Board Paper 2019/20/34

Shetland NHS Board Meeting: Shetland NHS Board

Paper Title: Quality Report – Update on Progress

Date: 27 August 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 will meet in September 2019

“Exempt / private” item

Public document

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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 April 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 in the in-patient wards is shown in Appendix A.

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. A local intra-occular injection therapy service commenced in Shetland in May 2019 and we are in the process of recruiting a specialist neurological conditions nurse who will support patients with Parkinson’s disease.

NHS Shetland, the Health and Social Care Partnership and the Shetland Patient Experience Network (SPEN) all attended some of the recent agricultural shows to highlight the work of the various organisations and speak to people about services. At the Voe Show, colleagues from the Drug and Alcohol Team provided demonstrations about drug and alcohol awareness and at the Cunningsburgh Show, community nurses provided mini health checks and signposting.

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Staff attending the Voe and Cunningsburgh Shows

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FUTURE PLANS FOR THE DEVELOPMENT OF OUR QUALITY FRAMEWORK

Specific redesign projects are being developed and implemented and progress will be reported through the Executive Management Team (EMT) rather than a separate Transformation Board in order to streamline communication and decision making. 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. Reports on progress with individual work streams are received by the EMT as part of a performance review programme that has been developed.

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 B.

We are continuing to implement the ‘iMatter’ staff experience programme across the organisation, under the direction of the Area Partnership Forum (APF). The next round of surveys will be completed by mid September 2019.

POGRESS ON LOCAL QUALITY STRATEGY IMPLEMENTATION FOR INFORMATION AND NOTING

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. Staff will join the Quality Improvement (QI) Flow Academy 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 of £223,000 in 2018-19 in patient travel. Our focus in 2019-20, is on developing patient initiated follow up, repatriating more services e.g. macular service and developing pathways that benefit both Orkney and Shetland residents.

Staff from across the organisation attended the NHSScotland event at the end of May 2019, showcasing a wide range of quality improvement

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work focussed on increasing patient and staff satisfaction. Amanda McDermott, Clinical Nurse Manager (Elective Care) was a finalist in the poster competition for the work that she led to repatriate orthopaedic services from Woodend Hospital in Aberdeen.

A patient information film has been commissioned to promote the work that we are undertaking to use technology enabled care as widely as possible to reduce unnecessary patient travel and inconvenience. The film can be viewed by following the link below:

https://youtu.be/Q-37g7Mc-oo

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 has focussed on using a clinical assessment tool to assess and manage patients whose medical condition is deteriorating. Quality measures in CAIR will be shared with the Clinical, Care and Professional Governance Committee (CCPGC) in September to raise awareness of this important quality improvement work. An EiC celebration event is planned for October 2019, to showcase quality improvement work that has been undertaken by nurses, midwives and health visitors through the year.

Work has continued to strengthen our relationship with Universities with a new group, which has been developed in order to respond to the changes set out by the Nursing and Midwifery Council (NMC) in the standards for undergraduate education and access routes; as well as role development requirements for postgraduate education. The group has representation from senior nurses and midwives as well as NHS Education for Scotland (NES) and all academic partners.

The work of the group includes a focus on developing opportunities for Healthcare Support Workers (HCSW) who want to pursue a healthcare career and access training and education locally. And supporting role development for science graduates who want to pursue a career in Healthcare Science, specifically the Biomedical Sciences.

In June 2019, Allied Health Professionals (AHPs) came together to showcase the work that they have undertaken to improve care locally and improve access routes into the varied AHP professions.

Also in June 2019, the inaugural leadership week was held with a variety of opportunities for staff to attend different sessions across the week.

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All teams and committees have been asked to review the key messages and recommendations from the Sturrock report in order that we can identify opportunities for learning locally. The outturn of these discussions, including a workshop facilitated by Area Partnership Forum (APF) will be presented in a report to Board later this year.

As part of our winter planning preparation, the Chief Nurse (Acute) attended the Scottish Government Unscheduled Care event in August 2019. We have a good track record in delivering continuity of care during the winter months and this is a result of careful contingency planning. We are starting to look at arrangements for winter including how we can offer early supported discharge and increased access to ambulatory care to ensure that we can respond to predicted increased levels of emergency care activity and continue to offer planned care as expected.

Alison Mustard, Chief Nurse (Acute), pictured along with colleagues from the other Island Boards at the Mapathon Event in August 2019

Ward 1

NA-HC-03

Ward 3

NA-HC-02

Ward 1

NA-HC-06

Ward 3

NA-HC-05

Jan-19 100% 100% 100% 95%

Feb-19 100% 100% 100% 96%

Mar-19 100% 100% 100% 100%

Apr-19 100% 100% 92% 100%

May-19 100% 100% 93% 100%

Jun-19 100% 97% 100% 97%

Jul-19

Aug-19

Sep-19

Oct-19

Nov-19

Dec-19

Reporting

period

CE01 - Overall, how would you rate your hospital

experience?

(Excellent/Good)

CE02 - You received the care/support that you

expected and needed

(% of those that answered 'Yes')

MD01 MD02 MD03 MD04 MD05

% of people who

say that we took

account of the

things that were

important to

them.

Aim 90%

% of people who

say that we took

account of the

people who were

important to

them and how

much they

wanted to be

involved in

care/treatment.

Aim 90%

% of people who

say that they have

all the

information they

needed to help

them make

decisions about

their

care/treatment.

Aim 90%

% of people who

say that staff took

account of their

personal needs

and preferences

Aim 90%

% of people who

say they were

involved as much

as they wanted to

be in

communication/

transitions/

handovers about

them

Aim 90%

Jan-19 100% 100% 97% 94% 100% 16

Feb-19 100% 100% 97% 95% 96% 23

Mar-19 100% 100% 98% 100% 100% 15

Apr-19 100% 92% 92% 100% 100% 13

May-19 100% 90% 97% 92% 89% 15

Jun-19 97% 93% 97% 97% 97% 18

Jul-19

Aug-19

Sep-19

Oct-19

Nov-19

Dec-19

Jan-19 100% 100% 98% 97% 100% 43

Feb-19 96% 90% 99% 94% 96% 29

Mar-19 100% 95% 100% 94% 96% 39

Apr-19 100% 95% 100% 94% 96% 37

May-19 100% 100% 99% 100% 98% 29

Jun-19 97% 91% 97% 97% 97% 37

Jul-19

Aug-19

Sep-19

Oct-19

Nov-19

Dec-19

Ward 3

Person Centred

Measure description

Number

of responses

Ward 1

WARD 1 INPATIENT SURVEY – PATIENT COMMENTS – JUNE 2019

Very pleasant, hard working staff.

Staff both in A&E and on ward 1 were excellent. Friendly, caring and helpful.

Had the very best of care. All staff friendly and professional and caring. Theatre staff also brilliant, everything explained clearly. Thanks.

Good service given by the staff. Can't thank them enough

Staff were courteous and polite. I never felt like they were too busy to answer any of my questions and they went out of their way to make my stay as comfortable as

possible. As hospital stays go, cannot fault the fantastic NHS staff of the GB

[Concerning question 7b] I wasn't given the opportunity, as [doctors] only came on ward round. [In the comments section] Continue antiemetic for antibiotics cause

nausea whilst in patients for discharge [written as it is in the questionnaire]. Check patient preference around ward round as no teaching took place but many people

in the room. Promised dietary sheet but not happened, but assumptions were made about my diet in advance.

The nurses were amazing. Very helpful and go extra mile

The staff in Ward 1 liaised very well with each other. They all had their own quirky sense of humour wich made everything lightsome. Well done

WARD 3 INPATIENT SURVEY - PATIENT COMMENTS – JUNE 2019

Dr * was amazing at explaining and provided much peace of mine and information. Nurses also amazing.

And the award goes to NHS Shetland. NHS Lanarkshire and Greater Glasgow couldn't lace your boots.

I would like to thank all the staff at ward 3 for their professionalism, wonderful care, understanding and kindness!

Thank you all

Good work guys and thank you very much.

I received excellent care from everyone.

I found the staff first class as always

Thank you for the excellent care that I received

Everyone did their very best

Staff lovely even though they were extremely busy. Very friendly and attentive

Hospital experience never excellent due to being sick for most of it

From cleaning staff, laundry, catering, porters, to nurses, doctors and specialists, the staff at the GB were just all fabulous. They all went over and beyond their calls

of duty. Only in Shetland you will find this kind of friendliness and care

Would ear plugs be available when one poor soul has horrendous snoring habits?

Excellent care, as usual

All the staff made me feel very safe and comfortable at all times. Very kind, professional and understanding. I was very happy with my experience in Ward 3

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Quality Report - Board Generated on: 07 August 2019

Health Improvement

Months Quarters Icon Target

Code & Description May 2019 June 2019 July 2019

Q3 2018/19

Q4 2018/19

Q1 2019/20

Q1 2019/20

Q1 2019/20

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)

Only measured quarterly 58.2% 61.1%

Exceeding national target of 50% and local target of 58%. National data for 2017-18 shows us at 59.7% - the 2nd best performing Board in Scotland (41.7%).

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

10 13 137 153 13

261

TABIs are one of the most effective and evidence based ways of identifying people who drink at harmful levels and supporting them to reflect on and potentially reduce their drinking. We know that people who drink at harmful levels are often drinking more than they think they are and are significantly contributing to potential future poor health, as well as costs to productivity and society generally. There have been consistent recording issues since ABIs were first introduced and it is therefore difficult to know whether ABIs are being delivered and not being recorded, or not being delivered at all. An improvement plan is in the process of being developed; this will require all partners to play their parts in this important intervention.

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Patient Experience Outcome Measures

Months Quarters Icon Target

Code & Description May 2019 June 2019 July 2019

Q3 2018/19

Q4 2018/19

Q1 2019/20

Q1 2019/20

Q1 2019/20

Latest Note

Value Value Value Value Value Value Status Target

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

97.7% 98.2% 97.4% 100% 100% 98.2%

90%

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

97.67% 98.11% 97.44% 96.43% 100% 98.11%

90%

NA-HC-14 What matters to you - % of people who say we took account of the things that were important to them whilst they were in hospital (aggregated)

100% 98.1% 100% 99% 99.4% 99.3%

90%

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)

96.97% 91.89% 100% 93.55% 96.97% 91.89%

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)

98.24% 97.21% 96.1% 98.12% 99.53% 97.21%

90%

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

97.4% 96.84% 96.1% 96.08% 95.88% 96.84%

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)

94.67% 97.2% 94.87% 95.19% 97.12% 97.2%

90%

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Patient Safety Programme - Maternity & Children Workstream

Months Quarters Icon Target

Code & Description May 2019 June 2019 July 2019

Q3 2018/19

Q4 2018/19

Q1 2019/20

Q1 2019/20

Q1 2019/20

Latest Note

Value Value Value Value Value Value Status Target

NA-CF-07 Days between stillbirths 648 678 701 497 587 678

300

NA-CF-09 Rate of neonatal deaths (per 1,000 live births)

0 0 0 0 0 0

2.21

NA-CF-15 Rate of stillbirths (per 1,000 births)

0 0 0 0 0 0

4

NA-CF-16 % of women satisfied with the care they received

Currently reviewing the questionnaire and collation process.

Service & Quality Improvement Programmes - Measurement & Performance

Months Quarters Icon Target

Code & Description May 2019 June 2019 July 2019

Q3 2018/19

Q4 2018/19

Q1 2019/20

Q1 2019/20

Q1 2019/20

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)

The Surgical Team are in the process of identifying a Junior Doctor to complete a snapshot audit.

NA-HC-08 Days between Cardiac Arrests 254 284 103 193 284

300

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

3.81 6.76 3.81 5.7 6.76

7

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

1.27 0 0 0 0

0.5

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

25 55 37 35 55

300 We have small numbers of hospital acquired pressure ulcers, however ongoing local training is in place to ensure more accurate recording.

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Months Quarters Icon Target

Code & Description May 2019 June 2019 July 2019

Q3 2018/19

Q4 2018/19

Q1 2019/20

Q1 2019/20

Q1 2019/20

Latest Note

Value Value Value Value Value Value Status Target

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

1.27 0 0 0 0

0

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

99.5 99.5 99.5 100 99.5

95

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

100 80 100 100

75

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

Only measured quarterly 100 100

The format of the Patient Safety Conversations are being reviewed by the Joint Governance Group and a result the Executive Management Team have asked that all scheduled PSCs are put on hold.

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

Only measured quarterly 0% 0% 0%

0% 8 C-section procedures were performed and no surgical site infections were reported.

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

Only measured quarterly 0% 0% 0%

0% 1 hip fracture procedure was performed and no surgical site infection was reported.

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

Only measured quarterly 50% 0% 0%

0% 3 large bowel procedures were performed and no surgical site infections were reported.

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

Only measured quarterly 18.18% 0% 0%

0% 12 procedures were performed and no surgical site infections were reported.

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Treatment

Months Quarters Icon Target

Code & Description May 2019 June 2019 July 2019

Q3 2018/19

Q4 2018/19

Q1 2019/20

Q1 2019/20

Q1 2019/20

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%

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

Only measured quarterly 49.3% 51.4% 55.4%

50%

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

Only measured quarterly 1.12 1.15 Latest available provisional national data. Prone to small number variation. Rate remains consistently well within expected levels. Next data due Nov 19.