the very best care for every patient, every day Our Transformation Journey
the very best care for every patient, every day Our vision Our aims are: • To deliver the best quality care for our patients • To be a great place to work and learn • To improve our financial sustainability • To develop a strategy for the future Our values: • Commitment, Care, Quality
the very best care for every patient, every day Watford General Hospital • Inpatient emergency and intensive care • Elective care for higher risk patients • Outpatient and diagnostic services • C.600 beds and nine theatres • Women's and Children's services Hemel Hempstead Hospital • UCC open 7 days a week 8am – 10pm • Diagnostic services, incl. MRI and pathology • Outpatient services • Simpson ward • Endoscopy and bowel cancer screening services • HCT operates intermediate care beds on site St Albans City Hospital • Elective care (inpatient low risk and day-case) • Outpatient and diagnostic services • Forty beds and six theatres • Minor Injuries Unit open 9am to 8pm, 7 days a week
the very best care for every patient, every day About us… Our local hospitals at Watford, Hemel Hempstead and St Albans treated: Over 500,000 people 136,200 emergency patients treated 450,000 outpatients attendances 39,000 planned and 52,000 emergency operations with 4,500 over 5,000 staff and 350 babies delivered volunteers
the very best care for every patient, every day The headlines • West Hertfordshire Hospitals NHS Trust has moved from ‘inadequate’ to ‘requires improvement’ and has seen a leap in the number of services graded as ‘good’ • The number of services rated ‘good’ is almost double that in 2015 and the number rated ‘inadequate’ has more than halved • There are 40 individual quality ratings of ‘good’ from the 2016 inspection, compared to 25 in 2015 • The number of services rated ‘inadequate’ is less than half that of the previous year, was 31, now 15 • The CQC inspection in September 2016 involved around 50 inspectors who visited all three of the trust’s sites • They interviewed frontline staff and the leadership team, spoke to patients and relatives and took soundings from key stakeholders • Before, during and after the inspection, inspectors considered nearly 1,000 documents; policies; patient notes; medical records and additional information in relation to specific questions. • Our staff are doing amazing things!
the very best care for every patient, every day Our 2015 ratings for Watford Hospital are:
the very best care for every patient, every day See the difference - 2016 Watford ratings: Urgent & emergency services
the very best care for every patient, every day 2015 ratings for Hemel Hempstead Hospital:
the very best care for every patient, every day See the difference - 2016 Hemel ratings:
the very best care for every patient, every day 2015 ratings for St Albans City Hospital are:
the very best care for every patient, every day See the difference - 2016 St Albans ratings:
the very best care for every patient, every day 2015 overall ratings for the Trust 2016 overall ratings for the Trust
the very best care for every patient, every day Our transformation journey • Mortality rates consistently ‘lower than expected’ putting us in top 10% of UK non specialist acute trusts • Clostridium difficile cases at 18 YTD against trajectory of no more than 23, sustained improvement in performance over last three years • No MRSA bacteraemia since October 2015 • Stroke service rated ‘A’, placing the service in the top 19% nationally – repeated success for 6 months • 31 and 62 day cancer and diagnostics performance remains strong, above national average • Strong partnerships in place with system stakeholders • Record CIP delivery 2015/16 of £12m, already above this level for 2016/17 • Cardiology move and first phase of endoscopy expansion complete (opening events to take place soon) • Strong clinical leadership - divisional directors part of our executive team, Board and sub-committees • Substantive transformation delivery team in place • Success in recruitment across the board; band 5 nurses, midwives, doctors • Recent staff survey score improvements since 2015.
the very best care for every patient, every day Feedback from our 2016 inspection Areas of good practice: Areas for further improvement: • Overall morale, attitude and values • Governance and lessons learnt • Progress with complaint management • Medicine management temperature but more work to be done monitoring, TTAs, patient own CDs • Improved medicine management • ED environment, escalation processes, pit stop, consultant oversight in ED resus • Empowered band 7 staff and team • Simpson ward working • Good understanding of MCA/DoLs • Communication between obstetricians • Evidence of a good safety culture in • Air flow in dermatology minor ops rooms maternity with use of safety • Track and review of MCA and DoLs thermometer • Level 3 safeguarding children training in • Maternity security issues addressed surgery for staff caring for 16 – 17 year olds • Vast improvement in end of life care Feedback during and after the CQC inspection has been included in our QIP
the very best care for every patient, every day Where did we perform well? • In the area of ‘caring’ the trust has moved from ‘requires improvement’ to ‘good’ • Medical care is one of six service areas whose overall ratings have moved from ‘inadequate’ to ‘requires improvement’ • Outpatient and diagnostic services at Hemel and St Albans have both moved from ‘requires improvement’ to ‘good’ • End of life care at Watford has moved from ‘requires improvement’ to ‘good’ • Maternity & gynaecology and critical care made significant improvement by moving up two ratings from ‘inadequate’ to ‘good’
the very best care for every patient, every day What the inspectors saw… • Inspectors commended the children’s emergency department, the treatment of patients with hip fractures and the hard work of the estate team to keep sites safe and clean • Inspectors noted good progress with recruitment and in the percentage of savings made • Inspectors commented on delayed transfers of care and patient flow • Inspectors noted inconsistencies in processes and training related to the care of patients with limited mental capacity • Inspectors noted improvements in incidents and complaints but felt that more time is needed to assess the effectiveness of changes
the very best care for every patient, every day Where is there room for improvement? • Urgent and emergency care at Watford was rated ‘inadequate’ for a second year running • Despite an ‘outstanding’ rating for the second year running in the domain of care for children and young people’s services, the overall rating has moved from ‘good’ to ‘requires improvement’ • At Hemel, the overall rating has moved from ‘requires improvement’ to ‘inadequate’ • At St Albans, the overall rating has moved from ‘inadequate’ to ‘requires improvement’ but for the minor injuries unit, the rating was down from ‘good’ to ‘requires improvement’
the very best care for every patient, every day What have we done? Emergency Care • Triage in place at UCC, all patients clinically reviewed on registering. Areas for improvement: • RCEM initial recognition decision triage position 2011 implemented to ensure clinical oversight • Ensure effective • Immediate alterations to mental health room made and new furniture in place Streaming in UCC (benchmarked with HPFT) and MIU • All patients screened prior to use of room using MH triage tool. Patients identified red, • ED mental health orange or yellow supervised until assessed by RAID room • Utilising second assessment bay with senior clinician utilising STARRing policy • Timely use of • Blue sticker to record notes review and no outstanding treatments pitstop and clinical • Implemented senior doctor oversight in resus and a resus bleep holder decision making • Pain management action plan developed • Consultant • Monthly ‘Test Your Care’ questions changed to monitor pain management in ED oversight in ED Resus • A&E Delivery Board, chaired by our CEO, oversees system-wide performance • Pain assessment • Hydration is included in the new ED safety checklist and hydration in • Comprehensive review of educational requirements for UCC and MIU. New training ED regime has begun
the very best care for every patient, every day What have we done? Planned Care Areas for Referral to Treatment: improvement: • Comprehensive governance in place • Revised trajectory to achieve • RTT performance compliance by March 2017 • Cancer two week wait performance Cancer Two Week Wait: • Consistent use of • Improving position, majority of breaches are patient choice so working with HVCCG WHO checklist to improve communication with patients WHO Checklist: • Consistent application of five step • WHO checklist in all theatres at Watford and St Albans
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