8 november 2017 appendix 1 safe august/september 2017

Quality Board Report – 8 November 2017 – Appendix 1

of 22

Safe – August/September 2017

Incidents: Overview

Serious incidents One Serious Incident (SI) was declared in September and none in August. The declared incident related to the potential failure to escalate safeguarding concerns. The investigation is part of a wider safeguarding process including a Serious Case Review and police investigation. The staff involved are aware of and are following the correct referral and escalation processes for all safeguarding concerns. Four previously reported SIs were submitted for closure within timeframes. The learning identified by the investigations will be shared across the organisation and the actions will be monitored for completion and closure.

Degree of harm

Six moderate harm incidents were reported in August, five of which related to pressure ulcers for patients under the care of the District Nursing Team in the Luton locality. All of these incidents will be reviewed by the specialist Tissue Viability Nurses and given final sign off by the Service Manager. The remaining moderate harm incident related to the iCaSH Service in Suffolk and is still being investigated to determine whether correct registration processes were followed. Eleven moderate harm incidents were reported in September; the majority (9) related to pressure ulcers which will be subject to internal specialist review and sign off. The remaining two incidents include the Serious Incident referenced above and an incident within the Dental Service that related to the mis-labelling of an x-ray which led to an inaccurate referral. The incident came to light during the dental procedure. Update from previous report A review of the management and prevention of pressure ulcers is being conducted and led by the Deputy Chief Nurse. Data review has been completed and a strategic meeting with partner organisations (L&D Hospital, Luton BC and Luton CCG) planned for November. The review is due to report at the beginning of March 2018.

By safe, we mean that people are protected from abuse* and avoidable harm. *Abuse can be physical, sexual, mental or psychological, financial, neglect, institutional or discriminatory abuse

of 22

Safeguarding Training Overall

Aug Sept

L1 97% 97%

L2 97% 98%

L3 91% 91%

L4 100% 100%

SOVA 92% 92%

MCA 93% 93%

DoLs 87% 87%

Safeguarding Supervision by locality

Aug 17 Sept 17

Luton 100% 100%

Cambridgeshire 95% 70%

Norfolk 95% 97%

Overall compliance 96% 93%

Safeguarding

Serious Case Reviews

Work is on-going to refine the reporting of Serious Case Review data to ensure actual activity is reflected.

Prevent

Feedback from the Prevent Facilitator’s Day held on 4 September 2017 showed it to be successful. The guest speakers from partner organisations provided insight and direction on how the Trust could hone its awareness around the Prevent strategy. The learning outcomes for the Trust are:

To develop documents and training which provide more practical tips for clinicians in making a prevent referral; and

To increase understanding around the duality of Prevent and mental health referrals.

Prevent referrals

The Trust made one Prevent referral in October after contacting Bedfordshire & Luton Constabulary. The decision to refer to the Channel Panel has not yet been made. The Luton Safeguarding Team is liaising closely with partner agencies to support the service user.

Safeguarding Training

The Safeguarding Adult Training figures have been affected by staff having difficulty accessing the Electronic Staff Record system. This has now been resolved.

Safeguarding Supervision

The Cambridgeshire supervision compliance has been affected by long term staff sickness within the team which required cancellation of some supervision sessions. These staff have now all been booked on supervision. It is noted, however, that data for the first two weeks of October show an improving position with compliance at 92.5%.

The overall compliance is reduced as a result of the low compliance for Cambridgeshire in September. It is envisaged that this will be significantly improved by the end of October when the mitigating actions in Cambridgeshire to improve supervision compliance have been implemented.

Luton Cambs/ P’boro Norfolk

Jun 17

Jul 17

Aug 17

Sep 17

Jun 17

Jul 17

Aug 17

Sep 17

Jun 17

Jul 17

Aug 17

Sep 17

Case Reviews On-going

2 3 3 2 1 2 3 3 4 4 4 6

Case Reviews Concluded

1 0 0 1 0 0 0 0 0 0 0 0

Domestic Homicide Reviews

2 2 2 2 1 1 1 1 0 1 0 0

LADOs on-going

1 1 1 0 0 0 0 0 0 0 0 0

Unexpected Child Deaths

1 2 0 0 0 1 0 0 0 1 0 0

Serious Adult Review

1 0 0 0 1 1 1 0 0 0 0 0

of 22

The graph below shows the number of IG incidents reported by month from April 2015 to

September 2017. The Upper Control Limit (UCL) and Lower Control Limit (LCL) show the

expected range based on historical data, the negative value is due to the variation in data.

Information Governance

There have been no incidents in August or September which required an internal Root Cause Analysis (RCA).

There was one near miss concerning a wrongly addressed envelope within one of the iCaSH services. This has been dealt with by arranging an information governance and safety walk through/audit of office practices. This will take place in November 2017.

In conjunction with the Communications Team, an infographic has been developed to demonstrate the appropriate use of envelopes which can be used by individuals or in team meetings.

The trend for incidents in August/September continued to centre on confidentiality breaches (11/14 respectively) though none of these incidents was in a specific area. A deep dive has been carried out into the confidentiality breaches and it was found that a large majority were not actual breaches of confidentiality. This is to be discussed further at the IG Steering Group’s November meeting and the outcome of this will be reported to the Quality Improvement & Safety Committee in due course.

of 22

Infection Prevention and Control

Surveillance

There were no confirmed MRSA bacteraemia or Extended Spectrum Beta-Lactamases (ESBL) bacteraemia reported during August and September 2017. E.coli (Escherichia coli) E.coli is a bacterium found in faeces which can survive in the environment (including soil) and can cause a range of infections including urinary tract infections (UTIs), cystitis, and intestinal infections. E. coli bacteraemia (bloodstream infection) may be caused by primary infections spreading to the blood. By 2021 the NHS’ ambition is to reduce all Gram-negative bloodstream infections (including E.Coli) by 50% within the whole healthcare economy.

Similarly to MRSA bacteraemia and C.diff, every confirmed case requires a root cause analysis (RCA) to be undertaken and discussed with the Clinical Commissioning Group (CCG). The main areas which have been identified nationally are the reduction of certain antimicrobials being prescribed for UTIs in acute and community settings and prolonged unnecessary use of urinary catheters. The Trust would also participate in other provider or CCG RCAs, e.g. where blood cultures were taken on admission. This would require the investigator to undertake a look back exercise of 28 days to review other healthcare input.

As part of the Trust’s mandatory surveillance we have not been informed of any positive blood cultures from our children's inpatient areas or participated in any investigations in relation to our other services during August and September. Incidents There were eight incidents reported in this period: one was a needlestick incident due to a neonate moving their leg suddenly, appropriate action was taken; one was due to a patient vomiting; the remaining six related to estates issues or waste collection. Essential Steps clinical audits All teams submitting data achieved 100% in September. Service leads were notified of all non-responders to ensure compliance in October. Details are discussed at the Trust’s Infection Prevention and Control Committee. Unannounced environmental audits Nine sites were audited during this period. Common themes were the overall department appearance, cleaning and sharp’s awareness. The reports were shared and action plans developed with the service leads to monitor progress. Details are discussed at the Trust’s Infection Prevention and Control Committee. Staff Seasonal influenza 2017-18 vaccination programme Following on from the Trust’s successful 2016-17 staff seasonal influenza vaccination programme, work has commenced in preparation for the 2017-18 campaign. The

Trust’s Workforce team has provided a breakdown of teams within each unit to help calculate local uptake. The National requirement for NHS Trusts is to vaccinate 75% of frontline healthcare workers; as at 25 October 2017, 25% of

eligible staff have been vaccinated. An action plan for the campaign has been developed and uptake will be monitored by the Trust’s Matron Infection Prevention and Control.

The Trust is also participating in the national CQUIN scheme for flu vaccination of frontline healthcare workers which involves those staff in services commissioned by Cambridgeshire & Peterborough CCG and Luton CCG.

NHS England and Public Health England have recently issued updated guidance to NHS providers to ensure that staff have easy access to the flu vaccine. It is the expectation that individual staff members have the vaccine if eligible and to sign a declined consent form if they refuse. In response the Trust has amended the consent form accordingly. In addition, staff are able to access a Survey Monkey questionnaire where they can state that they decline to have the vaccination.

Surveillance: August - September 2017 Compliance = 0

Trust area C.Diff

(post 72 hours) 2017-2018 total to date

Cambridgeshire 0 0

Luton 0 0

of 22

Safer Staffing

Compliance with safer staffing levels is reported nationally for inpatient areas (Holly Ward and Special Care Baby Unit at Hinchingbrooke for CCS NHS Trust) and is calculated as a mean percentage across the month. This information is shown in the graphs opposite.

This approach is not sensitive to variations in staffing levels on a daily basis and therefore can mask individual dips in compliance. The Paediatric Matron, therefore, also undertakes a review of staffing levels but takes a more detailed approach to identify when specific reductions in staffing has an impact on the ward. The commentary below reflects the analysis of this and therefore the percentages reflect her approach and differ slightly from the nationally reported data.

Work continues to develop a further refined methodology which takes into account the age and acuity of patients on the ward when considering the safe staffing position. Special Care Baby Unit (SCBU) During August SCBU achieved 100% compliance against the RN nursing levels and 100% against the total number of staff on duty. The use of bank and agency staff rose in August due to increased activity, staff summer leave as well as staff on maternity and long term sick leave. Efforts to recruit new staff are on-going. In September SCBU achieved 100% compliance against the RN nursing levels and 100% against the total number of staff on duty. Use of bank and agency staff continued to be high due to increased activity and staff on maternity and long term sick leave. Three new members of staff joined the team so some shifts were worked on a supernumerary basis during their induction. Holly Ward Inpatients In August, overall compliance rates were reported nationally as 93.7% for day shifts and 95.7% for night shifts. During this period, there were nine red shifts (5 day and 4 night) where only two RNCs were on duty. On the day shifts, inpatient numbers were small and cover was provided by RNCs on duty in either the assessment unit or day case area. Similarly, on the four night shifts, there were minimal numbers of patients (<5) and although further admissions were restricted, no children required transfer or breached in the Emergency Department. In September overall compliance rates were reported as 96.54% for day shifts and 97.78% for night shifts, which was an improvement on the previous month. There were two red shifts (nights) when only two RNCs were on duty. On these nights the ward was restricted to further admissions but no children required transfer or breached in the Emergency Department as a result of this.

of 22

Medicines Safety

There were a total of 81 medication incidents in Q2, of which 39 (49%) were attributable to the Trust. There was a lower number of incidents reported in Q2 compared to previous quarters; it is unknown whether this reflects reduced reporting or an actual reduction in the number of incidents. However, the proportion of incidents attributable to the Trust is comparatively low, which is encouraging and may reflect all the hard work to minimise incidents. Of the CCS incidents, all were no-harm except two low harm incidents: Holly ward: Swelling at an intravenous site, currently under investigation. DynamicHealth Hunts: Adverse drug reaction, recognised but rare. Yellow card report completed.

The distribution of incidents among the services attributable to the Trust is shown below left. The number of incidents reported by the Luton Adults service is markedly lower than in Q1. However the number in Q1 was unusually high, as shown in the table opposite:

The reduction in numbers in the Cambs Children’s Universal service may be due to a seasonal effect on the School Immunisation Team (school holidays). It is encouraging to note that the iCaSH services are starting to report more incidents. These services use large quantities of medicines and therefore a higher number of incidents would be expected and there may be a degree of under-reporting.

The chart below shows the most common categories in which incidents occur, with Q2 figures reflecting the reduced number of incidents in general.

Total incidents CCS % Attributable to CCS

Q3 2016-17 93 48 52%

Q4 2016-17 105 56 53%

Q1 2017-18 97 63 65%

Q2 2017-18 81 39 49%

Q2

2016-17 Q3

2016-17 Q4

2016-17 Q1

2017-18 Q2

2017-18

Adult Services (Luton) 17 19 16 29 13

of 22

Effective – August/September 2017

Workforce

SICKNESS ABSENCE

The cumulative rolling (12 months) sickness rate decreased from 4.72% in June to 4.7% in September 2017

In September 1.87% was long term sickness and 2.42% was short term sickness.

The highest sickness rate was the Luton C&YPS Community Unit (8.55%). The lowest (2.38%) was in the Corporate Unit.

The highest reason for absence was anxiety/stress/depression/other psychiatric and headache/ migraine.

4.59 4.51

4.56 4.63

4.72 4.81

4.76

4.65 4.72

4.67 4.72 4.71 4.7

4.00

4.50

5.00

Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17

Cumulative % Sickness Absence Rate - Rolling Year

STABILITY The Trust stability rate was 87.54% which compares to a stability rate of 88.2% for NHS England and 83.0%

for NHS Community Provider Trusts for “all employees” (Source: NHS iView July 2017). NB: CCS stability figures exclude staff on a fixed term contract of less than one year and staff that join as a result of TUPE until the anniversary of the transfer.

Managers review staff reasons for leaving, address local issues and discuss organisational issues with relevant corporate support functions. The Exit Interview process is led by managers and a questionnaire which is via a survey monkey. The HR team review the questionnaire feedback, discuss issues with service managers and report on reasons for leaving as part of the Workforce Review Reports.

83.40 82.83

85.34 85.38 85.88

86.31 85.94 85.81 85.83 86.04 85.81 85.96

87.54

82

83

84

85

86

87

88


Monthly % Stability Rate

MANDATORY TRAINING Mandatory Training compliance has remained stable since September 2016 and was 93% in September

2017.

This has been maintained despite on-going national ESR system and local IT compatibility issues, as local workarounds have been put in place to support staff to undertake the training.

Central reports reflect e-learning undertaken the day after its completion and within a week for face to face training.

92 92 92 92 92 92 92

93 93 93

92

93 93

92

92

93

93

94


Overall Uptake of Mandatory Subject Training Opportunities (%)

APPRAISALS

The Trust wide rate increased on last month and was above the Trust target of 91%.

Cambs C&YPS had the lowest rate (88.67%); Luton C&YP had the highest rate (98.62%).

All managers and leaders are promoting the importance of appraisal conversations in supporting the Trust and staff to

deliver high quality services.

The Trust wide objective setting process, which began in March 2016, means objectives are set outside the appraisal

process in March and April each year. The new appraisal, career and personal development planning conversation

began in September 2017.

Audits on the quality of appraisals take place.

90.80

85.74 84.64

85.52

89.93 89.55 91.05

89.94 88.70

87.97 89.22 89.13

92.16

82

87

92

97


Monthly % Appraisal Rate

of 22

Audits

The tables below highlights the following: Completed clinical audit activity for August and September. None of the 4 audits met 100% compliance but have action plans in place. National Clinical Audits that are applicable to the Trust – we are actively engaged in each of these for 2017.

August/September 2017 National Audits

No. of projects recorded as meeting 100% compliance:

0 BASHH National Clinical Audit 2017:

Management of Syphilis

No. of projects recorded as <100% compliance but include action plans:

4 Baby Friendly Initiative (Luton)

No. of projects recorded as <100% but do not include action plans:

0 UK Parkinson’s Audit

First Hour of Care: East of England Network Audit

NICE (National Institute for Health & Clinical Excellence)

NICE Guidance is now registered as safety alerts and this has resulted in a much faster and more detailed response rate by Clinical Leads. The table below show the NICE guidance for August and September 2017 that requires action by the service. All guidance are taken to local Governance meetings and action plans are in place to monitor. There was no guidance for action for either Dental or MSK Services.

Children & Young People Services

QS160 End of life care for infants, children and young people

Circulated to relevant Service Manager

CG160 Fever in under 5s: assessment and initial management

Acute Services to audit against standard

NG72 Developmental follow-up of children and young people born preterm

For Neonatal follow-up team to audit against

QS161 Sepsis Trust has already audited the Sepsis Pathway and presented results at local Clinical Governance meetings. Sepsis pathway is being reviewed with North West Anglia as they provide the A&E service for Children at Hinchingbrooke and their assessment scoring was different to the Paediatric scoring for our service.

CG192 Antenatal and postnatal mental health: clinical management and service guidance

Service to review against standards

Luton Adult Services

CG81 Advanced breast cancer: diagnosis and treatment

For Cancer and Palliative Care team to review and decide whether any changes to practice should be actioned

iCaSH Services

QS157 HIV testing: encouraging uptake Information circulated. To be discussed at iCaSH governance meetings in October.

of 22

Caring – August/September 2017

Patient Comments/Feedback

At Home First is a co-ordinated health and social care service which is provided at home for adults at risk; it includes Integrated Rapid Response and Intensive Case Management. Below is a summary of patient feedback received by the Service this year.

Luton Integrated Rapid Response for Adults (LIRRA) During January to April 2017 feedback from 24 patients was gathered using a questionnaire, followed up by a telephone call. The pie chart shows the

response to the Friends & Family Test question where 80% of respondents said they were “Extremely likely to recommend our service to friends and family if they needed similar care or treatment?”, and the graphic on the left details the action the Service took in response to other feedback received.

Intensive Case Management

Over 100 surveys were mailed to patients between January and June 2017 following completion of a care plan. Typical responses included “This care plan sets out all my wishes and will give help to my family should they need to call someone if I become ill”. Again, feedback was also sought on how the Service could be improved (see opposite).

By caring, we mean that staff involve and treat people with compassion, kindness, dignity and respect

of 22

Patient Comments/Feedback

Patient Advice & Liaison Service (PALS)

There were 46 PALS contacts in August: 34 were enquiries and signposting, 10 raised concerns and two comments. In September there were 58 PALS contacts: 50 were enquiries and signposting, 13 raised concerns and one comment.

Of the concerns raised in August and September, seven were about administration, four of which raised concerns with the appointment systems in iCaSH services. Four were about staff attitude and three delays in diagnosis, treatment or referral.

Everything. Kind, caring and explained everything really well so I understood it.

Cambs CYPS Community Nursing

Listened and supported in a caring professional manner.

Luton Community

Paediatrics

of 22

Friends & Family Test (FFT)

There were 2351 responses to the FFT question in August and 3163 in September.

Nineteen services received feedback during this period. Luton Cancer and Palliative Care Team have not been included in the summary as they are not due to receive feedback via this route.

Cambridgeshire CYPS Universal Services received one response - xxxx

The iCaSH service in Peterborough is the only iCaSH service commissioned to undertake specific Patient Reported Outcome Measures (PROMS) and includes the FFT question in its quarterly feedback reporting. This explains the reduced number of responses for August and September and expectation that October results will increase.

Although in August iCaSH Bedford was below target, response rates are improving each month with September’s response rate at 94%.

of 22

Responsive – August/September 2017

Complaints

Number of complaints received over April 2015 to September 2017

June 2017

July 2017

Aug 2017

Sept 2017

Number of complaints received in month 6 13 7 2

Number of complaints closed in month 10 2 9 18

Number of responses sent in month 4 7 13 10

Of responses sent in month number over 25 days 3 7 12 8

Of responses sent in month number within 25 days 1 0 1 2

Percentage of responses sent within target time frame 25% 0% 7.7% 20%

Number of complaints Upheld (of those responded to) 1 4 4 1

Partially Upheld (of those responded to) 2 2 5 8

Number of PHSO referrals in month 0 1 0 0

Number of PHSO recommendations received/ completed in month

0 0 0 0

Number of responses sent and number sent within target time frame

Responses to complaints

The chart above shows the CCS performance over the last six months against the 25-day target for responses.

A substantial number of complaints were closed in September and an improvement in response times is anticipated for October following work to review the process for complaints management which includes simplifying steps in the process. Parliamentary and Health Service Ombudsman (PHSO) There were no referrals to PHSO or recommendations received in August or September.

By responsive, we mean that services are organised so that they meet people’s needs

of 22

Trends/Themes The subjects identified in complaints received in August and September are shown below:

Complaint themes and outcomes Nine complaints were received in the two month period. Four identified issues with communication or information provided, including two stating that incorrect information was provided. Three were staff attitude, two complaining about staff rudeness. Two were about clinical care and one access. There were no themes in the services involved in the complaints. The experience of one service user relating to the Luton District Nursing service is presented to the Board as a filmed reflection of the negative impact of staff attitudes. A comprehensive action plan has been agreed and will be monitored through the Luton Clinical Operational Board.

Access – i.e. 18 weeks

Referral To Treatment (RTT) performance has remained consistent over the summer period. The Trust has migrated its SystmOne RTT recording to an upgraded system which will significantly improve data quality and reduce the number of clocks accidentally left running.

of 22

Our Quality Way

Individual behaviours Stage 1

Team/Service Activities & Culture Stage 1

Stage 1

Service Self Assessment Stage 2

Our Quality Way peer review Programme Stage 3

CQC Visit – against Fundamentals of Care standards and Key Lines of Enquiry

Well-led – August/September 2017

Quality Way/CQC self-assessment & peer review programme

During the last two months we have continued the roll-out of Our Quality Way. In August we focussed on the ‘Caring’ CQC Key Lines of Enquiry (KLOEs) and in September the ‘Responsive’ KLOES.

The main areas of achievement were:

The Our Quality Way KLOE dedicated months continue to be discussed at senior management meetings across the Trust.

There is a greater awareness of the Our Quality Way, including screen-shots, discussions at local service level meetings and development of resources to support teams at service level.

There continues to be weekly updates on the dedicated ‘Our Quality Way’ pages on the staff Comms Cascade, with contributions from staff to share across the Trust.

Next planned stages of ‘Our Quality Way’ for October/November are:

During October we will launch stage 2 of the Our Quality Way Programme, which is for all services to update their self-assessment against the updated KLOE domains.

We will start the stage 3 – ‘Our Quality Way Reviews’; we plan to carry out these reviews from November 2017 to February 2018.

What is the Trust’s Our Quality Way Review Programme? The Trust’s Our Quality Way Review Programme aims to improve care for the people we serve by:

Ensuring our services are as safe as possible

Improving the quality and effectiveness of care

Improving the patient and carer experience

Providing development and learning for all involved

Encouraging the dissemination of good practice

We do this by using a standardised peer review tool based on appreciative inquiry and the CQC’s interpretation of what ‘good’ looks like.

The Our Quality Way Review teams will comprise representatives from the Quality and Support Services Teams as well as a clinical representative from another service and a Chair (usually a member of the Trust’s Wider Executive Committee). At the end of the Our Quality Way Review, the service will receive a rating for how safe, caring, responsive, effective and well-led they are together with an overall rating. A report will also be provided to the service detailing areas of good practice and areas for improvement for the team to address.

By well-led, we mean that the leadership, management and governance of the organisation assures the delivery of high quality person-centred care, supports learning and innovation, and promotes an open and fair culture

of 22

Unit Team Jun-17 Jul-17 Aug-17 Sep-17

Health Visiting Luton Central 13 7 10 12

Health Visiting Luton South 17 17 17 17

Health Visiting Luton West 15 10 10 15

Health Visiting Luton North 10 8 10 12

Audiology 11 8 17 8

Community Paediatrics 15 15 20 13

Infant Feeding 10 10 10 10

Luton - Adults Community Nursing - Cavell Team 7 2 10 12

0-19 HCP Breckland Locality 14 12 13 12

0-19 HCP North & Broadland 11 12 6 8

0-19 HCP West Locality 16 16 16 11

0-19 HCP City Team 1 & 2 12 14 10 11

School Nursing Service 16 20 20 20

0-19 HCP Fenland 8 17 17 14

0-19 HCP Hunts 8 13 11 11

Chlidren's Continuing Care 11 13 11 11

Specialist School Nursing 12 12 8 6

iCaSH Bedfordshire 14 19 15 18

MSK Hunts 11 12 8 10

Norfolk HCP

Ambulatory Care

Cambs C&YP

Luton - Children's

Services

Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17

25+ 0 0 0 0 0 0

16-24 4 7 3 5 6 3

10-15 17 23 22 15 14 17

0-9 72 67 69 76 71 68

No. of tw o consecutive

non-responses0 0 0 0 0 0

Number of single non-

responses4 0 2 1 1 4

Total number of

responses received93 97 94 96 91 88

Total number of Teams 97 97 96 97 92 92

Overall QEWTT Scores

Number of responses

received by scoring

threshold

QEWTT (Quality Early Warning Trigger Tool)

Response rates for the QEWTT remain high with 99% achieved in August and 96% in September. The table below shows those teams that had a high score (16+) in August/September or those that have remained mid-range (10-15) showing little or no improvement over a three month period. There were 6 high scores in August and 3 in September. Common themes identified across the services are staffing issues (e.g. sickness and recruitment) leading to cancellation/postponement of clinical care, anticipated disruption to service delivery in the coming month, IT issues and staff not updating records within 24 hours.

Luton Community Unit

Health Visiting – Luton: All four Luton Health Visiting teams appear on the QEWTT table for Aug/Sept with Luton South continuing to score in the high range (16+) for the past 5 months. Common themes reported over the last 2 months include staffing levels (due to recruitment, sickness, etc.) and increased caseloads which have impacted on capacity to deliver services; mandatory training levels were below 91% target; and inability to update records within 24 hours. All 4 teams were anticipating service delivery disruptions in the next month. The availability of new laptops is making a positive difference to updating records within 24 hours but for some teams the issue around sending SMS messages and access to SystmOne during busy periods remain. Audiology: This team’s score has fluctuated over the past 4 months. Similar issues continue to be reported with cancelled clinics due to lack of staff, continued breaches for new referral patients due to recruitment issues and lack of locum staff. Disruption in services is anticipated in October.

Community Paediatrics: The increase in score in August reflects issues previously reported as well as frequent use of bank and agency staff, mandatory training compliance below target and receipt of a formal complaint currently being investigated. On a positive note, 2 new locums are in place and one vacancy has been filled subject to references. The Service Redesign Team is supporting the service with capacity review work with the commissioners.

Infant Feeding: This team was previously on the Emerging Issues table and has consistently reported a mid-range score for the past 4 months. Reasons for their score has fluctuated over this period but main issues continue to be staff sickness, vacancies, cancellation/postponement of clinics and not meeting mandatory training target. Due to

restructuring within Luton Children’s Services, this team will be merged into the four Health Visiting teams and will no longer be submitting a QEWTT report.

Community Nursing – Cavell Team: Although June/July showed some improvement, this team has remained on the QEWTT table due to an upward trend in Aug/Sept. Key areas are similar to those reported previously in April/May: staffing issues leading to cancellation/postponement of clinical care and anticipated service delivery disruptions due to lack of staff. In September, some staff did not receive clinical supervision.

Norfolk

Norfolk 0-19 HCP teams: These 4 teams remain on the table although compared to the last reporting period their scores show a downward trend. Even though lack of available staff and teams working to maximum capacity remain the main issues, recent recruitment to the West and North & Broadland localities has had a positive effect. All teams reported that clinical records were not being updated within 24 hours but has improved with support and guidance from team leaders and the IT Department. IT has also been asked to investigate rural areas with poor signal to assist with improving the ability to update records. Staff are also being supported in ensuring that their mandatory training compliance is up to date.

of 22

Cambridgeshire Children & Young People’s Services Cambs School Nursing Service: This team’s score remains high due to the continued difficulty in recruiting school nurses which is recognised as a national issue. Recruitment campaigns continue for a lead school nurse and a full time school nurse to cover the Duty Nurse Desk.

Cambs 0-19 HCP Fenland: Although a slight decrease in score in September, staffing levels remain the key issue for this service. Business Continuity Plans have been triggered in the Wisbech and Doddington teams. A recruitment day has been organised in October with interviews scheduled for November. An improvement to the appraisal rate in September (95%) is noted.

Cambs 0-19 HCP Hunts: This team is new to the table this month as it has shown an upward trend and remained in the mid-range for the past 3 months. Key areas for noting include lack of available staff leading to cancellation/postponement of clinical care; anticipating service delivery issues due to staffing levels; use of bank/agency staff and not updating records within 24 hours. A complaint received in July also contributed to their score that month.

Children’s Continuing Care: This team’s score remains in the mid-range due to similar issues detailed in previous reports. Further clinical resignations have been received in the past 2 months but the appointment of a Clinical Administrator to support the team was successful. IT connectivity remains an issue for carers work ing overnight in children’s homes and a trial of new dongles is continuing. Although mandatory training compliance remains below target, there is good evidence of staff booking themselves on training and completing training on-line.

Specialist School Nursing: This team was on the Emerging Issues table in the last report, but in August/September has shown an improvement in their scores. However, the team reported issues around recruitment with some posts having to be re-advertised. Requirements for special schools around protocols and training which have not been met has also impacted on this team, of which both the Commissioners and Senior Managers are aware.

Ambulatory Care iCaSH Bedfordshire: Staffing remains the key issue for this service and has led to cancellation/postponement of clinical care during Aug/Sept. Although a number of posts are being advertised, it is anticipated that staffing pressures within the team will continue into October. Staff have been contacted individually regarding their mandatory training compliance which should show an improvement next month. Two formal complaints were received in August which are currently being investigated.

MSK Hunts: There has been a slight reduction in score in Aug/Sept although their score remains mid-range (i.e. 10-15). Staff absence has remained an issue with a number of staff off sick in August and 2 on maternity leave which has led to the cancellation/postponement of clinical care

of 22

Patient Engagement

Norfolk 0-19 HCP Service

Staff regularly attend community events

across the county such as The Norfolk

Show, South Norfolk on Show, Norwich

Pride, preschool events and numerous

school and community events.

Health Passport for 16-19 age group:

Focus group at Norwich City College to support the development of a

digital Health Passport. c. 200 young people fed back to staff

at the Royal Norfolk Show – many ideas included within app.

ChatHealth and 5-19 pathway: Collaborative work with ChatHealth and young

people from City College to record 2 of 10 national podcasts aimed at supporting young people’s

emotional health. Consultation with young people around the

promotion of Chathealth in schools - new project to be implemented around training young people as

ChatHealth ambassadors.

Review of NCMP letter, following negative feedback received, by focus group of parents from

one of our Children’s centres: Outcome: the focus group suggested a new format

and contents which have been implemented.

Review of Norfolk antenatal groups

delivered in partnership with midwifery and children’s centres:

Outcome:

Parents work in partnership with

professionals to review the outcomes of antenatal

services

Development of additional and complex needs pathway: Parents and young people involved in design of HCP annual contact and feedback on assessment tools HCP approached by parents and staff to discuss support for pre-school children with additional needs –

Outcomes:

HCP staff support development of parent led early support groups and complex needs schools in all localities

HCP specialist practitioners work with acute trusts and children’s centres to develop and deliver a group for parents of newly diagnosed babies – enabling access to care and early support closer to home

of 22

Patient Engagement

Other Patient Engagement activity …

Children and their families, working

with the Family Nurse Partnership

(FNP) team, celebrated the 10 year

anniversary of FNP in England with a

Teddy Bear’s Picnic.

iCaSH Suffolk – Bury

YOU SAID:

“We need more bookable

appointments” iCaSH Suffolk - Bury

WE DID:

We have changed our Monday walk-in clinic to

appointments only.

Peterborough Immunisation Service – Update

Following on from the last Quality Data Pack regarding the reluctance of the Muslim communities in Peterborough to

consent to the nasal flu vaccination due to the porcine gelatine content of the vaccine, the Peterborough

Immunisation Service has met with the Muslim Council of Peterborough. This was a positive meeting and the next

step is for the team to present to the Joint Mosque Forum in Peterborough with a view to engage the public and parents to accept the nasal flu vaccination for primary

school children.

Epilepsy Awareness with South Asian

Families

Luton’s Paediatric Epilepsy Nursing

Service is running awareness sessions

to inform and support South Asian

Families who have children with

epilepsy. This follows learning from

feedback received from patients and

families in their community.

Virtual clinics are being run for young

people with epilepsy to attend to help

them with their transition into adult

epilepsy services.

of 22

Staff Engagement

Summary of activity

The 2017 National Staff Survey has been launched to all staff and will close at the end of November.

The Cultural Ambassador programme was launched at the Leadership Forum in September and are already being involved in investigations and hearings.

Feedback received from “Love Your Admin” week has been highly positive.

of 22

Research

External funding to Research. The CRN funded an additional interim six months full time B6 post to help with an MSK study set up. The new facilitator starts in post on 30 October.

Highlight: the role will support MSK on identifying potential studies.

Internships and Fellowships submitted and supported by the Senior Research Fellow

Five staff submitted for Health Education England (HEE) Pre-MSc Internships. Six were called for interview and five were successful.

Two members of staff submitted for the East of England Collaboration for Leadership in Applied Health Research & Care (CLAHRC) Fellowship scheme. One person was short listed for interview and was successful.

Greenshoots Clinical Research Network (CRN) has funded 0.5 PA – this capacity building funding has been targeted at Luton.

Highlight: The Greenshoots application was successful and was awarded to a Luton Paediatrician who is to be the Principal Investigator (PI) on an autism study. This is the second CRN PA within the Trust.

iCaSH Safetxt (behaviour change study) is running in Norwich, Lowestoft and Kings Lynn. Great Yarmouth has now started to recruit and Ipswich has newly opened.

Highlights: Nationally, for August and September iCaSH is second out of 40 recruiting centres. Cumulative and recruitment for Safetxt is 135.

iCaSH PrEP (Pre-exposure Prophylaxis) Impact Trial. This is a national study on HIV prevention medication in those engaging in high risk sexual activity and is currently at the ‘set up’ stage.

Highlight: All iCaSH centres are involved in this study with an initial pilot in Norwich.

Positive voices. Cumulative recruitment across all of iCaSH sites is 137. This study is due to close in September.

MSK Study. Boost study - following a long set up period and staff training recruitment is now at 17.

Children’s Studies

PRes Study (Health Visiting). Preventing the return to smoking post-partum. This study will be running in the Norfolk HV service. Update: agreements have been signed and awaiting start date from University of East Anglia (UEA).

Fluenz Tetra Nasal Spray (School Nursing). Follow up of children receiving the vaccine to monitor side effects (post marketing surveillance). Awaiting feedback from the expression of interest. Declined by the commercial sponsor.

Cost of Autism study (community paediatricians). This study is to be run in Luton and Cambridge. Each centre needs to review the case notes of 20 consecutive children seen who are diagnosed with autism. Admin support is required to ensure success.

Playing, talking and reading study in Speech & Language Therapy (SALT) is now open to recruitment.

Highlight: The Children’s portfolio continues to grow.

CCS NHS Trust recruitment (n=168) for 2017/18 (black line) against 2016/17 (grey line) and target (red dotted line).

‘Wellbeing’ Theme The Engineering & Physical Sciences Research Council (EPSRC) Funded National Institute of Health Research (NIHR) NewMind network for Mental Health Technologies grant has now launched. First task is to look at how websites and apps are rated.

New Collaborations with CCS NHS Trust Research Team Office of Health Economics, London. EQ5D-Y outcomes for children services potential project and a grant is being written.

In summary, the Trust maintains its level of research activity around the Clinical Research Network (CRN), with iCaSH having an outstanding performance both Trust wide and on a national level. The Medical Director and Senior Research Fellow actively encourage staff to apply for opportunities to develop their research skills.

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

of 22

Quality Dashboard


Standard/Indicator Description Contact

Annual

target

Ceiling or

Baseline

CCS

Overall

CCS

Overall

CCS

Overall

CCS

Overall

CCS

Overall

CCS

Overall Sparkline

SAFETY

Patient safety

% Harm free care 96% 93.33% 90.76% 97.86% 98.54% 98.57% 90.00%

% New harm free care 98.5% 99.05% 99.16% 99.29% 99.27% 100.00% 100.00%

C&YP safety thermometer % Harm free care no target N/A N/A 73.30% N/A 85.20% 90.90%

Incidents

Avoidable pressure ulcers declared as SI in month under CCS

Care0 0 0 1 0 0 0

Other SIs declared 0 0 1 1 0 0 1

Number of never events Number of never events reported in month 0 0 0 1 0 0 0

Number of medication incidents reported (CCS) no target 15 23 31 20 10 11.00%

% CCS medication incidents no harm no target 93% 91% 100% 95% 100% 91.00%

MRSA No of avoidable MRSA bacteraema cases in year (inpatients) 0 0 0 0 0 0 0

MRSA Screening Non-elective (inpatients) 100% 100.00% 100.00% 100.00% 100.00% 100.00%0 pat ients

required

screening

C.diff C.diff cases occurring >72 hrs follow ing admission (cumulative

over year)0 0 0 0 0 0 0

Hand hygiene Compliance w ith hand hygiene in all Trust inpatient areas 100% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%

Essential Steps Compliance w ith spread of infection indicator 100% 100.00% 100.00% 100.00% 100.00% 99.84% 100.00%

Overall mandatory training In line w ith Trust Training Needs Analysis 91% 93% 93% 93% 92% 93% 93%

Level 1: % staff trained 91% 97% 98% 97% 97% 97% 97%




SOVA 91% 92% 93% 93% 92% 92% 92%

Mental Capacity Act 91% 94% 93% 93% 92% 93% 93%

Deprivation of Liberty 91% 95% 95% 95% 95% 87% 87%

Manual handling % of staff undertaking manual handling (patients) 91% 87% 81% 88% 87% 88% 88%

Fire safety % of staff undertaking f ire safety training 91% 90% 90% 88% 89% 91% 91%

CPR/Resus % of staff undertaking CPR/Resus training 91% 89% 92% 91% 92% 91% 89%

IPaC training % of staff undertaking IPaC training 91% 95% 95% 94% 94% 95% 96%

Information governance % of staff undertaking IG training 95% 93% 93% 93% 91% 91% 90%

Infection Prevention & Control

Mandatory training

J Michael

C Sharp

EFFECTIVENESS

Safeguarding training

(Children)

Safeguarding training

(adults)

Medicines Management

H Ruddy

New SIs declared requiring

investigation

A Darvill

L Ward

Classic safety thermometer

of 22


Standard/Indicator Description Contact

Annual

target

Ceiling or

Baseline

CCS

Overall

CCS

Overall

CCS

Overall

CCS

Overall

CCS

Overall

CCS

Overall Sparkline

Safeguarding

Safeguarding supervisions

(Children)% eligible staff C Halls 95% 95% 97% 96% 96% 96% 93%

Workforce/HR

Monthly sickness absence rate no target 3.85% 4.74% 3.63% 4.37% 3.81% 4.28%

Short-term sickness absence rate 3.6% 1.60% 2.00% 1.48% 2.19% 1.50% 2.42%

Long-term sickness absence rate no target 2.24% 2.74% 2.15% 2.18% 2.31% 1.87%

Rolling cumulative sickness absence rate4.3%

by year end4.65% 4.72% 4.67% 4.72% 4.71% 4.70%

Turnover Rolling year turnover no target 15.34% 15.24% 16.79% 17.04% 17.19% 17.02%

Bank staff spend Bank staff spend as % of pay (f inancial YTD) no target 0.40% 0.55% 0.65% 0.52% 1.35% 1.34%

Agency staff spend Agency staff spend as % of pay (f inancial YTD) no target 2.81% 3.04% 3.38% 3.09% 3.15% 3.39%

Stability % of employees over one year w hich remains constant 87% 85.81% 85.83% 86.04% 85.81% 85.96% 87.54%

Appraisals % of staff w ith appraisals 91% 89.94% 88.70% 87.97% 89.22% 89.13% 92.16%

Recommending CCS as place for treatment - Quarterly reporting no target 84.99% 90.49%

Recommending CCS as place to w ork - Quarterly reporting no target 71.04% 74.35%

EXPERIENCE

Number of formal complaints received in month no target 8 10 6 13 7 2

Of responses sent in month, no. of complaints responded to

w ithin 25 days# / # 4/11 2/9 1/4 0/7 1/14 2/10

Percentage of complaints responsed to w ithin 25 days 0 36.00% 22.20% 25.00% 0.00% 7.00% 20.00%

Patients w ho w ould recommend our services 90% 97.78% 96.38% 95.78% 95.61% 97.28% 96.36%

Number of patients surveyed no target 1755 2678 2890 3007 2351 3163

25+ 0 0 0 0 0 0

16-24 4 7 3 5 6 3

10-15 17 23 22 15 14 17

0-9 72 67 69 76 71 68

Number of tw o consecutive non-responses 0 0 0 0 0 0

Number of single non-responses 4 0 2 1 1 4

Total number of responses received 93 97 94 96 91 88

Total number of Teams 97 97 96 97 92 92

N/A Data usually supplied but not available this month

Not relevant/not applicable to this area

H Ruddy

Friends & Family test score

D McNeill

Patient experience (monthly targets)

QEWTT (Quality Early Warning Trigger Tool)

QEWTT

Number of responses received by scoring threshold

R Moody

Staff Friends & Family testP Davies/

L Thomas

Sickness

Complaints

8 november 2017 appendix 1 safe august/september 2017

Documents