1. Paul Curley Mid Yorkshire Hospitals NHS Trust

2.  To put in context role of Health Informatics in the Keogh review process  To review “smoke alarm” indicators  Share insights into Keogh process – strengths and weaknesses  Explore possible surrogate indicators of quality  Explore Surgeon/service level data issues  Touch on Naughty Neighbour media storms..

3.  Francis report – Mid Staffs  “Could there be others ?”  14 organisations identified via HSMR or SHMI  Panel identification – RCS Invited Review Mechanism  Data Pack analysis – NHS England/PwC  Visits – Announced / Unannounced  Risk Summit

4.  Expenses to support visits - £169,000  Contract award (PwC) support - £2,773,000  Filming Risk Summits - £28,000  Legal Advice - £30,000 Total - £3,000,000 $58,000$1.1m

5.  Chair (Senior Nurse/Manager/Medical Director)  Consultants (2-3)  Senior Nurses (2-3)  Student Nurse  Junior Doctor  CQC  Patient/Public Reps  Senior Manager NHS England  CCG Observers

22.  Inadequate governance, and pace and focus of change to improve overall safety and experience of patients  Slow and inadequate responses to serious incidents and a culture which does not support openness, transparency and learning  Staffing shortfalls and other workforce issues across staff groups which may be compromising patient safety  Lack of support for staff and effective, honest communication from middle and senior management level  Failure in governance to ensure adequate maintenance of the estate and equipment  Significant weaknesses in infection control practices

23.  Drop in face-to-face staff meetings  Locum/Agency spend  Dealing with Serious Untoward Incidents (never events)  Equipment management  PPI / Junior doctor / Student Nurse members

24.  Published June/July 2013  Several specialties  Vascular – AAA, CEA  Tables non-risk adjusted

25.  "I am fain to sum up with an urgent appeal for adopting … some uniform system of publishing the statistical records of hospitals. There is a growing conviction that in all hospitals, even in those which are best conducted, there is a great and unnecessary waste of life … In attempting to arrive at the truth, I have applied everywhere for information, but in scarcely an instance have I been able to obtain hospital records fit for any purposes of comparison … If wisely used, these improved statistics would tell us more of the relative value of particular operations and modes of treatment than we have means of ascertaining at present?" Florence Nightingale in Notes on Hospitals, London: Longman, Green, Roberts,Longman, and Green, 1863.

26. Overlaid2 Quinsie1 Rickets8 Rising of the lights8 Scowering1 Scurvey2 Stillborn9 Stone1 Stopping of the stomach3 Suddenly6 Teeth16 Winde3 Worms1 Males 107 ChristenedFemale109 In all216 Males213 BuriedFemales196 In all 409 Plague0 Decreased in the buriels this week - 63 Parishes clear of the plague - 130 Parishes infected - 20 Abortive2 Aged36 Bedridden1 Bloody flux1 Bruised1 Cancer1 Chilbed3 Chrisoms19 Consumption77 Convulsions44 Cough2 Dropsie1 Executed33 Feaver10 Flox and smallpox5 Found dead in the street (an infant)1 French pox1 Gripping in the guts 13 Jaundies1 Infants18 Killed with a fall3 Murthered 1

31.  Pennine Acute Hospitals NHS Trust 266  4308472 89 3 86 0.0%  4187787 * * * *  3643174 84 11 73 2.4%  3560031 50 14 36 2.0%  6090793 * * * *

32.  Primary – STEMI  Planned – angina, NSTEMI etc  2 models :  Centralised (Leeds, Newcastle)  Distributed  Good data submission  Is “geography/service model” an issue ?

36.  Health Informatics can develop “smoke alarm” indicators  Detailed analysis of available data played an important role in the Keogh review process  Informatics alone were not adequate to diagnose issues in many of the Keogh sites  Multi-disciplinary teams brought huge value to the Keogh process

37.  At current levels of sophistication, health informatics are complementary to inspection processes  Listening to staff and patients will continue to play a vital role in assessments for the foreseeable future  Developing a standard “data pack” for Acute Trusts would be a valuable health informatics task

39.  Wakefield Prison – category A  Highest concentration of Sex offenders and Murderers in Prison population

40.  Only major Burns Centre in Yorkshire based in Pinderfields

41.  Document Management  PAS replacement  Outsourced letter printing  EDsM  Order Comms  PACS/RIS  PMI duplicates  Managed networks  VoIP/Mobile voice/Faraday cage construction