The annual NHS staff survey is completed by every NHS trust and compares performance against other NHS Trusts and the previous year’s performance.
Performance Data
- 82% of staff either agreed or strongly agreed that they feel satisfied with the quality of work and patient care they are able to deliver
- 54% of staff either agreed or strongly agreed that would be happy with the standard of care at their trust is friends and family needed treatment - 74% staff appraised
- 72% staff receiving job relevant training, learning and development - 49% staff able to contribute to improvements at work
Key Achievements
There has been an increase in the number of staff who had an appraisal and a decrease in the number of staff who felt they had suffered discrimination
Lessons Learned/Areas identified for further improvement
Staff reported a decrease in the amount job related training and also equality and diversity training. We will be addressing these issues through the Trust’s Engagement Strategy and Organisational Development Strategy.
2.4.2 Recruitment in Maternity, Health Visitors
and Nursing
The National Quality Dashboard issued guidance in relation to staffing capacity and capability in November 2013. We have been working hard to ensure we have the
appropriate Midwifery, Health Visiting and Nursing workforce in place within the Trust so that we can provide the best possible care to our patients.
Performance Data
Midwife to Birth ratio 1:30.
Health Visiting on target to meet the nation Health Visitor number for Hereford of 40.9 by March 2015.
Increased numbers of qualified staff in inpatient areas.
Key Achievements
Successful recruitment from overseas for nurses, 20 in place by the end of March 2014.
The Trust is now fully recruited to established midwifery levels which has been positively impacted by the introduction of a midwifery academy.
Increased staffing levels in some community hospitals and medical and surgical wards.
Lessons Learned/Areas identified for further improvement
Further work is underway to increase nursing members on wards and we are looking at creative ways to recruit District Nurses. Six monthly reports on staffing levels are presented to the Board.
2.5 External Reviews
2.5.1 West Midlands Quality Review Service
(WMQRS) Acquired Brain Injury team (ABI)
This review was initiated by Herefordshire Clinical Commissioning Group (HCCG) with the Trust to clearly understand the service and give clear guidelines for improving the service moving into 2014/15. The WMQRS team reviewed the community ABI team at Belmont on 5/12/13 but were unable to meet 2Gether trust regarding the Mental Health aspect of the service. HCCG met the reviewers and gaps in service specification were identified.Key Achievement
An excellent community based service was identified.
The ‘Return to Real Life’ programme was praised for being clear and restructured.
Lessons Learned/Areas identified for further improvement
Clear pathways of referral to the team were missing.
Out of county placements often have poor review processes in place.
Clear outcomes and goals for patients receiving individual rehabilitation programmes were hard to identify.
Limited Mental Health services have been commissioned.
No Neurological Rehabilitation consultant hours are commissioned. Clear service specification is needed for aspects of the ABI pathway.
2.5.2 Rapid Responsive Review and Care
Quality Commission Visit
On October 10 and 112013 the Trust was subject to a Rapid Response Review (RRR) and Care Quality Commission (CQC) Visit. The key areas covered by these visits were:
Patient Experience Workforce and Safety Governance and Leadership
Clinical and Operational Effectiveness
As a result of these visits the findings have been collated and used to develop the Patient Care Improvement Programme.
The Patient Care Improvement Plan is a comprehensive plan of action that is being delivered across the Trust’s operational and corporate directorates. The plan has been formulated to address essential service improvements to ensure that we deliver high quality, safe care to the patients and carers who use our services. The plan coordinates the actions that we are putting in place, following recent inspections. All of these actions aim to make specific service improvements.
Lessons Learned/Areas identified for further improvement
A number of areas were identified where the Trust need to make further improvements. These included:
The use of the Day Case Unit for inpatients Mixed sex breaches within the Day Case Unit
Medical cover arrangements within community hospitals Monitoring of governance and leadership arrangements Process for recording and reporting complaints data
Awareness of Friends and Family Test amongst front line staff members
Key Achievements
Since the visit, the Patient Care Improvement Programme has been developed and actions are underway to make the necessary improvements. To date we have:
Developed the Safety culture Survey and rolled it out to frontline staff.
Ensured annual monitoring of governance and leadership arrangements are in place. Developed an enhanced training programme in relation to governance and
leadership.
Improved Executive and Non-Executive Director visibility throughout the organisation. Opened the Clinical Assessment Unit (CAU) which is now operational seven days a
week.
Enhanced the phlebotomy service.
Increased medical input to community hospitals. Implemented the mortality reduction plan. Presented patient stories at the Trust Board.
Improved complaints data provided from Ward to Board and vice versa. Rolled out Friends and Family data to community hospitals.
Undertaken a review of Nursing and midwifery establishments.
Strengthened the Standard Operating Procedures for Day Surgery Unit. Developed a long term plan to improve the Day Surgery Unit layout.
Reviewed and updated the processes in relation to maximising privacy and dignity within Day Surgery Unit.
2.5.3 Royal College of Obstetricians and
Gynaecologists (RCOG) Review
On the 23and 24 October 2013 the Royal College of Gynaecologists attended Hereford Hospital to conduct a review into our Maternity Services. The visit was undertaken at the request of the Medical Director in response to a Serious Incident Requiring Investigation (SIRI).
Lessons Learned/Areas identified for further improvement
The report identified that a number of areas in the maternity service that required further improvement. To this end, an Extraordinary Plan (EOP) was put in place to address concerns pertaining to sustainability of the current model of care.
Key Achievements
The review noted that all staff are ‘dedicated and committed to providing safe and
sustainable maternity care for the women they serve. The review supported the governance and risk strategy/agenda and recognised the significant improvements that had taken place in recent weeks.
Through management of this EOP 20 actions have been completed. The outstanding actions have a scheduled completion date by 1April 2014.
The improvements undertaken have seen positive quality and safety outcomes and, with additional allocation of resources made available for 2014/15, we are confident that improvements will be sustained.
Any Other Information
The Trust has been supportive of the improvements needed to meet the safety standards required, this included agreement for a 6th consultant.