avoid hospital admission Health and Social Care Connect Launched April 2016: Single point of access: referrals, assessment , services Increased contact, faster support Joint Community Rehabilitation MDT: occupational therapist, physiotherapists, support workers HR Urgent Care Service model Know your own health Piloted Medicines optimisation Pregabalin review Care Homes medicines optimisation Improved patient experience & reduced pregabalin prescribing (NICE best practice) Pharmacy working with GP practice EHS HR ES, HR, ESHT & ESCC Priorities 2016-17: Acute KSS AHSN Patient safety Falls Enhanced Recovery Programme Medicines reconciliation Patient flow End of life care Outpatient appointments Investigation time for incidents reduce 60 days to 30 days – national targets; Safety & learning from incidents Incident reporting Falls & Frailty Diarrhoea Pressure damage Falls ERP Medicines optimisation Living well for longer Polypharmacy Mouth care matters
Clinical effectiveness Sepsis Pressure damage Hospital acquired infection Sepsis Medicines management Proactive audit of compliance 20% of NICE guidelines & quality standards Dementia Stroke VTE COPD Fractured neck of femur Clinical audit & learning Sepsis Pressure damage AKI Sepsis Dementia Stroke Respiratory Patient experience Frailty pathway Reduce patient transfer between wards Medicines management Improve signage & walkways Breast cancer referral Reducing LOS Nutrition Nutrition Medicines management Safe discharge & transfer Frailty Priorities 2016-17: Community & Mental Health KSS AHSN Patient safety Improve appointment systems Learning from incidents Infection control: improve IPC practice DoLs documentation, training & awareness Pressure damage Improve appointment systems Learning from incidents Infection control: improve IPC practice Safe care Suicide prevention Falls Serious incidents Abuse of staff Suicide prevention Align care pathways Discharge Living well for longer Polypharmacy Mouth care matters Leadership culture & capability Pressure damage Falls Patient safety Medication errors
Clinical effectiveness Review NICE guidance Embed clinical supervision IG & safeguarding training Dementia training (75% staff: 03/17; 100% staff: 03/18) Review NICE guidance Embed clinical supervision IG & safeguarding training Care plan involvement One person one plan Connected: Body & mind (physical health) Communities (equality) Care planning (electronic care record) MEWS rollout Cardiac monitoring Leadership & development Sepsis Safe discharge & transfer Leadership culture & capability Patient experience Share learning effectively Incorporate complaints training Increase digital feedback Appropriate support & format of information for those with disabilities Share learning effectively Incorporate complaints training Increase digital feedback Improve & gather patient experience feedback: Service users Carers assessment Staff survey response Discharge Listening into Action Medicines management Safe discharge & transfer Dementia End of life Falls Leadership culture & capability Priorities 2016-17: CCG Effectiveness Every child Effectiveness Prevention of ill health Effectiveness Quality of life (LTCs) Experience Mental health issues Safety Dementia Children’s health hubs Community nursing Eating disorder service Autism pathway Smoking cessation Weight management Diabetes Anti-coagulation Stroke Personal health budget Better Care plan MSK service Parkinson’s MND CYP mental health & wellbeing transformation plan CYP IAPT Polypharmacy Frailty care model Early years Weight management Stroke Wellbeing & resilience Personal care plans Palliative care service Rehabilitation CAMHS Mental health transformation board Let’s Talk Right place medicines & Pre-pregnancy service Self-care ICaRDS CAMHS End of life pathway
Child development Specialist school nursing Falls Prevention Health coaching Social prescribing Stroke Cancer Diabetes Reablement Rehabilitation Telecoaching Dementia Friendly Crawley Eastbourne Hailsham & Seaford & Community paediatrics Looked after children Eating disorders Smoking cessation Screening: bowel, breast, cervical Anti-coagulation Health & Social Care Connect telephone CAMHS IAPT Dementia Health hubs Personal health budget Telehealth 24/7 home treatment team Psychiatric liaison Dementia diagnosis Falls prevention Hospital at home Health & Social Care Connect telephone CAMHS IAPT Dementia “Golden Ticket” KSS AHSN Improvment Falls Prevention Medicines management Patient safety Dementia Living well for longer KSS AHSN Service Improvement: Acute KSS AHSN Service Improvement Brighton & Sussex University Hospitals NHS Trust East Sussex Healthcare NHS Trust Queen Victoria Hospital NHS Foundation Trust Surrey and Sussex Healthcare NHS Trust Western Sussex Hospitals NHS Foundation Trust AF (Stroke) Stroke Stroke Stroke Stroke AKI AKI AKI AKI AKI Cancer Cancer screening Cancer services COPD, Asthma & Discharge Respiratory COPD Respiratory COPD Respiratory COPD Respiratory COPD CVD / heart failure Heart failure Heart failure & disease Heart failure Cardiac arrest Dementia Dementia Dementia Dementia Dementia
CVD / heart failure CVD Heart failure (EQ) Dementia Dementia Living Lab Dementia Dementia Dementia Dementia “This is me” Butterfly scheme Carers’ prescription Emergency laparotomy EOLC Falls Nutrition Hydration Falls Nutrition Hydration Falls Nutrition Hydration DNACPR Falls Nutrition Hydration Bereavement pack ER Fractured neck of femur Bone health Frailty Falls Falls Frailty Falls Falls Falls Hydrate in care homes Nutrition Hydration Nutrition Hydration Nutrition Hydration Nutrition Hydration Hypogylcaemia care pathway Diabetes Diabetes Diabetes Leadership, culture & capability Safety culture Education Learning from incidents Record keeping Risk assessment Patient & carer involvement Safety culture Education Learning from incidents Record keeping Risk assessment Patient & carer involvement Education Learning from incidents Record keeping Patient & carer involvement Education Learning from incidents Education Apprenticeship opportunities Lifestyle Nutrition Hydration Nutrition Hydration Health coaching Health coaching Nutrition
Living well for longer Nutrition Hydration Nutrition Hydration Nutrition Hydration Polypharmacy Nutrition Hydration Polypharmacy Nutrition Medicines management Medication errors Storage Medication errors Medication errors Medication errors Mental health Care plan Physical & mental health Care plans Physical & mental health Anxiety issues: Healthy Child 5-19 Mouth care matters Oral health Oral health NIV Patient safety measurement Harm free care Harm free care Patient safety Harm free care Pressure damage Pressure damage Pressure damage Pressure damage Pressure damage Safe discharge & transfer Patient flow Discharge Discharge Sepsis Sepsis Sepsis VTE VTE Workforce Recruitment Retention Skill mix Recruitment Retention Skill mix Strategy Recruitment Apprenticeships KSS AHSN Service Improvement: CCGs KSS AHSN Improvement Brighton & Hove Coastal West Sussex Crawley; Horsham & Mid Sussex Eastbourne, Hailsham; Seaford & Hastings & Rother East Surrey High Weald Lewes & Havens AF (Stroke) Stroke Stroke Stroke Stroke Stroke Stroke
Anti-coagulation Anti-coagulation AKI AKI Cancer Cancer Cancer Cancer Cancer Cancer Cancer COPD, Asthma & Discharge Respiratory Asthma Respiratory COPD Asthma Respiratory Respiratory disease CVD / heart failure CVD Hypertension CVD CVD CVD Heart failure CVD CVD Dementia Dementia Dementia Dementia Dementia Dementia Emergency laparotomy EOLC Dementia Care plans Dementia EOLC pathway Dementia EOLC pathway Dementia Dementia Dementia Fractured neck of femur Hip fracture >65 MSK Hip fracture >65 MSK MSK MSK including falls MSK Hip fracture >65 Frailty Better Care plan Parkinson’s MND Model of care Falls Falls Falls prevention Hydrate in care homes Hypoglycaemia care pathway Diabetes Diabetes Diabetes Diabetes Diabetes Leadership, culture & capability Patient & carer engaged Education Development Patient & public engagement Education Development Lifestyle Patient activation Nutrition Smoking cessation Obesity Alcohol Patient activation Obesity Living well for longer Nutrition Health coaching Social prescribing Medicines Medicines Medicines Medicines Medicines Medicines
Safeguarding Policies & procedures Recruitment & retention Bullying Mental Capacity Act training Medicines management Medicines optimisation Handover Discharge Improvement: Acute Brighton & Sussex University Hospitals NHS Trust East Sussex Healthcare NHS Trust Queen Victoria Hospital NHS Foundation Trust Surrey and Sussex Healthcare NHS Trust Western Sussex Hospitals NHS Foundation Trust KSS AHSN Urgent & emergency services Patient safety Patient harm Patient flow Leadership Culture Morale Consultant cover Patient safety Leadership Culture Minor injuries unit Privacy & dignity Mandatory training Mental Capacity Act training Paediatric ED Leadership culture & capability Discharge & transfer Patient safety Medical care Leadership Culture Infection control Incident reporting Medicines management Learning and analysis of SUIs Inconsistent use of SBARs Specialist burns & plastic surgery Medicines storage Pain management Mandatory training Medicines management Medicines management Leadership culture & capability Surgery Never events Recruitment Patient privacy Medicines management Patient safety Medicines management RTTs Medicines management Leadership culture
Mandatory training VTE protocol tracking Learning from incidents Bed management & capability Patient safety Discharge & transfer Intensive / critical care Mandatory training Incident reporting Staffing levels Skill mix Infection control; hand hygiene Clinical governance Leadership Culture Delayed discharge to ward Medication errors Incident reporting Strategy Mental Capacity Act training Staffing levels Infection Control Waste disposal Medicines management Leadership culture & capability Maternity / family planning Recruitment Ventilation Infection control Mandatory training Leadership Learning Pain management Medicines management Leadership culture & capability Services for young people & children Records management Care plans Acute paediatrician lead Nurse prescribing Medicines management Records management End of life care DNACPR forms Records management Outpatients Infection control Incident reporting Records management Leadership Records management Medicines management Strategy Cancelled appointments Waiting times Records RTTs Medicines management Leadership culture & capability
Culture management Records management Improvement: Community Sussex Community NHS Foundation Trust CSH Surrey First Community Health & Care KSS AHSN Improvement Community health inpatient services Medicines management Pain assessment & management Records management Therapeutic staffing levels Pressure damage Medicines management Pressure damage Medication errors Leadership culture & capability Pressure damage Community health services: adult Staffing levels Records management Pressure damage Medicines management Pressure damage Living Well for Longer Community health services: children, young people & families Staffing levels Integration Leadership culture & capability Communities of practice Co-owner health & wellbeing
<18 alcohol related admission <18 alcohol related admission <18 alcohol related admission <18 alcohol related admission <18 alcohol related admission <18 alcohol related admission <18 conceptions <18 conceptions <18 conceptions <18 conceptions <18 conceptions <18 conceptions >65 Hip fractures >65 Hip fractures >65 Hip fractures >65 Hip fractures >65 Hip fractures >65 Hip fractures <75 mortality (cancer) <75 mortality (cancer) <75 mortality (cancer) <75 mortality (cancer) <75 mortality (cardio) <75 mortality (cardio) <75 mortality (cardio) Alcohol-related harm Alcohol-related harm Alcohol-related harm Alcohol-related harm Breastfeed initiation Breastfeed initiation Breastfeed initiation Diabetes Diabetes Diabetes Diabetes Excess weight (adult) Excess weight (adult) Excess weight (adult) Excess weight (adult) Excess weight (adult) Infant mortality Infant mortality Infant mortality Infant mortality Infant mortality Infant mortality Life expectancy (female) Life expectancy (female) Life expectancy (female) Life expectancy (male) Life expectancy (male) Life expectancy (male) Long term unemployed Long term unemployed Malignant melanoma Mental health Mental health Mental health Mental health Mental health Mental health Mental health Obesity (children) Obesity (children) Obesity (children) Obesity (children) Self-harm Self-harm Self-harm Self-harm Self-harm Smoking Smoking Smoking Smoking Smoking Smoking Smoking at delivery Smoking at delivery Smoking at delivery Smoking related death Smoking related death Smoking related death
Statutory homeless Statutory homeless Statutory homeless Statutory homeless STIs STIs TB Violent crime Violent crime Violent crime Winter deaths Winter deaths Winter death Winter deaths Winter deaths Winter deaths Causes of mortality Surrey & Sussex Brighton & Hove CCG Coastal West Sussex CCG Crawley CCG East Surrey CCG Eastbourne Hailsham & Seaford CCG Hastings & Rother CCG High Weald Lewes Havens CCG Horsham & Mid Sussex CCG Cancer Cancer Cancer Cancer Cancer Cancer Cancer Cancer Cancer Cardiovascular disease CVD CVD CVD CVD Circulatory disease Circulatory disease Circulatory disease Mental health Mental health Mental health Mental health Respiratory disease Respiratory disease Respiratory disease Respiratory disease Stroke Stroke Stroke Stroke Stroke
care (including older people's care) improvement Risk assessments Mentoring & support for overseas nurses Poor infection control Silo working Incident reporting Medicines management improvement Leadership, culture & strategy Incident reporting Surgery Requires improvement Never events Staffing levels Patient privacy Mandatory training & appraisals Referral targets Requires improvement Never events Mandatory training & appraisals Information governance Referral targets Maternity & Gynaecology Requires improvement Staffing levels & skill mix Targets missed Theatre risk Ventilation & infection control Mandatory training Requires improvement Staffing & skill mix Leadership & culture Services for children & young people Outstanding Good End of life care Good Good Documentation 5/7 access Outpatients Inadequate Infection control Incident reporting Mandatory training Security & storage of equipment & records Patient dignity, respect Cancelled appointments Leadership & staff support Requires improvement Incident reporting & learning Patient dignity & respect Appointment cancellations Leadership, strategy & staff support Referral targets
SBAR Urgent & Emergency Services (ECC) Requires improvement Learning from incidents Consultant cover Deteriorating patient Mental health assessment Requires improvement Consultant cover Staffing Pain management Hand hygiene Waste management Limited paediatric service Trauma surgery Triage delay Surgery Good Medicines management Staffing Good Critical care Good Patient flow Good Staff engagement Maternity & family planning Requires improvement Delays Cleaning Mandatory training Policies RTT Services for children & young people Requires improvement Incident feedback & learning Waiting times Lack of parents’ room Play specialist Requires improvement End of life care Requires improvement Audit KPIs Record keeping Leadership Requires improvement Outpatients Requires improvement Diagnostic results delay Staffing RTT Morale (diagnostics) Requires improvement
Appendix 5: Western Sussex Hospitals NHS Foundation Trust Western Sussex Hospitals NHS Foundation Trust delivers services primarily at St Richard’s Hospital, Chichester and Worthing Hospital providing A&E, maternity, intensive care, day surgery and outpatients. The West Sussex breast screening service is situated at Worthing Hospital. Southlands Hospital provides outpatients, diagnostic and day surgery; an ophthalmology unit is being built. Services are provided at Bognor War Memorial Hospital and Crawley Hospital. The Trust has: “a vision for the future that puts the patient at the heart of everything we do and is guided by the principles and values about which we care deeply” The 2014-19 strategy is: We care about you: Improving the overall experience patients receive from our Trust We care about quality Delivering improvement in the quality of care we provide We care about safety Delivering improvements to maintain and enhance patient safety We care about serving local people Delivering our strategic clinical change programmes We care about being stronger together Developing our role in delivering emergency and planned care We care about improvement Developing and delivering on leadership programmes We care about the future Implementing our Clinical Services Strategy and maintaining an acceptable financial risk rating and governance rating The Trust was inspected by the CQC in December 2015 and rated outstanding in the report published April 2016. Values: Our patients – Quality – Safety – The future – Serving local people – Improvement – Being stronger together In November 2016, it was announced that the trust would enter a buddying arrangement with Brighton and Sussex University Hospitals NHS Trust, a measure which will facilitate support to BSUH which was put into special measures in August 2016. From April 2017, the WSHFT Chief Executive will assume the role for both organisations. St Richard’s Hospital CQC report Department Rating Concern Good practice Urgent & Outstanding Doors to ED paediatric area 95% of ED patients
Emergency Services (A&E) unlocked No CCTV treated/admitted/discharged within 4 hours Infection prevention and control practice well established Medical care (including older people's care) Outstanding Emergency medicines not checked daily Exemplary care for patients living with Dementia Stroke patient care Staff morale Surgery Good Drug storage: room temps not monitored Junior Doctors’ out of hours Adequate storage (equipment left in corridors) Leadership Team attitude ERAS pathways of care "Knowing Me" booklet for dementia patients Intensive/critical care Requires Improvement Staffing Levels Storage of waste materials Poor quality scanners Orthopaedic ER programme Reporting & learning from incidents Safety & infection prevention Maternity & Gynaecology Outstanding Consultant cover Services for children and young people Outstanding Well led End of life care Outstanding Leadership Team attitudes Outpatients Good Referral to treatment times Worthing Hospital CQC report Department Rating Concern Good practice Urgent & Emergency Services (A&E) Outstanding Emergency Department targets Medical care (including older people's care) Outstanding Elderly care pathways Patients living with dementia accommodated on specific
Mental Capacity Act Sharing learning (incidents) Community based mental health services for older people Good Multidisciplinary team working Forensic inpatient/secure wards Good Physical health support Multidisciplinary teams Long stay/rehabilitation mental health wards for adults of working age Good Leadership Therapeutic, recovery focused interventions Mental health crisis services & health-based places of safety Good Mandatory training Generic information Waiting times Street triage: working with police officers to reduce arrests Specialist community mental health services for children & young people Requires improvement Documentation Risk assessment Cleanliness Waiting times Supervision & appraisal Wards for older people with mental health problems Requires improvement Medication errors Same sex accommodation breaches Lack of specialist services: nutrition, tissue viability, podiatry, diabetic Wards for people with learning disabilities or autism Good Appendix 8: Sussex Community NHS Foundation Trust Sussex Community NHS Foundation Trust provides community and inpatient services across West Sussex, Brighton & Hove and High Weald Lewes Havens area of East Sussex. Services provided include: community rehabilitation; community rapid response; intermediate care; integrated discharge; health promotion and flexible services for families and children. The Trust provides a medicines optimisation service to care homes in Eastbourne, Hailsham, Hastings, Rother and Seaford. The Trust vision is: “of a health and care system that has excellent care at the heart of the community”. (Appendix 1) Values: Compassionate care – Working together – Achieving ambitions – Delivering excellence The board has set three strategic goals to: Provide excellent care every time to reinforce wellbeing and independence Work with our partners to personalise services for the individual Be a strong sustainable business, grounded in our communities and led by excellent staff