Medicine for Members’ Meeting 13 th November 2018

1. Medicinefor Members’ Meeting13th November 2018 • Welcome & Introductions • ‘Getting to Good’ and our journey so far • Quality Strategy and ‘Getting to Good’ staff presentations • Close

3. The Board Maggie Oldham ChiefExecutive Vaughan Thomas Chair CharlesRogers Dr Tim Peachey NHSI Non-ExecutiveDirector (from 1 April 2018) Dr Barbara Stuttle CBE Director of Nursing, Midwifery, Allied Health Professionals and Community Services Caroline Spicer NHSI Non-ExecutiveDirector Darren Cattell Director of Finance, Estates and IM&T/Deputy Chief Executive Suzanne Rostron Director of Quality Governance Anne Stoneham NHSI Non-ExecutiveDirector Mr Alistair Flowerdew Medical Director Vice Chair & Senior Independent Director NHSI Non-ExecutiveDirector Dr Nikki Turner Director of Acute Services Julie Pennycook Director of Human Resources & Organisational Development Dr Lesley Stevens Director of Mental Health & Learning Disabilities Sara Weech Trust Non-ExecutiveDirector Dr Charles Godden Trust Non-ExecutiveDirector NHSI Vacancy Kemi Adenubi NHSI Non-ExecutiveDirector Phil Berrington Trust Non-ExecutiveDirector Dr Paul Evans NHSI Non-ExecutiveDirector

4. What is our "True North"? Best quality, safe, patient/service user careWithin the framework available • Most people who work in the NHS: • Care and are compassionate • Want to deliver safe effective care

5. Quality vs Finance Trust year to date (Mth 6) finance position -£1.9m off plan

7. Getting to Good Suzanne Rostron Director of Quality Governance

8. Quality Improvement Plan –Current Position Safety Recovery Programme Staffing levels/agency use Mandatory Training Learning from deaths Nursing Clinical Standards Effective Safe Competency assessments/ practice development EOLC KPIs Ambulance AQIs & ARPs Serious Incident process, quality, backlog & learning Safeguarding National Care of the dying audit NICE guidance compliance CARING Appraisals Well Led Strategic alliances – SCAS, Southern, Mountbatten, NTW, Solent Alliance Transformation programmes Responsive RTT Complaints process, quality, backlog & learning Leadership development programmes Board Governance Structure Staff & patient engagement Patient Flow Emergency Care Standard Case load management – community & mental health Staff morale

9. Quality Strategy

10. Getting to Good Video https://www.youtube.com/watch?v=Ue2k9F5z7zU

11. End of Life Care - Update Lead: Shane Moody Clinical Director – End of Life Care Consultant Nurse – Critical Care and End of Life Care

12. Getting to Good…… Vision To identify patients who are at risk of dying and ensure that future care planning occurs with them and other individuals that have been identified as important to the patient; to ensure they experience high quality end of life care. In order to do this we will create a prepared and able workforce ready to care for our patients and individuals important them.

13. SAFE MD - Processes for EOLC responding to risks ( 1, 3, 5) SD - Raise safeguarding concerns when they occur (1, 2, 3, 5) SD – Structured handover process between DN’s and community practitioners (all) *Ambitions for Palliative and End of Life Care Partnership (2015) EFFECTIVE MD- Data reporting for assurance (4) MD – Strengthened governance for EOLC (4) SD - audit quality of information in POC (1, 3, 4, 5) SD – Appropriate systems to monitor the outcome of care and treatment (2, 3, 4, 5) CARING -GOOD MD - Appropriate referrals for timely discharge (1, 2, 3, 4, 6) SD – Implement pain assessment tool (1, 3) SD – staff identify people in last 12 months of life who need support (all) RESPONSIVE MD - Take into account patients needs and preferences (1, 2, 3) MD - Improve EOL services by sharing/learning from incidents WELL-LED MD - Improved partnership working (4, 6) SD – NICE guidelines for Consultants are met (5) SD – services establishes relationships with various voluntary and community groups (2, 4, 5, 6) CQC Rating – “Inadequate” *6 Ambitions for End of Life Care 1. Each person is seen as an individual 2. Each person gets fair access to care 3. Maximising comfort and wellbeing 4. Care is coordinated 5. All staff are prepared to care 6. Each community is prepared to help Actions: 14 must dos 8 should dos 15 others Total = 48

14. Safety Concerns • Mandatory Training – not completed, didn't follow national standard for EOLC training, EOLC not mandatory • Staff could not apply principles of safe guarding • Risk assessments were not updated while on POCD • Not enough palliative care consultants • Poor record keeping of EOLC patients • Medications and prescribing • Syringe driver training • Service did not manage patient safety incidents well – recognise them, did not report them and lessons learnt were not shared.

15. Safety – 10 Week Plan Achievements • New Consultant starts in October 2018 • Medicines - Update “just in case” guidelines, Update JAC prescribing, Laminated guidelines for Computers On Wheels in wards • Syringe driver training – new training and competency assessment started. To date 70 staff trained • Integrating EOLC issues into Safeguarding training going forward and discharge issues • Mandatory training – current position 80%, current review of education • Risk assessment – prompt in new POCD • Patient safety incidents and EOLC – Revised Datix lay out a) EOLC box and b) subcategories added for EOLC incidents • Patient incidents now reviewed monthly at the revamped EOLC operational group and lessons learnt shared via this route • Record keeping audited daily on each death, improvement monitored via EOLC group, current improvement via informal bedside teaching

16. EOLC Improvement Plan – Current Position Medications / patient safety incidents Syringe Driver Training Audit Plan Intranet resource link Effective Safety EOLC Policy New POCD for EOLC ELOC KPIs Activity Data New palliative care consultant in post in October 2018 Training strategy for EOLC National Care of the dying audit NICE guidance Audit - daily CARING Rapid Discharge Policy Well Led Responsive MOU signed between Trust and Mountbatten Recruiting to Clinical Director /Nurse Consultant post to lead the service One EOLC/ Palliative care Service and one referral process (01.12.18) Pain tool for EOLC implemented 7 day cover Bereavement services EOLC vision and Strategy – align to Trust Quality Strategy Governance Structure - Functional ELOC operational group Team education and development ‘Thinking About uncertainty’ Patient engagement and EOLC companions

17. Quality Strategy Indicators

18. Issues, Risks and Improvement Actions

19. Next Steps and Planned improvement Trajectory

20. 0-19 Community Services Andrea BevanClinical Lead

21. 10 Week Improvement Plan 0-19 Public Health Nursing SAFE the journey ASPIRATION COMMUNICATION CONSULTATION COLLABORATION

22. CQC Regulatory Actions • Regulation 12: Safe Care & Treatment • Regulation 17: Good Governance • Regulation 18: Staffing

24. The Journey We Took • We studied the CQC report and developed a plan • We identified a COMMUNICATION pathway to include all the team weekly • MONDAY: Band 7 Brief and reflection on previous week • TUESDAY: Team brief in each Locality and follow up email • THURSDAY: ENERGY Meeting. Systematic approach on how we could achieve the change but also what else was needed to take things to the next step • Work was allocated across the team and with a timeline. Each person took ownership of a part of the improvement. • The team focused their ASPIRATIONS on not only achieving but also to look across other Trusts to learn and to become the best we can be. Working relationships have now been formed and visits made to both Southern and Solent Trusts. We have liaised closely with the heads of health visiting and school nursing for Wales who have recently reviewed their service to have a Wales wide standard and practice. • We engaged in CONSULTATION with a group of children aged 10-13 to identify how they would like to communicate with our service ,how their voice could be heard and this has led to the beginning of the COLLABORATIVE YOUTH COMMUNITY (CYC)

25. 0-19 Public Health Nursing

26. Mental Health – ‘Getting to Good’ Mental Health Team

27. Background • The CQC were quite clear in their report that the rating for MH Wards for Older People was largely attributable to Shackleton Ward • To focus on the ‘Safe’ domain findings with a view to addressing these rapidly • To consider changes already made since January 2018

28. Legal Requirements • The draft inspection reports conclude that the Trust has breached 11 legal requirements, across its services and locations • Mental Health services received 50 ‘must do’ actions: Older Persons Wards 12 must do’s 7 should do’s

29. Older Persons Wards

30. Improvement Process • 10-week process for urgent safety concerns – Exec oversight with senior team • Engagement and ownership in clinical areas to develop sustainable improvement plans • Clear measures of success and ‘what good looks like’ – agreed by all

31. Older persons wards Afton Care Plan Audits (CPA) Rapid Tranq Competencies Mental Capacity Act training Shackleton Female lounge Mandatory training PI training Care Plan Audits (CPA)

32. Recognised good practice – Older Persons Wards

33. Well-led Extract We found clear signs of recovery and improvement since our inspection in November 2016 and there was growing momentum. However this recovery was starting from a very low base and, despite some elements of outstanding leadership from the senior team, it was too early for the overall rating to change.

34. Summary • The volume of what needs to be done should not be underestimated • This is now part of everything we do and not a stand alone IIF process • We know what ‘good’ looks like and how to get there • The pace has been increased now foundations have been set

35. Medicine Care GroupSafety Recovery Journey Update Natalie MewMatron

36. The first 10 Weeks • Week 10

37. What we learnt… • Early and sustained staff engagement is essential • Identifying five key areas of focus kept us on track and was manageable • Tri weekly board huddles maintained momentum • Engagement with support services essential for success

38. Ongoing Actions • Sustain and embed changes from first phase of the programme • 3 additional measures identified: • Medicines Management-Focus Insulin pen training, ward based assessments, EPMA upgrade training and e-learning • Nutrition & hydration-Relaunch use of coloured plates, Meals Matter and Fluid chart audit& education • Falls- dedicated matron time, full roll out of “Baywatch” • Build on work undertaken in the two elements we didn’t achieve – work with other Care Groups/Divisions

39. Current position • Progress in Documentation and Lessons Learned • Sustained Resuscitation Equipment and Mandatory training achievements. Maintained majority of IPC targets • Early improvements in Medicines Management • Nutrition and Hydration Meals Matter coming on line • Falls – Dedicated Matron time to focus on reducing overall numbers and severity of falls • Overall reduction in Serious Incidents and Complaints • Initial reduction in upheld Section 42 Safeguarding Vulnerable Adult inquiries

40. Looking ahead • Keep focus on all 50 Must Do’s not just those in 10 week plans • Focus on Discharge summaries • Monitor Nurse attendance on Ward Rounds to aid communication • Keep staff motivated • Maintain momentum at times of operational pressure

41. Questions?