Board Paper 2019/20/01

Shetland NHS Board Meeting: Shetland NHS Board

Paper Title: Quality Report – Update on Progress

Date: 16 April 2019

Author: Kathleen Carolan Job Title: Director of Nursing & Acute Services

Executive Lead: Kathleen Carolan Job Title: Director of Nursing & Acute Services

Decision / Action required by meeting:

The Board is asked to note the progress made to date with the delivery of the action plan and other associated work which focuses on effectiveness, patient safety and service standards/care quality.

High Level Summary:

The report includes:

A summary of the work undertaken to date in response to the ‘quality ambitions’ described in the Strategy;

Our performance against a range of quality indicators (locally determined, national collaborative and national patient safety measures)

When available, feedback gathered from patients and carers – along with improvement plans

Key Issues for attention of meeting:

Noting the good performance as shown in the report

Corporate Priorities and Strategic Aims:

The quality standards and clinical/care governance arrangements are most closely aligned to our corporate objectives to improve and protect the health of the people of Shetland and to provide high quality, effective and safe services.

Implications : Identify any issues or aspects of the report that have implications under the following headings

Service Users, Patients and Communities:

The focus of the quality scorecard is on evidencing safe practice and providing assurance to service users, patients and communities that services are safe and effective

Human Resources and Organisational Development:

The focus of this report is on evidencing effective training and role development to deliver care, professionalism and behaviours which support person centred care

Equality, Diversity and Human Rights:

EQIA is not required.

Partnership Working Quality standards and assessment of impact applies in all NHS settings.

Legal:

Finance: Quality standards and the delivery of them is part of the standard budgeting process and are funded via our general financial allocation.

Assets and Property: Nil

Environmental: A Strategic Environmental Impact Assessment is not required or has been completed.

Risk Management: The quality agenda focuses on reducing risks associated with the delivery of health and care services. The adverse event policy also applies to HAI related events.

Policy and Delegated Authority:

Delegated authority for the governance arrangements that underpin quality and safety measures sit with the Clinical, Care and Professional Governance Committee (and the associated governance structure)

Previously considered by:

Data in this report is also shared with the Clinical, Care and Professional Governance Committee which met in February 2019

“Exempt / private” item

Public document

1

PROGRESS ON LOCAL QUALITY STRATEGY IMPLEMENTATION PROGRESS ON THE DEVELOPMENT OF A PATIENT EXPERIENCE

FRAMEWORK The Board supported a formal proposal to develop an approach (or framework) that would enable us to bring together the various systems that are in place to gather patient experiences and feedback so that we can demonstrate clearly how feedback is being used to improve patient care. Progress continues and since February 2019 the following actions have been taken:

We continue to promote Patient Opinion, inpatient surveys, outpatient surveys and other ways of gathering feedback. The results of a survey recently undertaken by the Podiatry team is shown in Appendix B.

The Scottish Health Council (SHC) continues to support staff to gather feedback from a wide range of patients and service users. http://www.shb.scot.nhs.uk/board/pfpi/feedbackposters.asp

NHS Shetland has been working closely with the Macular Society and Parkinson’s UK Scotland to look at service redesign options for both services.

FUTURE PLANS FOR THE DEVELOPMENT OF OUR QUALITY FRAMEWORK

Specific redesign projects are being developed and implemented and progress will be reported through the Transformation Board (TB). An action plan has been developed as a result of the scenario planning work which sets out redesign work, enablers and the outline for the organisational vision. Work is now underway to develop the vision and add in the specific detail under each work stream e.g. realistic medicine, acute care, community health and social care, communications plan etc. Highlight reports were presented at the March 2019 meeting, as a look back on achievements in 2018-19. A communication plan is being developed to go with the presentation which will be shared with groups and organisations through 2019-20.

2

We are continuing to review the way in which quality performance data is reported and made accessible to frontline teams, the joint governance group and the clinical, care and professional governance committee. The revisions to the quality scorecard are being progressed and the new format denoting high level measures is shown in Appendix A.

We are continuing to implement the ‘iMatter’ staff experience programme across the organisation, under the direction of the Area Partnership Forum (APF).

PROGRESS ON LOCAL QUALITY STRATEGY IMPLEMENTATION FOR INFORMATION AND NOTING

The realistic medicine group hosted an educational symposium in March 2019 to raise the profile of the concept of realistic medicine in Shetland and what that might mean for the way in which we deliver care now and how it might change in the future (by investing more in public health approaches). The event was well attended and included a wide range of topics from primary prevention, early years and reducing waste and variation.

The Joint Governance Group (JGG), in conjunction with the Area Clinical Forum (ACF) are leading on the development of a professional alliance, which is a concept to bring together clinicians, practitioners, managers and other professionals to agree collective decisions and/or solutions to problems. The first workshop was in March and subsequent events are planned between April and June 2019 to look at joint projects to redesign unscheduled care services.

Following the publication of the Gosforth report, the ACF has been asked to review the findings to identify any systematic learning for the Board and partner organisations. The JGG will receive a report from ACF at the next meeting in May 2019.

NHS Shetland has completed a self assessment against the HEI Inspection Findings from Greater Glasgow and Clyde, no comparable issues were identified and lessons learnt will be taken through our clinical governance structure (e.g. infection control team and standing committees), more details are set out in the HAI report.

NHS Shetland has completed the first draft of the Annual Operational Plan (AoP) which was submitted to Scottish Government at the end of March 2019. The AoP sets out the operational objectives for the Board

3

for 2019-20 including access and financial plans. Multi-disciplinary teams continue to work on quality improvement projects to support the delivery of the AoP, including work specifically to streamline patient pathways and deliver more care closer to home, using technology where it is appropriate to do so. The Acute and Specialist Services Directorate is reviewing the quality improvement capacity needed across the Directorate to support this work and the high impact changes that have been identified in the national Waiting Times Improvement Plan. In 2018-19, redesigning elective pathways made a significant contribution to the way in which we provide person centred care approaches for patients and also helped to avoid costs on patient travel which could then be redirected back into services.

The national Excellence in Care (EiC) dashboard is now available across Scotland on a digital platform (CAIR). Care assurance and measures of the quality of nursing care are being collected and displayed in the CAIR system; we are now looking at how we can use this data for improvement. The first improvement project will focus on using a clinical assessment tool to assess and manage patients whose medical condition is deteriorating.

1

Appendix A Quality Report - Board Generated on: 27 March 2019

Health Improvement

Months Quarters Icon Target

Code & Description

December 2018

January 2019

February 2019

Q1 2018/19

Q2 2018/19

Q3 2018/19

Q3 2018/19

Q3 2018/19

Latest Note

Value Value Value Value Value Value Status Target

NA-HI-01 Percentage Uptake of Breastfeeding at 6-8 Weeks (exclusively breastfed plus mixed breast and formula) (Rolling annual total by quarter)

Not measured for Months 58.6% 56.4%

Exceeding national target of 50% and just below local target of 58%. National data for 2017-18 shows us at 65.4% - the 3rd best performing Board in Scotland (51.3%).

PH-HI-03 Sustain and embed Alcohol Brief Interventions in 3 priority settings (primary care, A&E, antenatal) and broaden delivery in wider settings.

155 161 163 71 129 155

195

Patient Experience Outcome Measures

Months Quarters Icon Target

Code & Description

December 2018

January 2019

February 2019

Q1 2018/19

Q2 2018/19

Q3 2018/19

Q3 2018/19

Q3 2018/19

Latest Note

Value Value Value Value Value Value Status Target

NA-HC-01 % who say they had a positive care experience overall (aggregated)

100% 100% 100% 100% 100% 100%

90%

NA-HC-04 % of people who say they got the outcome (or care support) they expected and needed (aggregated)

96.43% 96.49% 97.96% 100% 96.49% 96.43%

90%

NA-HC-14 What matters to you - % of people who say we took account of the things that were important to them whilst

96.3% 100% 98% 99.3% 99.5% 99%

90%

2

Months Quarters Icon Target

Code & Description

December 2018

January 2019

February 2019

Q1 2018/19

Q2 2018/19

Q3 2018/19

Q3 2018/19

Q3 2018/19

Latest Note

Value Value Value Value Value Value Status Target

they were in hospital (aggregated)

NA-HC-17 What matters to you % of people who say we took account of the people who were important to them and how much they wanted to be involved in care/treatment (aggregated)

93.55% 100% 94.29% 94.74% 95.74% 93.55%

90%

NA-HC-20 What matters to you % of people who say that they have all the information they needed to help them make decisions about their care/treatment (aggregated)

98.12% 97.84% 97.95% 98.46% 94.69% 98.12%

90%

NA-HC-23 What matters to you % of people who say that staff took account of their personal needs and preferences (aggregated)

96.08% 96.4% 94.62% 98.06% 94.29% 96.08%

90%

NA-HC-26 % of people who say they were involved as much as they wanted to be in communication, transitions, handovers about them (aggregated)

95.19% 100% 96.04% 96.25% 96.3% 95.19%

90%

Service & Quality Improvement Programmes - Measurement & Performance

Months Quarters Icon Target

Code & Description

December 2018

January 2019

February 2019

Q1 2018/19

Q2 2018/19

Q3 2018/19

Q3 2018/19

Q3 2018/19

Latest Note

Value Value Value Value Value Value Status Target

MD-HC-05 SEPSIS Six - actions performed < 1 hour (Sepsis is a complication of an infection when the body's immune defences attacks the body’s own organs and tissues)

25%

There were a total of eight patients audited over the months of April and May, however during discussion of the results at the surgical audit meeting, it was thought that the criteria for inclusion in the audit may need to be clarified. The consultants will agree on this before the next audit which is scheduled for November 2018.

3

Months Quarters Icon Target

Code & Description

December 2018

January 2019

February 2019

Q1 2018/19

Q2 2018/19

Q3 2018/19

Q3 2018/19

Q3 2018/19

Latest Note

Value Value Value Value Value Value Status Target

NA-HC-08 Days between Cardiac Arrests 103 271 11 103

300

Performance measure will not become ‘green’ again until 300 days have passed without an event. Last cardiac arrest was in December 2018 and each event is subject to ‘root cause analysis’

NA-HC-09 All Falls rate (per 1000 occupied bed days)

3.81 7.33 6.13 19.13 4.85 3.81

7

NA-HC-10 Falls with harm rate (per 1000 occupied bed days)

0 0 0 1.28 0 0

0.5

NA-HC-53 Days between a hospital acquired Pressure Ulcer (grades 2-4)

37 68 4 31 19 37

300

All pressure ulcer care is subject to root cause analysis when a pressure sore develops. Performance measure will not become ‘green’ again until 300 days have passed without an event.

NA-HC-54 Pressure Ulcer Rate (grades 2-4)

0 0 1.23 0 1.21 0

0

NA-HC-59 % of patients discharged from acute care without any of the combined specified harms

99.5 98 97.4 99.5

95

NA-HC-72 % of patients who had the correct pharmacological/mechanical thromboprophylaxis administered

90 50 80

75

NA-IC-20 % of Patient Safety Conversations Completed (3 expected each quarter)

Not measured in these months 100 100 100

100

NA-IC-23 Percentage of cases where an infection is identified post Caesarean section

Not measured in these months 0% 0% 0%

0% 5 C-sections were performed and no surgical site infections were reported.

NA-IC-24 Percentage of cases developing an infection post hip fracture

Not measured in these months 0% 0% 0%

0% 2 hip fracture procedures were performed and no surgical site infection were reported.

NA-IC-25 Percentage of cases where an infection is identified post Large Bowel operation

Not measured in these months 0% 33.33% 50%

0% 4 large bowel procedures were performed and 2 surgical site infections were reported.

4

Months Quarters Icon Target

Code & Description

December 2018

January 2019

February 2019

Q1 2018/19

Q2 2018/19

Q3 2018/19

Q3 2018/19

Q3 2018/19

Latest Note

Value Value Value Value Value Value Status Target

NA-IC-30 Surgical Site Infection Surveillance (Caesarean section, hip fracture & large bowel procedures)

Not measured in these months 0% 7.14% 18.18%

0% 11 procedures were performed and 2 surgical site infection was reported, both in large bowel procedures.

Treatment

Months Quarters Icon Target

Code & Description

December 2018

January 2019

February 2019

Q1 2018/19

Q2 2018/19

Q3 2018/19

Q3 2018/19

Q3 2018/19

Latest Note

Value Value Value Value Value Value Status Target

CH-MH-03 All people newly diagnosed with dementia will be offered a minimum of a year's worth of post-diagnostic support coordinated by a link worker, including the building of a person-centred support plan

100% 100% 100% 100% 100% 100%

100%

CH-MH-04 People with newly diagnosed dementia who take up the offer of post diagnostic support (ie have an active link worker)

Not measured in these months 45.8% 47.8% 49.3%

50%

Note: this is an interim measure showing the percentage of people with newly diagnosed dementia who take up the offer of post diagnostic support (ie have an active link worker) as national data is not yet available. 138 of 280 cases. Continuing to promote the value of having this support to all patients at point of diagnosis, but it is down to individual choice as to whether they take up the offer.

MD-HC-01 Quarterly Hospital Standardised Mortality Ratios (HSMR)

Not measured in these months 1.03 0.97 Latest available provisional national data. Prone to small number variation. Rate remains consistently well within expected levels. Next data due May 19.

Podiatry Services

Lerwick Health Centre

South Road

Lerwick

Shetland

ZE1 0RB

PODIATRY SERVICES – SERVICE USER FEEDBACK – JANUARY 2019 - RESULTS

As part of NHS Shetland Podiatry Services ongoing commitment to service users, a feedback questionnaire was distributed to record service users views and opinions on the services provided.

Patient feedback forms were sent to 200 randomly selected service users. All returned forms were anonymised.

The feedback document consisted of ten (10) YES / NO questions, with opportunity to add comments.

A further two (2) questions asked respondents for comments and suggestions on their experience and how this could possibly be improved.

These service users encompassed all Podiatry locations and all specialities. The forms were sent out in January 2019 with a 2 week response date. 114 feedback forms were returned using pre-paid envelopes. This represented a 57% response rate. Returned forms were audited and collated by the Podiatry Manager. The results are reported according to the individual questions. Any forms received after 11

th February 2019 were not included in these results.

The aim of the document was to ascertain service user’s satisfaction with Podiatry provision.

The feedback document aimed to find service user’s opinions of clinician’s interaction with service users; service user’s involvement with their treatment; evidence of joint decision making and the opportunity to comment on their podiatry treatment and experience.

The questions had been devised by the Podiatry team and guidance had been sought from the Clinical Governance and Risk Department.

This results document also includes a section for conclusions, recommendations and an action plan.

1. Did the Podiatrist make you feel at ease at your appointment/s?

Yes 107

No 1

No response 6

Total responses 114

Comments All comments (16) received were positive.

Page | 2

Commonly used phrases / key words:

Key Word Number of times used

Friendly 7

Pleasant 3

Professional 2

Good 2

Helpful 1

Examples of comments received: “Very friendly, giving good explanation of procedures” “ They are always pleasant” “ All Podiatrists are friendly and act efficiently and professionally”

2. Did the Podiatrist give you the opportunity to explain your foot problem/s?

Yes 106

No 4

No response 4

Total responses 114

Comments All comments (10) received were positive. Commonly used phrases / key words:

Key Word Number of times used

Attentive 1

Answered 1

Yes 1

Felt at ease 1

Examples of comments received: “ They all listened attentively” “ Felt at ease speaking about my foot problems”

Page | 3

3. Did the Podiatrist pay close attention to what you were saying?

Yes 108

No 2

No response 4

Total responses 114

Comments All comments (8) received were positive Commonly used phrases / key words:

Key Word Number of times used

Listen / attentive 3

Yes 1

Understanding 1

Examples of comments received: “ Very attentive” “They were very patient and understanding” “ Always listens carefully” 4. Was your foot problem/s explained to you in a manner you could understand?

Yes 107

No 2

No response 5

Total responses 114

Comments All comments (7) received were positive.

Page | 4

Commonly used phrases / key words:

Key Word Number of times used

Effectively translated 1

Good explanation 1

Always 2

Examples of comments received: “ Always got a good explanation” “ Any professional jargon was effectively translated” 5. Were treatment options (if applicable) explained to you?

Yes 90

No 1

No response 23

Total responses 114

Comments All comments (10) received were positive. Commonly used phrases / key words:

Key Word Number of times used

Discussed fully 1

Well explained 1

Examples of comments received: “ Both short and long term options / treatments discussed fully” “ Very well explained”

Page | 5

6. Were you involved in the decision making process for your problem/s?

Yes 89

No 6

No response 19

Total responses 114

Comments Eight (8) comments received in total with one (1) negative comment. Commonly used phrases / key words:

Key Word Number of times used

Competent 1

Discussed 1

Excellent 1

Examples of comments received: “ Yes. Queries and suggestions are discussed and decisions made” Negative comment received: “ The only problem I have, it’s too long between appointments” 7. Did the Podiatrist clearly explain the improvements you could realistically expect following

treatment/s?

Yes 89

No 7

No response 18

Total responses 114

Comments Eight (8) comments received in total with one (1) negative comment.

Page | 6

Commonly used phrases / key words:

Key Word Number of times used

Yes 4

Examples of comments received: “ Yes. I have had suggestions on how to improve moisture to my feet which worked!” “ In my case, now mostly pain free” Negative comment received: “Only a wedge was provided due to length difference following operation” 8. Did the Podiatrist involve you in making a plan of action (treatment plan) for your problems?

Yes 77

No 15

No response 22

Total responses 114

Comments Seven (7) comments received in total with two (2) negative comments. Commonly used phrases / key words:

Key Word Number of times used

Forward planning / action 2

Yes 1

Examples of comments received: “ We discussed forward planning, appropriate and future action” “ Good advice as always” Negative comments received: “Don’t have a plan” “ Not really. Treatment will continue, it is ongoing”

Page | 7

9. Did the Podiatrist offer advice on how you could improve your problem/s yourself?

Yes 86

No 7

No response 21

Total responses 114

Comments Thirteen (13) comments received in total with one (1) negative comment. Commonly used phrases / key words:

Key Word Number of times used

Yes 5

Shoes 2

Exercises 1

Examples of comments received: “ Various exercises advised” “ Just try to keep my blood sugars as low as possible” “ Yes. I was to use a file on my strange toenails more often” Negative comment received: “ At the moment, nothing seems to be doing me any good” 10. Did you feel that any questions you may have asked , were fully answered?

Yes 101

No 3

No response 10

Total responses 114

Comments Three (3) comments received in total. Commonly used phrases / key words:

Key Word Number of times used

Very satisfied 1

Can’t remember 1

Page | 8

Examples of comments received:

“ Very satisfied” “ Can’t remember”

11. If you can, please describe your experience of Podiatry treatment? Seventy – five (75) positive comments and five (5) negative comments were received. Positive comments, commonly used phrases / key words:

Key words Number of times used

Good / very good 19

Helpful 13

Excellent 9

Pleasant 10

Professional 6

Friendly 8

Happy / very happy 6

Examples of positive comments received: “ Positive experience with helpful advice and treatment” “ Very well done and perfect understanding of treatment” “ Service is very good, excellent” “ I feel they were all very good. Couldn’t be better” “ Excellent. Any problems I have are always handled in an efficient and professional manner by all the staff” “ Prompt, attentive and comprehensive” “ Always met with respect and a smile” “ First time seeing a Podiatrist. Expert in their field, very knowledgeable and pleasant. Gave good advice.” “ Cannot praise this service enough. All staff are so pleasant and attentive” “ Always get outstanding treatment and can get emergency appointment if needed” Examples of negative comments received: “ Mixed results from doctors and Podiatry about my feet problems” “ Disappointment at not getting skin removed” “ Sometimes rushed and too long between appointments” “ Nail cutting should be re-instated for the elderly” “ Physically I find it very difficult to clip toe nails. This was glossed over when I mentioned it”

Page | 9

12. Can you suggest any ways in which your experience could be improved? Forty–two (42) positive comments and thirteen (13) negative comments were received. Positive comments, commonly used phrases / key words:

Key words Number of times used

Happy / very happy 3

Thank you 9

Excellent 3

Pleased 5

Examples of positive comments received: “ Very happy with everything” “ In my experience Ii could not ask for anything better” “ Excellent team offering a brilliant service” “ Cannot be improved – spot on” “ Really happy with the way it’s run, great staff, could not wish for better” “ It’s already excellent” “ I doubt it” Negative comments, commonly used phrases / key words:

Key Words Number of times used

Nail cutting re-instating 3

Too long between visits 2

Are these forms necessary 2

Examples of negative comments received: “ When they see people can’t physically cut their own nails, why can’t they do it. They used to do it” “ Too long between visits” “ Are these forms really necessary, or a waste of time and money?”

Page | 10

CONCLUSIONS

It is clearly evident from the results that the responses received are overwhelming positive. Podiatry team members appear to be highly thought of by service users. Podiatry team members are approachable and have good interactions with service users. Podiatry team members exhibit excellent examples of concern, compassion and are attentive to service users’ needs. Service users responses show that there is two-way dialogue when discussing, explaining and advising on problems and treatments. Podiatrists and service users are jointly involved in decision making, involvement in treatment and options for self help. Podiatry team members are realistic and encouraging in delivering advice to empower and enable service users. However, it is clear that some service user do express some concern or negative comments. Several comments show that some service users’ perceptions of treatment frequencies are at odds with their assessed treatment needs. Some service users are still unhappy and/or unclear on the changing role of NHS Podiatry services in respect to personal foot care. Simple nail cutting and removal of non-pathological callus is no longer in the remit of NHS services. Clearer explanation of treatment plans, how to contact the service, advice and information may be areas for the service to look at addressing.

RECOMMENDATIONS

Podiatry team members should be proud of the results of this feedback process. The team should be and will be informed and congratulated. Continuation and improvement of these excellent individual / team behaviours is of paramount importance. The Podiatry team will look at mechanisms to clarify and explain to service users individual treatment frequencies.

Page | 11

The Podiatry team will continue to explain to service users, colleagues and the wider public the differences between Podiatric treatment and personal foot care. Increased information on service contact details and the availability of information (both written and electronic) will be discussed and acted upon by the team. An action plan has been produced to reflect the above and is attached to this document. Chris Hamer February 2019

.