North Cumbria University Hospitals NHS Trust : Our improvement plan & our progress

1. North Cumbria University Hospitals NHS Trust : Our improvement plan & our progress Message from the Chair – Gina Tiller • North Cumbria University Hospitals NHS Trust was identified as one of the 14 hospitals across the country because of higher than expected mortality rates. As a result, the Prime Minister, David Cameron, requested Professor Sir Bruce Keogh, Medical Director of NHS England to fully review each hospital trust. The purpose of the Keogh Review was to help those trusts identified as having a higher than average mortality ratio on their journey of improvement. • In May the review took place at North Cumbria and a risk summit was then held in June, with representatives from all of the health service and regulators. This was to discuss what the review panel found during their visits and what urgent actions, over and above those actions already taken by the Trust, needs to be accelerated. • The Keogh review has provided us with further opportunities to really scrutinise our performance and approaches to patient care and we have wholeheartedly welcomed the Keogh report and fully support its recommendations. What is clear now is that we are beginning on a long journey of improvement at North Cumbria and the Keogh Review team clearly recognised this alongside the changes that have already been made, or are in development, which will positively impact on patient care. • This summary action plan provides a focus for short-term improvements on immediate issues. We envisage our improvement plan going beyond Keogh deadline dates to ensure that when the Chief Inspector of Hospitals, Prof Sir Mike Richards inspects, that the Trust is ready. Once the actions identified here have been completed, the Trust will set out a longer-term plan to maintain progress and ensure that the actions lead to measurable improvements in the quality and safety of care for patients. (Please note that the Chief Inspector of Hospitals inspection commences North Cumbria University Hospitals Trust from the 29th April 2014) • Change will not happen overnight, nor will it be easy. But change must happen and must be, at all times, in the very best interests of patients. The Trust’s focus as it begins this journey of improvement will be on: • Putting the patient at the heart of everything • Supporting patients and staff to challenge the status quo • Investing in services for the long term • Developing staff to achieve a culture of continuous improvement. • The weaknesses highlighted by Keogh must be transformed into areas of strength so that North Cumbria can rebuild confidence in local hospital services and, most crucially, regain the trust of local communities. To do this, the health system in Cumbria is committed to working much better together. This will ensure that, collectively, there is a long and lasting impact on the way hospital services are provided which will ultimately make a positive change on the health outcomes for people living in north Cumbria – something they rightly deserve. • We will continue to keep all of our stakeholders fully updated as we progress our safety and quality improvements. There will also be regular updates on NHS Choices and subsequent longer term actions will be included as part of a continuous process of improvement.

2. North Cumbria University Hospitals NHS Trust : Our improvement plan & our progress Who is responsible? Our actions to address the Keogh recommendations have been agreed by the Trust Board Our Chief Executive Ann Farrar is ultimately responsible for implementing actions in this document. Other key staff include Dr Jeremy Rushmer who is Interim Medical Director. Dr Dean Spencer from the NHS Trust Development Authority is supporting us to implement our actions for improvement Ultimately, our success in implementing the recommendations of the Keogh plan will be assessed by the Chief Inspector of Hospitals who will re-inspect our Trust in the coming months. If you have any questions about how we’re doing, please contact ann.farrar@ncuh.nhs.uk What are we doing? In July 2013, the Keogh Review made recommendations in eight core areas to help improve the quality and safety of our services for patients in North Cumbria. Specifically, the Keogh Review said that we need to: Carry out a full review of the Trust’s corporate risk, business assurance framework and quality governance plans Review leadership capability and develop a formal organisational development plan for all staff Ensure robust arrangements for serious incident investigations Review staffing levels to ensure safe care is delivered Ensure mandatory training is supported Promotion of a more supportive and open culture Review of estates capability and capacity Review infection control policies and practices with full organisational ownership This ‘plan & progress’ document shows how we already making these improvements and demonstrates how we’re progressing against the plan. This document builds on the ‘Key findings and action plan following risk summit’ document which we agreed immediately after the review was published on NHS Choices (click here) While we take forward our plans to address the Keogh recommendations, the Trust is in ‘special measures’ and continues to work closely with the NHS Trust Development Authority (TDA), with our acquisition partner Northumbria Healthcare NHS Foundation Trust and with NHS Cumbria Clinical Commissioning Group (CCG). Oversight and improvement arrangements have been put in place to support changes required How our progress is being monitored and supported We will update this progress report on the first day of every month while we are in special measure and provide a monthly stakeholder update and regular briefings as we implement changes. Progress on our improvement will be reported at our Trust Board meetings every month which are open for the public to attend. (Timescale: From September 2013; Owner: Trust) Appointment of a senior representative by the TDA, who will provide expertise to the Trust Board and check that we're meeting our promises to deliver our improvement plan. (Timescale: By October 2013; Owner: TDA). Access support from partnership working as appropriate with the Academic Health Science Network, NHS Improving Quality and the NHS Leadership Academy. (Timescale: By April 2014; Owner: NHS England). Signed by the Chair of the Trust (on behalf of the Board)

3. Our improvement plan This table shows the actions we’re taking to address the concerns about the quality of our services which were raised in the Keogh report. It also shows how we are progressing against our actions.

6. How we’re checking that our improvement plan is workingThis table shows how and when we are checking that the actions we’re taking are making a real difference in our hospitals. Key for progress reports Blue -delivered Green – on track to deliver Narrative – disclose delays/risks/plan to recover Red – not on track to deliver