nhs north west dons conference

Healthier Horizons

WelcomeChris Jeffries Acting Director of Workforce and Education NHS NW

Better Care Better Health Better Life

Welcome


Housekeeping

• Mobiles

• Fire Alarms

• Toilets

• Catering

• Reception desk


Today is about


Today is about

Celebrating nursing success


Today is about

Harnessing energy and enthusiasm


Today is about

Improving delivery of patient care, patient and staff experience


Change


Service Reconfigurations


QIPP and savings

3 and1/2 years to go


Continuously improving Quality for patients


Patient Safety and the public Francis

Inquiry


Service reorganisations following Transfers of Community Services


Organisational Changes: clinical Commissioning

Groups


Move to all degree Nursing


Changes to Health Visiting service and

increase in Numbers


Remember what is was like when you first started as a student nurse......


And then when you qualified......


And now looking back from where you are now.........


We have plenty of success to celebrate!

SUCCESS

Directors of Nursing Conference 1 September 2011

Coming together is a beginning;

Keeping together is progress;

Working together is success

Henry Ford

What is Success?

In order to succeed, your desire for success should be greater than your fear of failure

Bill Crosby

The Beginning

Manchester

Bringing People Together

Shaping the Future of Nursing in the North West

1st Annual Director of Nursing Conference

North West Nursing Indicators

General Nursing Care Indicators• Tissue Viability• Falls Assessment• Infection Prevention & Control• Medication Assessment• Nutritional Assessment • Pain Management• Patient Observation

Community Nursing Care Indicators • Care of the Dying• Pressure Ulcer Care• Falls Prevention

NW CIs 2011

• MRSA

• C Difficile

• Mixed Sex Accommodation

• Quality Assurance

Improvements Needed and Made

229201

302

415

668

0

250

500

750

2007/08 2008/09 2009/10 2010/11 PCT Objective2011/12Financial Year

24% reduction

NHS North WestReduction in MRSA Bacteraemia cases 2007 - 2011

38% reduction

27% reduction

12% reduction

MRSA

NHS North West Reduction in C difficile infections 2007 - 2011

9579

6726

4911

2912

3859

0

2000

4000

6000

8000

10000

2007/08 2008/09 2009/10 2010/11 PCT Objective2011/12

Financial Year

30% reduction

21% reduction

27% reduction

25% reduction

C Difficile

MSA Performance January - July 2011 Northwest

822 823923

176 183 201 158

0

100

200

300

400

500

600

700

800

900

Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11

Month

Nu

mb

er

of

Bre

ach

es

Mixed Sex AccommodationNumber of Breaches

Quality Assurance - Francis

Francis Review: Assurance

• AQuA has been established as a membership organisation through the active leadership of North West CEOs and Board Directors

• It is firmly focused on supporting delivery of QIPP goals• Results are already being delivered:

• Stroke 90:10 driving up compliance with Sentinel Audit > 90%

• AQ improving outcomes and experience for five conditions

• Safety Networks – improvements in falls, pressure ulcers and VTEs

• Mortality Collaborative – reducing HSMRs in 9 Trusts with highest rates

AQ : A Progress Report

Clinical Area UK Year One Position* UK Year Two Position

**

US Year One Position

***

AMI 92.55% 96.89% 89.31%

CABG 96.76% 96.94% 87.34%

HF 62.11% 69.95% 69.60%

HK 88.97% 92.73% 87.52%

PN 76.32% 81.55% 73.72%

*UK Year One Position reflects the AQ programme’s overall Composite Quality Score per clinical area for October 2008 – September 2009.

** UK Year Two Position reflects the AQ programme’s overall Composite Quality Score per clinical area for October 2009 – March 2010

***US Year One Position reflects the HQID overall Composite Quality Score per clinical area for October 2003 – September 2004.

Note: while similar, the measures analysed within each clinical group for the year one HQID project are not identical to those used in year one of the AQ project. For a full list of the HQID initial measure set go to www.qualitydemo.com

Phase 2 teams joinedPhase 1 teams joined

90%

Stroke 90:10 drove up standards in stroke care

• Background to Mortality Collaborative

• The Dr Foster Hospital Guide 2009

• Collaborative driven by the will of CEO community

• 9 participating organisations came together

Mortality Collaborative

Collaborative Improvement Aim

By April 2011 participating organisations will have improved adjusted mortality by at least 10 points during 2010 – 2011 as measured by CHKS or Dr. Foster.

The Collaborative Rate of Improvement – Dr Foster

The Collaborative Rate of Improvement - CHKS

• 2007• Primary Care Organisation of the Year – Wirral PCT• Clinical Service Redesign – Salford Royal FT and Salford PCT• Improving Patient Access – Bolton PCT• Reducing Health Inequalities – East Lancashire PCT• Improving Care with E-Technology – NHS North West

• 2008• Workforce Development – NHS North West• Patient Centred Care – Blackburn with Darwen PCT• Patient Safety – Salford Royal FT• Improving Health with Nice Guidance – Central and Eastern Cheshire PCT

• 2009• Primary Care Organisation of the Year – Liverpool PCT• Acute and Primary Care Innovation – Salford Royal FT• Reducing Health Inequalities – NHS Blackburn with Darwen• Using Date to Improve Care – NHS North West

• 2010• Primary Care Organisation of the Year – NHS Western Cheshire• Improving Care with Technology – Central Manchester University Hospitals FT• Quality and Productivity – Salford Royal FT

• 2009• Child Health – NHS Tameside and Glossop 2009

• Chief Nursing Officer Award – Salford Royal FT

• Accident and Emergency – Salford Royal FT

• Innovation in your Speciality – Royal Bolton FT 2009

• Mental Health – Greater Manchester West Mental Health FT

• 2010• Patient Safety – Stockport NHS FT

• Improving Maternity Services – Blackpool Fylde and Wyre FT

• Patient Dignity – NHS Tameside and Glossop

• Accident and Emergency Nursing – Royal Liverpool and Broadgreen University Hospital

• Innovation in your Speciality – Liverpool PCT 2010

• Infection Prevention and Control – 5 Boroughs Partnership FT

• Child Health – NHS Tameside and Glossop 2010

Nursing Standard – Nurse of the Year 2011Fiona Murphy – Royal Bolton FT

Hazel Holmes – Director of NursingLiverpool Heart and Chest Hospital NHS FT

Travel Scholarship

Honours Awards 2007 - 2011

29 New Years/Birthday HonoursAwarded to North West Hospital Staff since 2001

Leadership

• The Prime Minister’s Commission on the future of Nursing and Midwifery in England – Front Line Care

• Providing advice to the Department of Health on Nurses in Commissioning

• Regional Energise for Excellence leadership

• Rapid Spread

• Best practice and improvement – peer to peer support

Leadership

LEADERSHIP

Energise for Excellence

Where did it start:

Energise for Excellence

Safer Nursing Care Tool (AUKUH)HURSTPANDA

Birth Rate+E Rostering

Safer Nursing Care Tool (AUKUH)HURSTPANDA

Birth Rate+E Rostering

Productive CareSafety Express

High Impact Actions

Essence of CareNW Care Indicators


High Impact Actions

Essence of CareNW Care Indicators


High Impact Actions

Nurse Sensitive Outcome Measures


High Impact Actions

Nurse Sensitive Outcome Measures

Real-time Monitoring

Experience Based Design

Single Sex AccommodationPatient Stories

Real-time Monitoring

Experience Based Design

Single Sex AccommodationPatient Stories

High Impact Actions

Real-time MonitoringHealth and Well Being

High Impact Actions

Real-time MonitoringHealth and Well Being

Get Staffing Right

Get Staffing Right Deliver CareDeliver Care Measure

ImpactMeasure Impact

Patient Experience

Patient Experience

Staff Experience

Staff Experience

Safety Express/Thermometer

NHS Confederation Launch 2011

• Tracy Nurse – District Nurse

• Emma Wilkes – Senior Nurse Practitioner

• Joan O’Hanlin – Clinical Team Manager

• Graeme Mitchell – Matron

• Pauline McGarth – Acting Assistant Director

• Caroline Rees- Sister

• Sarah Sillitoe – Ward Manager

• Joanne Mc’Donnell – Head of Nursing

Local Nurses Leading the Way

• Delivering QIPP

• Dealing with increasing need and less resource

• Really integrating care

• Keeping quality, safety and experience at the heart of everything we do

The Future

NHS North of England

How wonderful it is that nobody need wait a single moment before

starting to improve the world

Anne Frank

The New Mental Health Strategy for England

Dr Hugh GriffithsNational Clinical Director for Mental Health

Introduction

• The scale

• The history

• The policy context

• The new mental health strategy

• Mental health and QIPP

• Some potential challenges

• Future developments

The Scale

• 1 in 4 people

• Cost to English economy £77 billion pa.

• More likely £105 billion pa.

• A million people on IB

• A third of GP consultations

• Largest proportion of disease burden

• Premature mortality

The History

• The National Service Framework – 1999

• The NHS Plan – 2000

• New Horizons – 2009

• All adults

• Dual approach

• The General Election – May 2010

• The new Mental Health Strategy

Policy Context

• Patients at the centre – shared decision-making, choice and information

• Focus on outcomes – quality at the heart of the healthcare

• Devolution – clarity about the “what” more than the “how”

• Strengthening public health

• Reform of adult social care

Policy Context

• Equity and Excellence White Paper - towards GP- led commissioning and outcomes (12 July 2010) – Health and Social Care Bill

• The Outcomes Frameworks• Healthy lives, healthy people White Paper: Our

strategy for public health in England (30 November 2010)

• Healthy lives, healthy people: consultation on the funding and commissioning routes for public health (21 December 2010)

Policy Context

• A vision for adult social care: Capable communities and active citizens

(16 November 2010)• Liberating the NHS: developing the

healthcare workforce (20 December 2010)• The Operating Framework for the NHS in

England 2011/12 (15 December 2010)• Quality Innovation Productivity & Prevention

(QIPP) agenda

Mental Health Strategy

A strategy to transform the mental health and well-being of the nation

An ambition to mainstream mental health and achieve ‘parity of esteem’ with physical health

The aim for mental health to be ‘everyone’s business’ – all of Government, employers, education, third sector

Mental Health Strategy - Themes

• Services and public mental health• Outcomes and quality• A life-course approach• Early intervention• Patient choice and control

(personalisation)• Reducing inequality and tackling

stigma• Improving efficiency (QIPP) in the

context of a challenging financial climate

2. More people with mental health problems will recover

Objectives

1. More people will have good mental health

3. More people with mental health problems will have good physical health

4. More people will have a positive experience of care and support

5. Fewer people will suffer avoidable harm

6. Fewer people will experience stigma and discrimination

Mental Health Strategy

A Cross-Government Mental Health Strategy

• Key messages for a cross government mental health strategy

• Good mental health is essential for everyone

• Improving public mental health and well-being, with prevention and early intervention, can cut the £105bn annual cost of mental ill health

• People with mental ill-health are likely to have better outcomes if they have real, well-informed choices over their care

• A twin-track approach will improve outcomes for people with mental ill-health and build resilience and well-being to prevent mental ill-health in the whole community

• How public service reforms will work for mental health

A “Call to Action” with key stakeholders

A Call to Action

Quality, Innovation, Productivity and Prevention (QIPP)

Three mental health elements:• The acute care pathway

Local variations• Out of area treatments

Allocative efficiency • Physical and mental health

Medically Unexplained Symptoms,

co-morbidities

Potential Challenges

• General:• History• Lack of Payment by Results• Poor information• Stigma and culture

• Social care system changes• Criminal justice system changes

Future Developments

• Implementation• The Joint Commissioning Panel

• RCPsych and RCGP• The NHS Commissioning Board

• Position mental health• Managed Networks

Where to find all documents

• Strategy and companion document – “Delivering better mental health outcomes for people of all ages” available at :

• www.dh.gov.uk/mentalhealthstrategy• Also, “Talking Therapies: a four-year plan of

action” and:• Impact Assessment and Analysis of Impact

on Equality

Safety Express

Maxine PowerQIPP Safe Care National Work Stream LeadDepartment of Health

[email protected]

The only thing that exceeds my admiration for the NHS is my hope for the NHS. I hope that you will never, never give up on what you have begun. I hope that you realize and reaffirm how badly you need, how badly the world needs, an example at scale of a health system that is universal, accessible, excellent, and free at the point of care – a health system that is, at its core, like the world that we wish we had: generous, hopeful, confident, joyous, and just.

Donald Berwick, July 1, 2008

The NHS in 2040

Abby – student nursepaediatrics 2012 - 15

Charlotte – student nurseAdult branch 2012 - 15

Our challenge

Equivalent to the number of patients with new stroke?

Can we ‘engineer’ pace and scale?

Preventable cases?

29,000

8,000

49,222

Our research into the issues

Safety Express Aim

To deliver ‘harm free care’ *to 95% of patients by December 2012

Defined as the absence of pressure ulcers, falls, urinary infection (in patients with catheters) and new VTE

What is harm free care?

Pressure Ulcer

Fall CatheterInfection

VTE HFC

Patient 1 √ x x x x

Patient 2 x x x x √

Patient 3 x √ x x x

Patient 4 x x x √ x

Total 75% 75% 100% 75% 25%

Benefits

What have we learned?

Patients affected

One Programme: Four Harms

Findings

• Strategic Fit

• Disruptive

• Measuring

• Reliability

• We didn’t help!!!!!

Frontline TeamsMeasuring 4 Harms at the point of care

NHS Safety Thermometer

Pressure Ulcers Harm from falls Urinary catheters

VTE Risk assessment &

treatment

New VTE Harm Free Care

Kings College hospital joined Safety Express in January 2011, they are also implementing the Energising for Excellence programme. This work is lead by Liam Edwards (Corporate Nurse)

They are working in partnership with their community services and Guys and St Thomas. At the outset they committed to working together to deliver:

5% reduction in urinary catheter utilisation 20% reduction in injurious fallsEradication of category 4 pressure ulcers50% reduction in category 3 pressure ulcers90% patients receiving VTE risk assessment and management

They selected four wards to test the Safety Express programme They measured progress with the NHS Safety Thermometer tool They have used the Safety express programme to work across organisational boundaries They have implemented systematic training They have reviewed equipment stocks They have ignited nurse leadership for hourly walk rounds In August 2011 they are launching Safety Express with governors In July they are planning to spread the changes

KING'S COLLEGE HOSPITAL NHS FOUNDATION TRUSTLONDON SHA

Total falls with harm

Show national benchmark

New

0%

1%

2%

3%

4%

5%

6%

7%

8%

9%

10%

Sep-10

Oct-10

Nov-10

Dec-10

Jan-11

Feb-11

Mar-11

Apr-11

May-11

Jun-11

Pressure ulcers

0%

1%

2%

3%

4%

5%

6%

7%

8%

Sep-10

Oct-10

Nov-10

Dec-10

Jan-11

Feb-11

Mar-11

Apr-11

May-11

Jun-11

Falls

0%

5%

10%

15%

20%

25%

Sep-10

Oct-10

Nov-10

Dec-10

Jan-11

Feb-11

Mar-11

Apr-11

May-11

Jun-11

% patients with catheter % patients with catheter AND UTI

Catheters

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Sep-10

Oct-10

Nov-10

Dec-10

Jan-11

Feb-11

Mar-11

Apr-11

May-11

Jun-11

% patients assessed % patients given prophylaxis

VTE

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Sep-10

Oct-10

Nov-10

Dec-10

Jan-11

Feb-11

Mar-11

Apr-11

May-11

Jun-11

No Harms 1 Harm 2 Harms

Harm free care

Total number of patients at selected organisation surveyed to date: 337Safety Thermometer Results

DashboardStep 1: select SHA Step 2: select organisation

New Total falls with harm

Patients with a new VTE

0%

1%

1%

2%

2%

3%

3%

4%

4%

5%

Sep-10

Oct-10

Nov-10

Dec-10

Jan-11

Feb-11

Mar-11

Apr-11

May-11

Jun-11

Provider Case Study [1]Kings College Hospital NHS FT

Impact of Safety Express and E4E on the pilot wards

New Pressure Ulcers Falls with Harm Catheters

VTE Risk assessment & prophylaxis New VTE Harm Free Care

Next steps 2011-12

Policy fit

Building resources

Measuring HARM

Scaling up activity

What will they say about us?

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