold with 12.8% health delays recorded in February.
• HCT above the 19 day threshold for Non-Stroke Rehab LOS with 21 days recorded in February.
• Health Visiting movement in target of 98% not achieved in February.
• HCT above national target for health visiting caseloads.
• Underlying Staff turnover over threshold with14.6% recorded in February.
• Absence rate reduced to 3.93% in February and just over threshold.
Scorecard Key Messages Quality KPIsPerformance
KPIsL&D KPIs
Workforce & Finance KPIs
Appendices
4
5
Ref Indicator
Quality - Clinical Governance
Q22 Number of inpatient falls resulting in moderate or more severe harm (Quarterly) For information
Q20 Percentage of inpatient deaths compared to all discharges (Quarterly) For information
Q18 No of avoidable category 2 pressure ulcers acquired in HCT care
30% reduction on
baseline from
2016/17
2 R G
Q21 Number of inpatient falls by 1000 OBD (Quarterly) For information
Q19 No of avoidable category 3 or 4 pressure ulcers acquired in HCT care 0 2 R R �
�
G G
2017/18
Target /
Threshold
Current
period
performance
Current
Period
RAG
YTD RAG
Trend
from
previous
month
Trend over time
�Q1 % of patients receiving harm free care (New Harms only) Compliant 97.0%
�
�
�10
Q8
GG
Q13 Number of patient-related incidents reported in month For information 435
Q12 The number of SI's that remain open to HCT For information
Reduction in the prevalence of CAUTI, based on safety thermometer data 1% 0.83% G G
100% G
�
Q10The percentage of SIs that have 60-day RCA and action plans completed and
submitted to commissioner within 60 days. Reported monthly
Monthly
90% �G
Q9The number of Serious Incidents reported in month to the Commissioner against the
SI policyFor information 0
Q6 % of relevant patients screened for MRSA (excluding respite patients).Monthly
95% �100.0% G G
�
�
Q4 C.diff cases rates per 1000 occupied bed days For information 0.19
Q5 Compliance with Hand hygiene in all Community Hospitals will be > 95% 95% 98.0% G G
1 R
�
Q3C.difficile cases occurring post 3 days following admission into HCT bed based
facilities (i.e. acquired in our facility)
Full Year 6
Monthly trajectory
0 - Feb
Q2 Number of Avoidable MRSA bacteraemia cases in year for HCT 0 0
�G
Q7 No of E. coli blood stream infection cases in year for HCT’ For information 0 �
Scorecard Key Messages Quality KPIsPerformance
KPIsL&D KPIs
Workforce & Finance KPIs
Appendices
6
Ref Indicator
2017/18
Target /
Threshold
Current
period
performance
Current
Period
RAG
YTD RAG
Trend
from
previous
month
Trend over time
EMSA breaches reported in month 0 0 G G
�
�98% G
�
Q28 Number of PALS enquiries (for HCT services) reported monthly For information �
Q29 Number of compliments received Quarterly (Quarterly) For information
Q30
76
G
Quality - Patient Experience
Q25 Friends and Family test >95%
G �
Q26 Number of complaints received in month For information �
Q27 Proportion of complaints resolved within timescale agreed with complainant 80%
Monthly92% G
12
Q24 Number of clinical negligence claims closed in the quarter (Quarterly) For information
Q23 Number of clinical negligence claims received in quarter (Quarterly)6
(Q3) C.difficile cases (CDI) occurring post 3 days following admission into HCT bed based facilities (i.e. acquired in our facility)
There was one CDI case notified in February 2018 (St Peters Ward). Case 9 – Patient admitted to St Peters Ward from Watford Hospital in January 2018.
Toxin positive sample collected in February 2018 and Root cause analysis is being undertaken for action and learning.
The total number of cases since April 2017 is 9. Cases 1, 2, 3 and 4 were successfully appealed at the CCG, which means the Trust remains within the
monthly trajectory and annual ceiling. Cases 5 & 6 are with the CCG appeals panel, awaiting outcome. Case 8 is to be appealed and case 7 and 9 are
undergoing Root cause analysis.
(Q18, Q19) No of avoidable category 2, 3 or 4 pressure ulcers acquired in HCT care
There are 4 avoidable Pressure Ulcers to report for February 2018. Two category 2 and two unclassified category 3. Two patients live in residential care
homes, one was receiving home care and one was receiving clinical care from multiple providers. Two occurred in the care of the Upper Lea Valley ICT
and a serious incident has been reported for one of these and an investigation is underway.
Scorecard Key Messages Quality KPIsPerformance
KPIsL&D KPIs
Workforce & Finance KPIs
Appendices
7
8
Ref Indicator
2017/18
Target /
Threshold
Current
period
performance
Current
Period
RAG
YTD RAG
Trend from
previous
month
Trend over time
Perform
ance - Community Hospitals
R �
�
P13Percentage of patients discharged on, or before, the Estimated Date of Discharge set
upon admission90% 53% R
100% G G
R �
P12Patients admitted to a bed based unit who have an Estimated Date of Discharge set
and recorded within 3 days of admission95%
P11Community Hospitals - Average length of stay in HCT community hospital - Non Stroke
(Rehab Pathway ONLY)19 days 21.8 R
31.3
Percentage and number of patients who have a planned discharge, by bed based unit
before midday>40% 48% G
R
G �
P10 Community Hospitals - Average length of stay in HCT community hospital - Non Stroke 21 days �R
P9Community Hospitals - Average length of stay in HCT community hospital - Stroke
(Rehab Pathway ONLY)42 days 27.0 G
34.6 G
Total 17.7%
(Health 12.8%
HCS 4.9%
Both 0.0%)
A �
P8 Community Hospitals - Average length of stay in HCT community hospital - ALL Stroke 42 days �G
P7 Community Hospitals - average occupancy 82%-88% 91.3% A
RP6Community Hospitals - % of NHS (health) bed days lost due to delayed transfers of
care
5%
for health
delays
4% by Mar 18
�
GP4Percentage of patients who have a planned discharge, by bed based unit at the
weekend - % discharged>50%
P2 % of patients who have had a VTE assessment when admitted to Community Hospital 100% 100% G G
P3 Community Hospitals - Readmission rates within 30 days <0.5% 0.00% G
G GP1Notification to the GP practice 24 hrs. before community hospital discharge of
vulnerable or Elderly patient96% 100%
�
�
G �
G67% �
P5 G �
R
Scorecard Key Messages Quality KPIsPerformance
KPIsL&D KPIs
Workforce & Finance KPIs
Appendices
9
Ref Indicator
2017/18
Target /
Threshold
Current
period
performance
Current
Period
RAG
YTD RAG
Trend from
previous
month
Trend over time
Perform
ance - Child Health
P25% of children in reception year who have received vision and audiology screening
(subject to school participation)90%
P26 HPV - % of eligible children immunised
Year 8
80% dose 1
Year 9
80% dose 2
Commence Q4
9.8%
90%
T40%50.9% G
99.1% G G
G �
P21 % of 2.5 year health review undertaken as a proportion of total cohort VALIDATED 90% �
P22% of 1 year health review undertaken as a proportion of total cohort BEFORE
VALIDATION
For
Information89.7%
98.5% G G
�
P20% of 2.5 year health review undertaken as a proportion of total cohort BEFORE
VALIDATION
For
Information84.7%
95.2% R G
�
G
94.3%
G �
P19Health Visiting - % of families with Children under 1 who transfer into area from other
counties receive an offer giving them contact with a member of the HV service within 5
days of notification.
98% �
P23 % of 1 year health review undertaken as a proportion of total cohort VALIDATED 90% �
P24School Nursing - % of children who have had height and weight monitored in reception
and year 6
90%
P14 % Completed medical CLA Initial Health Assessments within 10 day timescale 90%
P17Health Visiting - % of babies who have had a face to face contact with health visitor
within 14 days of birth - BEFORE VALIDATION
For
Information �
P18Health Visiting - % of babies who have had a face to face contact with health visitor
within 14 days of birth - VALIDATED 95% 99.2%
P16Health Visiting - average caseload size
Actual WTE caseload ratio<=400 412 A A
100% G
�96% G G
�
G �
P15% Completed statutory review health assessments within 4 weeks (Paeds, CUS and
CLA)
Scorecard Key Messages Quality KPIsPerformance
KPIsL&D KPIs
Workforce & Finance KPIs
Appendices
10
Ref Indicator
2017/18
Target /
Threshold
Current
period
performance
Current
Period
RAG
YTD RAG
Trend from
previous
month
Trend over time
P43 All data entered on S1 within 24 hours of contact >=90% 91.1% G G �
G �
P31All patients who smoke to be given brief intervention advice which includes second
hand smoking advice
90% by end of
year
P30 All patients to have smoking status recorded on SystmOne 90.0% 94.6% G
R �
�
P32 All patients who smoke to be offered support to quit smoking
400 patients to
be referred to
HSSS
19 R
64.0% R R
P36Minor Injuries Unit - Herts and Essex hospital - patients to be seen treated and
discharged with 4 hours95% �99.9% G G
�95.9% G GP34 Patient waiting within 18 weeks (including Consultant & Non-consultant led services) 92.0%
�P33 The number of Deprivation of liberty (DOLS) requests during the month For information 10
P44
P45
Perform
ance - other KPIs
EoLC patients have or have been offered, completed and refused an ACP (Quarterly) >=75% �
Patients dying in their preferred place (Quarterly) >=60% �
HCT were over the 5% threshold after recording 12.8% health delays in February. This was an increase of 2.1% health delays and above the target
threshold. The main categories seen within the health delays are delays relating to continuing healthcare assessment, Patient choice delays and self-
funders looking for home care or placements. HCT are continuing to work on these constraints using the red to green work stream. The units with
the biggest delays were Herts and Essex (10.5%) and QVM (12.1%) for East and North and St Peters (24.8%) and Potters Bar (14.3%) for Herts
Valley. These three units combined for 421 bed days out of the 681 days lost in February which equates to 61%.
Actions
HCT have continued to participate in a weekly DTOC call which is led by the Patient Flow Manager and includes social care, Ward manager and/or
Therapy lead, HV and E&NCCG representation This call focuses on all the DTOCs and HCT is currently working on a DTOC Escalation Trigger
process to ensure blocks to the patient’s discharge are actively progressed internally and externally.
All information is included in the Daily Capacity reports on the DTOC tab which outlines the actions needed that day, whether the actions from the
previous days happened and whether any issues have been escalated to the relevant leads. In addition during the ‘winter pressures’ period there have
been internal calls led by Director of Operations and Assistant Director Operations linked to HCTs Surge and Escalation Policy.
HCT are doing a refresh of Red 2 Green across all hospitals, focusing on the actions which came out of the “Flow in Providers of Community Health
services: Good Practice Guidance Nov 17”. HCT are also providing a brief summary of the actions which are agreed by system partners as part of the
twice weekly DTOC calls to HVCCG and HCC.
(P10) Non-Stroke ALOS
HCT were over the ALOS thresholds for Non-stroke patients in February. HCT recorded an ALOS of 31 days for non-stroke patients, which was an
increase of one day on previous month. Eight patients stayed 80 days or more and of these patients, four stayed over 100 days. Of these four patients
one was a Discharge to Assess patients requiring further care. These patients were only able to rehab for 125 days out of the combined 478 total
length of stay days due to health. The overall length of stay improved to 21 days under the rehab pathway.
P13) Estimated discharge date (EDD) achievement
The majority of non-met EDD are linked with delayed transfers of care issues with 53% of patients achieving their estimated discharge date. This is a
drop of 5% from previous month. When patients who did not have a delayed transfer of care are excluded, 81% of patients were discharged on or
before their EDD. This is being escalated to the locality managers of each hospital unit and EDD processes are currently being reviewed.
Scorecard Key Messages Quality KPIsPerformance
KPIsL&D KPIs
Workforce & Finance KPIs
Appendices
11
12
(P16) Health Visiting - Average caseload size
Caseload figures are beginning to rise again and are 412 for February 18 based on WTE of 184.79 including Team Leads and Practice Teachers .
The latest prediction for further shifts in Health Visitor numbers are for 181.89 wte in post end June 2018 (to include leavers & starters), with maternity
leaves increasing from 2.91 to 6.91 wte. The predicted increase in Nursery Nurse numbers to 37.60 wte by October 2018 stands at 29.57wte in post
currently with further recruitment of 8.25wte in progress. There are four new part time Student HV’s in post training over 2 years with remainder of
their post as part time Community Staff Nurses within the teams. KPI performance for 100% offer for 1 and 2 year development reviews continues.
With award of the contract with HCC, the Public Health Nurse service will begin consultation with staff at end of March to work towards new
contracted staff numbers by October 18 and caseload figures will become less relevant for the Health Visiting service as a sign of team capacity.
(P19) Health Visiting - % of families with Children under 1 who transfer into area from other counties receive an offer giving them contact
with a member of the HV service within 5 days of notification.
The transfer target of 98% was missed again in February with HCT achieving 95.2% of an offer of contact with the health visiting service within five
days of notification. Four of 83 families were not contacted on time. All contact has now been made with these families. Processes around
transfers in are being reviewed accordingly with the localities and this has been escalated to the Head of school nursing and Health Visiting for action
(P31, P32) Smoking advice & intervention
HCT are meeting the thresholds for recording smoking status, however referrals to Hertfordshire Stop Smoking Service are still under performing and
this is currently being reviewed and monitored with Herts County Council (HCC) for 17/18
Scorecard Key Messages Quality KPIsPerformance
KPIsL&D KPIs
Workforce & Finance KPIs
Appendices
13
Ref Indicator
2017/18
Target /
Threshold
Current
period
performance
Current
Period
RAG
YTD RAG
Trend from
previous
month
Trend over time
Learning & Development
�
L16 Equality & Diversity Training 90% 94.6% G G �
L15 Conflict resolution training 90% 93.2% G G
L14 % of staff completing Information Governance training (Rolling Year) 95% 92.6%
L13 % of relevant staff who have undertaken PREVENT training 90% 91.4%
L12 % of relevant staff who have undertaken MCA training 95% 97.6%
L2% of eligible staff who have received mandatory fire training in the last
12 months90% 91.2%
L11 Staff undertaken DOLS training in previous 3 years 95% 96.2%
L10% of all clinical and medical relevant staff (all clinical staff including staff
in supervisory roles requiring a clinical registration) will undertake Level
2 safeguarding adults
L8% of staff who have undertaken level 1 /2 safeguarding adults training at
induction95% 96.0% G G
90% 96.7%
L9% of staff who have undertaken level 1 / 2 safeguarding adults training
every 3 years90% 97.6%
L7% of eligible staff who have undertaken safeguarding children
supervision appropriate to their role (Quarterly)95%
L1 % staff who have undertaken mandatory training 90% 92.6%
L3 Patient moving and handling 90% 83.9% A
G
�
�
�
G
�
�
L4 Infection control 90% 90.9% G
L6% of eligible staff trained at appropriated level of safeguarding children
in accordance with IC document Level 1, Level 2, Level 395% 97.0% G G
L5 Basic life support 90% 85.8%
G
A A
G
G
G
G
G
�
�
G G
A A
�
G
�G
�
�
G
�
�
G
G
A
�
Scorecard Key Messages Quality KPIsPerformance
KPIsL&D KPIs
Workforce & Finance KPIs
Appendices
L&D EXCEPTION REPORT (15 KPIs RAG RATED) 0 3 12
ACTION
(L3, L5,) Patient Moving & handling, Basic life support
Of the statutory training only Patient Moving and Handling and basic life are now below target. Moving and handling dropped to 83.9% and Basic life
support increased to 85.8%. Overall mandatory training is now at it’s highest level with 92.6% recorded in February.
(L14) % of staff completing Information Governance training (Rolling Year)
IG training increased to 92.6% for February. Questionnaire currently being reviewed and refresher reminders sent. HCT expect the target to be achieved
Two East & North Business unit under investigation for January and February 2018. One Herts Valley Business Unit reported in December : Systems
Process and staff support issues, actions in place and monitoring impact at operational level
(W7) % Posts Vacant
The Trust’s vacancy rate has decreased to 11.6% in February. In Q3 there were 105 leavers but only 85 new starters.
Implementation of the Trust Resourcing Plan continues with renewed pace following the recent re-organisations.
(W10) Underlying Staff turnover
Staff turnover rates are currently at 14.6% for underlying turnover and 24.42% for total turnover (which includes TUPE Transfers out). Underlying turnover
has been on a slightly downward trend since August, when it stood at 14.77%. Total turnover has increased due to the TUPE transfer of the MSK
service. The focus on nurse retention continues in line with the NHSI Nurse Retention Programme action plan. Two career clinics have taken place for the
Watford area for February, initially focussing on Community Nursing. A Nurse Forum/Workshop is also being run to seek staff feedback on areas for
improvement.
(W12) Absence Rate
In-month sickness absence for February is significantly improved to 3.93% from 4.52% in January.. The winter generally sees an increase in sickness, but
the 12 month rolling absence rate is also above target at 3.88% The Business Units are continuing work to reduce sickness absence rates (as previously
reported) and support staff resilience to embrace the pace of change. In addition, 72% of front line staff have been vaccinated for flu, meeting the CQUIN
The Trust performance against the control total is £2k ahead of plan in month 11, and £43K ahead of plan year to date. As a result of this, the Trust's
single oversight risk rating is maintained at a 1. An adjustment was requested to our retained earnings position in quarter one, relating to the transfer of the
Parkway property to NHS Property Services
(W15) Aged Debtors
Overall debt has reduced by £707k during February 2018 to an overall total of £3,260k. The level of debt over 90 days has increased to £683k with the
proportion of this category to overall debt increasing from 9% to 21%. The increase of the debt is mainly due to the change of the Financial Services and
the Finance Team will focus on resolving all outstanding issues.
(W16) Capital Plans
Capital expenditure is £2045k at the end of month 11 which is £3202 below the Trust's submitted YTD plan for 2017-18. Expenditure to date relates mainly
to schemes which have continued from 2016-17 together with the Hemel Hub and current year's IT equipment replacement programme.
Safe Staffing Community Hospital Dashboard Feb 2018Day Night
19
Safe Staffing Exception Report
Staffing Levels
Average staffing levels on all units were above the NHSE and HCT threshold. The high unregistered fill rate at Danesbury, Holywell and Langley is due to
the requirement for enhanced care for patients. St Peters ward has extra staffing for one patient from Barnet and escalation beds. Simpson Ward has
increased Heath care assistants (HCA) to mitigate the reduction in trained nurses.
Vacancy Rates
All units other than Danesbury had vacancy rates above the Trust target. Nascot Lawn is due to be closed at the end May. The unit is currently providing
a reduced service, but safe staffing was maintained for the number of children who were on the unit. Simpson Ward, Langley House, St Peters and Herts
& Essex Hospital continue to have high vacancy rates and targeted recruitment is continuing. Herts and Essex are recruiting successfully to posts.
Sickness Rates
All units other than Danesbury, Holywell and QVM had sickness absence rates above the Trust target. The Trust absence policy is being enacted to
manage sickness.
Bank & Agency use
High levels of bank and agency staff were needed on to care for patients at high risk of falls and also cover vacant posts and back fill sickness and
absence. St Peters high use of bank and agency was to provide extra HCA support for a patient requiring 2:1 care.
Moderate/Severe falls
One fall resulted in ‘Moderate harm’ at Potters Bar (fractured arm) Patient had all expected falls prevention in place at the time - not declared as a serious
incident. One fall resulted in ‘Severe harm’ at Langley House (fractured neck of femur). Incident reviewed by the Patient Safety team and a falls Root
cause analysis requested.
Healthcare associated infections
One case of Clostridium difficile on St Peters Ward reported February 2018.
Complaints
One multi-agency complaint raised at HEH regarding the care received by a stroke patient throughout their patient journey from Acute to Inpatients to
Community. ENHT are leading on the complaint, with HCT providing answers to specific questions.
Scorecard Key Messages Quality KPIsPerformance
KPIsL&D KPIs
Workforce & Finance KPIs
Appendices
Board 29th March 2018 Attachment K4
FINANCE REPORT TO THE BOARD
Title: Month 11 Finance Report (February2018)
Sponsoring Director: Director of Finance
Author(s): Finance Department
Purpose: The purpose of the report is to provide the Board with HCT’s financial position as at Month 11 – 2017/18.
Action required by the Board:
The Board is asked to note the Trust’s financial position as at 28th February 2018.
Finance Strategy & Resources Report February 2018 (Month 11)
Contents DoF Message Clinical Income Pay Non Pay CIP SOFP SOF Glossary
Contents
Section Title
1 Director of Finance Message
2 Clinical Income
3 Pay Expenditure
4 Non Pay Expenditure
5 Cost Improvement Programme (CIP)
6 Statement of Financial Position
- Cash Flow Statement
- Capital Expenditure
- Aged Receivables
- Better Payments Practice Code (BPPC) Performance
7 Single Oversight Framework (SOF)
8 Glossary
Finance Strategy & Resources Report February 2018 (Month 11)
Contents DoF Message Clinical Income Pay Non Pay CIP SOFP SOF Glossary
1 Director of Finance Message
The Trust performance against the control total is £2K ahead of
plan in month 11 and £43K ahead of plan year to date.
The Trust performance against the control total is £2K ahead of plan in month 11 and £43K ahead of plan year to date. As a result of this, the Trust's single oversight risk rating ismaintained at a 1.
An adjustment was requested to our retained earnings position in quarter one, relating to the transfer of the Parkway property to NHS Property Services. The transfer was reflected as a£1,206K deficit which is adjusted back in the performance against the control total resulting in zero impact to the Trust for the property transfer.
Due to the above the Trust is reporting a year to date deficit position of £368K which is £1,166K behind plan.
Year to date the Trust had a favourable position relating to
Revenue from Patient Care Activities of £1,059K.
Revenue from Patient Care Activity is ahead of plan as at month 11 by £209K due to additional income (non block related). The additional income year to date is offset against additionalexpenditure incurred.
The Trust income position includes £809K as at month 11 for the planned recognition of the Sustainability and Transformation Fund (STF) allocation.
At the end of month 11, the Trust had delivered £4,757K of CIPs against a plan of £4,757K. Of the CIP savings delivered to date, £1,977K has been delivered non-recurrently and £2,780K recurrently. The slippage against the recurrent plan is mainly due to the Customer Service Transformation project and SLA scheme.
The year to date CIP delivery for the Trust as at month 11 is
£4,757K as per plan.
Finance Strategy & Resources Report February 2018 (Month 11)
Contents DoF Message Clinical Income Pay Non Pay CIP SOFP SOF Glossary
Table 1: Income and Expenditure Summary Table 2: Income and Expenditure Performance
Income and Expenditure Summary Budget Actual Variance Budget Actual Variance Budget Forecast Variance£'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000
Income 11,411 11,647 235 128,819 130,110 1,292 140,257 141,757 1,500
16 (427) (273)NHSPS recharges and HCT occupancy levels
KCRegular meetings with commissioners and NHSPS to agree occupancy levels and variations for volume changes
Total (1,395) (998)
RAG Rating KeyRAG Rating Description Risk Score
Green 1-3Amber-Green 4-7Amber 8-13Amber-Red 14-17Red 18-25
The Trust is currently forecasting a surplus of £539K. When adjusting for the transfer of the Parkway property to NHSPS and depreciation on donated assets the forecast surplus is £1,973K.Current risks and opportunities to the Trust 's forecast outturn position are detailed below:
Finance Strategy & Resources Report February 2018 (Month 11)
Contents DoF Message Clinical Income Pay Non Pay CIP SOFP SOF Glossary
Table 4: Income Performance
2 Clinical Income (Patient Care Activity)
The trust had a year to date favourable position relating to
Revenue from Patient Care Activities of £1,059K.
The Trust had a year to date favourable position relating to Revenue from Patient Care Activities of £1,059K and £209K in month. The year to date favourable position includes £642K for estates recharges, £165K winterresilience funding and continuing over-performance in PALMS, Hertfordshire School Nursing and ICT. The income is partly offset by under performance against plan within Homefirst, ESD, Children's SLT, E&N Physio and OT.The income position also includes CQUIN slippage of £100k and service reconfiguration changes such as ICT/Rapid Response.
The income year to date position includes £809K income year to date for the planned recognition of the Sustainability and Transformation Fund (STF) allocation.
The forecast out-turn position for the Trust's Patient Care Activity is a favourable variance of £1,500K which includes £700K for estates recharges and £400K additional NHSE income for School Nursing (Flu Imms), as well asother non- recurrent income such as winter resilience funding.
INCOME PERFORMANCE Budget Actual Variance Budget Actual Variance£'000 £'000 £'000 £'000 £'000 £'000
Clinical Commissioning Groups 7,940 8,017 77 90,755 91,267 512Injury Cost Recovery Scheme 2 2 0 19 32 14Local Authorities 2,031 1,682 (349) 22,331 22,553 221NHS England 592 1,043 451 6,511 6,953 442NHS Foundation Trusts 65 72 7 711 669 (42)NHS Other 0 6 6 0 64 64NHS Trusts 518 530 13 5,805 5,738 (67)Non NHS: Other 44 43 (1) 480 401 (79)Non HS: Private Patients 3 8 5 33 26 (7)Operating Income - Patient Care Total 11,193 11,403 209 126,645 127,704 1,059Education And Training 52 (23) (75) 659 627 (33)Non-Patient Care Income 41 60 19 465 603 138Other 18 100 82 240 368 128STF 107 107 0 809 809 0Other Operating Income Total 218 244 26 2,174 2,406 232TOTAL EBITDA Income 11,412 11,647 234 128,819 130,110 1,293
In Month Year to Date
Finance Strategy & Resources Report February 2018 (Month 11)
Contents DoF Message Clinical Income Pay Non Pay CIP SOFP SOF Glossary
Table 5: Total Pay Breakdown
3 Pay Expenditure
The pay position as at month 11 is £199K
unfavourable and £1,087K favourable year to date.
The Trust posted a pay expenditure overspend of £199K in month 11 and £1,087K underspend year to date. The pay underspend is as a result of non-recurrent vacancies in ICT's and continuingvacancies predominately within School Nursing, Health Visiting, Dental, Continuing Care Carers, Nascot Lawn, Physio and SLT. The in month overspend is mainly due to a realignment adjustment whichwas coded within nonpay.
The Trust had an under-establishment of 257 wte (10%) in month 11 of which 225 wte was covered by temporary Bank and Agency staff. Monthly detailed reviews are taking place at cost centre levelto ensure the agency spend is reduced compared to the year to date run rate as well as the 16-17 spend.
The forecast out-turn position for the Trust's pay position is an underspend of £1,162K. The forecast has been updated to reflect winter pressures and service reconfigurations including; ICT WestRedesign, MSK service, SACH Beds and Simpson Ward. The forecast continues to show full recruitment of Health Visitors and Nursery Nurses within the Children's Business Unit.
The Trust agency spend is below the NHSI Agency Ceiling threshold by £12K in month and below the threshold by £36K year to date. In line with the above recruitment plans, the year-end trust agencyspend is forecast to be £8,703K, which is slightly below the £8,710 target by £7K. The Medical Agency spend is below the NHSI threshold by £10K YTD and is forecast to be £744K at year end, which isbelow the target of £811K by £67K.
Pay Budget Actual Variance Budget Actual Variance Budget Actual VarianceWTE WTE WTE £'000 £'000 £'000 £'000 £'000 £'000
Finance Strategy & Resources Report February 2018 (Month 11)
Contents DoF Message Clinical Income Pay Non Pay CIP SOFP SOF Glossary
Table 6: WTE Budget v Actual Table 7: Bank & Agency WTE
Table 8: Bank & Agency Total Spend
0
50
100
150
200
250
Apr-
17
May
-17
Jun-
17
Jul-1
7
Aug-
17
Sep-
17
Oct
-17
Nov
-17
Dec-
17
Jan-
18
Feb-
18
WTE Bank & Agency WTE
Bank
Agency
Finance Strategy & Resources Report February 2018 (Month 11)
Contents DoF Message Clinical Income Pay Non Pay CIP SOFP SOF Glossary
Table 9: Non Pay Analysis
4 Non Pay Expenditure
Non-pay recorded a £72K overspend in month 11 and a
£2,541K overspend year to date.
The Trust has delivered an unfavourable non-pay expenditure variance of £72K in month 11 and £2,541K year to date. The overspend is mainly within other nonpay and includes £530K year to date towards VACS UK for the FluImms. programme which is offset by income received from NHS England, as well as slippage against plan for the central CST scheme, contingency cost pressures, increased consultancy spend as well as Building Repairs andMaintenance costs pressures within estates.
The £209K year to date unfavourable variance within Clinical Supplies and Services includes cost pressures within continence products and purchases of equipment, appliances, walking aids and instruments. Furthermore, the£579K year to date variance within Premises includes rental expenditure which is partly offset by income.
The forecast out-turn unfavourable variance of £2,663K is based on the above expenditure continuing to year end.
Non Pay Budget Actual Variance Budget Actual Variance£'000 £'000 £'000 £'000 £'000 £'000
Grand Total (2,117) (2,190) (72) (24,964) (27,505) (2,541)
In Month Year to Date
Finance Strategy & Resources Report February 2018 (Month 11)
Contents DoF Message Clinical Income Pay Non Pay CIP SOFP SOF Glossary
5 CIP
At the end of month 11, the Trust had delivered £4,757K of CIPs against a plan of £4,757K. Of the CIP savings delivered to date, £1,977K has been delivered non-recurrently and £2,780K recurrently. The slippage against the recurrent plan is mainly due to the Customer Service Transformation project which has been recovered via vacancy underspends within the various Business Units. Business Units are working closely with the Project Management Office to closely manage deviations from plan and over recover CIPs in future months.
The year to date CIP delivery for the Trust as at month 11 is £4,757K as
per plan.
Table 12: CIP by Programme
Plan Actual Variance Plan Actual Variance Plan Actual Variance
In Month Actual £'000 Year to Date £'000 Forecast Year End Achievement £'000
In Month £'000 Year to Date £'000 Forecast Year End Achievement £'000
In Month £'000 Year to Date £'000 Forecast Year End Achievement £'000
6 Statement of Financial Position
Finance Strategy & Resources Report February 2018 (Month 11)
Contents DoF Message Clinical Income Pay Non Pay CIP SOFP SOF Glossary
Table 13: Statement of Financial Position
Table 14: Cash Flow Statement
Statement of Financial Position Opening Balance Closing Balance Forecast£000's £000's £000's
NON-CURRENT ASSETS:
Intangible Assets 595 385 357
Property, Plant and Equipment 60,087 57,788 63,036TOTAL Non Current Assets 60,682 58,173 63,393CURRENT ASSETS:Trade and Other Receivables: NHS 5,405 6,329 2,126Trade and Other Receivables: Non NHS 1,204 3,105 474
Cash and Cash Equivalents: GBS/NLF 18,772 19,209 21,644Cash and Cash Equivalents: Other 1 6 0TOTAL Current Assets 25,382 28,648 24,244CURRENT LIABILITIESTrade and Other Payables: Capital (336) (68) (298) The fall in capital payables refIects the reduced capital programme of 2017-18.Trade and Other Payables: Non Capital (13,601) (14,767) (13,758) The increase in payables is due to the system changeBorrowings (176) (176) (176)Provisions (144) (101) (245) Provisions relating to redundancy and CQUIN have been utilised. Other Liabilities: Deferred Income (1,405) (1,784) (1,244) The movement reflects normal quarter four invoices deferral.Total Current Liabilities (15,662) (16,896) (15,721)TOTAL ASSETS LESS CURRENT LIABILITIES 70,402 69,925 71,916NON-CURRENT LIABILITIES:Borrowings (2,532) (2,444) (2,356) The first scheduled loan repayment was made in September 17.Provisions (1,031) (1,009) (653) Unwinding of the discount.Total Non-Current Liabilities (3,563) (3,453) (3,009)TOTAL NET ASSETS EMPLOYED 66,839 66,472 68,907
Financed by:Public Dividend Capital 1,131 1,131 1,131Revaluation Reserve 17,221 17,193 18,996 The transfer of the balance for Parkway to the Income and Expenditure Reserve.Other Reserves 4,946 4,947 4,947Income and Expenditure Reserve 43,541 43,201 43,833 The movement on the Income and Expenditure Reserve relates to the operating position for February
2018 less the transfer of the Revaluation Reserve balance for Parkway.
TOTAL TAXPAYERS' AND OTHERS' EQUITY 66,839 66,472 68,907
Non Current Assets have reduced in value due to the transfer of Parkway to NHS Property Services and the disposal of IT equipment; additionally the depreciation charge is currently greater than expenditure from the capital programme for 2017-18.
Cash balances have increased as a result of the settlement of prior year receivables and reduced capital activity up to month 11
The increase in receivables is mainly caused by the change of the Financial Services
Finance Strategy & Resources Report February 2018 (Month 11)
Contents DoF Message Clinical Income Pay Non Pay CIP SOFP SOF Glossary
Cashflow StatementPlan Actual Variance
£'000 £'000 £'000
Operating Surplus/(Deficit) 2,418 2,476 58Depreciation and Amortisation 3,355 3,213 (142)Impairments and Reversals 0 0 0Operating Cashflow before working capital 5,773 5,689 (84)
Movements in working capital(Increase)/Decrease in Trade and Other Receivables 1,150 (2,993) (4,143)Increase/(Decrease) in Trade and Other Payables 873 885 12Increase/(Decrease) in Movement in Provisions (8) (43) (35)Net Cash Flows from working capital 2,015 (2,151) (4,166)
Net Cash Inflow/(Outflow) from Operating Activities 7,788 3,538 (4,250)
Interest Received 28 41 13(Payments) for Property, Plant and Equipment (5,369) (2,381) 2,988(Payments) for Intangible Assets 0 0 0Proceeds from sales of PPE and investment property 0 84 84Net Cash Inflow/(Outflow) from Investing Activities (5,341) (2,256) 3,001
Loans from Department of Health - repaid (88) (88) 0Interest Paid (44) (45) (1)Dividend (Paid)/Refunded (874) (707) 167Net Cash Inflow/(Outflow) from Financing Activities (1,006) (840) 166
NET INCREASE/(DECREASE) IN CASH AND CASH EQUIVALENTS 1,441 442 (1,083)
Cash and Cash Equivalents at Beginning of the Period 17,061 18,773 1,712
Cash and Cash Equivalents at the end of the period 18,502 19,215 629
Plan Actual VarianceLiquidity Ratio (days) 20 32 12
Year to Date
Year to Date
Finance Strategy & Resources Report February 2018 (Month 11)
Contents DoF Message Clinical Income Pay Non Pay CIP SOFP SOF Glossary
Table 15: Cash Performance and Rolling Projection
The cash balance of £19,215k at the end of February 2018 is above the planned figure for the year. This is mainly due to the delay in finalising the capital programme, the majority of which is now scheduled for the latter part of the financial year. It is anticipated that cash outlay will increase over plan in the next few months with the forecast cash balance for the end of the year being in line with the plan. The liquidity ratio remains above plan at 32 days. This is due to current working capital balances and operating expenses being more favourable than originally forecast.
Finance Strategy & Resources Report February 2018 (Month 11)
Contents DoF Message Clinical Income Pay Non Pay CIP SOFP SOF Glossary
Table 16: Capital Expenditure
Capital Expenditure by Programme
Plan Actual Variance Plan Forecast Variance£000's £000's £000's £000's £000's £000's
• Additional investment schemes of £623k are planned to were approved during February's Capital Investment Group in order to utilise unallocated capital funds. All schemes are expected to have finished by the end of March 2017
• The Trust can add the net book value of disposals from the Fixed Asset Register within year to the capital programme but for reporting purposes this is deducted to arrive at the agreed Capital Resource Limit of £4,633k. In 2017-18 to date HCT has disposals of £136k enabling the Trust to spend £4,769k on capital schemes.
• We still have £75k unallocated at this time as we need to account for amendments on the budgets of the existing schemes.
• At the Capital Investment Group at the end of December 2017 new schemes were approved which are expected to have finished by the end of March 2017.
• Planned expenditure reflects the capital plan for 2017-18 as submitted to NHSI. This plan included additional investment above the level of forecast depreciation; NHSI has now approved additional expenditure of £1,134k bringing the current capital resource limit to a total of £4,633k.
• Capital expenditure is £2,045k at the end of month 11 which is below the Trust's submitted plan for 2017-18. Expenditure to date relates mainly to schemes which have continued from 2016-17 together with the Hemel Hub and current year's IT equipment replacement programme.
Finance Strategy & Resources Report February 2018 (Month 11)
Contents DoF Message Clinical Income Pay Non Pay CIP SOFP SOF Glossary
1,343 602 632 683 3,260 100%Percentage of total debt 41% 18% 19% 21% 100%
-1,087 -66 117 329 -707
% Total Debt
NHS OtherNon NHS Total
Movement in Month £000
Debtor Type 0-30 Days £000's31-60 Days
£000's61-90 Days £000's > 90 Days £000's Total Debt £000's
Overall debt has redused by £707k during February 2018 to an overall total of £3,260k. The level of debt over 90 days has increased to £683k with the proportion of this category to overall debt increasing from 9% to 21%. The increase of the debt is mainly due to the change of the Financial Services and the Finance Team will focus on resolving all outstanding issues.
Finance Strategy & Resources Report February 2018 (Month 11)
Contents DoF Message Clinical Income Pay Non Pay CIP SOFP SOF Glossary
Table 20: BPPC Performance
Cumulative (Taken from BPPC cumulative reports)April May June July Aug Sept Oct Nov Dec Jan Feb Mar
April May June July Aug Sept Oct Nov Dec Jan Feb MarTarget 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95%% Volume 94% 88% 94% 94% 94% 91% 92% 91% 84% 82% 77%% Value 98% 64% 99% 96% 95% 97% 99% 91% 85% 87% 87%
The BPPC performance for volume has decreased for both in month and cumulative from 82% to 77% and from 92% to 90% respectively. Performance for value has remained constant during February for both in month and cumulative at 87% and 89% respectively.
Finance Strategy & Resources Report February 2018 (Month 11)
Contents DoF Message Clinical Income Pay Non Pay CIP SOFP SOF Glossary
Table 16: Single Oversight Risk Rating
7 Single Oversight Framework (SOF)The Single Oversight Framework Risk
Rating for the Trust is 1. The Single Oversight Framework Risk Rating (SOF) is the NHS Improvement’s approach, to overseeing NHS providers. The SOF assesses the financial performance of providers via the “Use of Resources Metrics (UOR)” comprising the following five metrics:
• Liquidity Ratio• Capital Servicing Capacity• I&E Margin• I&E Distance from Plan• Agency
The overall metric is calculated by attaching a 20% weighting to each category.
The Single oversight risk rating for the Trust as at month 11 has been maintained at 1. The Trust is forecasting to achieve the year end control total and risk rating of 1 as per the plan.
Plan Actual Variance Plan Actual Variance
Capital service cover rating 1 1 1 1Liquidity rating 1 1 1 1I&E margin rating 2 2 1 1Distance from financial plan 1 2Agency rating 1 1 1 1
Overall Rating 1 1
YTD Forecast
Finance Strategy & Resources Report February 2018 (Month 11)
Contents DoF Message Clinical Income Pay Non Pay CIP SOFP SOF Glossary
DoLs - Deprivation of Liberty Safeguarding CQUIN - Commissioning for Quality and Innovation
IDAT - Integrated Discharge and Admissions Team CCG - Clinical Commissioning Group
MEN C - Meningococcal C PALMS - Positive Behaviour Autism Learning Disability and Mental Health Service
NHSI - National Health Service Improvement CIP - Cost Improvement Programme
OT - Occupational Therapy PT - Physio Therapy
CAPEX - Capital Expenditure Programme ICT - Integrated Community Teams
BUPR - Business Unit Performance Review ENHT - East and North Herts Trust
FP10 - Community Prescription BPPC - Better Payment Practice Code
