Quality Account 2019-20

Quality Account 2019-20

Contents Content Foreword Statement of directors responsibilities About this report Governance arrangements Care Quality Commission rating Priorities for quality improvement in 2020-21 Statement relating to quality of care provided Priorities set for completion in 2019-20 Our patients  Patient experience and engagement  Our Patient Panel  Improving care for vulnerable patients  Infection prevention and control  Patient safety and learning from incidents  Pharmacy improving medicine safety Our people  Celebrating and recognising our amazing people  The national NHS staff survey  Staff friends and family test results  Inclusion Our performance  Participation in clinical audits  Achievements in information technology  Research and development Our places  Improving our estate  Progress on the new hospital Statements from stakeholders Glossary of terms

1

Page 2 4 4 5 5 8 9 26 35 35 36 38 39 43 45 47 47 50 51 52 53 53 59 60 62 62 64 66 70

Introduction from the chief executive officer Welcome to our annual Quality Account 2019-20. Of course, at a time when the current COVID-19 pandemic is at the forefront of our daily life it is important that we also continue to share with you detailed updates on the changes, developments and improvements we have put in place across the year.

The COVID-19 pandemic is an unprecedented time for all of us and the impact and management of the virus has placed a considerable pressure on our services delivered at the Princess Alexandra Hospital in Harlow; St Margaret’s Hospital in Epping and Herts and Essex Hospital in Bishop Stortford and also the significant impact on our people.

I remain proud of the response and commitment from all our people and their resilience and support of others during such difficult times; times that we have never experienced before. I am pleased to put on record here my heartfelt appreciation of the difference PAHT people and their teams have made and continue to make. You will understand that in addition to our skilled and specialist clinicians our hospital and services are supported by a wide range of other skilled teams who ensure that our hospital is well-stocked, cleaned and functions efficiently to allow us to ensure that high quality patient care remains at the centre of everything we do.

The Princess Alexandra Hospital NHS Trust received recognition of our ongoing improvements in the quality of care we provide to our 350,000 residents, with improved quality ratings awarded by the Care Quality Commission (CQC) in July 2019. The ratings followed an inspection of six of our core services across the trust in March and April 2019.

I am delighted that we received an outstanding rating for caring for children and young people which made for an overall rating of Good. Five of the six core services that were inspected have at least one area that has improved, including surgery whose overall rating also improved to Good. Our responsiveness domain improved most, followed by the wellled domain, with at least one improvement in every domain.

Although the overall quality rating for the trust remains the same; Requires Improvement, we received an overall rating of Good for both the well-led assessment and also for our Use of Resources assessment with 72% of our ratings’ scorecard for all services now rated as Good or Outstanding.

I am pleased that the CQC has recognised the hard work and commitment of all of our people to providing high quality care for our patients.

We have an established quality improvement plan that is managed across all our servic es, both clinical and support and professional services, as we continue our drive towards achieving our vision of providing outstanding healthcare to our community. This is detailed in the pages that follow.

2

Another area that the team of Care Quality Inspectors (CQC) all commented positively on was how friendly and welcoming everyone at the hospital was and this was reflected in a tangible improvement in the overall culture and experience of being at the Princess Alexandra Hospital. This improvement is a clear sign of our people working together as one team.

It is well documented that when staff feel positive about their workplace, colleagues and roles they provide better care for patients. Again, this year I was proud to see this commitment to patient care reflected in the results of our annual NHS Staff Survey.

Comments from our people show an improvement in staff being happy with the quality of care they give to patients and being able to provide the care they aspire to.

Patient care is at the centre of all that we do and it is great to know that staff feel recognised and able to do their jobs to a standard they are proud of.

A significant piece of fantastic news was the announcement in October 2019 that we were part of the new national Health Infrastructure Plan to build 40 new hospitals. We are in the first phase of this (HIP1) and are in line for the funding to build a new Princess Alexandra Hospital. This is fantastic news for our patients and for our people as we can develop a hospital fit for the future. Our new hospital project team are focused on the completion of an outline business case by March 2021. Alongside this, our clinical leaders are undertaking a full review of our services and the models of care we will need to develop and adopt to provide high quality patient care. As a clinically-led organisation, these models of care will underpin the design, technology and overall environment for the new hospital and the grounds and outside spaces around it.

This account gives a detailed insight into how we are continuing to deliver to national standards of care and how we are putting in place quality improvements in areas where we are not as strong and need to do better.

I know from the many letters from our patients and their relatives and the frequent positive posts on our social media platforms how much the care they have received and witnessed is valued and appreciated. I am proud to know the difference PAHT people continue to make is recognised and know that that it is only made possible with the commitment and hard work our people and volunteers.

I commend this quality account to you, and I am, as always, grateful to the many people who have contributed to its content. I confirm that, to the best of my knowledge, the information in this account is accurate.

Lance McCarthy Chief executive

3

Statement of director’s responsibilities in respect of the Quality Accounts 2019-20 The trust directors are required under the Health Act (2009) National Health Service (Quality Accounts) Regulations (2010) and National Health Service (Quality Account) Amendment Regulation 2011 to prepare Quality Accounts for each financial year.

The Department of Health has issued guidance on the form and content of annual Quality Accounts which incorporates the above legal requirements.

In preparing the Quality Accounts, directors are required to take steps to satisfy themselves that: • • • •

The Quality Accounts present a balanced picture of the trust’s performance over the reporting period The performance information in the Quality Account is reliable and accurate There are proper internal controls over the collection and reporting of the measures of performance included in the Quality Accounts, and these controls are subject to review to confirm that they are working effectively in practice.

The data underpinning the measures of performance reported in the Quality Accounts are robust and reliable, conform to specified data quality standards and prescribed definitions, is subject to appropriate scrutiny and review. The Quality Accounts have been prepared in accordance with Department of Health guidance.

The directors confirm that, to the best of their knowledge and belief, they have complied with the above requirements in preparing Quality Accounts.

By order of the board About this report What is a quality account?

Every year all NHS hospitals in England must write a report for the public about the quality of their services; this is called the quality account. The purpose of the report is to make the hospital more accountable to you and drive improvement in the quality of our services.

In 2020 the arrival of COVID-19 pandemic has impacted upon how all NHS organisations provide the best possible care and service. At The Princess Alexandra Hospital NHS Trust we are committed to making sure that we keep our patients and our people safe. We have been working hard to respond to the fast-changing national situation through our incident management team. Our focus has been on ensuring that we can provide all necessary care and treatment in the safest possible way. This year we will be providing a more concise Quality Account; looking at our performance over the previous year, identifying areas for improvement. Through this we are making our pledge to you about the improvements to be made over the next year.

4

The report will tell you how well we did against the quality priorities and goals we set for the period of April 2019 to March 2020 and the areas we have improved through the year. It will also detail the priorities we have agreed for April 2020 to March 2021.

We will describe to you the areas where we have reviewed our patient care in order to evaluate the quality of services provided. This includes information and data about how PAHT compares with other service providers through reviews of data and audits.

The report will contain mandated information from our Board, along with statements from our commissioners and partners. We will provide a glossary of terms.

Governance arrangements Our Quality Account is prepared in line with the Quality Accounts toolkit guidance (201011). Additional information is included in line with advice received by NHS England as follows: • • •

Details of ways in which staff can speak up (including how feedback is given to those who speak up), and how the trust ensures that staff who speak up do not suffer detriment.

A statement regarding progress in implementing the priority clinical standards for seven day hospital services.

A statement that evidences an improvement plan to reduce rota gaps for NHS doctors and Dentists (Schedule 6, Paragraph 11b of the terms and conditions of service for NHS doctors and dentists in training (England) 2016).

A timetable for the production of the quality account was presented and approved by the trust Quality and Safety Committee on 28 February 2020. This was subsequently deferred as a result of the COVID-19 pandemic and a new deadline developed.

We established a working group to develop, review and finalise the Quality Account. The content has been provided by our healthcare groups (HCG), corporate teams and relevant subject experts.

A draft of the report was shared internally with the Senior Management Team members for peer review and with external stakeholders (Clinical Commissioning Groups, Healthwatch and the Health Overview and Scrutiny committees for both Hertfordshire and Essex in addition to our trust external auditors in September 2020.

The draft quality account is planned to be presented to the trust’s Quality and Safety Committee (a subcommittee of trust board) for review on planned for 25 September 2020.

The final draft document was presented to the trust board for final approval in November 2020.

Care Quality Commission rating The trust is registered with the Care Quality Commission (CQC) and our current status is ‘registered without condition’.

Our staff have used the CQC Inspection outcomes as the foundation upon which to critically examine our services and focus on how we plan and deliver the fundamental aspects of

5

safe care and have taken decisive action to change everyday activities which have led to significant improvements.

Our dedicated staff have worked incredibly hard to deliver continuous improvements over the course of the year and we can demonstrate this progress by reviewing previous ratings against our most recent inspection, see tables 1 and 2. The CQC ratings in 2016, had an overall grading of inadequate and is detailed in table 1.

The trust was inspected by CQC during March and April 2019 and the outcome of those inspections reported in July 2019 showed further improvements, with five of the trust’s core services rated as Good. The trust received an outstanding rating for caring for children and young people. The overall quality rating for the trust remained the same; requires Improvement. However, the trust received an overall rating of Good for both the well-led assessment and also for the use of resources assessment.

Table 1: The current CQC ratings received in July 2019

Within this inspection report the CQC identified areas where the trust was performing well or had made improvements, these were:  Safety incidents reported well  Pain management regularly monitored  Patients treated with compassion and kindness  Privacy and dignity respected  Services were inclusive and complaints treated seriously  Positive culture where staff felt respected, supported and valued  Clear vision for the trust  Clear embedding of large amounts of change over the last 3 years  72% of all ratings are now ‘good’ or ‘outstanding’  Caring rated as ‘good’ for the third consecutive inspection

6

Within this inspection report the CQC identified areas where the trust needed to improve performance and these were:  Mandatory training not completed (doctors) and insufficient nursing staff  Poor and incomplete record keeping  Limited audit activity (national and local)  4-hour standard for urgent and emergency care not achieved  Slow response to issues of risk and poor performance The report detailed 42 recommendations for the trust;  22 MUST do actions  20 SHOULD do actions.

To deliver the required improvements, the trust is using our tried and tested Quality Improvement process to enable a consistent and sustained approach to the achievement and maintenance of compliance with regulatory and quality standards.

The 42 CQC must and should recommendations have been collated into 14 individual projects based on themes. The improvements are being overseen by a designated executive and senior responsible officer (SRO). A small project team has been appointed to undertake the improvement actions required to achieve the desired outcomes for the 14 work streams.

There are two specific approaches being used to address the recommendations  Where there are clear and straightforward actions identified to ensure compliance, the SRO leads the development of an action plan.  Where the SRO and executive lead identify the need for an improvement project, a dedicated team has been identified to explore what success will look like, develop key performance indicators and milestones for achievement.

The trust is using our improvement plan as a dynamic document; where additional topics arise that require further improvement actions throughout the trust, these will be added to the plan.

Significant improvement seen in children and young peoples It has been a busy year in maternity and paediatrics. The improvements in paediatrics have been dramatic since the last CQC inspection and reflected in the rating. The service was rated as outstanding for care due to various elements but is was noted in particular how communication had improved with the parents and patients, how the staff communicated with patients and used alternative ways with those children who had additional needs.

It was also commented that our staff treated children, young people and their families with compassion and kindness, respected their privacy and dignity, and took account of their individual needs. This has been such a great boost for the paediatric service. The team have developed an advice and guidance service for GP’s to improve communication with the hospital paediatric team and GP based clinics working towards an integrated care model. In addition the trust has increased the hours of operation for the GP hotline.

The neonatal service are working towards reducing the numbers of admissions through our midwives working differently to deliver intravenous antibiotics to babies on the postnatal

7

ward which would keep mothers and babies together, promoting long term neurological and developmental outcomes as well as improved maternal mental health and wellbeing. A total of 556 babies received antibiotics in this year, and this change would reduce 2,500 hours of separation time for mother and babies. All our nurses working on the Neonatal Intensive Care Unit had completed the Bliss family and infant neurodevelopmental education course, we are one of the only units to have completed this.

Work underway to deliver improvements in maternity care Maternity have been working hard since the CQC inspection to ensure our performance against the must and should recommendations will be different at the next visit. The service has been shown to be an outlier for post-partum haemorrhage, to address this we have developed a focus group of staff in the trust working with our partners in Essex and Hertfordshire, we are benchmarking our services against others, auditing notes and reviewing our antenatal pathway to recognise those women for whom this is a risk.

Maternity has achieved all the 10 safety actions that are part of the maternity incentive scheme up to May 2021.

Better Births, the report of the national maternity review, set out a vision for maternity services in England. The heart of this vision is that the woman should have continuity of the person looking after them during their maternity journey, before, during and after the birth. Our maternity team have introduced two teams of midwives that are part of a continuity of carer process and a second team will commence this later this year. This would mean that 35% of women will have a continuity of carer by March 2021.

CQC unannounced winter assurance visit In February 2020 the CQC conducted an unannounced winter assurance visit which resulted in a Section 29a warning notice. This was given for maintaining safe record keeping and provision of a gastro intestinal bleeding out of hour’s service.

The Trust has developed an action plan to address the warning notice which has been shared with CQC. We feel assured that we are addressing the findings and have oversight of these actions through our governance structure.

Priorities for quality improvements 2020- 2021 Our seven Quality Account priorities for the next year are identified in line with the quality elements of the trust five Ps strategy: which covers our patients, our people, our performance and our places.

Our patients: 1. Aim to reduce trust mortality rate (improve Hospital Standardised Mortality RateHSMR), continue with the work already started on learning from every death.

2. Improve our performance for timeliness of treating patients requiring Emergency and Urgent Care

8

Our people 3. Our people - aim to improve nurse staffing levels by reducing vacancies Our performance 4. Quality improvement projects to transform services: Outpatient improvement programme; reduce face to face consultations through better use of technology and redesigned services. Measures of success will include improved patient experience, reduced numbers of face to face consultations and freeing up clinician time to deliver acute in-patient services.

5. Theatre transformation; aiming to ensure available operating resources (including staff) are used effectively and efficiently. Measures of success will include reduced additional operating sessions and reduced work being outsourced to other providers.

There will be evidence of reduced waiting time for necessary operations so improving patient experience.

6. Medicines optimisation; aiming to ensure that patients are involved in the decision making about their medications and that they receive the correct medications at the correct time. Measures of success will include improved patient safety, reduced waste caused by unnecessary prescribing of medications and improved patient outcomes.

Our places 7. Harlow in partnership to improve our hospitals and health infrastructure Monitoring progress on our 2020-2021 quality improvements The priorities will be monitored using our existing governance structures; this will be monitored through the trust quality and safety committee.

Statements relating to quality of care provided PAHT is a 414 bedded hospital with a full range of general acute services, including a 24/7 Accident and Emergency Department (A&E), an Intensive Care Unit (ICU), a Maternity Unit (MU) and a Level II Neonatal Intensive Care Unit (NICU).

The trust serves a core population of around 350,000 and is the natural hospital of choice for people living in West Essex and East Hertfordshire. In addition to the communities of Harlow and Epping, the trust serves the populations of Bishop’s Stortford and Saffron Walden in the North, Loughton and Waltham Abbey in the South, Great Dunmow in the East, and Hoddesdon and Broxbourne in the West. Its extended catchment incorporates a population of up to 500,000.

The trust owns the main hospital site in Harlow, and also operates outpatient and diagnostic services out of the Herts and Essex Hospital, Bishops Stortford and St Margaret’s Hospital, Epping. The operation of these facilities forms part of the longer term strategy of bringing patient services closer to where they live and making services, where appropriate, more

9

accessible and easily available to patients. The trust operates over forty different services to meet the needs of its patients (see service portfolio in table 2) Table 2: Directory of our services Ambulatory care

Dermatology

Interventional radiology

Petal counselling service

Ante-natal clinic

Diabetic medicine

Pharmacy

Anticoagulant service

Dietetics

Maternal and Foetal Assessment Unit (MAFU) Maternity

Audiology

Early Pregnancy Unit

Maxillofacial surgery Post Anaesthetic Care Unit (PACU)

Birthing unit

Emergency Department Endocrinology

Medical oncology

Pre op assessments

Neurology

Radiology

Breast screening service Breast surgery

Physiotherapy

Respiratory medicine

Cardiac cath lab

Endoscopy services New born Hearing Screening Service ENT clinics NICU

Cardiology

Fleming Ward

Obstetrics

Short stay unit

Care of the elderly clinics Chemical pathology

Frailty service Gastroenterology

Occupational therapy Speech and language therapy Ophthalmology Surgery clinics

Chemotherapy

General medicine

Oral surgery

Surgical Assessment Unit

Child death review service

General surgery

Paediatric Ambulatory Unit

Termination of pregnancy service

Clinical Decision Unit

Paediatric diabetic medicine Paediatric oncology

Theatres

Clinical haematology

Genito-Urinary Medicine Geriatric Medicine

Clinical oncology

GP Assessment Unit Paediatrics

Transfusion services

Colorectal services

Gynaecology

Trauma and orthopaedics

Colposcopy and Gynaecology hysteroscopy services Ambulatory Service Community midwifery team

Paediatric Emergency Department Palliative Care

Haematology clinics Pathology

10

Rheumatology

Therapies

Urology Vascular services

Community neonatal team Day surgery

High Dependency Unit Intensive Care Unit

Patient appliances Patient at home service

The review of services and all associated data is undertaken through the trust Governance structure. This includes a monthly patient safety group, then through to the monthly Quality and Safety Committee which reports to the trust board.

Review of each services’ performance (in table 2) within the trust is monitored through the Performance and Finance Committee with external review undertaken by both Essex and Hertfordshire commissioners at the monthly Service Performance and Quality Review Group (SPQRG).

Table 3: Statements of assurance from the board

1.

Prescribed information

Form of statement

The number of different types of relevant health services provided or subcontracted by the provider during the reporting period, as determined in accordance with the categorisation of services:

The Princess Alexandra Hospital NHS Trust (PAHT) during 2019-20 has provided a range of health services listed in the directory of services, table 2.

(a) specified under the contracts, agreements or arrangements under which those services are provided or (b) In the case of an NHS body providing services other than under a contract, agreement or arrangements, adopted by the provider.

Services are provided by the trust to local/main Clinical Commissioning Groups (CCGs) and are commissioned under standard form NHS contracts. For 2020, contracts have been put on hold due to COVID-19 pandemic and block contracts are in place until further guidance is received from NHSE/I. Non-contracted activity: beyond services that are provided to main/local CCGs the trust receives income for Non-Contracted activities also with other CCGs. This income mainly relates to activity provided to CCGs that are not within the trusts’ immediate catchment area and/or where activity does not require formal contracts to be in place.

In 2019-20 this level of activity totalled ÂŁ3.8m. In 2020/21 due to COVID-19 having an effect from

11

March 2020, PAHT received Block Contract value monies for this cohort.

Sub-contracted activity: during the year the trust subcontracted a small number of services to private or other NHS providers. Services are generally subcontracted where either short term capacity constraints arise or specialist services are required. In 2019-2020 the main services sub-contracted were Urology (day case and OPD), Endoscopy surveillance and specialist clinical tests.

Subsequently in March 2020 and due to the COVID-19 pandemic restrictions PAHT were also advised

by NHSE/I to commission Independent Sector work for some Cancer services that were appropriate.

Prescribed information 1.1 The number of relevant health services identified under entry 1 in relation to which the provider has reviewed all data available to it on the quality of care provided during the reporting period.

1.2 The percentage that the income generated by the relevant health services reviewed by the provider, as identified under entry 1.1 represents of the total income for the provider for the reporting period under all contracts, agreements and arrangements held by the provider for the provision of, or subcontracting of, relevant health services.

2 The number of national clinical audits (a) and national confidential enquiries (b) which collected data during the reporting period and which covered the relevant health services that the provider provides or subcontracts.

12

Form of statement We have reviewed all the data available to them on the quality of care provided by the services listed in table 2.

In 2019-20, 90% of the trusts’ revenue was received for patient care activities relating to the services listed in table 2.

PAHT has during 2019-20 participated in 48 national clinical audits and 4 national confidential enquiries covering relevant health services that are provided

2.1

The number, as a percentage, of national clinical audits and national confidential enquiries, identified under entry two, that the provider participated in during the reporting period.

2.2

A list of the national clinical audits and national confidential enquiries identified under entry two that the provider was eligible to participate in.

2.3

A list of the national clinical audits and national confidential enquiries, identified under entry 2.1, that the provider participated in.

2.4

A list of each national clinical audit and national confidential enquiry that the provider participated in, and which data collection was completed during the reporting period, alongside the number of cases submitted to each audit, as a percentage of the number required by the terms of the audit or enquiry.

The national clinical audits and national confidential enquiries that we have participated in, and for which data collection was completed during 2019-20, are listed alongside the number of cases submitted to each audit or enquiry as a percentage of the number of registered cases required by the terms of that audit or enquiry, tables 6 and 7.

Prescribed information

Form of statement

The number of national clinical audit reports published during the reporting period that were reviewed by the provider during the reporting period.

A description of the action the provider intends to take to improve the quality of healthcare following the review of reports identified under entry 2.5.

The number of local clinical audit (a) reports that were reviewed by the provider during the reporting period.

A description of the action the provider intends to take to improve the quality of healthcare following the review of reports identified under entry 2.7.

The reports of 18 national clinical audits were reviewed by the provider in 2019-20.

2.5

2.6

2.7

2.8

13

During that period we have participated in 98% national clinical audits and 100% of those national confidential enquiries that were relevant and which it was eligible to participate in.

The national clinical audits and national confidential enquiries that the trust was eligible to participate in during 2019-20 are detailed in tables 6 and 7.

The national clinical audits and national confidential enquiries that we have participated in during 201920 are detailed in tables 6 and 7.

The actions undertaken in the trust are detailed in table 8.

The reports of 27 local clinical audits were reviewed by the trust in 201920 See table 9 for actions.

3.

4

4.1

4.2

5.

The number of patients receiving relevant health services provided or subcontracted by the provider during the reporting period that were recruited during that period to participate in research approved by a research ethics committee within the National Research Ethics Service.

Whether or not a proportion of the provider’s income during the reporting period was conditional on achieving quality improvement and innovation goals under the Commissioning for Quality and Innovation (CQUIN) payment framework agreed between the provider and any person or body they have entered into a contract, agreement or arrangement with for the provision of relevant health services.

If a proportion of the provider’s income during the reporting period was not conditional on achieving quality improvement and innovation goals through the CQUIN payment framework, the reason for this.

If a proportion of the provider’s income during the reporting period was conditional on achieving quality improvement and innovation goals through the CQUIN payment framework, where further details of the agreed goals for the reporting period and the following 12 month period can be obtained.

Whether or not the provider is required to register with CQC under Section 10 of the Health and Social Care Act 2008.

14

The number of patients receiving relevant health services provided or subcontracted by PAHT in 2019-20 that were recruited during that period to participate in research approved by a research ethics committee 501.

A proportion of PAHT income in 2019-20 was conditional on achieving quality improvement and innovation goals agreed between NHS England – East of England Specialised Commissioning, West Essex Clinical Commissioning Group and any contract associates they entered into a contract, agreement or arrangement with for the provision of relevant health services, through the Commissioning for Quality and Innovation payment framework.

Both CCG’s and NHSE agreed due to the COVID-19 pandemic 100% achievement for 2019/20 was confirmed, and for 2020/21 CQUIN was suspended and monies were incorporated into the block contract values to support trusts due to the COVID-19 pandemic Not applicable Due to the COVID-19 pandemic CQUIN submissions for Q4 were removed and 100% achievement was advised by the CCG’s and NHSE. 2020/21 CQUIN was suspended and monies were incorporated into the block contract values to support trusts due to the COVID-19 pandemic PAHT is required to register with the Care Quality Commission.

The current registration status is “registered without condition”.

5.1

6 7.

7.1

If the provider is required to register with CQC: (a) whether at end of the reporting period the provider is: (i) registered with CQC with no conditions attached to registration (ii) registered with CQC with conditions attached to registration (c) If the provider’s registration with CQC is subject to conditions, what those conditions are and whether CQC has taken enforcement action against the provider during the reporting period.

(c)The Care Quality Commission issued a Section 29 Warning notice against the trust during 2019-20.

A robust action plan has been completed and all actions delivered within required timeframes within the trust.

One action is outstanding and requires a service level agreement to be completed and signed by trust partners.

Removed from the legislation by the 2011 amendments Whether or not the provider has taken part in any special reviews or investigations by CQC under Section 48 of the Health and Social Care Act 2008 during the reporting period.

If the provider has participated in a special review or investigation by CQC: (a) the subject matter of any review or investigation (b) the conclusions or requirements reported by CQC following any review or investigation (c) the action the provider intends to take to address the conclusions or requirements reported by CQC and (d) any progress the provider has made in taking the action identified under paragraph (e) prior to the end of the reporting period.

15

PAHT has not participated in any special reviews or investigations by the CQC during the reporting period.

Prescribed information

Comment

8.

Whether or not during the reporting period the provider submitted records to the secondary uses service for inclusion in the hospital episode statistics which are included in the latest version of those statistics published prior to publication of the relevant document by the provider.

8.1

If the provider submitted records to the Secondary Uses Service for inclusion in the Hospital Episode Statistics which are included in the latest published data: (a) the percentage of records relating to admitted patient care which include the patient’s: (i) valid NHS number (ii) General Medical Practice Code (b) the percentage of records relating to outpatient care which included the patient’s: (i) valid NHS number (ii) General Medical Practice Code (c) the percentage of records relating to accident and emergency care which included the patient’s:

PAHT submitted records during 2019-20 to the secondary uses service for inclusion in the hospital episode statistics which are included in the latest published data.

The percentage of records in the published data which included the patient’s valid NHS number was: 99.7% for admitted patient care 99.9% for outpatient care and 98.6% for accident and emergency care.

This included the patient’s valid General Medical Practice Code was: 99.8% for admitted patient care; 99.7% for outpatient care; and 99.4% for accident and emergency care.

9

The provider’s Information Governance Assessment Report overall score for the reporting period as per the Data Security Protection Toolkit (DSPT) grading criteria.

PAHT Information Governance Assessment Report via the DSPT overall score for 2019-20 was standards met.

10

Whether or not the provider was subject to the Payment by Results clinical coding audit at any time during the reporting period by the Audit Commission.5

PAHT was not subject to the Payment by Results clinical coding audit during 2019-20 by the audit commission.

However an internal Clinical Coding IG audit was undertaken by an NHS Digital qualified Clinical Coding Auditor.

16

10.1 If the provider was subject to the payment by results clinical coding audit by the audit commission at any time during the reporting period, the error rates, as percentages, for clinical diagnosis coding and clinical treatment coding reported by the Audit Commission in any audit published in relation to the provider for the reporting period prior to publication of the relevant document by the provider.

11

Primary diagnosis Secondary diagnosis Primary procedure Secondary procedure

% error rate 21% 16.8% 9.2% 13.6%

Prescribed information

Comment

The action taken by the provider to improve data quality.

PAHT will be taking the following actions to improve data quality:a) a full suite of data quality reports produced daily/weekly and circulated to operational teams for resolution of key issues b) data quality issues are monitored and addressed through the trust data quality group c) data quality updates are provided to the Performance and Finance Committee, Information Governance Steering group and Access Board. d) respond in full to externally reported data quality issues from NHS Digital and our commissioners.

The NHS Digital Data Quality Maturity Index score is 99.2% for June; the national average 80.4% e) conducts full user training and refresher training to support the capture and recording of good quality data, operational processes are reviewed and aligned to system functionality. Furthermore, system user training guides are regularly reviewed and updated f) Complies with the data quality standards within the Data Security and Protection Toolkit. g) Specialist clinical coding workshops to develop coders knowledge

17

Prescribed information

Comment

12. (a) The value and banding of the summary hospital-level mortality indicator (‘SHMI’) for the trust for the reporting period; and (b) The percentage of patient deaths with palliative care coded at either diagnosis or specialty level for the trust for the reporting period.

13.

14.

15.

16.

17.

18.

Mental health trusts Ambulance trusts Ambulance trusts Ambulance trusts Mental health trusts The trust’s patient reported outcome measures scores for: (i) groin hernia surgery (ii) varicose vein surgery (iii) hip replacement surgery and (iv) knee replacement surgery during the reporting period.

19. The percentage of patients aged: (i) 0 to 14 and (ii) 15 or over Re admitted to a hospital which forms part of the trust within 28 days of being discharged from a hospital which forms part of the trust during the reporting period.

18

h) Undertaking coding audits across a variety of specialities i) Education programme for clinical colleagues to raise awareness of coding and its impacts on data quality a) SHIMI banding 109.56 ‘as expected’ range for period Jan 19 Dec 19 (the latest data available) b) Palliative care coding was 3.30% at either diagnosis or speciality level.

This is an improvement on previous years, this continues to be slightly behind the national and peer group rates.

N/A

PAH EQ5D Index Hip Replacement: 90.91% Knee Replacement: 100% EQ-VAS Hip Replacement: 80.95% Knee Replacement: 88.89% National EQ5D Index Hip Replacement: 91.40% Knee Replacement: 84.32% EQ-VAS Hip Replacement: 70.58% Knee Replacement: 60.96% It has been acknowledged that an error was made in the drafting of the regulations and that the split of patients for this indicator should be (i) % of 0 to 15 years readmitted was 6.7% (ii) 16 years and over readmission rate was 10.1% The regulations refer to 28-day readmissions rather than 30.

20. The trust’s responsiveness to the personal needs of its patients during the reporting period.

PALS responded to 640 more cases in 2019-20 than in 2018-19.

The patient advice and liaison service is our first contact and point of care resolution service and in total responded to 3467 cases vs 2827 in the previous year (a 22% increase in activity).

21. The percentage of staff employed by, or Quarter 1 2019/20: 75% under contract to, the trust during the Quarter 2 2019/20: 78% reporting period who would recommend the Quarter 3 2019/20: Questions asked trust as a provider of care to their family or differently so cannot use for friends. meaningful comparison Quarter 4 2019/20: 75% 21.1 Friends and Family Test – Patient. The data Not part of the quality accounts made available by National Health Service regulations Trust or NHS Foundation Trust by NHS Digital for all acute providers of adult NHS funded care, covering services for inpatients and patients discharged from Accident and Emergency (types 1 and 2) Please note: there is a not a statutory requirement to include this indicator in the quality accounts reporting but provider organisations should consider doing so.

23. The percentage of patients who were Data for period April 2019-Decembr admitted to hospital and who were risk 2019 shows assessed for venous thromboembolism PAHT: 98.28% during the reporting period.

National:95.47% Data for Q4 is not available as trust moved to a new server and the programme was being rewritten 24. The rate per 100,000 bed days of cases of C.difficile infection reported within the trust amongst patients aged 2 or over during the reporting period.

19

23 cases of Clostridium Difficile reported to the national surveillance database for April 2019-March 2020 9 cases were attributable to PAHT (14 cases were successfully appealed) Rate per 100,000 bed days as published by Public Health England is 10.71

25. The number and, where available, rate of patient safety incidents reported within the trust during the reporting period, and the number and percentage of such patient safety incidents that resulted in severe harm or death.

April 2019 - March 2020 Total number of incidents = 7328 Severe harm incidents: Total of 29, (0.35%) Death incidents: Total of 8 (0.1%) National Reporting and Learning System (NRLS) shows for the period 1 April to 20 September 2019, trust severe and death incidents is below 1%, which is the national average.

Due to the COVID-19 outbreak, NRLS have not yet released the data for the last half of the year 1 October 2019 to 31 March 2020.

26

Statement on seven day hospital services as a trust we are working towards implementation of seven day services.

Our assessment of the current position against the clinical standards for a seven day service is:  Time to first consultant review – Standard not achieved.  Access to diagnostics – Standard achieved consistently.  Access to consultant directed interventions - Overall the standard not achieved.

This is because the trust is non-compliant for interventional radiology and interventional endoscopy at the weekends only. The trust is in discussion with our partners to scope potential solutions, and is representative of the national picture for these areas. 

20

Ongoing consultant directed reviews o Twice daily reviews led by consultants consistently achieved

o Once daily review standard is not consistently achieved The trust has implemented hospital at night during the spring and autumn of 2019 Prescribed information 27.1 The number of its patients who have died during the reporting period, including a quarterly breakdown of the annual figure.

Form of statement From 1 April 2019 to 31 March 2020, 1,325 of Princess Alexandra Hospital Trust patients died.

This comprised the following number of deaths each quarter: Quarter 1: 321 Quarter 2: 283 Quarter 3: 329 Quarter 4: 392

27.2 The number of deaths included in item 27.1 By March 2020, 191 case record which the provider has subjected to a case reviews and 18 serious incident record review or an investigation to determine investigations were completed in what problems (if any) there were in the care relation to 1,325 deaths (item 27.1) provided to the patient, including a quarterly In one case a death was subjected to breakdown of the annual figure. both a case record review and an investigation.

The number of deaths in each quarter for which a case record review or a serious investigation was carried out was: Quarter 1: 0 case record reviews 3 serious incident investigations Quarter 2: 0 case record reviews 6 serious incident investigations Quarter 3: 65 case record reviews 5 serious incident investigations Quarter 4: 98 case record reviews 14 serious incident investigations The case record review process commenced mid November 2019 therefore no case record reviews were undertaken in the first two quarters.

21

27.3 An estimate of the number of deaths during the reporting period included in item 27.2 for which a case record review or investigation has been carried out which the provider judges as a result of the review or investigation were more likely than not to have been due to problems in the care provided to the patient (including a quarterly breakdown), with an explanation of the methods used to assess this.

10 cases [0.75%] of the patient deaths during the reporting period are judged to be more likely than not to have been due to problems in the care provided to the patient.

In relation to each quarter, this consisted of: Quarter 1: 1 - SI [0.3%] Quarter 2: 5 – SI [1.77%] Quarter 3: 4 – 1 SJR and 3 SI [1.2%] Case record reviews commenced midNovember Quarter 4: 0 [0%] Cases referred for a Structured Judgment Review (case record review) has data captured on an electronic system called Clarity. All of these cases are rated with an avoidability rating of:Score 1: Definitely avoidable Score 2: Strong evidence of avoidability Score 3: probably avoidable (more then 50:50) Score 4: Possibly avoidable, (less than 50:50) Score 5: Slight evidence of avoidability Score 6: No evidence of avoidability For cases that receive a score of 1 or 2, all of these cases are referred for: - a review by the trusts learning from deaths panel - logged on Datix as an incident and will be - reviewed by the trusts Incident Management Group

22

Prescribed information

Form of statement

27.4 A summary of what the provider has learnt from case record reviews and investigations conducted in relation to the deaths identified in item 27.3.

Learning identified from completed case record reviews includes: - Antibiotic prescribing not always compliant with trust recommendations.

- Some patients have delays in the commencement of end of life care.

- Development of pressure sores within our frailer patient group whilst in hospital.

- Delays in referral and review from speciality team input - improvements required to the standard of record keeping - Process issues leading to delays in communication - Trust has improved compliance with the Sepsis 6 bundle of care.

27.5 A description of the actions which the - Development of Harm Free Care provider has taken in the reporting period, improvement plan and strategy and proposes to take following the reporting development period, in consequence of what the provider - Sepsis 6 bundle audit undertaken has learnt during the reporting period (see monthly. item 27.4).

- A sepsis 6 Consultant champion in place in the Emergency Department.

- End of life training provided for Doctors at ward level.

- Antibiotic mobile phone app introduced to improve accurate usage.

- Audit of Healthcare records in Emergency Department to identify residual risk and further inform improvement work, commenced February 2020 and restarted July 2020 - Specialty Assessment Tool for completion for unplanned admissions - Redesign of fluid balance charts to ensure they were simple and easier to use - Support the development and roll-out of fluid prescribing on our electronic prescriptions (EPMA) - Improving medical handover in all adult in-patient areas using Nervecentre functionality

23

- Further development of the Treatment Escalation Plan (TEP) form and roll out for all adult in-patients, commenced using it in this year.

27.6 An assessment of the impact of the actions described in item 27.5 which were taken by the provider during the reporting period.

The Sepsis 6 bundle audit has shown an increase in compliance.

During March 2020 as a result of COVID-19 the trust: -job roles changed for doctors who were their areas mortality leads, and redeployed staff completed structured judgement reviews.

-There has been a restructure and review of the mortality process to include new appointments and a redesign of the governance process.

This will assist with our ongoing projects in order to improve service delivery.

-Emergency department was separated into a Covid-19 area and non-COVID-19 area 27.7 The number of case record reviews or 1 case record review and 10 serious investigations finished in this reporting period incident investigations were which related to deaths during the previous completed after 1/4/2020 which reporting period but were not included in item related to deaths which took place 27.2 in the relevant document for that before the start of this reporting previous reporting period 2018/19. period.

27.8 An estimate of the number of deaths included 4 representing [0.3%] of the 1195 in item 27.7 which the provider judges as a deaths detailed in point 27.1 of the result of the review or investigation were quality account for 2018/9 period, are more likely than not to have been due to judged to be more likely than not to be problems in the care provided to the patient, been due to problems in care provided with an explanation of the methods used to to the patient. This number has been assess this. estimated using the case record review and serious incident investigations 27.9 A revised estimate of the number of deaths 18 deaths representing [1.5%] of the during the previous reporting period stated in 1195 deaths noted in point 27.1 of the item 27.3 of the relevant document for that Quality Account in 2018/9, and 27.8 previous reporting period, taking account of of this quality account are judged to the deaths referred to in item 27.8. be more likely than not to have been due to problems in the care provided to patients .

24

28

29

In response to the Gosport Independent We offer staff the following main Panel Report provide details of ways in which routes to raise concerns: staff can speak up (including how feedback is Freedom to Speak Up Guardians; given to those who speak up). How we various HR policies including ensure staff speak up do not suffer detriment. whistleblowing, Dignity at Work and This disclosure should explain the different Grievance Procedure. ways in which staff can speak up if they have Concerns raised through Freedom to concerns over quality of care, patient safety Speak Up Guardians are treated or bullying and harassment. entirely confidentially. Agreement is sought with the individual about how best to escalate their concern, usually through the relevant senior manager with a request for response/action plan to be agreed, with an aim to improve the associated situation whatever the nature of the concern.

Annual staff survey and quarterly staff friends and family test survey identify key themes and trust-wide and healthcare group level action plans are developed to respond to these key themes. Full action plans are developed, monitored and reviewed on an annual basis.

Following the terms and conditions of service The trust did not complete an annual for NHS Doctors and Dentists in Training report in 2019/20. We have a plan to (England) 2016 requires a consolidated complete a report for 2020/21. annual report on rota gaps and the plans to reduce rota gaps.

The trust has rota gaps for middle grades in some specialities. This is Within the Quality Account these gaps shall due to a shortfall in Health Education be included in a statement England trainees as well as vacancies in non-training posts.

This is a national problem; the Trust is mitigating this by:  Prioritising acute and on call cover  Daily review of on call cover  Active recruitment programme for middle grade doctors including overseas recruitment  Implementing retention measures e.g. CESR programme  Recruiting FY3 and extending roles from other clinical staff groups e.g. advance nurse practitioners

25

  

Smarter electronic roster planning Improved ratio of doctors employed via NHSP bank rather than from agencies Increased use of locum short term contracts rather than ad hoc cover

Priorities we set for completion in 2019/20 1. Our patients To reduce mortality, improve HSMR and improve our patients’ experience .

Aim: To have a normal Hospital Standardised Mortality Ratio (HSMR) with no outlier alerts by 2021 Outcome: objective: work is ongoing Mortality improvement (improving patient outcomes) The trust is a national outlier as it has a significantly high Hospital Standardised Mortality Ratio (HSMR). Programmes of work are well established and quality improvement methodology is embedded into practice and approach.

To inform the improving patient outcomes programme for 2020/21, several workshops have been planned for February and March 2020 with the Triumvirate, project leads and other stakeholders to review what has been achieved to date, what is outstanding and needs to be progressed and what we can learn from the past year to influence quality improvements going forward.

Planned measurable outcome(s): Graph 1: Below shows trust mortality rates (Hospital Standardised Mortality Rate – sourced Dr. Foster) over time for PAHT from September 2017 to September 2019. If we have two more months (data points) below the mean we will have achieved ‘special cause – improvement’.

26

For the months of May 2019 through to September, PAHT were no longer recorded as outlying for trust mortality rates (i.e. as expected), which is a good indication that the quality im provement work is beginning to make the required impact; however for the previous twelve months (as a rolling average) we remain an outlier (120.6 HSMR for the period Oct 2018 – September 2019). This stresses the importance of a long term plan and why there is a need for the PAHT’s quality improvement strategy (2019-2022).

Our patients Aim: Reduce length of stay by 10% for non-elective patients to support the flow of patients in, through and out of the hospital by April 2020.

Outcome: not achieved Our average monthly reduction for our non-elective length of stay was 5%.

Nine out of twelve months saw a reduction in length of stay with December, January and March seeing an increase.

March saw the biggest increase in length of stay, largely as a result of the COVID-19 pandemic.

Our patients Aim: Improve by 10% the numbers of patients that are dying in their preferred place of death (as expressed at time of imminent death) by April 2020 Outcome: not achieved Progress has been made over the year but our aspirational goal was not achieved.

The key reason for non-achievement is as a result of a rapidly changing clinical condition of patients towards the end of their life and the constraints in the timeliness of arranging hospice places and packages of care to enable a safe discharge.

In West Essex this has improved to 70.1% from 68% in 2018/9 East and North Herts patients have an average of 61%, having decreased from 62% in 2018/19.

27

Our patients Aim: Reduction of 10% in the number of formal complaints received from 205 to 185.

Outcome: achieved - the trust received 35 fewer complaints going from 205 last year to 175 (trajectory) this year a reduction of 17%.

Aim: Acknowledge 100% of complaints within 3 working days Outcome: achieved: 100% of complaints in 2019-20 were acknowledged within 3 working days.

Our patients Aim: Increase by 10% the numbers of successfully resolved PALs concerns from 2827 to 3109 by April 2020.

Outcome: achieved: An increase of 27% The patient advice and liaison service (PALS) received 730 more enquiries (total 3421) by promoting the service online, through social media, communications channels and a greater presence around the hospital site.

2. Our places Improve our clinical areas and critical functions Our places Aim: Work with our partners to complete a pre consultation business case for the preferred way forward for a new hospital by the end of September 2019 Outcome: achieved: Our pre-consultation business case was completed and submitted to NHS England and Improvement in September 2019. The business case provided evidence to support a new hospital build on a green field site in Harlow as our preferred way forward Our places Aim: Run a public consultation on the new hospital following the completion of the pre-consultation business case Outcome: achieved Following our submission of the Pre-Consultation Business Case, the trust is developing our Public Engagement Plan to take forward as part of our New Hospital Development Programme.

This public engagement plan will ensure our communities, staff and patients have access to up to date information and decisions throughout the programme.

Our places Aim: Complete a strategic outline business case for a new hospital by March 2020 Outcome: achieved: Following on from the Government announcement in October 2019 that The Princess Alexandra Hospital NHS Trust is one of the first six hospitals to be allocated improvement monies, we are now working towards completing our Outline Business Case (OBC) for December

28

2020.

This OBC will detail the options we have available to us and the cost assumptions, benefits and risks for each option.

3. Our people To improve nursing staffing and our staffs culture and well being Our people Aim: Introduce a talent management programme and newly appointed consultant development programme by January 2020.

Outcome: achieved Cohort 1 of the talent management programme (direct reports to executive team) has been completed, with evaluation and train the trainer development still to be arranged. As part of this, the current appraisal paperwork and approach will be reviewed to bring in line with agreed talent management process/principles going forward in 2020/21.

A bespoke programme developed jointly by the trust and NHS Elect to support and develop all newly appointed medical consultants to be the clinical leaders we expect, and help to ensure they take accountability for their actions and lead on culture change has commenced. The first day ran in February 2020 and was very well received by the 18 attendees. A further three days at three monthly intervals is to be finalised during 2020/21.

Our people Aim: Continue to improve staff survey results of experience being consistent with the trust’s four values by April 2020.

Outcome achieved: The response rate for 2019 was 45%, a 5% improvement on 2018.

PAHT’s most improved areas from the previous survey included: not working additional unpaid hours, reporting harassment/bullying/abuse, doing my job to a standard I am pleased with, satisfied with quality of care given and being able to provide the care I aspire to.

Our people Aim: Significantly reduce the registered nurse vacancy rate to between 10-15% by April 2020.

Outcome achieved: The trust finished 2019/20 having exceeded the target. The nursing vacancy rate was 8% with the band 5 vacancy rate of 4.3%.

Due to COVID-19 any significant recruitment activity is on hold and staff are choosing not to leave or transfer employment at this time.

There is a healthy recruitment pipeline of 80 overseas nurses waiting to start work in the trust and the domestic recruitment remains positive.

We anticipate maintaining and further reducing the vacancy rates during 2020/21 to less than 2% Our people Aim: Introduce unconscious bias training to raise awareness of equality and inclusion issues in attracting, recruiting and retaining our people by January 2020.

29

Outcome achieved: ‘Am I a Bully? Unwrapping Unconscious Bias & Bullying at PAHT’ workshops for 2019/20 were delivered to 319 trust managers of all levels (full days = 74 and half days = 245).

Proposals are under development for continuing into 2020/21.

Our people Aim: Implement a new extranet website for our people by April 2020.

Outcome not achieved: Our plans for a new Extranet where delayed by the impact of COVID-19 on our time resource and remain in place for a new site for our people to be in place by summer 2021.

Our people Aim: Implement a new trust website by October 2020.

Outcome achieved: New website went live March 2020.

4. Our performance Aim to improve our performance against the national standards Our performance Aim: Improve the numbers of patients that receive timely treatment in the Emergency Department (ED) and improve performance to 90% by March 2020 Outcome: not achieved The trust has continued to work on improving the time taken to receive treatment in Urgent Care and assesses progress through the Urgent Care Board with both clinical and operational staff. The implementation of the Emergency Department (ED) Internal Professional Standards, setting target times for each part of the ED pathway has been a useful tool to drive change.

30

Table 5 details the trust emergency performance in year.

The use of the Urgent Treatment Centre, same day emergency care service, the Frailty Unit and the Surgical Assessment Unit has ensured that more patients received timely urgent care in 2019/20 and during COVID-19 the rapid set-up of a Respiratory Emergency Department ensured both COVID-19/ non-COVID-19 patients received appropriate timely care.

We have continued to struggle to meet the four hour standard, with a year-end performance of 80% however since December 2019, there has been a consistent improvement in performance every month.

We have continued to have workforce challenges and a consistently high bed occupancy level so that moving admitted patients from the Emergency Department to inpatient wards has often been slower than is required. During this year there has been an increase of nearly 6% in attendances up to COVID-19 in February/March when compared with same period last year.

Ongoing work has reduced our length of stay to reduce bed occupancy and the ED internal professional standards have created improvements in the internal and external delays. The development of the Adult Assessment Unit incorporating frailty, surgical and medical emergencies will further assist in the improvement of ED performance standards in 20/21.

Our performance Aim: Achieve all key access standards, including RTT (referral to treatment) and cancer wait times Outcome: diagnostics - partially achieved The trust has performed well against this target this year and achieved the 99% target for 10 out of the 12 months. In December 2019 a one-off administrative error caused a very small dip in

31

performance and then in March 2020 COVID-19 created a more significant reduction in performance as routine diagnostics were paused.

Outcome: Cancer 62 Day Standard – partially achieved The trust has had a mixed year with regards to this standard. We did not achieve the target for the first five months of the year with an average performance of 78%. Some focused Demand and Capacity work with the tumour site specialties enabled the trust to achieve the 62 day standard for four subsequent months however the impact of the festive season catch-up in January and then COVID-19 has meant that the national performance has been missed. The trust performance has remained higher than national average performance during 19/20 and the tumour site teams are working collaboratively to ensure that we recover our performance and ensure that patients receive timely cancer care.

32

Outcome: The two week wait standard - partially achieved This standard has also been a challenge for PAH with dermatology waits in summer 2019 significantly impacting the overall trust performance, due to a combination of season increases in referrals and unexpected medical staffing shortages. Recovery of the standard was in place by February.

The trust was also shadow reporting the anticipated new cancer standard, 28 day diagnosis and consistently achieved an average of 65%. Further pathway work was in progress at the end of 2019/20 to improve the time between referral and diagnosis/treatment and it will continue into 20/21 to assist in ensuring the COVID-19 recovery is as quick as possible.

Outcome: Referral To Treatment (RTT) - partially achieved The trust has had a mixed year with regards to this standard but has continually been approximately 5-6% above the national performance for this standard. The start of the year saw the trust deliver the 92% incomplete performance target for the first 5 months of the year however prioritising capacity for cancer patients adversely affected the RTT performance.

33

Our performance Aim: Commence the redesign of outpatient services (OPD), to modernise services in primary and secondary care. This is work planned to be within the trust transformation programme. The project for outpatients including the KPIs will be set through this process.

Outcome achieved: In July 2019, a system workshop was held with multi-disciplinary input from both the trust, West Essex CCG and Stellar healthcare. The process through outpatients was mapped and the ideal future state identified.

A three year programme of work was established and programme leads identified. The project documentation was completed and the impact assessments signed off. The governance structure was established along with programme measures. The outpatient quality improvement programme aims to transform the way we deliver outpatient services and is being delivered system wide to establish a patient centred service that is more efficiently, effectively and seamlessly coordinated.

The impact of COVID-19 dramatically increased this transformation programme and within 2 weeks in March all out-patient appointments were being delivered virtually, first by telephone and later by Attend Anywhere, a nationally procured video consultation software.

This has created significant efficiencies for example the Did Not Attend rate has dropped from an average of 5.5% to 2.5% in early 20/21 and we have been able to book more follow-up appointments for patients who have waited longer than advised. COVID-19 restrictions in elective operating allowed clinicians to hold more out-patient clinics in March and early 20/21 and the virtual delivery of the clinics helped to maintain activity alongside social distancing and isolation requirements.

34

Our patients Patient experience and engagement - learning from feedback and actions taken Highlights from 2019-20 The trust achieved the goals set for the year; increasing PALS activity and simultaneously reducing the number of complaints received. There was a 27% increase in PALS activity and a 17% decrease in complaints.

Our third goal, to acknowledge 100% of complaints within 3 working days was also achieved.

Section 18 report Every year, the trust must make a statement under the NHS Health and Social Care Act (2009) about how many complaints it received, their subject, the issue they raise, whether or not they were well founded and any actions taken.

Complaints received The trust received 175 (trajectory) complaints in 2019-20 Subjects of complaints The most frequently occurring themes were  Medical care expectations (59),  Communication (42),  Delay (22).  Nursing (19) Actions to address the themes from complaints are taken over the year and demonstrate a clear connection from the concern raised to the change the organisation has made. The following case studies illustrate the approach to learning.

Case study one: A patient complained about being removed from a waiting list after she had cancelled several operation dates. The patient also raised concerns about the attitude and behaviour of the surgeon and booker.

An investigation revealed that the patient has mental health issues and cancellations by the patient were due to her anxiety. The patient was invited to meet with the safety and quality team and her anxieties and support needs were discussed.

The patient was subsequently offered her operation under a different consultant and supported through her admission process. This included an anaesthetic review where her specific needs were discussed and a plan formulated which included somebody accompanying her in the anaesthetic room on the day of surgery and also being with her in the recovery room following her operation.

35

As a result of the complaint a new standard operating procedure has been developed for use for all patients with mental health issues.

Case study two The daughter of patient who died was concerned that her father had received too much medication which had adverse effects. She was also concerned and confused that the patient had been expecting an aortic valve replacement but three days prior to the planned operation, family were told that the operation would not be going ahead.

Part of the investigation identified the need for the patient’s treatment plans to be reviewed by the mortality and morbidity Group, who meet to review all deaths, scrutinise the care and treatment provided, identify any gaps and take learning for improvement.

The mortality and morbidity Group panel concluded that the patient was receiving the correct medications; however the patient’s heart failure proved difficult to manage. The panel were able to confirm that this situation is common in patients with a diagnosis of aortic stenosis. There were no medical treatment problems identified from the panel review.

The value of this independent assessment was to give a fresh perspective, thereby providing some assurance that the service had not provided a poor service.

Case study three The daughter of a patient raised issues involving medical and surgical wards as well as discharge issues. She felt that several failed discharges and multiple infections had stopped her mum from being fit enough to undergo surgery.

A review by a consultant doctor and the safety team confirmed that the treatment of intravenous antibiotics followed by oral antibiotics was appropriate. On each of the patient’s admissions to hospital, the doctors discussed her treatment and followed advice given by the microbiology team. Sadly although the appropriate decisions were made with regard to the patient’s care and treatment, as the cancer was so aggressive, there was unfortunately no further treatment available. The investigation allowed the daughter of the patient to see the fuller context of her mother’s care and treatment.

This provides a brief overview; investigations are not always successful at answering the questions and concerns raised by patients, families or carers, but we hope that these examples give some sense of the work which takes place, led by our clinical investigators across the organisation.

Our Patient Panel 2019/20 has been a very productive yet challenging year for our Patient Panel. They have successfully initiated and supported the creation of 16 user groups and this has involved many patients, who attended the “Away Day” to plan the 10-year strategy. Our Patient Panel are providing mutual development and support to the members of the user groups.

The Trust complaints group has examined its terms of reference (aims and objectives) and developed a rigorous and consistent approach to the oversight of complaints. This process

36

aims to monitor the quality and effectiveness of responses that service users receive and this is included in the trust complaints policy.

The patient panel continues to support the bereavement team and the new medical examiners by conducting telephone bereavement surveys several times a year. The data collected is analysed and used to highlight where improvements can be made by the bereavement team.

Patient Panel representatives continue to participate in health care group strategy meetings; this work supports and informs the developing policies for the new hospital.

This year the Patient Panel presented their work to the hospital consultants at the trust Medical Advisory Committee. This included the results of recent consultant surveys and dialogue suggested a more collaborative approach between patient and consultant will be of mutual benefit.

Achievements Our Patient Panel was instrumental in setting up a support network across the Eastern region for chairs and vice chairs of other organisations panels. To date, there have been two meetings; the inaugural meeting taking place in Harlow with the second meeting in February 2020 at Ipswich hospital. The next meeting is scheduled to take place in June 2020 at Norfolk and Norwich hospital.

Early indications are that the meetings will be beneficial in supporting the sharing of best practice in the various localities. Plans are underway for the group to present at 2021 NHS Expo.

During this year our Patient Panel were short listed for two prestigious awards and in a formal assessment before Christmas 2019 they showed the work completed. Following this our panel chair and vice chair attended a reception to congratulate the 27 top charity and voluntary organisations shortlisted for the Queen’s Award for Voluntary Services (QAVS).

In June 2020, we are delighted to say that our Patient Panel were successful and awarded The Queens Award for Voluntary Services. This equates to an MBE for Voluntary groups.

The award will be presented in February 2021.

In March the chair and vice chair attended a national conference to celebrate best practice in the category of the national patient cancer survey. The Patient Panel entry was the Patient Led Conference on Cancer Services.

The patient panel recognised that for a number of long-term patients’ loneliness and boredom may hinder their recovery. In July 2019 the Patient Panel organised an informal afternoon tea for patients and visitors. Thanks to the generosity of local businesses, the U3A, volunteers from the patient panel and a local Ukulele band, the afternoon was

37

extremely successful and was appreciated by patients. A similar event was planned for July 2020.

The Patient Panel is continually growing and developing, providing a voice for our patients and service users. Moving forward, they will be actively participating in the development of the new hospital.

Image: afternoon tea for patients and their visitors July 2019 (image taken before COVID-19).

Improving care for vulnerable patients - delirium and dementia We have made good progress on our goal to deliver the very best possible care for our patients with dementia, in line with National policy. The trust has in place an integrated Dementia Strategy which identifies goals and actions and is monitored through our Dementia and Delirium Steering Group.

We participated in the National Audit of Dementia care in general hospitals, Royal College of Psychiatrists, (2019) and the recommendations now form part of our strategy document.

Music therapy In 2019 we undertook a project to introduce singing for the brain into the hospital setting.

The aims were to reduce the social isolation that patients often experience during a stay in hospital, to improve well-being and mobility. Music therapy is known to play a crucial role in the care of many people with or without dementia, helping to minimise apathy, anxiety, restlessness and depression.

Following the successful pilot, we now provide a weekly music therapy session which his facilitated by the Clinical Nurse Specialist for Dementia and volunteers. In the next 12 months our plan is to take the music therapy sessions to other ward areas across the hospital.

38

The output form the successful project is being presented at a national nursing conference and has been submitted to the Nursing Times publication.

Feedback from family members and carers has been very positive with patients participating and talking about the experience for many days afterwards.

Delirium work Delirium (sometimes called ‘acute confusional state’) is a common clinical syndrome characterised by disturbed consciousness, cognitive function or perception, which has an acute onset and fluctuating course (NICE 2010). Older people admitted to hospital with infections are vulnerable to developing delirium, this can be very frightening for them and their loved ones. To support our staff in the care of patients presenting or developing delirium in hospital, we now have clearly described treatment pathways and guidelines. We also have a leaflet designed to be given to patients and their families or carers.

Training To support our patients, we have introduced mandatory training on delirium as well as creating a simulation training which has received excellent evaluation. The National Audit of Dementia care (2019) identified an improvement in the screening of our patients for delirium.

The training complements the dementia training that already exists for staff and we are proud that our Virtual Dementia Tour which enables staff to experience what it may be like to have dementia, and learn how to work with people living with dementia.

Dementia sensory garden In June 2019, we held our first summer fete in the Gibberd ward garden; this was a great success, enjoyed by patients, families and carers. We are delighted that a local company (Countryside properties) are funding the development of a sensory garden for our patients and their families. This work has been on hold over the pandemic period, but will include dementia friendly pathways, handrails and raised flower beds.

Working with our patients and their carers We have introduced a weekly carers group and have revised the carer’s card which allows extended visiting time to meet the needs of vulnerable patients and their loved ones. There are more than 63 dementia and delirium champions in the organisation. Their role is to lead by example and share best practice in the workplace.

Infection prevention and control The trust has robust infection prevention and control (IP&C) measures in place that are part of a safety culture that helps control healthcare associated infections (HCAIs). This year PAHT has continued to maintain excellent control of HCAIs and antimicrobial resis tance (AMR). Commitment by clinical and management staff to work together and maintain the ‘board to ward’ model supported by audit and feedback, helped to provide a safe environment for our patients.

The trust remains in a favourable position nationally for various alert organisms. For trust apportioned Methicillin sensitive Staphylococcus aureus bacteraemia (MSSA) control we are amongst the best in England. We continue to do well with Clostridium difficile (C difficile)

39

management. NHS England requested our control plan for gram negative bacteraemia as we are a trust that has shown significant improvement compared to previous years.

An unexpected threat in the form of the respiratory virus; COVID-19 brought new challenges to the trust from the end of January 2020. The virus tested every aspect of infection prevention and control. Dealing with the pandemic has given us a new perspective on organisational IP&C, and shown the trust to be versatile and responsive.

MRSA bacteraemia During 2019-20, there were two cases of trust apportioned cases of MRSA bacteraemia and two cases of non-trust apportioned MRSA bacteraemia. Although numbers are small, these are higher case numbers than in previous years and the IP&C team worked with colleagues in our local CCGs, to address any learning in relation to these cases.

Clostridium difficile The trust was set a challenging trajectory of 27 cases for 2019-20 combining for the first time hospital associated cases and community cases where the patient had been in hospital during the preceding month. This target reflects our excellent C difficile numbers in previous years, as the target is based on previous case numbers. We have coped well with this target, ending the year below the trajectory, with 23 cases in total.

Methicillin Sensitive Staphylococcus Aureus (MSSA) bacteraemia The trust remains in an excellent position as one of the top performing NHS organisations in the country in terms of low MSSA blood infections (bacteraemia). This was noted by the CQC inspectors on their last visit to the trust. This year there have been six trust apportioned cases. This is a reduction from eight trust apportioned cases last year. Nontrust apportioned cases are the usual source of MSSA bacteraemia and we had 36 patients who presented to our Emergency Department with this infection.

Aggressive treatment of all MSSA bacteraemia is undertaken to reduce mortality associated with this infection.

Escherichia Coli (E.coli) and Gram Negative Blood Stream Infections (GNBSIs) In April 2017, a new national target to halve healthcare associated GNBSI by 2021 was introduced. Initially, the focus was on reducing healthcare associated E. coli BSIs because they represent 55% of all gram-negative BSIs. Now attention is also being given to other GNBSIs. Numbers of trust-apportioned E.coli cases remain low this year and the trust is in a favourable position when compared with other hospitals nationally. During 2019-20 we had a total of 163 cases; of these 150 were found to have an E. coli bacteraemia on admission and the remaining 13 cases were considered to have been hospital associated.

Klebsiella sp. blood stream infections (classified as GNBSIs) During 2019-20 we had a total of 41 cases. Of these 38 were found to have a bacteraemia on admission and the remaining three cases were hospital associated. We have achieved a significant reduction in our hospital associated cases from eight cases last year to three cases.

40

Pseudomonas aeruginosa blood stream infections (also classified as GNBSIs) During 2019-20 we had a total of 22 cases. Of these, 19 had a bacteraemia on admission and three cases were hospital associated. Our hospital associated cases remain under control largely due to control of Catheter associated UTI (CaUTI) as pseudomonas aeruginosa is an organism often associated with catheters. The team managing the trust catheter pathway have worked hard to control of this infection.

Outbreaks and incidents Norovirus Five norovirus outbreaks occurred in the trust in 2019-20. Isolated incidents occurred in April, October, two outbreaks occurred in December 2019 and the last outbreak occurred in February 2020. The trust has systems in place for the management of outbreaks with daily meetings for the duration of the outbreak, led by the IP&C team supported by the director of infection prevention and control or director of nursing, midwifery and allied health professionals.

MRSA transmissions Four wards had more MRSA transmissions than expected during the year. 54 of the 71 MRSA transmissions that occurred in the trust, occurred on Gibberd, Harold, Lister and Ray wards. There was no increase in MRSA infections. Regular MRSA control meetings were held with the IP&C team, clinical and management staff and the transmissions were brought under control. Sustained transmission occurred on Harold and Lister wards, especially affecting the latter ward and this was deemed to be an outbreak. It was decided to rectify estates issues and refurbish Lister ward as part of managing the outbreak.

Vancomycin resistant enterococci (VRE) A VRE outbreak started in critical care in January 2019, and was declared over in July 2019. However, due to on-going low grade VRE in the summer, apart from carrying on with the usual IPC standards, it was decided to refurbish both HDU and ITU to rectify estates issues, put in modern sinks and create more isolation facilities. ITU now has two isolation pods rather than one, HDU has one side room rather than none.

There were no clinical infections due to VRE on ITU or HDU during 2019. A few colonised patients were treated as a precaution, such as patients with vascular grafts.

COVID-19 The COVID-19 pandemic required a change to the way the organisation and the IP&C team functioned. Being relatively close to London meant PAHT experienced a significant COVID19 case load. Different ways of working to ensure compliance with social distancing including home working with remote access helped reduce virus transmission both in primary and secondary care between staff, and between staff and patients. Efforts focussed on ensuring the hospital had sufficient ward capacity and Critical care capacity to manage

41

case numbers. Most elective surgery was stopped and the hospital was ‘zoned’ to manage COVID-19 and non COVID-19 patients.

A meeting structure was introduced to manage all aspects of the pandemic in the organisation. Apart from an IP&C cell, there was a clinical cell, an operations cell, a people cell and strategic cell.

The IP&C cell focussed exclusively on IP&C matters linked to COVID-19 including the roll out of personal protective equipment (PPE) and any staff concerns or queries around the programme. The groups met daily and the IP&C cell was chaired by the director of nursing, midwifery and allied health professionals.

From 13 March 2020, when PAHT had its first COVID-19 inpatients to 31 March 2020 a total of 478 samples were tested for the virus. 182 of those tests were positive and 34 deaths were reported in this period. All deaths were, and continue to be reviewed as the pandemic continues to be managed during 2020.

Our approach to PPE was fully co-ordinated across the trust. It was consistent and supportive, with clear messages endorsed by regular education and Fit testing of FFP3 respirators for staff groups who need FFP3. Training was provided to staff across the trust and team work and communication improved as time passed.

A fully co-ordinated procurement process for securing PPE supplies was put in place with NHS approved stocks received from a central procurement pathway. Ten PPE safety marshals were appointed to work alongside the IP&C team to support and monitor the PPE programme.

PPE was just one of a complete IP&C package which included respiratory segregation, testing of respiratory in-patients for COVID-19 with appropriate isolation, ward cleaning, twice daily cleaning of frequently touched surfaces, hand washing,

42

respiratory etiquette, social distancing of patients from each other and staff from each other, and staff wearing PPE in ED, critical care and across all COVID-19 wards.

Staff were supported by the staff health and well-being service (SHaW) as well as the people team. A staff swabbing programme and a process for monitoring sickness were introduced.

Patient safety - learning from incidents and actions taken Patient safety is a trust priority, we continually strive to ensure incidents are managed effectively and most importantly that we learn and share the improvements that arise from them. A patient safety incident is defined as ‘any unintended or unexpected incident which could or did lead to harm for one or more patients receiving NHS funded care’.

During 2019-20 the trust reported a total of 10,204 incidents. Of these incidents 98.17% resulted in either no or low harm, the remaining resulting in moderate (1.48%), severe (0.29%) or death (0.06%).

The total number of incidents reported has increased by 8.9% when compared with 201819. Overall incident severity ratings have remained consistent. The increase in incidents reported demonstrates that our staff are conscious of patient safety and our organisation can continue to improve through critical review.

As part of the COVID-19 response, the trust reviewed and changed it approach to incident management. We introduced a rapid review process in March 2020, has ensured the identification of incidents and their immediate actions could be implemented with speed.

In year we have developed trust wide action plans in response to incident themes.

In year we led and completed our first system wide investigation that was undertaken with two mental health trusts, another acute district hospital, an out of area GP practice and with our local CCG.

43

Incident themes The most common themes from completed investigations, regardless of location or specific details are related to  Standard operating procedures, guidelines and policies being either inadequate, clinically out of date or not in place  IT systems not working efficiently or together  Gaps in process, or local processes not supporting robust service delivery Actions to address the themes from incidents and investigations are taken over the year and demonstrate a clear connection from the incident raised to the change the organisation has made. The following case studies illustrate the approach to learning.

Case study one An incident reported in August 2019 related to a patient’s death demonstrated that the involvement of six organisations was required, all of whom had specific involvement in the last year of the patient’s life. These organisations carried out a system wide investigation, led by PAHT, supported by the CCG and the HM coroner for Essex. The opportunity for all staff involved in this patients care to talk to one another, establish how things happened, why and how they could be improved for other patients was invaluable.

Actions completed  The need for a standard level of knowledge and understanding in the mental capacity act, nutrition has been improved through the completion of training for the ward team involved.  The trust has changed the whole safeguarding adults and children’s training programme this year.  Improved our partnership working with our local mental health provider who now have staff available through Care 24 to provide input for patient’s across the Trust.  That digital systems to be accessible so that professionals can access a complete patient record.

Case study two An incident reported in July 2019 demonstrated the need for increased training and the development of pathways and guidance on caring for patients who required long term intravenous access to prevent complications and unintended injury.

Actions completed  Improved the education given to staff in how to care for these long term intravenous devices and to support staff through robust supervision to assist staff in the management of these devices  A Standard Operating Procedure was developed to support the care of patients who have long term intravenous devices  Changed the trust documentation to assist in accurate record keeping of all large vein catheter access.

There has been no reoccurrence of an incident of this type.

44

Case study three During the period of September to December 2019 it was identified that there were concerns over the blood spot screening within maternity, resulting in the need to repeat blood samples.

Actions completed  A checking process was implemented to reduce sampling errors in Maternity  Implemented a process to ensure that staff would all know when a repeat blood sample is required  Further training was completed with the team on taking samples was required There has been a significant reduction in the number of errors since these actions were taken.

Pharmacy – improving medicine safety Over the last 12 months the pharmacy team have worked collaboratively with colleagues across the whole organisation to strengthen and improve medication safety.

Optimising safe prescribing of medicines The trust provides a weekend pharmacy service to the acute admissions ward to support vital work reviewing patient medication history, thereby ensuring that our patients receive only those medicines required to maintain their safety.

Developing the roles of our pharmacists We have developed a number of independent prescriber pharmacists, these individuals are able to assist with prescribing medicines in specialist clinics and writing prescriptions for medicines that patients take home on discharge (TTA’s). This role is vital in supporting prompt and safe discharge from hospital.

We now have specialist pharmacists working in critical care, gastroenterology, rheumatology and dermatology; these individuals provide expert advice and guidance to support patient care.

Medicines optimisation The introduction of a Matron role has made an impact on medication safety by ensuring that nursing staff in wards/departments can access information on the location of medicines after 17.00 hour and overnight when the pharmacy is closed; this helps to avoid missed doses. The medicines optimisation matron also provides training for ward/department staff on medicines use and storage.

Antimicrobial stewardship This vital role ensures that local antimicrobial guidelines are easily available (including the use of an app) to doctors and other prescribers. This means that our patients receive the shortest effective course of antibiotics by the most appropriate route. A programme of audit, feedback, surveillance and education and review of patient safety incidents related to antimicrobial use is in place so that we can monitor our practices and ensure that our patients are receiving safe care.

45

Electronic Prescribing and Medicines Administration (EPMA) EPMA continues to be successful in providing clearer prescriptions which supports safer administration. This year we have extended the electronic prescribing to include intravenous fluids.

Medication incidents The most recent report from NHS Improvement, for incidents occurring between 1 October 2018 and 31st March 2019, showed that the proportion of reported incidents that were medication incidents was 11.7% for this trust. This is just above the average for acute (non-specialist) trusts in England (Graph 4).

20

Percentage of reported incidents that were medication incidents (per 6 monthly reporting period)

15

10

5

Average of other Essex and Hertfordshire hospitals The Princess Alexandra Hospital NHS Trust Milton Keynes University Hospital NHS Foundation Trust National average for acute (non-specialist) hospitals

0

Oct 14 to Apr 15 to Oct 15 to Apr 16 to Oct 16 to Apr 17 to Oct 17 to Apr18 to Oct 18 to Mar 15 Sept 15 Mar 16 Sept 16 Mar 17 Sept 17 Mar 18 Sept 18 Mar 19

Medication safety programme Other areas where good progress has been made include  Training for medical staff; prescribing assessments for newly qualified doctors and nonmedical prescribers and mandatory medicines management update training for registered nurses.  Medication incident multi-disciplinary reviews take place on a weekly basis. The trends from incidents and actions taken are summarised every month and presented to the trust Patient Safety and Quality Group to ensure shared learning.  Our Medicines Management and Incident Committee meets monthly to review incident trends, patient safety alerts and approve documents.  The trust weekly staff bulletin includes ‘Medication safety tip of the week’.  Medicine storage audits are in place to ensure that medicine storage rooms are maintained at the appropriate temperature. 

The safety of patients prescribed anticoagulants is monitored through the trust’s multidisciplinary anticoagulation monitoring service.

46

 

Staff are made aware of National medicine shortages and received advice about alternative medicines that can be prescribed.

STOPIT tool for de-prescribing has been introduced on selected wards.

Our people Without doubt, our people are our greatest asset, regardless of their role. We recognise the value of a committed, dedicated workforce and over the last year we have continued to support individuals to develop and improve and recognised their success.

Celebrating and recognising our amazing people September 2019 saw the return of the annual Our Amazing People Awards and an opportunity to thank, celebrate and recognise our fantastic PAHT people who help make a difference every day to the people we care for and the people they work with.

We received over 800 nominations for the Our Amazing People Awards categories; our health care group judging panels had the tough task of whittling the nominations down winners from the local awards then went on to our trust-wide award ceremony.

The Our Amazing People Awards 2019 ceremony put the spotlight on PAHT staff who were nominated by colleagues and members of the public for their exceptional commitment and care. Awards were presented to winners and runners-up by the PAHT executive team led

by Lance McCarthy, chief executive and Steve Clarke, chair, who expressed their huge gratitude for the work and dedication of these staff members.

Our worthy highly commended and winners took centre stage to receive their certificates and awards – the photos below are taken before the coronavirus (COVID-19) pandemic.

Caring Award winner Steve Walker, healthcare assistant

Respectful Award winner Paul King, ward assistant

47

Responsible Award winner Jodie Smith, bed manager

Committed Award winner Fran Humphries, urology service manager

Equality and Inclusion Award winner Dr Chandra Chandrasekaran, Dr Rony Cherian and Dr Geoff Raine, anaesthetists

Outstanding Learner Award winner Shally Biju, diabetes specialist nurse

48

Outstanding Contribution to Learning Award winner Rebecca Parrott, outreach clinical librarian

Amazing Individual Award winner Julie Davies, Charnley ward coordinator

Amazing Team Award winner Radiology department

Unsung hero Award winner Dorothy Hutton, ED domestic

49

Volunteer of the Year Award Winner Vera Girling, volunteer support administrator

Patient Panel Award winner Sarah Baker, clinical nurse manager for chemotherapy

The National NHS Staff Survey The annual NHS National Staff Survey (NSS) is recognised as an important tool for ensuring that the views of people working in the NHS are used to help inform local improvements. The feedback is useful in helping highlight strengths, and improvements that will make the hospital a better place to both work and be treated.

A full census was held in the trust between October and November 2019 with all our people employed on 1 September 2019 having the opportunity to take part. In total 1520 (45%) completed and returned their survey questionnaire, which was 5% higher than 2018, and 2% lower than the average acute trust response rate (there are 85 acute trusts within the benchmark group).

Table 4: Summary of the trust results by the key national themes, benchmarked against the 85 acute trusts.

50

Table 4

The report findings from the 2019 National Staff Survey were presented to the Workforce Committee in March 2020, and to trust board in April 2020. A series of action plans are being developed by each of the health care groups to address those areas requiring improvement, which will align to three priority actions identified by the trust: Priority one: Improving the physical and mental health and wellbeing of our people Priority two: Improving our learning and safety culture, encouraging people to openly raise concerns and ensure they are acted upon (improving psychological safety) Priority three: Improving the quality and effectiveness of line management skills These are particularly important as we continue to deliver our quality improvement plan, which focuses on enabling outstanding care for all of our patients, all of the time.

Staff Friends and Family Test Results Since April 2014, the quarterly Staff Friends and Family Test (SFFT) has been carried out in all NHS trusts, and are seen as a crucial barometer of how our people view their workplaces. The SFFT is helping to promote a significant cultural shift across the NHS, encouraging our people to have both the opportunity and confidence to speak up, and ensuring their views are increasingly heard and then addressed.

Research has shown a clear relationship between staff engagement and both individual and organisational measures, such as staff absenteeism and turnover, patient satisfaction and mortality; and safety measures, including infection control rates. The more engaged our people are, the better the outcomes for our patients and the organisation generally. It

51

is, therefore, important that the trust strengthens our people’s voice, as well as our patient’s voice.

On a quarterly basis (quarter 3 data is included within the National Staff Survey (NSS) and the questions are slightly different) our people are asked to respond to a short survey.

The 2019 results to the two key national questions are shown below in Table 5: Table 5: National SFFT Questions

National Target %

Q1 2019

Q2 2019

Q4 2020

How likely are you to recommend this organisation to friends and family if they 67% 75% 78% 75% needed care or treatment?

How likely are you to recommend this organisation to friends and family as a place to 61% 65% 65% 61% work?

Actions taken from the SFFT results are fed into the health care group NSS action plans.

Inclusion The equality, diversity and inclusion steering group (EDISG) meet on a monthly basis with the purpose of reviewing activities and initiatives to promote, support awareness and education of EDI within the trust. The EDISG has widened its membership to ensure that there is greater representation across our clinical teams and job roles. Diversity champions have been identified and they are advocates for our staff across the nine protected characteristics identified in the equality act.

Equality, diversity and inclusion policy has been reviewed to support an inclusion focus and the Trust group has agreed a schedule of events highlighting the whole range of the protected characteristics throughout the coming year. Some activities focus on celebration, other focus on awareness and education. These events have included: 

Highlighting disability issues with staff in a series of well attended interactive sessions held during the September 2019 staff “Event in a Tent”.



Co-ordination with the BAME network of Black History Month celebrations in October 2019, involving a diversity event for each week of October.



Celebration of International Men’s Day in November 2019 and International Women’s Day in March 2020, including social media campaigns.



During January 2020, celebrating World Religion Day with an awareness event for staff. The Trust also facilitated an awareness event and memorial service on International Holocaust Memorial Day, in conjunction with Rabbi Irit from Harlow Synagogue.

52

The end of 2019-20 saw the EDI steering group and BAME Staff Network working with our partner colleagues in other NHS Trusts across the Integrated Care System in preparation for the coronavirus (COVID-19) pandemic.

Our performance

Participation in clinical audits The Princess Alexandra Hospital NHS Trust is required to participate in national audits to ensure that it is taking every opportunity to learn and improve. During the period 1 April 2019 to 31 March 2020, there were 48 national clinical audits and 4 national confidential enquiries that covered NHS services that the trust provides.

During that period the trust participated in 98% of the national clinical audits and 100% of the national confidential enquiries which it was eligible to participate in.

The national clinical audits and national confidential enquiries that the trust was eligible to participate in are as shown in tables 6 and 7.

Table 6 national clinical audits that the trust is eligible to participate in Project name Assessing cognitive impairment in older people (care in Emergency Departments) Care of children (care in Emergency Departments) Case Mix Programme (CMP) Elective surgery (national PROMs programme) Endocrine and thyroid national audit National audit of inpatient falls National hip fracture database Inflammatory Bowel Disease (IBD) audit Trauma Audit and Research Network (TARN) Mandatory surveillance of bloodstream infections and clostridium difficile infection Maternal, new-born and infant clinical outcome review programme:  Perinatal Mortality Surveillance

Participation % cases or number submitted Yes 156 cases submitted

Yes

139 cases submitted

Yes Yes

100% 86%

Yes Yes Yes No

Submitted until COVID-19 6 100%

Yes

69%

Yes

100%

Yes

100%

53

 

(reports annually) Perinatal morbidity and mortality confidential enquiries (reports alternate years)  Maternal mortality surveillance and mortality confidential enquiries (reports annually) Maternal morbidity confidential enquiries (reports annually) In-hospital management of out-ofhospital cardiac arrest acute bowel obstruction Mental health (care in Emergency Departments) National Asthma and Chronic Obstructive Pulmonary Disease (COPD) Audit Programme (NACAP) paediatric asthma secondary care National Asthma and Chronic Obstructive Pulmonary Disease (COPD) Audit Programme (NACAP) adult asthma secondary care National asthma and Chronic Obstructive Pulmonary Disease (COPD) Audit Programme (NACAP)Chronic Obstructive Pulmonary Disease (COPD) secondary care National Audit of Breast Cancer in Older People (NABCOP) National Audit of Care at the End of Life (NACEL) National Audit of Dementia (care in general hospitals) National Audit of Seizure management in Hospitals (NASH) National Audit of Seizures and Epilepsies in Children and Young People (Epilepsy12) National Cardiac Arrest Audit (NCAA) National Audit of Cardiac Rhythm Management (CRM) Myocardial Ischaemia National Audit Project (MINAP) National Heart Failure Audit National Diabetes Foot Care Audit

Yes

100%

Yes Yes

100% 114 cases submitted

Yes

2 cases

Yes

131 cases

Yes

250 cases

Yes

100%

Yes

100% (40 cases submitted as per requirement) 25 cases submitted.

Yes

Yes Yes

April 2019 – June 2019 30 cases submitted.

No trust cases.

Trust data submitted stating no cases Submitted until COVID-19 100%

Yes

100%

Yes Yes

76% (336 cases) 100%

Yes Yes

54

National Diabetes Inpatient Audit (NaDIA) -reporting data on services in England and Wales NaDIA-Harms - reporting on diabetic inpatient harms in England National Core Diabetes Audit National Diabetes Transition National Pregnancy in Diabetes Audit (NPDA) National Early Inflammatory Arthritis Audit (NEIAA) National Emergency Laparotomy Audit (NELA) National Oesophago-gastric Cancer (NOGCA) National Bowel Cancer Audit (NBOCA) National Joint Registry (NJR) National Lung Cancer Audit (NLCA) National Maternity and Perinatal Audit (NMPA)

Yes

60 cases

Yes

58 cases

Yes Yes Yes

Data submitted by Primary Care Automatic submission 100%

Yes

Submitted until COVID-19

Yes

Submitted until COVID-19

Yes

Suspended due to COVID-19

Yes

Suspended due to COVID-19

Yes Yes Yes

National Neonatal Audit Programme Neonatal Intensive and Special Care (NNAP) National Paediatric Diabetes Audit (NPDA) National Prostate Cancer Audit National Smoking Cessation Audit 2019 National Vascular Registry Perioperative Quality Improvement Programme (PQIP) Serious Hazards of Transfusion (SHOT): UK National haemovigilance scheme UK Parkinson’s Audit

Yes

96% (2019) 100% 100% Data collection via NHS Digital Maternity Services Dataset 100%

Yes

117 cases

Yes Yes

100% 20 cases

Yes Yes Yes

100% (2019) 44 recruited – suspended due to COVID-19 100%

Yes

21 cases

Table 7: NCEPOD studies that the trust was eligible to enter data for NCEPOD study title Out of hospital cardiac arrests (OHCA) Dysphagia Acute bowel obstruction Long term ventilation

Participation Yes Yes Yes Yes

55

% Cases submitted 100% 100% 100% No applicable cases

The reports of a number of national clinical audit were reviewed by the trust during 2019/20.

Examples of action taken to improve the quality of healthcare provided can be found in Table 8 below: Table 8: examples of actions / key successes taken to improve the quality of healthcare relating to national audits Name of national audit Falls and Fragility Fractures Audit programme (FFFAP) National Hip Fracture Database

National Asthma and Chronic Obstructive Pulmonary Disease (COPD) Audit Programme (NACAP)- Chronic Obstructive Pulmonary Disease (COPD) Secondary Care

Actions completed / achievements The audit showed that there are an increasing number of patients whose surgery was delayed as a result of them being on new anticoagulants. The hip fracture team looked at the evidence and came up with a protocol to avoid unnecessary delay to surgery with this patient group. The protocol was introduced in September 2019 and since then the number of anticoagulant related delays has decreased.  April 2019 to March 2020 = 79.4% had surgery within 36 hours of admission (the anticoagulant protocol was introduced Sept 2019)  April 2018 to March 2019 = 73%  





Online Home oxygen (HOOF) prescription registered via JAC system (electronic prescribing system) Inhaler technique getting standardised across the trust (with the help of PDT matron) as registered nurses core competency.

This helps every patient on inhalers to be assessed, and if any problems encountered to be referred to respiratory specialist team for further support, education and advise to patients and staff.

Inhaler technique already embedded onto electronic (JAC) prescribing system of trust.

When an inhaler is prescribed by a doctor on JAC, the technique displays next to the prescription of the specific inhaler which makes it easy for the nurses and pharmacists to educate the patients Work in progress about COPD alert embedded onto EPR (Cosmic and Nerve centre) to help clinicians identify confirmed COPD patients quicker and follow the directed pathway from admission itself.

56





National Asthma and Chronic Obstructive Pulmonary Disease (COPD) Audit Programme (NACAP) - Adult Asthma Secondary Care



 





National Audit of Cardiac Rhythm Management (CRM)

 

Work in progress about COPD discharge bundle elements getting embedded into COSMIC. This will help every responsible clinician to follow the 6 vital elements (CQC requirement) to ensure best possible outcomes is benefitted by COPD patients and safety netting executed to prevent hospital admissions.

Integrated MDT coordinator leading Asthma and COPD MDT (airway MDT) with respiratory consultant, secondary and community respiratory nurses, on a regular basis.

Perform FeNO testing (by respiratory CNS) for difficult Asthma patients and refer to speciality centres for complex management and support.

Weekly follow up of discharged asthma patients via telephone clinic by respiratory nurse specialists and update GP. Integrated MDT coordinator leading asthma and COPD MDT (airway MDT) with respiratory consultant, secondary and community respiratory nurses, on a regular basis.

Inhaler technique getting standardised across the trust (with the help of PDT matron) as Registered nurses core competency.

This helps every patient on inhalers to be assessed, and if any problems encountered to be referred to respiratory specialist team for further support, education and advise to patients and staff.

Inhaler technique already embedded onto electronic (JAC) prescribing system of trust.

When an inhaler is prescribed by a doctor on JAC, the technique displays next to the prescription of the specific inhaler which makes it easy for the nurses and pharmacists to educate the patients.

Improvements on data accuracy, complications count so operators are aware.

Improvement in implanting the right pacemaker for the right indication (e.g. VVI on AF patients and DDDR on SSS patients).

57

National Smoking Cessation Audit

 

National Paediatric Diabetes Audit (NPDA)

   

National Audit of Dementia care in general hospitals



Increase of 25% in people being asked if they would like help to quit smoking.

Licensed Nicotine Replacement Therapy was offered to a 33% of current smokers to help quit compared 5% previously.

All clinics currently being held remotely Applications being used to help with structured education at time of diagnosis and information dissemination remotely Enrolled a project looking at link between COVID-19 and newly diagnosed Type 1 diabetes Clinic template asking for required information being sent out in preparation of virtual clinic attendance Recommendations now form part of trust’s Dementia Strategy – see section titled Improving care for vulnerable patients: delirium and dementia (page 38)

27 local clinical audits were completed by PAHT during 2019/20. Examples of actions completed / planned and the achievements in the quality of healthcare provided can be found in Table 9 Table 9: Examples of actions completed / planned / achievements following review of local clinical audit reports

Name of local audit Performance of eye casualty

Audit to evaluate the compliance to Royal Collage of Pathologists dataset on core criteria in histopathological reporting of breast cancer surgical resection specimens (in-situ and invasive disease)

Actions completed / planned / achievements  There is an improvement of eye casualty performance after introducing triaging by ophthalmic nurses  Eye casualty clinic is no longer overbooked  Number of unnecessary referrals has dropped from 56% to 19%  2/3 of cases can be managed by specialist nurse  Improved clinical details on request forms for breast excision specimens  Implementing a macroscopic cut-up proforma for breast surgery to

58

Antibiotic Prescribing

    

Evaluating the accuracy of qualitative measurement of blood loss during massive obstetric haemorrhage

   

include the presence or absence of micro invasion.

Micro teaching for all grades of doctors Increase in antimicrobial ward rounds Keep some antibiotics only in high risk areas Quick reference posters for most common conditions Have summarised versions of guidelines in induction packs of doctors and nurses Continued to calculate blood loss (for 3 months) with modified gross formula to review results Tranexamic Acid (TXA) located in pre-packed delivery box for easy access when blood loss is >500ml TXA prophylaxis considered for use in LSCS for high risk patients Suture recommended at the apex if actively bleeding post 3rd degree tear / episiotomy

Achievements in information technology The year leading up to COVID-19 in March was one of great change within the information technology (ICT). The ICT Strategy was developed with our colleagues in all clinical services and we developed a roadmap showing the how trust wished to move forward for 2020-21 and onwards.

The ICT team undertook a reorganisation to ensure our staff could support the plans detailed within the strategy, and two initial changes paved the way for a number of innovative Technology advances we have taken this year:   

The whole trust has moved to NHSMail, a nationally supported system that has allowed us to progress to Skype for Business messaging, voice and video conferencing.

A subsequent move to Microsoft Teams has allowed for better collaboration and integration throughout the whole NHS. The trust investigated and upgraded many systems this year, we installed screens around the trust to help with moving patients throughout the trust, we upgraded several key software systems that our staff using on a minute by minute basis to record observations for ward patients (Nervecentre, store information about patients

59

     

appointments (Cambio), and create letters using a dictation service for doctors to use after patients attend outpatients.

Built a video conferencing system that is used across the trust.

Replaced desktop computer devices and laptops used by our staff which has improved speed and performance.

Upgraded over 70% of our trust computers with new Windows 10 and internet browsers, this has improved speed for people to login and improved security for the trust.

Provided systems used for ordering x-rays and blood tests onto mobile devices.

Set up a IT technician (Tech) Bar in the hospital canteen so staff could access support and assistance quickly Telemedicine has enabled virtual consultations with staff, which we later saw the deployment of hundreds of webcams and headsets and significant numbers of outpatient’s appointments have since been completed using this system.

ICT further developed our business continuity plans and disaster recovery plans, undertaking a series of exercises to confirm these and even a few security scenarios within the trust as tests of our ability to respond together.

At the time of the preparation by the trust to the COVID-19 pandemic, this saw our ICT team play a significant role across every area of the trust. The team provided support to individual staff members, to all clinical teams and they undertook significant change in an exemplary, agile manner. They managed a high number of urgent requests for support to clinical teams looking after our patients throughout the pandemic. This included employing customer relationship officers and business partners to bring an increase in partnership working between the clinical teams and our ICT colleagues, this ensured the support was there when it was needed.

Research and development At the beginning of the year no target was not set by North Thames Clinical Research Network regarding the number and recruitment of participants into National Institute for Health Research (NIHR) trials.

Nearing the end of the financial year, the number of participants recruited into research at PAHT was 501. The trials are undertaken in a variety of clinical specialities.

60

Active studies (18/19 - 19/20) 80 60 40 20 0

27

19

78

74

Commercial CommercialAcademic Academic 2018/19 2019/20 2018/19 2019/20

Infection, Prevention & Control <0% Emergency 6% Anaesthetics 8%

Cancer

Urology 7%

Gastroenterology

Cancer 10%

Respiratory Gastroenterology 25%

Surgical 3%

Cardiology Dermatology

Rheumatology Maternity 22%

Respiratory Dermatology 4% 1%

Ophthalmology Maternity

Surgical Ophthalmology 2%

Cardiology 9%

Anaesthetics Infection, Prevention & Control

Rheumatology 3%

Emergency Urology

61

Recruitment trajectory/ actual 1000

800 600

2019/20 501

400 200

0 Apr May Jun

Jul

Aug Sept Oct

Nov Dec

Jan

Feb Mar

2018-19 (1001) 2017-18 (732) 2016-17 (652)

Our places Improving our estate Whilst work on developing plans for our new hospital is well underway, we still have to ensure we improve the existing hospital site and buildings.

The approved capital programme for 2019-20 included schemes to the value of over £11m.

The programme is made up of three key elements: 

Capital investment schemes - £3.5m



Backlog maintenance - £2.1m



Emergency backlog maintenance - £5.4m

The trust has a number of capital investment schemes under development including one for an urgently needed medical assessment unit.

62

The trust secured office accommodation at Kao Park, enabling the relocation of some nonclinical staff to modern off-site accommodation.

This project is an opportunity to address the wider accommodation issues the trust is facing whilst allowing modernisation and co-location of our workforce.

During 2019-20 works commenced to build a new fracture clinic (repatriation of services from the Herts and Essex hospital) with a build programme from April 2019 with planned completion in July 2020.

In 2019-20 the trust addressed the following areas of backlog maintenance: 

Theatres air handling units – critical function chiller replacement works This scheme was part of an ongoing project that commenced in 2018-19 with final commissioning of the plant in late November 2019. This project has resolved concerns with theatre temperature controls that need to be constantly monitored and managed manually.



Generator – North side installation A generator has been installed with final testing completed in July 2019. The installation provides site resilience and a backup facility for the existing generator set.



ITU refurbishment and HTM ventilation system This project was initially to be a relatively simple upgrade of the ward space however, on starting the work it was established that the entire air handling system needed replacing. The scheme was delayed as a result, however, despite a challenging programme; the facility was opened before the official commencement of ‘winter pressures’.

Sustainability To ensure NHS trusts are delivering high quality health care service with minimal negative impact on the environment, the Sustainable Development Unit (SDU) in association with NHSI instituted the Sustainable Development Management Plan (SDMP) outline to guide and to enable trusts evidence their commitments to sustainability. In compliance with the SDMP guidance and to fulfil our moral responsibilities the trust board approved its SDMP (2018-2020) which set out the key measures and actions that enable the trust to contribute to global sustainability goals and the NHS target to reduce carbon emission by 28% by 2020 (from 2013 baseline).

Waste The trust now has an approved waste management plan in place to enable compliance with HTM 07-01 recommendations and to ensure 100% of our waste is reused, recycled or reprocessed. This is in line with the trust’s sustainable strategy to reduce waste and negative environmental impacts. The trust’s waste carbon emission for 2019 is 16.4 tonnes.

63

Waste recycling efforts and process changes put in place have yielded positive results this year; we have sent ‘zero waste’ to landfill and recycled over 22% of our waste. This was achieved through segregating our waste into the below waste streams and sending the non-recycled waste for energy from waste (EfW) incineration: 

Cardboard: baling of cardboard boxes



Metal: using a separate receptacle for all metal waste



Food waste: removing food waste separately for Anaerobic Digestion (AD)

Progress on the new hospital Last year we set ourselves three specific priorities in support of our aim to improve clinical areas and critical functions.

A Pre Consultation Business Case (PCBC) was developed by PAHT and submitted at the end of September 2019. Consultation with the public took place in the spring of 2019 with 36 individuals attending the engagement event including representation from the following organisations, covering numerous representative protective groups:  PAH Patient panel  PAH (chaplaincy, BME representatives, safeguarding adults and children, volunteers)  Carers first  Essex County Council (homelessness, Looked after children and unaccompanied asylum seekers)  Community Voluntary Services: Uttlesford, Epping Forest and Harlow for those with disabilities and their carers  Beacon house ministries (homelessness)  Essex integration (refugees and asylum seekers and gypsy/traveller)  Accuro (charity supporting those living with/carers of those with disabilities in West Essex  Harlow Ethnic Minority Umbrella (supporting ethnic groups across Harlow)  Support 4 sight  St Clare’s Hospice  Department of Work and Pensions  The workshop looked at the equality impact in two distinct areas, firstly around the issue of access to the new hospital and secondly, all other impacts.

On 27 September 2019 we were visited by the Prime Minister and very shortly after that, we were informed by Secretary of State for Health and Social Care that our hospital would be one of the first six new hospitals to be developed in the period 2020-2025 under the Government’s Health Infrastructure Plan (HIP).

Since then, we have been working hard with our many partners nationally and regionally to achieve this ambition:  A new hospital that is an anchor for the people of Harlow  A new hospital that is in alignment with the NHS long term plan and medium term financial plan

64

 

A new hospital in a growing town with urgent regeneration and housing needs A new hospital in a region with a bold vision and plans to drive economic growth and sustainability

Through 2020 and into early 2021, we will develop the Outline Business Case, in accordance with the HM Treasury Business Case Development Process, in order to:  Identify the investment options which best meet providing Value for Money (VfM)  Prepare our proposed clinical models of care, workforce models and digitisation plans  Put in place the necessary funding and management arrangements for the success ful delivery of the scheme.

The process requires that we look carefully at all the options, including what could be done on the current site. But our preferred way forward remains a new build on a Greenfield site, as this offers the best value for money and full alignment to our strategy.

There is a lot of work to do; if all goes well we expect actual construction to start in 2023, following completion of the junction (7A) off the M11.

65

Statements from stakeholders

Statement from West Essex Clinical Commissioning Group West Essex Clinical Commissioning Group and East and North Hertfordshire Clinical Commissioning Group are responsible for the commissioning of acute health services from The Princess Alexandra Hospital NHS Trust for the citizens of west Essex and east and north Hertfordshire.

Both West Essex and East and North Hertfordshire CCGs would like to commend and thank all the staff and volunteers that work for The Princess Alexandra Hospital NHS Trust in relation to their response to the COVID-19 pandemic. Staff responded with professionalism, energy and adaptability. Their team work and continued energy has enabled the care of patients to continue during the challenging time of the pandemic.

The trust has identified seven priorities for 2020/21 that are fundamental elements of their five P strategy: our patients, our people, our performance, our places and our pennies. This includes continuing the work to reduce the mortality rate.

These priorities will be monitored through the Trust Quality and Safety Committee. The CCGs supports the trusts approach to having fewer priorities than last year, this can lead to sharper focus and improved opportunities for achievement.

During the last year the trust has made significant progress in relation to the number of patients waiting for a follow-up outpatient appointment. The trust has reviewed all ophthalmology patients waiting for an appointment and changed the booking system so that in future patients do not have to wait to be given a date for their next appointment. Both CCGâ&#x20AC;&#x2122;s would like to express their continued support to the trust with this work on outpatient management which is improving the quality of care that can be delivered to patients.

The trust has reported against last yearâ&#x20AC;&#x2122;s quality priorities (2019/20), it is clear from the narrative whether these priorities were fully achieved or not. Of the two not achieved and the one where partial achievement is stated (national standards) it is clear that these priorities have been affected by the pandemic.

Timely treatment for urgent and emergency care has been identified as a continued priority for the coming year. It would be useful for the trust to add information on how the nonachieved elements will be managed when they are not quality account priorities, particularly the cancer waiting time targets.

The trust has provided more than the required information in the Learning from Deaths section. Learning and changes to practice as a result of the trusts review of patients deaths are clearly articulated.

66

There are clear statements on seven day services, junior doctorâ&#x20AC;&#x2122;s hours and the arrangements in place for the support of staff who wish to raise any concerns about patient care and how these are managed.

The trust has identified many departments and speciality teams within which improvements have been made in the last year, notably the work of: the teams caring for patients with dementia, the infection control team, case studies in relation to learning from incidents and complaints and the wide ranging and constructive work of the patient panel.

The integrated working with staff and the high esteem with which the patient panel are viewed is very clear in the quality account.

We confirm that we have reviewed the information contained within the account and checked this against data sources where these are available and it is accurate in relation to the services provided. Some of the data that is required to be included for example, a comparison of the trust results to the highest and lowest scores of other organisations has not been included, we expect this will be addressed in the final version.

Within the Quality Account there is limited explanation regarding the data sets included, and it is therefore unclear how specific results have been achieved. We hope this will be rectified in the final version of the report.

Whilst the account currently includes the required statements in relation to the CQC status of the trust, it would be beneficial to include the action plan that resulted from the CQC safety notice that was issued to the trust within 2019/20.

We have reviewed the content of the account; it complies, on the whole, with the prescribed information as set out in legislation and by the Department of Health.

We believe that the account is a fair, representative and balanced overview of the quality of care at the trust. We will continue to collaborate with and support the trust to achieve good quality care and treatment for the people of west Essex and east and north Hertfordshire.

Jane Kinniburgh Director of nursing and quality Hertfordshire and West Essex Integrated Care System October 2020 Dr Rob Gerlis, chair and Dr Jane Haplin, chief officer

67

Response to Princess Alexandra Hospital Trust (PAHT) Quality Account 2019-20 from Healthwatch Essex

Healthwatch Essex is an independent organisation that works to provide a voice for the people of Essex in helping to shape and improve local health and social care. We believe that health and social care organisations should use people’s lived experience to improve services. Understanding what it is like for the patient, the service user and the carer to access services should be at the heart of transforming the NHS and social care as it meets the challenges ahead of it.

We recognise that Quality Accounts are an important way for local NHS services to report on their performance by measuring patient safety, the effectiveness of treatments that patients receive and patient experience of care. They present a useful opportunity for Healthwatch to provide a critical, but constructive, perspective on the quality of services, and we will comment where we believe we have evidence – grounded in people’s voice and lived experience – that is relevant to the quality of services delivered by Princess Alexander Hospital Trust. In this case, we have received quality feedback about services provided by the hospital, and so offer only the following comments on the Princess Alexander Hospital trust Quality Account.  







 

It’s encouraging to see the trust received an outstanding rating from the CQC for caring for children and young people.

The patient advice and liaison service (PALS) received 730 (27% increase) more enquiries (total 3421) by promoting the service online, through social media, communications channels and a greater presence around the hospital site. This is a great way to listen to people stories around their care.

Public consultation with local public around plans for the new hospital in green field site in Harlow is taking place and opinions are being sort from stakeholders. This will help to shape an all-inclusive site for the people of West Essex.

Staff survey results were up by 5% on 2018. PAHT’s most improved areas from the previous survey included: not working additional unpaid hours, reporting harassment/bullying/abuse, doing my job to a standard I am pleased with, satisfied with quality of care given and being able to provide the care I aspire to.

PAHT aimed to improve nurse staffing levels by reducing vacancies - The trust finished 2019/20 having exceeded the target. The nursing vacancy rate was 8%, with the band 5 vacancy rate of 4.3% It’s great to see the Friends and Family Test is above the national target.

Disappointing to see that PAHT did not achieve 10% improvement of the numbers of patients that are dying in their preferred place of death (as expressed at time of imminent death) by April 2020 but they are working on this.

68

ď&#x201A;ˇ

ď&#x201A;ˇ

Also disappointing to see PAHT overall quality rating from the CQC, for the trust remained the same; requires Improvement even though great work is happening in the trust with an outstanding rating for children and young people.

PAHT are clear they will improve their performance for timeliness of treating patients requiring Emergency and Urgent Care.

Listening to the voice and lived experience of patients, service users, carers, and the wider community, is a vital component of providing good quality care and by working hard to evidence that lived experience we hope we can continue to support the encouraging work of Princess Alexandra Hospital Trust.

Samantha Glover Chief executive officer, Healthwatch Essex

October 2020 Healthwatch Hertfordshire values the relationship with The Princess Alexandra Hospital NHS Trust and looks forward to continuing to work closely with the trust to help improve services for patients including supporting the quality priorities outlined in this Quality Account.

Steve Palmer Chair, Healthwatch Hertfordshire April 2020

69

G lossary of terms Acute Bowel Obstruction - Significant mechanical impairment of the passage of contents through the intestine (bowel) due to a blockage of the bowel Allied Health Practitioners - Are healthcare professionals working in dietetics, occupational therapy, physiotherapy, operating department assistants, radiography and speech and language therapy. This is distinct from nursing, medicine, pharmacy and healthcare scientists Ambulatory Care - Medical care provided on an outpatient basis, includes diagnosis, observation, consultation, and treatment Ante-natal - Is the care you get from health professionals during your pregnancy Anticoagulation - Are medicines that help prevent blood clots Antimicrobial Resistance - Is the ability of a bacteria to resist the effects of medication (antibiotics) that once could successfully treat the infection Antimicrobial Stewardship - A coordinated intervention designed to improve and measure the appropriate use of antimicrobials by promoting the selection of the optimal antimicrobial drug regimen, dose, duration of therapy, and route of administration Audiology - The study of hearing and balance Avoidable - See unavoidable Bacteraemia – An infection of bacteria in the blood Cardiac Arrest –Sudden loss of blood flow from failure of the heart to pump effectively Cardiac Catheter Lab – Procedures of placing catheters (small tubes) into the blood stream to access the heart and blood vessels Cardiology - The branch of medicine that deals with diseases and abnormalities of the heart Care Quality Commission (CQC) - CQC is an executive non-departmental public body of the Department of Health United Kingdom. Established in 2009 to regulate and inspect health and social care services in England Chemical Pathology – A branch of pathology dealing with biochemical basis for disease Chemotherapy - The treatment of disease by the use of chemical substances, especially the treatment of cancer by cytotoxic and other drugs

70

Chronic obstructive pulmonary disease (COPD) - Is the name for a collection of lung diseases including chronic bronchitis, emphysema and chronic obstructive airways disease Clinical Audits - A process aimed to improve quality of patient care and outcomes through systematic review of care against explicit criteria and the implementation of change Clinical Coding - The process by which patient diagnosis and treatment is translated into standard, recognised codes that reflect the activity that happens to patients Clinical Commissioning Group (CCG) - NHS organisations set up by the Health and Social Care Act 2012 to organise the delivery of NHS services in England Clinical Nurse Specialist (CNS) - A nurse who has advanced knowledge and competence in a particular area of nursing practice Clostridium Difficile (C.Difficile) - Clostridium difficile, also known as C. difficile, or C. diff, is a type of bacterial infection that can affect the digestive system COSMIC - The Electronic Patient Record system we have in place at PAHT. See Electronic Patient Record Colorectal care - Treatments for patients with symptoms of the gastrointestinal tract including colorectal cancer and inflammatory bowel disease Colposcopy and hysteroscopy services - A procedure used to examine the cervix and inside of the womb (uterus) CPR - Cardiopulmonary arrest means that a personâ&#x20AC;&#x2122;s heart and breathing has stopped.

When this happens it is sometimes possible to restart their heart and breathing with this emergency treatment CQC - The Care Quality Commission is the independent regulator of all health and social care services in England CQUIN - Commissioning for Quality and Innovation is a system introduced in 2009 to make a proportion of healthcare providersâ&#x20AC;&#x2122; income conditional on demonstrating improvements in quality and innovation in specified areas of care Datix - Software used in healthcare to collect patient safety incidents and for reporting adverse events Delirium - Is a state of mental confusion that can happen if you become unwell. It is also known as an acute confusion Dementia Champions - A group of staff who have had specific training in dementia care.

Their aim is to make other colleagues more understanding of why a patient may be more challenging and encourages them to tailor therapies accordingly

71

Dermatology - The branch of medicine concerned with the diagnosis and treatment of skin disorders Diagnostics - Tools used to help identify disease and illness Dietetics – A branch of healthcare concerned with the diet and its effects on health, especially with the practical application of a scientific understanding of nutrition Dr Foster – A provider of healthcare information in the United Kingdom, monitoring the performance of the National Health Service Dysphagia – Medical term for swallowing difficulties Early Warning Score (NEWS) and Vital Signs - A simple system in which a score is allocated to physiological measurements already undertaken when patients present to, or are being monitored in hospital. Six simple physiological parameters form the basis of the scoring system: a) respiratory rate b) oxygen saturations c) temperature d) systolic blood pressure e) pulse rate f) level of consciousness Endocrinology - The branch of physiology and medicine concerned with endocrine glands and hormones Endoscopy - Is a procedure that allows a view the inside of a person's body ENT Clinics – An area where diagnosis and treatment is provided to conditions of the ear, nose and throat Escherichia Coli (E.coli) bacteraemia - Type of bacterial infection and a blood stream infection– a broken bone that has occurred due to frail or brittle bones Frailty service – Reviews frail older people using a holistic assessment of physical, mental and social needs Friends and Family Test (FFT) - Test aimed at providing a simple headline metric which, when combined with follow-up questions, is a tool to ensure transparency, celebrate success and galvanize improved patient experience. It asks “How likely are you to recommend our services to friends and family if they needed similar care or treatment?” with answers on a scale of extremely likely to extremely unlikely Gastroenterology - The branch of medicine which deals with disorders of the stomach and intestines

72

Genito-Urinary - The brand of medicine relating to the genital and urinary organs.

Geriatric - Relating to old people, especially with regard to their healthcare Governance - Establishment of policies, and continuous monitoring of their proper implementation, by the members of the governing body of an organisation Gram negative blood stream infections (GNBSIs) - Type of bacterial infection and a blood stream infection Gynaecology - The branch of physiology and medicine which deals with the functions and diseases specific to women and girls, especially those affecting the reproductive system Haematology - The branch of medicine involving study and treatment of the blood Healthcare Associated Infections (HCAI) - Infections that are acquired as a result of health care. The burden of healthcare-associated infections has mainly been in hospitals where more serious infections are seen Health Education England - Is the new national leadership organisation for education, training and workforce development in the health sector Health Overview and Scrutiny Committee – Local authority committees that scrutinise health issues and care in their area Healthwatch – Obtain the views of people about their health needs and experiences of having care and social services Hospital Standardised Mortality Ratio (HSMR) - Calculation used to monitor death rates in a trust Inflammatory Bowel Disease – The name for a group of conditions that cause the digestive system to become inflamed Interventional Radiology - Is a sub-specialty of radiology which utilises image-guided procedures in order to diagnose and/or treat diseases using the least invasive techniques Intravenous – Giving fluids or drugs directly into a vein Klebsiella bacteremia - Type of bacterial infection and a blood stream infection Laparotomy - A surgical incision into the abdominal cavity, used for diagnosis or in preparation for major surgery Maternal and Fetal Assessment Unit - Outpatient Antenatal Unit offering planned appointments for assessment of the mother and unborn baby in pregnancy

73

Maxillofacial department – An area where diagnosis and treatment is provided to conditions of the mouth, face and adjacent structures MCA - The Mental Capacity Act is designed to protect people who can't make decisions for themselves or lack the mental capacity to do so Medicines optimisation - Is the process of ensuring patients are on the most effective and fewest medications Methicillin-Resistant Staphylococcus Aureus (MRSA) / Methicillin-Sensitive Staphylococcus Aureus (MSSA) – A specific bacterial infection Morbidity and Mortality - Meetings established to review deaths as part of professional learning Myocardial Infarction - Commonly known as a heart attack Myocardial Ischaemia - When blood flow to your heart is reduced, preventing the heart muscle from receiving enough oxygen National Confidential Enquiries (NCEPOD) - National Confidential Enquiry into patient Outcome and Death National Reporting and Learning System (NRLS) - A central database of patient safety incident reports Neonatal (NICU) - New born children and new born intensive care unit Neurology - The branch of medicine or biology that deals with the anatomy, functions, and organic disorders of nerves and the nervous system NHSE/I - NHS England and Improvement is responsible for overseeing trusts and NHS services, as well as Independent providers that provide NHS-funded care.

NICE - The National Institute for Health and Care Excellence provides guidance which supports healthcare professionals and others to make sure that the care they provide is of the best possible quality and offers the best value for money Norovirus - A type of viral infection that can affect the digestive system Obstetrics - The branch of medicine that deals with the care of women during pregnancy, childbirth, and the recuperative period following delivery Oesophago-gastric care – Treating patients with problems of the gullet (oesophagus) and stomach

74

Oncology - The study and treatment of cancer and tumours Ophthalmology - The study of the structure, functions, and diseases of the eye.

Orthopaedic - The branch of medicine that deals with the prevention and correction of injuries or disorders of the skeletal system and associated muscles, joints, and ligaments Paediatrics - The specialty of medical science concerned with the physical, mental and social health of children from birth to young adulthood Palliative Care - An approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual Pathology - The scientific study of the nature of disease and its causes, processes, development and consequences Patient Advice and Liaison Service (PALS) - Offering confidential advice, support and information on health-related matters. Provides a point of contact for patients, their families and their carers Patient Panel - A group of volunteers who represent patients, families and carers of The Princess Alexandra Hospital NHS Trust Patient Safety Alerts - Issued by NHS Improvement to rapidly warn the healthcare system of risks. They provide guidance on preventing potential incidents that may lead to harm or death Perioperative care - Occurring or performed at or around the time of an operation Post Anaesthetic Care Unit (PACU) – An area in theatre where patients are taken directly after surgery so they can wake up from their anaesthetic and will remain until well enough to go to a ward for ongoing care Postpartum Haemorrhage – A complication where there is bleeding heavily after the birth of a baby Preferred Priorities of Care (PPC) - Document used to plan an individual’s future end of life care. Includes thoughts and feelings about the patient’s illness, what is happening, preferences and priorities for future care and where the individual would like to be cared for in the future Pseudomonas aeruginosa - A specific bacterial infection Public Health England - A government body with the role to protect and improve the nation’s health and wellbeing and reduce health inequalities

75

Pulmonary Embolism (PE) - A sudden blockage in a lung artery Rapid Assessment and Treatment (RAT) - A treatment model used in emergency care to provide an early senior assessment and early treatment Radiology - The branch of medicine that deals with the use of radioactive substances used in diagnosis and treatment of disease.

Referral to Treatment (RTT) – A constitutional standard that trusts are measured against in which a person’s waiting time starts on the day the hospital receives the referral letter from a GP to the time of first appointment or treatment Respiratory Medicine – The branch of medicine that deals with the act of breathing Rheumatology - The study and treatment of arthritis, autoimmune diseases, pain disorders affecting joints, and osteoporosis Safeguarding - Protection or defence that ensures safety Sepsis and Septicaemia - Sepsis is a serious blood stream infection. A serious complication is septicaemia which is when inflammation occurs throughout the body which can be life threatening Serious Incidents (SIs) - An unexpected or unplanned event that caused harm or had the potential to cause harm to a patient, member of staff, student, visitor or contractor Stakeholders - A stakeholder is anyone with an interest in a business. Stakeholders are individuals, groups or organisations that are affected by the activity of the business. They include: Owners who are interested in how much profit the business makes Standard Operating Procedures – A set of step by step instructions compiled to help workers carry out complex routine work, aimed to achieve efficiency and uniformity of performance Standardised Mortality ratio (SMR) and Summary Hospital-level Mortality Indicator (SHMI) - Ratio between the actual number of patients who die following treatment at the trust and the number that would be expected to die, on the basis of average England figures given the characteristics of the patients treated there.

Sustainability and Transformation Partnerships (STP) - Bringing together local health and care leaders to plan the long-term needs of local communities and how care will be delivered Trauma Audit and Research Network (TARN) – An audit where information is collected and analysed for patients who are moderately or severely injured after an injury. Data is submitted by trusts and a comparison can be undertaken

76

Triage - A process for sorting injured people into groups based on their need for or likely benefit from immediate medical treatment To Take Away (TTA) – Medication given to patients to take after their discharge from hospital Unavoidable - Used when an individual has been affected even though the:  condition and risk has been evaluated  goals and recognised standards of practice that are consistent with individual needs had been implemented  impact of these interventions had been monitored, evaluated and recorded  approached had been revised as appropriate Term usually used in relation to cases of hospital acquired infections, pressure ulcers and falls Urology - The study of urinary organs in females and the urinary and sex organs in males Vancomycin resistant enterococci (VRE) - A specific bacterial infection that is resistant to a key antibiotic used Vascular surgery – Specialists that treat people with diseases of the circulation which can be conditions affecting arteries, veins and where there are blockages to the flow of blood.

Venous Thromboembolism (VTE) - A condition where a blood clot forms in a vein. Most commonly in a leg where known as a DVT, a blood clot in the lungs is called a pulmonary embolism (PE) VTE Prophylaxis - The giving of a medicine or treatment to prevent a VTE

77

Meeting your needs We can provide information about our service in different formats and adapt the ways we communicate with you - depending on your needs.

For example, we can use Braille, large print or different languages.

Please let us know what your particular needs are and we will do our best to help. You can contact us about accessibility by calling 01279 82 7211.

The Princess Alexandra Hospital NHS Trust, Hamstel Road, Harlow, Essex, CM20 1QX 01279 44 44 55 Keep up to date with our latest news via social media:

@NHSHarlow @NHSHarlow