NHS North West DoNs Conference


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Includes - Chris Jeffries
Jane Cummings
Hugh Griffiths
Maxine Power

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  • Cases prevented 23,151 & 5,788
  • The changes we will introduce are based on empirical evidence, widely recognised in best practice guidelines but simplified for execution. This simplification should not be misinterpreted as ‘dilution’. Our experience of improving healthcare quality has clearly shown that focussing a small number (3-4) key interventions and figuring out strategies for local implementation are key to breakthrough improvement. The rationale is clear, find the key interventions which make the biggest difference and implement reliably for every patient, all the time. However, in requiring that four clinical specialist areas work together with frontline teams to create a single plan for harm free care this design concept forces teams to agree on a single model, for example, in the active risk management domain clinical specialists in pressure ulcers and falls are moving towrds intentional or hourly rounding to manage ‘risk’, by combining their requirements in a single rounding proforma we can deliver against multiple agendas with the ultimate design being a form which is elegantly designed to accommodate ALL areas.
  • NHS North West DoNs Conference

    1. 1. Welcome Chris Jeffries Acting Director of Workforce and Education NHS NW
    2. 2. <ul><li>Welcome </li></ul>
    3. 3. Housekeeping <ul><li>Mobiles </li></ul><ul><li>Fire Alarms </li></ul><ul><li>Toilets </li></ul><ul><li>Catering </li></ul><ul><li>Reception desk </li></ul>
    4. 4. <ul><li>Today is about </li></ul>
    5. 5. Today is about <ul><li>Celebrating nursing success </li></ul>
    6. 6. Today is about <ul><li>Harnessing energy and enthusiasm </li></ul>
    7. 7. Today is about <ul><li>Improving delivery of patient care, patient and staff experience </li></ul>
    8. 8. <ul><li>Change </li></ul>
    9. 9. <ul><li>Service Reconfigurations </li></ul>
    10. 10. <ul><li>QIPP and savings </li></ul><ul><li>3 and1/2 years to go </li></ul>
    11. 11. <ul><li>Continuously improving Quality for patients </li></ul>
    12. 12. <ul><li>Patient Safety and the public Francis Inquiry </li></ul>
    13. 13. <ul><li>Service reorganisations following Transfers of Community Services </li></ul>
    14. 14. <ul><li>Organisational Changes: clinical Commissioning Groups </li></ul>
    15. 15. <ul><li>Move to all degree Nursing </li></ul>
    16. 16. <ul><li>Changes to Health Visiting service and increase in Numbers </li></ul>
    17. 17. <ul><li>Remember what is was like when you first started as a student nurse...... </li></ul>
    18. 18. <ul><li>And then when you qualified...... </li></ul>
    19. 19. <ul><li>And now looking back from where you are now......... </li></ul>
    20. 20. <ul><li>We have plenty of success to celebrate! </li></ul>
    21. 21. SUCCESS Directors of Nursing Conference 1 September 2011
    22. 22. <ul><li>Coming together is a beginning; </li></ul><ul><li>Keeping together is progress; </li></ul><ul><li>Working together is success </li></ul><ul><li>Henry Ford </li></ul>What is Success? In order to succeed, your desire for success should be greater than your fear of failure Bill Crosby
    23. 23. The Beginning
    24. 24. Manchester
    25. 25. Bringing People Together
    26. 26. Shaping the Future of Nursing in the North West
    27. 27. 1 st Annual Director of Nursing Conference
    28. 28. 1 st Annual Director of Nursing Conference
    29. 29. North West Nursing Indicators <ul><li>General Nursing Care Indicators </li></ul><ul><ul><li>Tissue Viability </li></ul></ul><ul><ul><li>Falls Assessment </li></ul></ul><ul><ul><li>Infection Prevention & Control </li></ul></ul><ul><ul><li>Medication Assessment </li></ul></ul><ul><ul><li>Nutritional Assessment </li></ul></ul><ul><ul><li>Pain Management </li></ul></ul><ul><ul><li>Patient Observation </li></ul></ul><ul><li>Community Nursing Care Indicators </li></ul><ul><ul><li>Care of the Dying </li></ul></ul><ul><ul><li>Pressure Ulcer Care </li></ul></ul><ul><ul><li>Falls Prevention </li></ul></ul>NW CIs 2011
    30. 30. <ul><li>MRSA </li></ul><ul><li>C Difficile </li></ul><ul><li>Mixed Sex Accommodation </li></ul><ul><li>Quality Assurance </li></ul>Improvements Needed and Made
    31. 31. MRSA
    32. 32. C Difficile
    33. 33. Mixed Sex Accommodation Number of Breaches
    34. 34. Quality Assurance - Francis
    35. 35. Francis Review: Assurance
    36. 36. Francis Review: Assurance
    37. 37. Francis Review: Assurance
    38. 38. Francis Review: Assurance
    39. 39. <ul><li>AQuA has been established as a membership organisation through the active leadership of North West CEOs and Board Directors </li></ul><ul><li>It is firmly focused on supporting delivery of QIPP goals </li></ul><ul><li>Results are already being delivered: </li></ul><ul><ul><li>Stroke 90:10 driving up compliance with Sentinel Audit > 90% </li></ul></ul><ul><ul><li>AQ improving outcomes and experience for five conditions </li></ul></ul><ul><ul><li>Safety Networks – improvements in falls, pressure ulcers and VTEs </li></ul></ul><ul><ul><li>Mortality Collaborative – reducing HSMRs in 9 Trusts with highest rates </li></ul></ul>
    40. 40. AQ : A Progress Report *UK Year One Position reflects the AQ programme’s overall Composite Quality Score per clinical area for October 2008 – September 2009. ** UK Year Two Position reflects the AQ programme’s overall Composite Quality Score per clinical area for October 2009 – March 2010 ***US Year One Position reflects the HQID overall Composite Quality Score per clinical area for October 2003 – September 2004. Note: while similar, the measures analysed within each clinical group for the year one HQID project are not identical to those used in year one of the AQ project. For a full list of the HQID initial measure set go to www.qualitydemo.com Clinical Area UK Year One Position * UK Year Two Position ** US Year One Position *** AMI 92.55% 96.89% 89.31% CABG 96.76% 96.94% 87.34% HF 62.11% 69.95% 69.60% HK 88.97% 92.73% 87.52% PN 76.32% 81.55% 73.72%
    41. 41. Stroke 90:10 drove up standards in stroke care Phase 2 teams joined Phase 1 teams joined 90%
    42. 42. <ul><li>Background to Mortality Collaborative </li></ul><ul><ul><li>The Dr Foster Hospital Guide 2009 </li></ul></ul><ul><ul><li>Collaborative driven by the will of CEO community </li></ul></ul><ul><ul><li>9 participating organisations came together </li></ul></ul>Mortality Collaborative
    43. 43. Collaborative Improvement Aim By April 2011 participating organisations will have improved adjusted mortality by at least 10 points during 2010 – 2011 as measured by CHKS or Dr. Foster.
    44. 44. The Collaborative Rate of Improvement – Dr Foster
    45. 45. The Collaborative Rate of Improvement - CHKS
    46. 46. <ul><li>2007 </li></ul><ul><ul><li>Primary Care Organisation of the Year – Wirral PCT </li></ul></ul><ul><ul><li>Clinical Service Redesign – Salford Royal FT and Salford PCT </li></ul></ul><ul><ul><li>Improving Patient Access – Bolton PCT </li></ul></ul><ul><ul><li>Reducing Health Inequalities – East Lancashire PCT </li></ul></ul><ul><ul><li>Improving Care with E-Technology – NHS North West </li></ul></ul><ul><li>2008 </li></ul><ul><ul><li>Workforce Development – NHS North West </li></ul></ul><ul><ul><li>Patient Centred Care – Blackburn with Darwen PCT </li></ul></ul><ul><ul><li>Patient Safety – Salford Royal FT </li></ul></ul><ul><ul><li>Improving Health with Nice Guidance – Central and Eastern Cheshire PCT </li></ul></ul><ul><li>2009 </li></ul><ul><ul><li>Primary Care Organisation of the Year – Liverpool PCT </li></ul></ul><ul><ul><li>Acute and Primary Care Innovation – Salford Royal FT </li></ul></ul><ul><ul><li>Reducing Health Inequalities – NHS Blackburn with Darwen </li></ul></ul><ul><ul><li>Using Date to Improve Care – NHS North West </li></ul></ul><ul><li>2010 </li></ul><ul><ul><li>Primary Care Organisation of the Year – NHS Western Cheshire </li></ul></ul><ul><ul><li>Improving Care with Technology – Central Manchester University Hospitals FT </li></ul></ul><ul><ul><li>Quality and Productivity – Salford Royal FT </li></ul></ul>
    47. 47. <ul><li>2009 </li></ul><ul><ul><li>Child Health – NHS Tameside and Glossop 2009 </li></ul></ul><ul><ul><li>Chief Nursing Officer Award – Salford Royal FT </li></ul></ul><ul><ul><li>Accident and Emergency – Salford Royal FT </li></ul></ul><ul><ul><li>Innovation in your Speciality – Royal Bolton FT 2009 </li></ul></ul><ul><ul><li>Mental Health – Greater Manchester West Mental Health FT </li></ul></ul><ul><li>2010 </li></ul><ul><ul><li>Patient Safety – Stockport NHS FT </li></ul></ul><ul><ul><li>Improving Maternity Services – Blackpool Fylde and Wyre FT </li></ul></ul><ul><ul><li>Patient Dignity – NHS Tameside and Glossop </li></ul></ul><ul><ul><li>Accident and Emergency Nursing – Royal Liverpool and Broadgreen University Hospital </li></ul></ul><ul><ul><li>Innovation in your Speciality – Liverpool PCT 2010 </li></ul></ul><ul><ul><li>Infection Prevention and Control – 5 Boroughs Partnership FT </li></ul></ul><ul><ul><li>Child Health – NHS Tameside and Glossop 2010 </li></ul></ul>
    48. 48. Nursing Standard – Nurse of the Year 2011 Fiona Murphy – Royal Bolton FT
    49. 49. Hazel Holmes – Director of Nursing Liverpool Heart and Chest Hospital NHS FT Travel Scholarship
    50. 50. Honours Awards 2007 - 2011 29 New Years/Birthday Honours Awarded to North West Hospital Staff since 2001
    51. 51. Leadership
    52. 52. <ul><li>The Prime Minister’s Commission on the future of Nursing and Midwifery in England – Front Line Care </li></ul><ul><li>Providing advice to the Department of Health on Nurses in Commissioning </li></ul><ul><li>Regional Energise for Excellence leadership </li></ul><ul><li>Rapid Spread </li></ul><ul><li>Best practice and improvement – peer to peer support </li></ul>Leadership
    53. 53. LEADERSHIP
    54. 54. Energise for Excellence Where did it start:
    55. 55. Energise for Excellence Safer Nursing Care Tool (AUKUH) HURST PANDA Birth Rate+ E Rostering Productive Care Safety Express High Impact Actions Essence of Care NW Care Indicators Productive Care Safety Express High Impact Actions Nurse Sensitive Outcome Measures Real-time Monitoring Experience Based Design Single Sex Accommodation Patient Stories High Impact Actions Real-time Monitoring Health and Well Being Get Staffing Right Deliver Care Measure Impact Patient Experience Staff Experience
    56. 56. Safety Express/Thermometer
    57. 57. NHS Confederation Launch 2011
    58. 58. <ul><li>Tracy Nurse – District Nurse </li></ul><ul><li>Emma Wilkes – Senior Nurse Practitioner </li></ul><ul><li>Joan O’Hanlin – Clinical Team Manager </li></ul><ul><li>Graeme Mitchell – Matron </li></ul><ul><li>Pauline McGarth – Acting Assistant Director </li></ul><ul><li>Caroline Rees- Sister </li></ul><ul><li>Sarah Sillitoe – Ward Manager </li></ul><ul><li>Joanne Mc’Donnell – Head of Nursing </li></ul>Local Nurses Leading the Way
    59. 60. <ul><li>Delivering QIPP </li></ul><ul><li>Dealing with increasing need and less resource </li></ul><ul><li>Really integrating care </li></ul><ul><li>Keeping quality, safety and experience at the heart of everything we do </li></ul>The Future
    60. 61. NHS North of England
    61. 62. How wonderful it is that nobody need wait a single moment before starting to improve the world Anne Frank
    62. 63. The New Mental Health Strategy for England Dr Hugh Griffiths National Clinical Director for Mental Health
    63. 64. Introduction <ul><li>The scale </li></ul><ul><li>The history </li></ul><ul><li>The policy context </li></ul><ul><li>The new mental health strategy </li></ul><ul><li>Mental health and QIPP </li></ul><ul><li>Some potential challenges </li></ul><ul><li>Future developments </li></ul>
    64. 65. The Scale <ul><li>1 in 4 people </li></ul><ul><li>Cost to English economy £77 billion pa. </li></ul><ul><li>More likely £105 billion pa. </li></ul><ul><li>A million people on IB </li></ul><ul><li>A third of GP consultations </li></ul><ul><li>Largest proportion of disease burden </li></ul><ul><li>Premature mortality </li></ul>
    65. 66. The History <ul><li>The National Service Framework – 1999 </li></ul><ul><li>The NHS Plan – 2000 </li></ul><ul><li>New Horizons – 2009 </li></ul><ul><ul><ul><li>All adults </li></ul></ul></ul><ul><ul><ul><li>Dual approach </li></ul></ul></ul><ul><li>The General Election – May 2010 </li></ul><ul><li>The new Mental Health Strategy </li></ul>
    66. 67. Policy Context <ul><li>Patients at the centre – shared decision-making, choice and information </li></ul><ul><li>Focus on outcomes – quality at the heart of the healthcare </li></ul><ul><li>Devolution – clarity about the “what” more than the “how” </li></ul><ul><li>Strengthening public health </li></ul><ul><li>Reform of adult social care </li></ul>
    67. 68. Policy Context <ul><li>Equity and Excellence White Paper - towards GP- led commissioning and outcomes (12 July 2010) – Health and Social Care Bill </li></ul><ul><li>The Outcomes Frameworks </li></ul><ul><li>Healthy lives, healthy people White Paper: Our strategy for public health in England (30 November 2010) </li></ul><ul><li>Healthy lives, healthy people: consultation on the funding and commissioning routes for public health (21 December 2010) </li></ul>
    68. 69. Policy Context <ul><li>A vision for adult social care: Capable communities and active citizens </li></ul><ul><li>(16 November 2010) </li></ul><ul><li>Liberating the NHS: developing the healthcare workforce (20 December 2010) </li></ul><ul><li>The Operating Framework for the NHS in England 2011/12 (15 December 2010) </li></ul><ul><li>Quality Innovation Productivity & Prevention (QIPP) agenda </li></ul>
    69. 70. Mental Health Strategy A strategy to transform the mental health and well-being of the nation An ambition to mainstream mental health and achieve ‘parity of esteem’ with physical health The aim for mental health to be ‘everyone’s business’ – all of Government, employers, education, third sector
    70. 71. Mental Health Strategy - Themes <ul><li>Services and public mental health </li></ul><ul><li>Outcomes and quality </li></ul><ul><li>A life-course approach </li></ul><ul><li>Early intervention </li></ul><ul><li>Patient choice and control (personalisation) </li></ul><ul><li>Reducing inequality and tackling stigma </li></ul><ul><li>Improving efficiency (QIPP) in the context of a challenging financial climate </li></ul>
    71. 72. <ul><li>More people with mental health problems will recover </li></ul>Objectives <ul><li>More people will have good mental health </li></ul><ul><li>More people with mental health problems will have good physical health </li></ul><ul><li>More people will have a positive experience of care and support </li></ul><ul><li>Fewer people will suffer avoidable harm </li></ul><ul><li>Fewer people will experience stigma and discrimination </li></ul>Mental Health Strategy
    72. 73. A Cross-Government Mental Health Strategy <ul><li>Good mental health is essential for everyone </li></ul><ul><li>Improving public mental health and well-being, with prevention and early intervention, can cut the £105bn annual cost of mental ill health </li></ul><ul><li>People with mental ill-health are likely to have better outcomes if they have real, well-informed choices over their care </li></ul><ul><li>A twin-track approach will improve outcomes for people with mental ill-health and build resilience and well-being to prevent mental ill-health in the whole community </li></ul><ul><li>How public service reforms will work for mental health </li></ul><ul><ul><li>A “Call to Action” with key stakeholders </li></ul></ul><ul><li>Key messages for a cross government mental health strategy </li></ul>
    73. 74. A Call to Action
    74. 75. Quality, Innovation, Productivity and Prevention (QIPP) <ul><li>Three mental health elements: </li></ul><ul><li>The acute care pathway </li></ul><ul><li>Local variations </li></ul><ul><li>Out of area treatments </li></ul><ul><li>Allocative efficiency </li></ul><ul><li>Physical and mental health </li></ul><ul><li>Medically Unexplained Symptoms, </li></ul><ul><li>co-morbidities </li></ul>
    75. 76. Potential Challenges <ul><li>General: </li></ul><ul><ul><ul><li>History </li></ul></ul></ul><ul><ul><ul><li>Lack of Payment by Results </li></ul></ul></ul><ul><ul><ul><li>Poor information </li></ul></ul></ul><ul><ul><ul><li>Stigma and culture </li></ul></ul></ul><ul><li>Social care system changes </li></ul><ul><li>Criminal justice system changes </li></ul>
    76. 77. Future Developments <ul><li>Implementation </li></ul><ul><li>The Joint Commissioning Panel </li></ul><ul><ul><ul><li>RCPsych and RCGP </li></ul></ul></ul><ul><li>The NHS Commissioning Board </li></ul><ul><ul><ul><li>Position mental health </li></ul></ul></ul><ul><li>Managed Networks </li></ul>
    77. 78. Where to find all documents <ul><li>Strategy and companion document – “Delivering better mental health outcomes for people of all ages” available at : </li></ul><ul><li>www.dh.gov.uk/mentalhealthstrategy </li></ul><ul><li>Also, “Talking Therapies: a four-year plan of action” and: </li></ul><ul><li>Impact Assessment and Analysis of Impact on Equality </li></ul>
    78. 79. Safety Express Maxine Power QIPP Safe Care National Work Stream Lead Department of Health [email_address]
    79. 80. The only thing that exceeds my admiration for the NHS is my hope for the NHS. I hope that you will never, never give up on what you have begun. I hope that you realize and reaffirm how badly you need, how badly the world needs, an example at scale of a health system that is universal, accessible, excellent, and free at the point of care – a health system that is, at its core, like the world that we wish we had: generous, hopeful, confident, joyous, and just. Donald Berwick, July 1, 2008
    80. 81. The NHS in 2040 Abby – student nurse paediatrics 2012 - 15 Charlotte – student nurse Adult branch 2012 - 15
    81. 82. Our challenge Equivalent to the number of patients with new stroke?
    82. 83. Can we ‘engineer’ pace and scale? Preventable cases? 29,000 8,000 49,222
    83. 84. Our research into the issues
    84. 85. Safety Express Aim <ul><li>To deliver </li></ul><ul><li>‘ harm free care’ * </li></ul><ul><li>to 95% of patients </li></ul><ul><li>by December 2012 </li></ul><ul><li>Defined as the absence of pressure ulcers, falls, urinary infection (in patients with catheters) and new VTE </li></ul>
    85. 86. What is harm free care? Pressure Ulcer Fall Catheter Infection VTE HFC Patient 1 √ x x x x Patient 2 x x x x √ Patient 3 x √ x x x Patient 4 x x x √ x Total 75% 75% 100% 75% 25%
    86. 87. Benefits
    87. 88. What have we learned? Patients affected
    88. 90. One Programme: Four Harms
    89. 91. Findings <ul><li>Strategic Fit </li></ul><ul><li>Disruptive </li></ul><ul><li>Measuring </li></ul><ul><li>Reliability </li></ul><ul><li>We didn’t help!!!!! </li></ul>
    90. 92. Frontline Teams Measuring 4 Harms at the point of care NHS Safety Thermometer Pressure Ulcers Harm from falls Urinary catheters VTE Risk assessment & treatment New VTE Harm Free Care
    91. 94. Provider Case Study [1] Kings College Hospital NHS FT <ul><li>Kings College hospital joined Safety Express in January 2011, they are also implementing the Energising for Excellence programme. This work is lead by Liam Edwards (Corporate Nurse) </li></ul><ul><li>They are working in partnership with their community services and Guys and St Thomas. </li></ul><ul><li>At the outset they committed to working together to deliver: </li></ul><ul><ul><li>5% reduction in urinary catheter utilisation </li></ul></ul><ul><ul><li>20% reduction in injurious falls </li></ul></ul><ul><ul><li>Eradication of category 4 pressure ulcers </li></ul></ul><ul><ul><li>50% reduction in category 3 pressure ulcers </li></ul></ul><ul><ul><li>90% patients receiving VTE risk assessment and management </li></ul></ul><ul><li>They selected four wards to test the Safety Express programme </li></ul><ul><li>They measured progress with the NHS Safety Thermometer tool </li></ul><ul><li>They have used the Safety express programme to work across organisational boundaries </li></ul><ul><li>They have implemented systematic training </li></ul><ul><li>They have reviewed equipment stocks </li></ul><ul><li>They have ignited nurse leadership for hourly walk rounds </li></ul><ul><li>In August 2011 they are launching Safety Express with governors </li></ul><ul><li>In July they are planning to spread the changes </li></ul>Impact of Safety Express and E4E on the pilot wards New Pressure Ulcers Falls with Harm Catheters VTE Risk assessment & prophylaxis New VTE Harm Free Care
    92. 95. Next steps 2011-12
    93. 96. Policy fit
    94. 97. Building resources
    95. 98. Measuring HARM
    96. 99. Scaling up activity
    97. 100. What will they say about us?