1. Quality Accounts 2011/12 Looking back, looking forward Dr Patricia Bain Director of Quality and Standards 12 th September 2012

2. Quality Accounts 2011/12 Legal requirement to produce quality account Statement of assurance, Monitor, DH Audited: KPMG – without conditions, green for all selected indicators Chief Executive commentary: context Looking back: Achievements, External Assurance Looking forward: Improvement programmes, new indicators, supporting programmes

3. Section 2: Looking Back Between 2010 and 2011, for the National surveys, more positive feedback from patients in 2 of the 5 questions the same for one question less positive feedback for 2 of the 5 questions

4. Staff Survey In 2011-12 national survey, reduction in staff reporting good communication between senior management and staff, (33% to 24% ) Staff satisfaction for 2011-12 is 3.55, above the national average for acute Trusts (3.47 in 2011-12) Reduction in the number of harmful errors witnessed (5%) Local survey highlighted training, job satisfaction as areas of concern, feeling valued higher Local survey Subject areaAverage Score Feeling valued 7.2 Learning and Development 6.0 Performance 6.1 Health and Wellbeing 7.3 Communication from managers 6.6 Job satisfaction 5.7 Conflict resolution 7.0 Overall score 6.5

5. Looking back: 2011/12 Quality Review Acute & Community Patient Experience Tracker High risk medication compliance Communication IR1s & RCA 30 day readmission rates Liverpool Care Pathway Looking Back: Improvement programmes 2011-12

6. Improvement Programme1i: High risk drugs - compliance Improvements in the prescribing, administration and monitoring of opiates, antibiotics and the anticoagulation medicine Tinzaparin; prescription and administration of Warfarin are the key areas for on-going focus Current actions: reviewing of anticoagulation service, training on anti-coagulants routinely included in junior doctor study day Focus remains, expanded to all aspects of medicines management- Trust wide medicine management task finish group currently taking a comprehensive work programme forward

7. Improvement Programme 1ii: Communications Incident reporting & Root Cause Analyses (RCA) Formal RCA of communications related incidents ensures that learning is captured, and proactive steps taken to minimise communication issues which may affect their care. Incidents relating to ‘Communications between staff and teams ‘ showed 5% increase in reporting and 33% increase in completed RCAs Incidents relating to communication with the patient showed a 3% increase in reporting and 31% increase in completed RCAs Investigations into issue relating to patient case notes increased by 20% A key theme incidents related to handover; progress noted by deanery, to be further progressed in 2012-13, linking to EPR

8. Improvement Programme 2i: Reducing 30 day readmissions arising from elective admissions

9. 30 day re-admissions: on-going actions Work continues to try and impact on the rate of readmission for all types of admission across the Trust, including: Implementation of ‘open access’ to follow up appointments for selected specialties A review of discharge information provided to patients Scoping of the ‘virtual ward’ concept Exploration of ‘telemedicine’ and a Single Point of Access call/contact centre to signpost patients appropriately to the care they need Development of the Early Pregnancy Advisory Unit (EPAU) telephone triage service, introduction of urgent outpatient appointments Accident and Emergency, piloting of a GP triage service, a Community Matron pilot, audit of admissions with a length of stay less than 48 hours and Multi Disciplinary Team meetings to review issues related to frequent attenders

10. Improvement Programme 3i: Increasing our responsiveness to patient needs: volume Significant improvement in the volume of community surveys by Quarter 4, No improvement for Acute services. Both Adult and Universal Services Community Health achieved year end results in excess of their quarter 2 baseline.

11. Increasing our responsiveness to patient needs: responses Focus on improving patient’s rating of their experience will be continued throughout 2012-13 in the acute setting.

12. Improvement Programme 3ii: Compliance with 5 key Liverpool Care Pathway measures Proportion of deceased on LCP increased from 41% to 47%, national average is 26% 95% target for 5 elements was not achieved, although increase shown across all questions, continued target for 2012-13 Governors indicator for this years quality accounts and extended to the community setting

13. ‘Quality at a glance’ Indicators: 2011-12  Zero local targets set for MRSA (with 23 months of zero MRSA infections) One occurrence impacted on zero achievement for the whole year; still achieves DoH targets  C. Difficile performance achieved and improved by 30% against last year’s performance, falling from 50 (March 2011) to 35 for the year ending March 2012.  Performance against National Peers incredibly strong – with the average rate for MRSA = 4.1, C.Diff 82.7  Medication error rate, reduced year on year – from 1.6 to 1.5 (per 1,000 dispensed items). Attributed in part to focus on high risk medication protocol adherence  Fluid Balance and Patient At Risk (PAR) scoring on wards have improved vastly – from 64.5% and 50% (2010-11) to 83.8% and 82.7% respectively- major contribution towards optimising conditions for patient recovery.  First Never Event in 3 years – retained swab, zero target re-set for 2012/13

14. ‘Quality at a glance’ 2011-12 contd.. Grade 2+ pressure ulcer occurrences for acute inpatients have reduced by 8% against performance in 2010-11. Risk Adjusted Mortality Index (RAMI – CHKS Live) has decreased from 95 (2010-11) to 84 (2011-12). Our Summary level Hospital Mortality Indicator also reflects some improvement, decreasing from 76.1 (2010-11) to 74.2 (2011-12), for in hospital deaths. Falls from height increasing by 1.8/1000 bed days to 2.3/1000 bed days, however improvements already seen in Q1 this year. National comparisons NHS Safety Thermometer lowest number of ‘harms’ from falls (1.2% national, 0.2% TRFT)

15. Section 2b: Statement of Assurance Service reviews: External reviews, NHSLA,CQC risk profile CQUIN : For 2011-12 the baseline value of CQUIN was £2.5m, total estimated value payable to the Trust for CQUIN for 2011-12 is £2.32m Clinical Audit activity, broadened and expanded include NICE Quality Standards (currently 15) Research programmes, number of patients increased by 300 Data Quality >98% on selected indicators Information Governance: 5 of 6 categories satisfactory, IG training increased 30% to 80%, not satisfactory rating overall National Priorities indicators 23 out of 28 targets met

16. Quality Accounts 2012/13 Our overarching strategic objectives for the next 3 years as set out in our Quality Strategy and linked to the Quality Accounts programme, are: SAFE  Reduce mortality: achieve a position in top 10% of organisations with lowest risk adjusted mortality  Reduce Harm: 95% of patients are harm-free CARING  Improve the patient/staff experience: achieve top 20% for patient and staff experience surveys RELIABLE  Provide reliable care: ensuring that evidence based practice is followed by meeting 90% compliance with all NICE Quality Standards

17. End of Life Care Pathway, extended to community setting Fast track discharges to CHC for Dementia patients Dementia investigations Never events (cont’d) Medicines management (cont’d and expanded) NHS Safety Thermometer (Falls, UTI,VTE,PU) Health assessments for looked after children * NICE Quality Standards on- going Specific Improvement Programmes 2012-13 Safe Caring Reliable

18. CQUINs 2012-13 Goal Number Goal Name Indicator Number Indicator Name Indicator Weighting Expected Financial Value of Indicator 1VTE Prevention1VTE Risk Assessment (Numerator 1) and Use of Appropriate Prophylaxis (Numerator 2)5.0%£204,118 2Patient Experience 2aComposite indicator on responsiveness to personal needs5.0%£204,118 2bPatient Experience - Community3.5%£142,882 3Dementia 3aDementia Screening2.5%£102,059 3bDementia Risk Assessment2.5%£102,059 3cReferral for Specialist Diagnosis2.5%£102,059 4NHS Safety Thermometer4NHS Thermometer5.0%£204,118 5 Improving Non-Elective Care Pathways 5aAssessment of patients in a non-admitted care setting8.0%£326,589 5b Fast Response engagement in assessment of and/or utilisation of alternative levels of care as an alternative to admission or further assessment. 5.5%£224,530 5c Community and Secondary Care Clinicians engagement with GP practice multi- disciplinary team meetings 9.5%£387,824 5d Engagement and improvements to the LTC/Urgent Care pathways - CRMC 5 Pathways plus in 12-13 Childrens & General/Elderly Medicine - Cross -cutting Intermediate care 4.8%£195,953 6 Improving the Patient Pathway/Experience in A&E 6a Patient Pathway/Experience in A&E - Improve access to A&E Triage Assessment and maintain time to treatment 4.8%£195,953 6b To reduce the average length of time patients have to wait to be admitted into a specialty bed after a decision to admit has been made by the A& E department 12.6%£514,377 7Clinical Communications 7aImproving quality & timeliness of clinic letters from secondary to primary care6.0%£244,941 7bImproving quality & timeliness of discharge letters from secondary to primary care4.8%£195,953 7cImproving quality & timeliness of handover/case management plans to primary care3.6%£146,965 8 Improving the Planned Care Pathway 8a Audits of First and Follow-Up Outpatient Appointments and Engagement in the CRMC agenda 4.8%£195,953 8bDiagnostics provision of Datsets1.2%£48,988 9 Improving End of Life Care (EoLC)and the Interface with Continuing Health Care (CHC) 9 Reduction of inappropriate Fast Track discharges to Continuing Healthcare (CHC) and increasing the number of patients on to LCP who are at End of Life 2.4%£97,977 10Safeguarding10Implementation of the Safeguarding Standards6.0%£244,941 Total100.0%£4,082,357

19. Quality indicators for 2012-13 DomainIDIndicator nameRationale for monitoring Culture C_1All applicable staff to have in year PDRLinks to ‘caring’ objectives C_2Increase in IRI reportingReflects ‘no blame’ culture C_3 All staff to maintain compliance against MAST training Links to supporting staff objectives C_4Employee sickness ratesReflects morale of staff Patient Safety SAFE PS_1 To ensure that we are meeting 90% compliance against all of the standards set out in relation to safe and secure storage of medications High risk medications review to be reported as part of the Ward Nursing Accreditation Scheme (WNAS), which includes all wards – due to limited success attained in the four areas reviewed last year. The selected indicator for this year is a more comprehensive review of all medicines management processes PS_2aHave zero ‘Never Events’Zero target not achieved for 2011/12-continue PS_2bRate of patient safety incidents/1000 admissionsNew DoH/Trust indicator PS_2c Percentage of patient safety incidents resulting in severe harm or death New DoH/Trust indicator PS_3Number of patients with CDiff/Rate of CDiffNew DoH/Trust indicator PS_4Number of patients with MRSAOn-going Trust requirement PS_5Increase in number of complaintsOn-going Patient Experience indicator Patient Experience CARING PE_1 Increasing our responsiveness to our patients needs using a composite indicator of care, from April 2011 baseline Improvement on 2011/12 required, metric continues to be a CQUINs indicator for 12012-13 PE_2 Increasing compliance to 95% of 5 key measures on the Liverpool Care of the Dying Pathway (LCP) by April 2012 This is the Governor selected indicator for 2012-13, also continues to be a CQUINs indicator PE_3 Increase the proportion of community OT visits for assessment within 28 days from April 2012/13 baseline to 95% by April 2013/14 New programme - community focus

20. DomainIDIndicator nameRationale for monitoring Patient Experience PE_4 Increase the number of Health Visitor first visit within 10-14 days of birth from 90% to 97% New programme - community focus PE_5 Increase in the number of patients assessed using the MUST nutritional tool and completed fluid balance charts On-going Trust requirement PE_6PROMS dataNew DoH indicator Clinical Effectiveness RELIABLE CE_1 Reducing the number of hospital re-admissions from care homes within 30 days from April 2012 baseline New programme - community focus CE_2 Reducing emergency re-admissions to hospital within 28 days of discharge New DoH indicator CE_3Reduction in Mortality: SHMI value and banding New DoH indicator CE_4% patients admitted treatment inc palliative care New DoH indicator CE_5 % patients whose death inc in SHMI treatment palliative care New DoH indicator CE_6 Reducing weekend mortality rates as at April baseline 2012 New Trust indicator mortality targets Data Quality DQ_1Data Quality index CHKS live (HRG4 based)On-going Trust requirement DQ_2 Blank or invalid or unacceptable primary diagnosis rates CHK live HRG4 based On-going Trust requirement DQ_3 Depth of coding average diagnosis per coded episode CHKS live exclude Breathing Space On-going Trust requirement Quality indicators for 2012-13 contd.

21. Developments for 2012-13 SDS3 and Quality Strategy implementation, monitored PMO Strengthening of the Quality Governance Framework Revised Patient Safety, Patient Experience and Clinical Effectiveness Strategies Initiatives aligned with the Trust’s Business Intelligence strategy – currently being implemented Datix/CHKS/ Quality Dashboards: Service to Board –Supports end user ‘self service’ Dashboards configured to suit end user requirements Capability to ‘drill down’ to data detail as necessary Data available for review as soon as it is entered Will provide ‘real time’ information to the Board and weekly Harm meetings

22. Any Questions?