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SUMMARY REPORT ABM University Health Board

Health Board 30TH JULY 2015

AGENDA ITEM: 3 (i)

Subject Update on Implementation of the Andrews Report - “Trusted to Care”

Prepared by Joanne Davies, ‘Action After Andrews’ Taskforce Leader

Approved &

Presented by

Paul Roberts, Chief Executive

Purpose

To update the Board on progress with implementation of the Andrews Report ““Trusted to Care” ” – the independent review of care at Princess of Wales Hospital and Neath Port Talbot Hospital commissioned by the Minister for Health and Social Services in the Welsh Government to the Board one year post publication.

Decision

Approval X

Information

Other

Corporate Objectives

Excellent

Population Health

Excellent

Population Outcomes

Sustainable

& Accessible Services

Strong

Partnerships

Excellent

People

Effective Governance

X X X X

Executive Summary

The ‘Action After Andrews’ Taskforce has been working with colleagues across the Health Board and our stakeholders to address the recommendations of the “Trusted to Care” report. This paper outlines the progress made one year after the report’s publication. It also outlines the arrangements for the Review Team’s revisit from 8th -11th July and the anticipated timescale for the resultant report on how well the Board has addressed the recommendations.

Key Items for Noting

The Board is asked to:

Note the progress made against the “Trusted to Care” recommendations one year after its publication, as outlined in the end of year newsletter (Appendix A – enclosed separately) which has been distributed to all staff as well as to stakeholders.

Note the reports prepared outlining the progress made by the Health Board over the past year which are enclosed separately as Appendix B and which were shared with the Review Team prior to their visit in July.

Note the arrangements for the Review Team’s return in July and the anticipated production date for the review.

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MAIN REPORT ABM University Health Board

Health Board 30th July 2015

AGENDA ITEM: 3 (i)

Subject Update on Implementation of the Andrews Report “Trusted to Care”

Prepared by Joanne Davies, ‘Action After Andrews’ Taskforce Leader

Approved &

Presented by

Paul Roberts, Chief Executive

1. PURPOSE To update the Board on progress with implementation of the Andrews Report “Trusted to Care” – the independent review of care at Princess of Wales Hospital and Neath Port Talbot Hospital commissioned by the Minister for Health and Social Services in the Welsh Government to the Board one year after its publication.

2. BACKGROUND At each Health Board meeting since the publication of the Andrews Report “Trusted to Care” there has been a report on progress against the recommendations and update on work to date by the ‘Action After Andrews’ Taskforce. The report was published on 13th May 2014 and this report reflects progress made in the year given in the document to address the recommendations made.

3. PROGRESS MADE AGAINST RECOMMENDATIONS The final quarterly meeting to discuss progress against the “Trusted to Care” recommendations with Welsh Government was held on 1st June and a presentation plus series of draft end of year reports on each of the recommendations were shared. Based on these discussions, a newsletter “Trusted to Care” – One Year On” (enclosed separately as Appendix A) and a set of final end of year reports and an overarching summary document were produced which are enclosed separately as Appendix B. These reports highlight the significant progress which has been made across ABMU Health Board in addressing the recommendations within “Trusted to Care” . Clearly there is more work to be done to fully address all of these issues throughout the whole organisation and the work which has been actioned over the past year needs to be consolidated to ensure the pace of change is sustained.

4. PREPARING FOR THE REVIEW TEAM – ONE YEAR ON The Board will remember that Recommendation 18 of the “Trusted to Care” report stated that:

The Welsh Government should institute a further independent review of provision for older people within a year of the date of this Report. A further Review is essential for the assurance of patients, local communities and staff and to measure the progress that can be made with open acknowledgement of problems, acceptance of help and support and concentrated effort.

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Welsh Government commissioned this follow-up review from Professor June Andrews and her team for July 2015 and the terms of reference for this are enclosed separately as Appendix C. At the time of writing this paper, unannounced visits had occurred at both Princess of Wales and Neath Port Talbot Hospitals at the beginning of July, both in and out of working hours. In addition a series of meetings have been held between Professor June Andrews and Mark Butler and groups of front-line staff, local management teams, Executive Directors and Non Officer Members over 3 days, 8th – 10th July. In addition they attended the Stakeholder Reference Group on 8th July. Visits to some wards and departments at the hospitals have also taken place during this time.

5. NEXT STEPS It is expected that the review of progress one year on will be published and presented to the Senedd in September 2015. Over the summer period the Taskforce is winding up its activity by preparing legacy packs for the new Directors of the six new delivery units within the revised management arrangements to ensure they can consolidate the work underway to address the “Trusted to Care” recommendations and to continue to implement the changes necessary with focus and pace. The Taskforce is planned to continue until the end of August 2015 when the handover to the new delivery units will occur.

6. KEY ITEMS FOR NOTING The Board is asked to:

Note the “Trusted to Care” – One Year On newsletter with its end of year outline of progress against the recommendations as outlined in Appendix A.

Note the end of year reports on progress one year after “Trusted to Care” was published as outlined in Appendix B.

Note the terms of reference for the Review of progress one year on, as commissioned by Welsh Government and outlined in Appendix C.

Note the next steps outlined in the paper for the publication of the outcome of the review and the legacy arrangements being put in place to ensure a smooth transition to the new delivery units.

Trusted to Care - one year on

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“If ABMU Board adopts the recommendations and acts with conviction and

determination, there is no reason to believe that the issues raised in this report

cannot be fully resolved within the year....” Andrews, Butler, “Trusted to Care"

(May, 2014)

A year has now passed since the publication of Trusted to Care. Over the past 12

months a huge amount of work has been undertaken, not only to meet the

challenges set out in the Andrews Report, but in many cases to go even further. We

decided from the outset that it was not enough to focus solely on the Princess of

Wales and Neath Port Talbot hospitals. A board-wide approach was needed.

We believe we’ve done all we could in the last year to resolve the issues set out in

the report. But it will take a little while yet to complete everything we need to do

across ABMU. We remain determined to do so.

A crucial part of the past twelve months has been the development and launch of our

values; which we have placed at the very heart of all the changes we’re making:

caring for each other

working together

always improving

We would also like to thank our staff, patients, their families and carers and our other

stakeholders, who have worked so closely with us over the past year. This journey of

improvement will continue. But the steps we have taken already have only been

possible because of this crucial partnership, and the true sense of ownership it

inspires.

This newsletter highlights just some of the projects, changes and improvements we

have achieved since May, 2014, but it is by no means a comprehensive list. As ever,

if you wish to find out more, we would love to talk with you about our work. Please

contact:

Email: abm.letstalk@wales.nhs.uk

Telephone: 01639 684440

Andrew Davies

Chairman

Paul Roberts

Chief Executive

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Where we were

Trusted to Care – the Andrews Report: overview

The report – while pointing out examples of exemplary practice - highlighted specific

issues and themes around care:

o Poor or variable care of frail, older people

o A care culture which lacked respect or involvement of relatives

o Lack of suitably qualified and motivated staff, particularly at night

o Unacceptable limitations to essential services 24/7

o Adversarial and slow complaints system

o Confusion over leadership/accountability

o Problems with organisational strategies on quality and patient safety

It made 14 recommendations for the health board. In response, we set up a

dedicated Action after Andrews taskforce who worked on seven themed

workstreams to put these recommendations into practice:

o Care Standards

o Environment

o Learning, Skills and Knowledge

o 24/7 Services

o Medicines management

o Integrated Quality

o Values and Leadership

Where we are now

A great deal has been achieved over the past year, but we also know we have more

to do. ABMU is a massive and complex organisation, and change takes time. But we

are encouraged by the clear evidence of positive changes taking place. Here are just

some of these indicators:

Readmission rates for patients over the age of 80 have dropped by 43%.

Formal complaints about ABMU have gone down by 18%; while informal

complaints have increased by 52% - a sign that we are encouraging feedback at an

earlier stage and resolving issues there and then.

At the Princess of Wales Hospital specifically, complaints have almost halved.

Cases referred to the Ombudsman which are then investigated have dropped by

56%

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The number of Friends and Family Test positive responses (which asks patients

and relatives if they would recommend a ward or unit) has gone up from 90% to

96%.

Over 2,400 complimentary reviews about the Princess of Wales Hospital have been

published on the iWantGreatCare website. iWantGreatCare, which is similar to

Tripadvisor, has given the hospital an overall maximum 5-star rating.

Out of hours spot checks (average 12 per month) since October have not

identified any incidents of the medication issues raised in Trusted to Care. But we

appreciate this is not infallible, so we are ever watchful.

Over 2,500 personal pledges offered by staff at our values launch.

Our staff sickness absence rate has dropped by 0.36%.

What have we been doing?

A comprehensive and wide-ranging set of actions have been underway – here are

some of the main ones:

We immediately communicated with staff via a range of methods the ‘never events’

– poor care which must not be allowed to happen in any of our hospitals. These

covered medication, continence and hydration issues. We also began our regular

unannounced visits to wards out of hours and at weekends to ensure standards of

care were being adhered to, and issued new medication guidelines. Hydration and

toileting good practice was also widely promoted among staff.

Over the summer and autumn of 2014 we worked with staff, patients and voluntary

groups to develop 12 standards of care for older people:

STANDARDS OF CARE FOR OLDER PEOPLE IN HOSPITAL

I will be treated with dignity, care, and compassion; and supported to feel safe at all times.

If I have carers, their needs will be taken into account; and they will be involved in my care and discharge planning with my consent.

If I am in pain or discomfort, it will be recognised, and I will have help to manage it.

I will have choice about what I can eat and drink any time I wish, and will be given support with eating and drinking if I need it.

My skin will be looked after and not damaged.

If I am anxious or depressed, staff will recognise my mood, listen to me, and my carers, and support me to feel as well as possible.

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Our values

During 2014 we also engaged with more than 6,000 staff, patients, families and

carers to help develop our values and behaviour framework, to underpin all we do.

We held 66 staff listening events and 18 patient listening events, as well as staff and

patient surveys. These were designed to help each group understand what made

good days and bad days for them, and patients were able to talk about their

experiences with staff. From all this information, we were able to drill down into what

behavioural changes were really needed to bring about a cultural change.

These events were followed by a series of workshops to develop our new values,

and from there agree a set of expected behaviours, which are too long to reproduce

here. However you can see them on: www.abm.wales.nhs.uk/actionafterandrews

Meanwhile, here is a summary of our values, formally launched in the spring of 2015:

I will be able to get to the toilet when I need it; but if I am incontinent, I can expect to feel clean, comfortable and dry promptly.

If I have difficulty understanding or expressing myself, this will be recognised. I will be listened to and supported, to make choices and decisions by appropriately trained staff.

I will be able to move about easily and safely, or to be helped to do this as comfortably as my condition allows.

I will have the right medicine at the right time.

My care will take account of any disability, sight or hearing loss I may have.

If I am at the end of my life, my wishes and spiritual beliefs, and those of my carers, will be assessed and met wherever possible.

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Over 2,500 staff pledges have

already been made (left, key words

from top pledges). Work is now

underway to embed the values in all

we do, for example:

values-based team meetings have started

Singleton Hospital’s antenatal clinic has a ‘welcome to our clinic’ board based entirely around the values

managers are using values-based questions in interviews, and also in staff appraisals.

values are included at induction for new staff

Better trained staff

With the growing number of very elderly patients and

patients with dementia on our wards, we are making a

concerted effort around training. Over 10,000 staff

across all our hospitals have received dementia

awareness training since November and this will

continue until our entire workforce is trained.

Our dementia training has been recognised by the

Alzheimer’s Society, which has awarded us with

‘Working to become dementia friendly’ status, with the

aim of achieving full dementia friendly status next year. We are first health board in

Wales to achieve this.

In addition we are giving 270 specific clinical staff more intensive Level 2 dementia

training, and ensuring wards each have 2-3 dementia champions.

We are also delivering training focused on the care of frail older people, to around

600 staff in Neath Port Talbot and the Princess of Wales hospitals. Over 400 have

received the training to date, and once that is complete training will be rolled out to

staff in our other hospitals.

We have also been working with CRUSE and our palliative care clinicians to deliver

dying in hospital training to nearly 400 staff.

A coaching scheme for frontline clinical leaders is also in place.

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Complaints and feedback

A root and branch overhaul of our complaints system began even before Trusted to

Care was published, and this work was completed in the spring. Our new system is

aimed at encouraging a culture where patients and their families feel they are safely

and easily able to raise concerns at any time. We will learn from feedback, good and

bad.

To help us do this, we have invested in new electronic systems to collect and

analyse feedback and enhance information gathering. We also have dedicated

online surveys, text and phone numbers to assist patients, families and staff to

contact us 24/7. These are publicised widely via Let’s Talk posters and banners in

our hospitals. The online survey link also appears on users’ mobile phones and

tablets if they access the free public WiFi offered in our hospitals.

At the Princess of Wales Hospital a new Patient Advice and Liaison Service

(PALS) was introduced, designed to nip issues in the bud. It deals with around 40

queries a month and since it was set up, complaints have almost halved in the

hospital. PALS will now be rolled out in Neath Port Talbot, Morriston and Singleton

hospitals by the end of September.

We have also set up a dedicated serious incident investigation team which takes

remedial action and supports the patient and family throughout. And over 500 of our

staff have received verbal complaints training.

On our wards

We have introduced flexible visiting to our acute

adult wards, allowing relatives, carers and friends

to visit any time between 11am and 8pm seven

days a week. Initial feedback has been excellent,

with families reporting that as well as being

convenient, it has helped with communication.

Relatives and carers are encouraged to help their

loved ones with eating and drinking if they wish.

Patients tell us they are happier and less bored.

Staff also see the benefits of this move. We will

be carrying out a full evaluation shortly.

Work is moving apace on the development of the

ideal ward which looks at a range of issues like

environment, staffing, information, leadership,

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etc. Ward hostesses have also been introduced to manage mealtimes, and ward

administrators to deal with paperwork and free up nurses to spend more time with

patients. These pilot schemes are being assessed before being rolled out.

Ward-based pharmacists are in place, monitoring medicines management, and a

dedicated continence nurse has been recruited to the Princess of Wales Hospital.

Nurses’ paperwork has been streamlined to avoid unnecessary duplication, and an

older people’s ward assessment toolkit has been developed to help clinical staff

check their progress towards ideal ward status.

In the Princess of Wales Hospital staff have introduced a number of new schemes,

for example:

o An activities programme for patients, e.g. afternoon tea; musical

entertainment

o Concerns clinics for relatives, held on wards

o Story time session in Ward 2 each week

o Ward upgrades including better lighting, new furniture, new call bell systems

and a more homely feel to the lounges (day rooms)

Neath Port Talbot Hospital also has new projects underway, like:

o An activities room offering complementary therapies; a juke box with old-time

music; reading groups and creative therapies

o Cwtch – a quiet room on Ward E offering a peaceful environment

o Memory walk on Ward C, with images of local scenes from the past

o A clerking system which gathers information about the patient’s life outside of

hospital, to help staff offer more person-centred care

o Dedicated work to reduce falls

We have spent £200,000 already on improving ward environments to make them

more dementia-friendly, and work is ongoing to replace signage at all our hospitals

with clearer, easier to understand signs. We are also upgrading medicine storage

facilities. Some of the environmental improvements we need to take toward will need

bigger capital investments we have another £150,000 identified but extra monies are

being prioritised in future plans.

To ensure we continue to develop dementia-friendly environments, we are also

training estates staff to recognise the significance of colour schemes, furniture, and

other design elements. We’re buying soft-close bins to minimise loud noises.

Better access to services

We are focussing on what is practical and deliverable regarding 24/7 care. This

means ensuring access to services equally across seven days for unscheduled care

patients; which is in line with the BMA position paper (October 2013). It won’t mean

providing pre-booked appointments 24/7.

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We’ve made it easier for staff to access out of hours pharmacy and produced clear

guidance on how staff can access medicines outside normal pharmacy hours.

To ensure patients do not go for longer than necessary periods nil by mouth, we are

training more general nursing staff in swallow screening (which looks at whether a

patient can safely swallow fluids.) We have also revised our guidelines to ensure

doctors check these patients where the screening causes concern within a few hours

so that they are not unnecessarily kept nil by mouth.

Senior clinicians now have input into interpreting diagnostic tests for acutely unwell

older patients at the weekend, as well as during the week.

We have identified the need to invest in therapy services, to strengthen our core

five-day service so it can support evening and weekend working. We need to invest

in additional nutrition and dietetics posts, along with physiotherapy, occupational

therapy and speech and language therapy. As well as supporting 24/7 working, this

investment will boost stroke services, acute care and critical care – demonstrating

the principles of prudent healthcare. Just under £1million needs to be invested in

2015/16, rising to £1.4m in the following two years.

We are acutely aware of the current financial pressures within the NHS. However,

we are ensuring that values-based, prudent healthcare investments like these are

reflected in our Integrated Medium Term Plan (IMTP), which is the health board’s

three-year plan. However our IMTP for 2015-2018 has yet to be signed off by Welsh

Government because it is not yet balanced. This continues to be a challenge.

Recruitment

We have been actively recruiting

both doctors and nurses over the

past year. This has been

challenging, because of clinical

staff shortages across the UK.

Social media is being used widely

to promote vacancies and four

nurse recruitment open days

have been held. (Pictured, a nurse

recruitment day at the Princess of

Wales Hospital)

We have set up dedicated medical and nursing recruitment web pages:

www.abm.wales.nhs.uk/nursejobs and www.abm.wales.nhs.uk/medicaljobs We

have also produced a recruitment-focused video, All about ABMU which is uploaded

onto YouTube and Facebook and linked to our website.

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We have recruited 80 nurses to the Princess of Wales Hospital and the open days

for all our hospitals have resulted in scores more nurses being appointed or in the

process of joining us. However, while we no longer have any posts held vacant,

rather than being recruited to, it remains a challenge to increase the overall number

of nurses in substantive posts. We’re now looking overseas for additional staff, and

promoting the new ward hostess and ward admin roles to support nurses.

Accountability and Auditing

We appointed a new Director of Nursing and Patient Experience last summer,

and the ‘patient experience’ part of the title was new and deliberate. Executives and

senior clinicians regularly meet patients and families at ABMU Concerns Clinics.

We have also developed a new integrated

Quality and Patient Safety Strategy around

the needs of our patients. We’ve done this with

wide involvement not only of our clinical staff,

but also of our patients and their families. We

have made quality and safety the central focus

of our IMTP, moving away from concentrating

on targets and money in isolation.

We are also in the advanced stages of overhauling the way the health board is

managed. In future our hospitals will be managed as individual units, rather than

board-wide directorates. The new system will be easier to understand, be more

patient-facing and create clarity about who is responsible and accountable. We are

appointing to the key management posts now, and we hope these changes will be in

place shortly.

Closer working with our universities

We are working more closely with Swansea and Cardiff universities. We now have

collaborative plans and a shared commitment to ensure excellent health, medical

and nursing care, research, innovation and healthcare education in the region. We

are taking a joint strategic approach to recruitment and retention, improving and

expanding educational placements and maximising economic development through

access to EU and other regeneration funding.

Looking ahead

We will continue to embed the learning and recommendations from Trusted to Care

and also the AQuA report, which was commissioned by the health board to help us

make quality improvements at the Princess of Wales Hospital. We are re-

commissioning AQuA to carry out similar work at our other hospitals.

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Although Trusted to Care focussed on two hospitals, we have always believed that

improvements needed to be board-wide. And this is not just about nursing, but

applies to all our staff and services. We will be rolling out the pilots and actions which

started at the Princess of Wales and Neath Port Talbot hospitals to our other

hospitals.

We are realistic that we continue to face significant challenges. But we believe our

commitment to quality, sustainability and a balanced healthcare system – built on

values - will serve our patients and their families well.

If you would like any further information about anything in this newsletter, please feel

free to contact us on:

Email: abm.letstalk@wales.nhs.uk

Telephone: 01639 684440

ABM University Health Board

Headquarters, 1, Talbot Gateway

Baglan Energy Park

Baglan,

Port Talbot

SA12 7BR

June 2015

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ABERTAWE BRO MORGANNWG

UNIVERSITY HEALTH BOARD

TRUSTED TO CARE

PROGRESS REPORT

1 YEAR ON

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1. Introduction

ABMU Health Board commissions, plans and delivers care for a resident population

of approximately 550,000 people with over 16,000 staff and a budget of £1.2 Billion.

We provide primary, community and secondary care services as well as mental

health and learning disability services and a range of tertiary services for larger

populations.

This report outlines how we are Changing for the Better, the title we have

adopted for our service strategy and change programme, by explaining how the

organisation is changing significantly, why this was needed, what has already been

achieved and further work planned. It has been prepared to set the context for the

independent review team commissioned by Welsh Government to establish the

extent to which progress has been achieved since Trusted to Care was published.

This summary should be read in conjunction with the progress reports produced for

each of the 14 recommendations within Trusted to Care which form appendices to

this document.

2. Background - Why transformational change was needed

On his appointment in January 2013 our chairman undertook a fundamental review

of the organisation’s governance arrangements with the chief executive. Board

members together then developed a plan to ensure the Health Board was in a

position to deal with the significant challenges it faced. This included some

emerging indications that radical change was needed in some services to ensure we

were providing the quality of care our patients and their families should expect.

The Board identified particular concerns over mortality rates, Ombudsman Reports,

very negative patient feedback and some other indications of poor care at Princess

of Wales Hospital, Bridgend, through our own internal escalation mechanisms in

March and April 2013. The chairman, chief executive and acting medical director

brought these concerns to the attention of senior Welsh Government colleagues who

asked to receive regular updates on progress. As a result a quality improvement

board for the Princess of Wales Hospital was set up and Advancing Quality

Alliance (AQuA) was commissioned by the Board in July 2013 to examine these

issues and to evaluate the quality of care being provided at that hospital. Initial

recommendations from AQuA were received by the Board in March 2014 and the full

report in May 2014.

In October 2013 the minister decided to commission an independent external

review of care from Professor June Andrews following a meeting with a member of

the public who expressed serious concerns about the quality of care at Princess of

Wales Hospital and Neath Port Talbot Hospital.

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In May 2014, the AQuA findings were further reinforced and significantly added to

by the ‘Trusted to Care’ report (Andrews & Butler, 2014) which painted a

distressing picture about the care provided at Princess of Wales and Neath Port

Talbot Hospitals.

Trusted to Care in particular gave significant added urgency and impetus to the

Health Board to improve its services dramatically including the culture within it, and

made clear the requirement to act more quickly, with more focus and determination.

The publicity surrounding Trusted to Care, whilst painful for the Board and its

staff, provided a strong message which no one in the Board could ignore about the

need to confront and address these failings. In particular there was a need to:

- Put quality and safety first, supported by appropriate resources;

- Operate with openness and transparency;

- Work harder to put our patients at the centre of all we do, and involve

them and their families in all our work at all stages, jointly with our staff.

In addition the Health Board faced a range of other challenges, some of which were

cited in Trusted to Care, which it needed to address in order to move forward,

including:

- Unacceptable and unjustified variation in the standards of care provided to

our patients in different hospitals and different settings;

- Increasing numbers of frail older people, those with dementia and those with

multiple co-existing diseases and disabilities without necessarily the right mix

of staff with the right skills to meet their needs;

- The need to further strengthen community services to support more

people with more complex needs at home;

- Supporting the development of primary care services and their joint

working to increase the range of services available to patients;

- Ways of working and environments which meet the needs of younger more

mobile patients but which hadn’t been adapted to meet these more complex

needs;

- Staff groups who had lost focus on their responsibilities as registrants with

professional codes of conduct to uphold;

- Frequent peaks in unscheduled care pressures;

- The need to adopt the principles of prudent healthcare;

- Workforce challenges, particularly shortages in nursing staff and high

sickness absence rates;

- Staff feeling disempowered and unable to act;

- Patient voices not being heard or acted upon;

- A lack of clarity over who was in charge, particularly for hospital sites;

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- A perceived narrow focus on financial and activity targets not on quality

and wider value for money;

- Developing of integrated services with our Local Authorities to provide

better, seamless services for patients.

The combination of these reports and challenges led to a dedicated Taskforce

being established in May 2014 reporting directly to the Chief Executive which has

taken the lead in addressing the recommendations in Trusted to Care and

contributing to the wider transformation of the organisation with pace and focus.

3. Our Vision

The Trusted to Care report directly challenged the Board to demonstrate how it was

fulfilling its purpose. The purpose of ABMU Health Board is:

“to fulfil our civic responsibilities by improving the health of our communities,

reducing health inequalities and delivering effective and efficient healthcare in which

patients and users always feel cared for, safe and confident”

In order to fulfil this purpose the challenges and issues outlined above need to be

addressed, and in a thorough, systematic way, which enables the culture of our

organisation to be properly aligned with the needs of our communities. Only then

will we be a truly open, forward thinking organisation with a motivated workforce

delivering consistently high standards of care to all our patients and is held to

account by our public.

Trusted to Care recommended that the Board’s current leadership should be given

the support and responsibility for delivering the changes necessary. However it

challenged us to accelerate the transformation which we had started. We believe

we have made significant and demonstrable progress over the past year.

Nevertheless we also believe that to truly change the culture of our organisation and

fully implement everything within the Report (not just the recommendations), given

the complexity of the Health Board, this is not a one year programme but one which

will take 3-5 years to fully embed. The leadership team of the Board continues to be

committed to meeting this challenge.

4. Our Leadership, Values & Behaviours

The chairman’s governance review resulted in actions to ensure that the Board was

fully sighted on and could focus time on the important issues we face.

In February 2014 the Board’s development programme commenced and the

Board Committee structure was revised with amended terms of reference and

membership to ensure this focus. To support this the portfolios of the Executive

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Directors were revised to provide a better concentration on key issues, with Patient

Experience being explicitly incorporated into the Director of Nursing role (and title)

and a Director of Strategy role replacing the Director of Planning to demonstrate the

wider longer term focus of this director. The Medical Director post was also revised

to incorporate the role of “chief information officer” in order to ensure that

information was focused on improving clinical care.

Trusted to Care also highlighted, as did the governance review, that our

organisational structure was unclear, causing confusion over accountabilities and

responsibilities. In February 2014 we changed the management arrangements for

Princess of Wales Hospital because of some of the concerns raised, and created a

Hospital Director supported by a local management and clinical leadership

structure. This approach has been evaluated and shown some real improvements in

accountabilities.

As a result we decided to change our management arrangements for the whole

Board so that they would:

- Be easier to understand for staff and patients;

- Accelerate progress on delivering new models of primary and community care

services;

- Be based on how patients experience our services, rather than specialties or

professions;

- Have fewer layers and so shorter lines of communication between senior

management and frontline teams;

- Be clear about who is responsible and accountable at all levels and on all

sites;

- Allow more devolution of responsibility and decision-making to local teams;

- Improve joined up working about service improvement, major operational

challenges and performance issues;

- Have more local ownership and clinical engagement.

The new Executive Director roles were all substantively filled in 2014, (half the

senior management team were changed with four new directors, three from outside

the organisation) and recruitment to the new 6 Delivery Units as part of the new

management structure is currently underway.

Values

Trusted to Care challenged us to demonstrate how we would put citizens at the

heart of everything we do. We therefore started a major programme on the values

of the organisation which are those things which define our culture and answer the

question “What is important to us?”. They serve as a reference point for everything

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we do and how we lead and manage our organisation. At the beginning of 2014 we

started to develop Our Values by undertaking an organisation wide structured

listening exercise. We held a series of staff and patient engagement events as well

as surveying our patients, their carers and relatives, our staff and other stakeholders

to get their views. In early 2015 we launched Our Values and Behaviours

Framework, based on this engagement with over 6,000 patients and carers and

members of staff and working in partnership with them and other stakeholders to

develop and agree these. The Board has set out clear expectations for the next

three years focused on embedding these values in everything that we do, including

recruitment and staff appraisal. They contain a clear set of the standards and

behaviours which all our staff are expected to comply with. These values will also

allow patients, the public and staff to hold us to account if they are not being

delivered appropriately.

Our Values:

- Caring for each other – in every human contact in all of our communities and each of our hospitals

- Working together – as patients, families, carers, staff and communities so that we always put patients first

- Always improving – so that we are at our best for every patient and for each other

In developing our Values, we have undertaken one of the largest patient, staff, and

public engagement exercises in NHS Wales. This has been an enormously

rewarding and humbling experience for the Health Board. We are using the

information derived from what our patients, their families, patient groups, the

voluntary sector, other stakeholders and the public have told us to fundamentally

change how we plan, provide and deliver care.

We believe that if every one of our 16,000+ staff do their best to live up to our

Values and to the specific behaviours that underpin them we will provide consistently

great experiences for our patients and each other, together. Whilst it is early days

we believe this values based approach is beginning to have an impact on how we

care for patients.

5. Our Progress so far

2014-15 was a very tough year for the Health Board. Our priority has been to

engage with our staff and work with them to start putting right the problems

identified in Trusted to Care. This focus on protecting our public and keeping

patients safe has been strengthened as the underlying principle of all our actions.

7

Detailed reports on progress against each of the 14 recommendations within

Trusted to Care have been provided as appendices to this summary. However we

wanted to highlight our progress on some specific and critical issues below:

5.1 Staffing Issues

We have strengthened our commitment to improving our standards of care,

particularly by investing in our nursing workforce. We have moved away from

holding nursing and other clinical posts vacant as a cost saving mechanism and our

vacancy rate has reduced. However recruitment and retention of nursing staff

across the NHS in Wales and the UK is a significant challenge and we have focused

on working towards achieving the Chief Nursing Officer’s principles and fully

establishing our nursing teams whilst supporting them with the creation of additional

roles to free up their time to care – in the form of ward hostesses, administrative

support and a team of specially trained Healthcare Support Workers to provide 1:1

support for patients with high levels of cognitive impairment. These improved

staffing plans are part of the Board’s three-year Integrated Medium Term Plan

submitted to Welsh Government.

Whilst there have been improvements in staffing at Princess of Wales Hospital the

turnover of staff across the Health board means that gains in recruiting additional

staff and improving levels of sickness absence have been offset to some extent by

staff turnover. To help address these issues we are working with our local

Universities to develop a joint approach to recruitment and retention as well as

improving the educational provision and placements to attract more applicants.

5.2 Standards of Care

We have been clear with all our staff about the standard of care that we expect

them to give to all patients. Immediately after the publication of Trusted to Care we

defined a range of “never” events and instigated a zero tolerance to these, which

focused on hydration, nutrition, toileting and medicines management. To support

this and make clear relevant responsibilities, particularly around medicines, we have

reissued relevant codes of practice to registered nurses, pharmacists and health

care support workers.

In addition to our “Values and Behaviours framework” we have also developed care

standards for older people by bringing older people, groups that represent them

and third sector organisations together with our staff. We have been commended

for these by the Wales Commissioner for Older People and she is planning to use the

process we developed for their production to produce care standards for care homes

in Wales.

8

We have also worked hard to move the focus from form filling to providing patient

care. We have conducted a wide-ranging review of paperwork on wards and

have achieved a significant reduction in the number and complexity of forms which

need completing as well as streamlining the patient assessment documentation.

This means that time has been released to provide direct patient care.

In parallel with implementing the changes necessary to address the Trusted to

Care recommendations we have also been checking to make sure that the care we

are giving to our patients is appropriate and that the failures outlined in the report

are not continuing. We have a rolling schedule of unannounced spot checks

carried out by corporate nursing staff at night and weekends so that we are assured

about the care provided, with a particular focus on “never” events and improving

standards of care.

5.3 Concerns & Complaints Handling

Even before Trusted to Care highlighted the deficiencies in our management of

complaints, we had initiated a root and branch review of our processes and

started to implement the changes necessary. We have made huge improvements in

the way concerns are handled, with a significant increase in informal complaints but

a reduction in formal complaints. We believe this demonstrates that we are

encouraging patients and their relatives to raise concerns earlier, allowing us to

address these effectively, with fewer becoming formal complaints. We have also

been commended by the Public Services Ombudsman for Wales for the rigorous

investigation process we now apply, indeed he has used our case study as an

exemplar of good practice for other organisations.

5.4 Improved Stakeholder Engagement

The Health Board has a Stakeholder Reference Group (SRG) which is a standing

committee of the Board, with the SRG Chair having a seat at the Board. We now

have a Memorandum of Understanding agreed between the Health Board and the

SRG regarding its membership and role, which includes a specific remit for patient

experience. The SRG is made up of elected members representing all the equality

dimensions in the Equality Act 2010, plus Welsh Language, as well as stakeholder

organisations such as the Police, Fire and Rescue, Ambulance, Community Councils,

Private Care Home and Home Care Providers, the Community Health Council and

Local Authorities. The Disability representative is supported by a Disability

Reference Group (DRG) which has representation on behalf of different access

and disability groups both at a local and national level.

This group works with the Health Board to advise us on the most appropriate actions

we should take to make our services and buildings accessible to all patient

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groups, including ensuring that by improving access for one disability group we don’t

disadvantage others. Some of the DRG members were involved in the Dementia

Design School held in March for the Health Board and as a result consideration of

design for people with Dementia is now incorporated into their advice to the Health

Board on how best to meet the needs of all patients with varying physical and

cognitive losses.

The Health Board also has well established relationships with the over 4,000

third sector groups in our area through the three local Councils of Voluntary Services

(CVS). We fund a facilitator in each CVS who supports the development of

relationships between the sector and the Health Board, and there is a Health Board

wide Voluntary Sector Forum as well as more local ones which we regularly

attend. In addition we commission over 80 third sector organisations to provide

services for our population via service level agreements (SLAs). All of these SLAs

now incorporate our Values and Behaviours Framework and the standards of care

for older people and we expect these to be implemented for all our patients in their

contact with the third sector.

5.5 Focus on Training & Developing our Staff

Trusted to Care highlighted a range of training needs and demonstrated that a lot

of the in-house provision previously available had been eroded over time and

needed to be rebuilt. For example the dementia training team required significant

additional resources to be able to implement the required training. Our mandatory

training framework has been revised to include dementia and other skills gaps

highlighted in Trusted to Care and to date we have over 10,000 of our staff who

have received dementia awareness training. However once the training was

available, release of staff has also been a significant challenge because of the

number of people who needed training, at a time of increasing difficulties in

recruiting, and with increasing peaks in unscheduled care pressures. This has meant

that in some areas we have had to slow our planned implementation timescales in

order to facilitate the release of staff for the wide range of training they require.

Nevertheless, significant progress has been made and we are adapting our approach

to address these issues.

5.6 Closer working with our Universities

We have also been working closely with Swansea and Cardiff Universities to

achieve the real benefit of being a University Health Board. We now have

collaborative plans with our Universities with a shared commitment to ensure

excellent health, medical and nursing care, research, innovation and healthcare

education in the Region. As part of this in addition to the joint strategic

approach to recruitment and retention and improving and expanding educational

10

placements mentioned previously, we are also maximising economic development

through access to European Union and other regeneration funding.

5.7 Our Integrated Medium Term Plan (IMTP - 3 Year Plan)

We have reviewed and fundamentally revised our IMTP to reflect the

recommendations from Trusted to Care. We have embedded our Quality and

Safety Strategy and Our Values at the heart of our IMTP for 2015-18.

Our Strategic Priorities in the IMTP are to:

- Implement the recommendations of Trusted to Care including the new

Quality and Safety Strategy and radically different management arrangements

- Maintain enough “head room” to continue with our strategic change

programmes

- Stabilise and improve our unscheduled care system

- Develop and implement a stretching but realistic and affordable planned

care programme

By putting quality at the heart of all that we do, we recognise the many demands

placed on the Health Board. All these elements need to be aligned if we are to meet

our responsibilities appropriately, whilst maintaining our statutory responsibility of

maintaining a balanced financial position.

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6. Looking Forward

We will take the learning we have already implemented in our acute hospitals

from the AQuA and Trusted to Care reports and as our top priority will apply these

to all our other services and settings, which will include substantially moving the

healthcare system to a community-based model. We are in the process of re-

commissioning AQuA to carry out similar external reviews into the quality of care

at the remainder of our acute Hospitals so that we can be assured that any issues in

these hospitals have been addressed.

The Health Board has taken the stance from the day the Trusted to Care report

was published that the issues within it should be considered as applicable across the

whole of our organisation (including in community and primary care) and not

just in the Princess of Wales and Neath Port Talbot Hospitals. We have also been

clear that this is not a report about nursing; it applies to all our staff and all our

services. We have stressed the importance of services applying the lessons from the

report, even if they aren’t hospital based or providing care for older people. We

have implemented some of the recommendations across the whole of our

organisation from the outset (e.g. Quality Strategy, Concerns & Complaints

management, Values & Behaviours Framework). For others we have focused initially

on the two hospitals about which the report was based (e.g. some of the training

requirements, development of ward hostesses, trialling new management structures)

with a view to spreading these initiatives later this year as they are evaluated.

In future, all of our work will be based on the values that have been agreed by our

staff, patients and stakeholders and will underpin how we work as Health Board. We

have committed to involve staff and our patients in shaping all that we do, as

we have to date with our work on Trusted to Care. Within our hospitals, care will

be of the highest quality and will reflect our commitment to quality and safety at the

heart of everything we do. We know that in common with other UK health

providers, our Health Board faces significant challenges ahead. We believe we have

achieved a huge amount in the past year to address the issues raised in Trusted

to Care, but we recognise that we still have more to do. However we believe our

commitment to quality, sustainability and a balanced healthcare system which is

built on strong values, a quality focus and partnership working will serve our

patients, families, carers and staff well now and into the future.

The publication of Trusted to Care was a watershed moment for ABMU Health

Board and whilst it was hard to read, it has helped to focus everyone working here

and those of us leading the organisation on doing better for our patients and

communities.

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Some quotes from our staff about what feels different a year after Trusted

to Care (May 2015)

Patient feedback, hearing less

complaints and more positive

reports during hospital stays. Better

awareness of patients needs,

hospital staff seem more proactive

The focus on patient

experience is clear to see

and it is obvious there are a

lot of colleagues trying to

make a huge difference

Greater emphasis on values, patient

and staff views in board discussions

with team (rather than financial and

A&E targets)

More staff taking ownership

for care in the wider sense, e.g.

more comfortable in their own

knowledge of dementia areas

all staff groups.

Issues are all on the table and a

great deal of effort is going in to

addressing them. Much more

cohesive team feel within the

organisation. Clear where we need

to get to. More balance between

positive and negative publicity.

A better understanding of

dementia friendly environments

and the affects the environment

can have on patients with

dementia. Witnessed more staff

stopping and asking

visitors/patients if they need

assistance. Values.

I feel that we are beginning to have pride in our hospital

and our services and you can see this when you walk

around the hospital.

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Some quotes from our patients from Iwantgreatcare (February 2015)

The staff were all lovely and very

helpful and had a lot of time for

you even though it was clear how

rushed off their feet they were.

This is by far one of the friendliest

wards I've stayed on. (Feb 15)

Overall exemplary care from the nursing

and clinical team. Specifically: -

Compassion and care shown by all

involved. - Good handover between

shifts so there is continuity of care. -

Clearly a motivated team. - My mum

was treated with respect and dignity. -

clear communication from staff. - Good

availability of staff when care or

information needed. (Feb 15)

The nurse I saw initially was very welcoming and

understanding when I said I was nervous about having

blood taken. Questions were answered that I needed

answers to feel relaxed about having an

operation.(Feb 15)

Everyone was so kind,

considerate and professional.

And seem very happy in their

work -which is nice to see

(Feb 15)

The care is professional, but

friendly. I did not feel rushed and

was treated with kindness. All of

the three nurses who dealt with me

made me feel like an individual

which is reassuring. (Feb 15)

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Appendix 1

Trusted to Care

Month 12 Report – Recommendation 1

Workstream:

Care Standards

Executive Lead:

Rory Farrelly, Director of Nursing and Patient Experience

Executive Support:

Christine Williams, Assistant Director of Nursing Professional Standards and Practice

Taskforce Lead:

Deborah Thomas, Strategic Nursing Lead, Action after Andrews Taskforce

Recommendation: Recommendation 1 within Trusted to Care required the Health Board to create a set of clear standards for the care of frail older people in Accident and Emergency and general medical and surgical wards within the 2 hospitals, within 3 months of publication and audit them quarterly thereafter. These should be in the form that sets standards for all clinical staff irrespective of professional background and provides the basis for skills and knowledge development and audit. There are reference points for the development of such standards in the work of Healthcare Improvement Scotland. The Board should clarify what data it really needs to take a proactive approach to the public’s experience and the quality of the services ABMU provides to older people. Data would begin with screening for commonest conditions at the point of admission to hospital especially cognitive impairment so that the appropriate care can be provided through admission and into discharge. Other key data would include length of stay, adverse incidents by age and cognitive impairment, capacity, complaints, use of catheters, antipsychotic drugs and sedation, hospital acquired incontinence, nutritional status, and deaths where the cause was not the reason for admission

Progress & Key Achievements

The standards for care of older people in hospital were drafted through a series of workshops involving staff, patients, carers and stakeholder groups. They were then

15

against targets:

circulated widely both internally and externally from ABMU for comment and the final draft version approved at the August Trusted to Care Steering Group and subsequently published. Once our Organisational Values and Behaviour Framework was agreed in January 2015, the Standards were mapped to these Values to ensure they were consistent, and then the final version published and widely made available. The Standards have been communicated to respective partner organisations, patient stakeholder groups and are displayed within our hospitals (for example on the standardised notice boards being rolled out across the Health Board) for all to be aware of what the older person can expect of the care they receive. The Standards have been communicated to staff via email cascade, through face to face meetings, incorporated into team brief, posters printed and distributed, utilised as a screensaver on our intranet and they have also been published on the intranet and internet. They have also been incorporated into the Ward Assessment Toolkit to enable multi-disciplinary teams to self-assess how well they are doing and develop action plans to address any areas of concern (see recommendation 6). An educational programme relating to the care of frail older people is also being delivered as part of the Action After Andrews Learning, Skills and Knowledge Work stream and the Standards form the basis of this educational programme. The Standards are audited via the application of the Ward Assessment Toolkit (see recommendation 6) and through the reporting of the older persons dashboard to the Quality and Safety Committee on a bi-monthly basis (see recommendation 17) and the majority of the suggested data indicators suggested in the sub-text of recommendation 1 are included in the dashboard. Within our hospitals all patients who die have a stage one mortality review undertaken by a junior doctor which involves asking whether the patient died for a reason other than their reason for admission. If specific questions trigger a “yes” response then the patient would be referred for a stage 2 mortality review which is undertaken by a consultant from within the same Directorate who was not involved in the patients care. Completed Stage 2 mortality reviews are reviewed by two of our Assistant Medical Directors. This information is reported to the Quality and Safety Committee.

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Screening for cognitive impairment now occurs on admission through Emergency Departments or other assessment areas and forms part of the medical clerking and nursing assessments. The Standards for care of older people in hospital are included below.

Challenges Faced:

Some of the challenges relating to the development of the standards included:

Staff groups wanted to use jargon in the standards but the underpinning ethos was that they were meaningful to all, not just staff

Keeping the number of standards to a manageable yet meaningful number

Conflicting views on what was important and therefore should be included from those involved in the consultation

Views from some staff that there was no need to define these standards in the first instance as they were self evident

Concern that these standards only apply to older people but actually are relevant to other patient groups

Further Actions Planned:

Continue to monitor compliance via the older persons improvement dashboard being reported to the Quality and Safety Committee (see recommendation 17) and addressing any areas for improvement

Development of Children’s Charter using the same approach to participation in the development of standards alongside the Convention on Children’s Rights

Consider how the standards can be applied to other patient groups

All ABMU ward areas either have or are in the process of carrying out a self-assessment against the components of the ideal ward (see recommendation 6), which includes the Standards for the Care of Older People, and developing action plans to implement any required improvements. This work will continue to ensure consistency and improved standards of care across the Health Board for all our patients.

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18

Appendix 2

Trusted to Care

Month 12

End of Year Report – Recommendation 2

Workstream:

Quality and Safety

Executive Lead:

Hamish Laing, Medical Director Rory Farrelly, Director of Nursing & Patient Experience

Executive Support:

Mandy Collins, Assistant Director, Patient Safety

Taskforce Lead: Joanne Davies, Action after Andrews Taskforce Lead Jonathan Goodfellow, Medical Lead, Action after Andrew Taskforce

Recommendation: The Board should develop a quality and patient safety strategy which focuses on the realities of care, connects the Board to the experience of patients, monitors standards in practice and shapes Board decisions accordingly. The Review Team were reassured about the personal commitment of the Chairman to looking objectively and purposefully at changing the culture and focus of the Board in line with this recommendation. There are clear commercial and public sector models which would provide useful reference points for doing so. It is not for the Review Team to recommend a particular model but it is highly recommended that patients and their representatives are involved in the creation of the ABMU strategy. The quality strategy should be sensitive to the needs of patients with dementia and reflect the importance of environment and meaningful activity in maintaining their safety.

Progress & Key Achievements against targets:

Our Quality Strategy In January 2015, we published our Quality Strategy (the Strategy) which sets out the steps that we will take to improve the quality of our services and achieve excellence consistently by ensuring that quality assurance and quality improvement are at the forefront of all our thinking and

19

embedded in everything that we do. The Strategy describes what we want to achieve (our strategic quality objectives), the approach that we will take to achieve them and how we will measure success (our quality measures). It is relevant to all services (health promotion, prevention, primary, community, secondary and tertiary) provided and commissioned by the Health Board; it provides a shared vision of how we will: Put the people of Bridgend, Neath Port Talbot and

Swansea, our wider communities and the experiences of all our patients at the heart of our services by promoting and encouraging patient and carer decision-making and involvement in everything that we do.

Support and enable our staff to deliver high-quality, evidence-based care and prevention compassionately by making it easier for them to consistently do the right thing.

Make tangible and measurable improvement to the aspects of quality that people have told us are important to them

Become a 'high reliability' organisation that has quality and improving the experiences of our patients at the core of all our services.

Through the implementation of our Strategy we will focus on delivering high quality services by addressing those matters that will contribute to the achievement of the following strategic quality objectives:

Quality Objective 1: To plan and deliver our services

with the people living in the communities we serve, so that they are person centred, caring and responsive to need.

Quality Objective 2: To deliver excellent, effective and efficient services that are based on evidence and standards.

Quality Objective 3: To make sure that everything we do is as safe as possible.

Quality Objective 4: To organise the Health Board for excellence and continuous improvement.

As we drive forward to improve the quality of our services, and most importantly the outcomes for our communities

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and patients, all strategic decisions, plans and activities will be aligned to one of these four quality objectives. Our Quality Strategy outlines an ambitious programme of work that we must take forward over the next three years if we are to consistently deliver health services that are always of the highest quality. By this we mean safe, effective, person-centred, caring and compassionate services that respect people's needs and their right to make informed decisions and choices. Our Annual Quality Plans To support the delivery of the Quality Strategy we will each year publish an Annual Quality Plan. These Annual Quality Plans will set out the quality priorities for the year ahead. The Annual Quality Plan developed for 2015-16, sets out the steps we will take to take us towards the achievement of our four strategic quality objectives, by focusing on the following priorities that are aligned to those areas where there is evidence of a need to further improve and develop: A1. Improving the way we collect and use Patient Reported Experience Measures (PREMs). [Contributes to the achievement of Quality Objective 1] Current health policy emphasises that patient experience, together with effectiveness and safety, is a key component of quality of care. As a consequence, Patient Reported Outcome Measures (PROMs) and Patient Reported Experience Measures (PREMs) are increasingly being seen as important for assessing quality of care, evaluating outcomes of specific interventions and for clinical assessment and decision support. A2. Improving the way we collect and use patient reported outcome measures (PROMs). [Contributes to the achievement of Quality Objective 1] The intention is to develop PROMs for all our services. In practice, this will mean that anyone accessing our services will be asked to complete a questionnaire at the start of their treatment and/or care and another at the end of their care and treatment which allows a comparison to be made against an individual’s expectations of the care and treatment they were to receive and what they actually received. B. Further developing our stroke services by

reconfiguring the patient pathway. [Contributes to

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the achievement of Quality Objective 2] Results from the most recent National Audit of Stroke Services show that ABMU has significant room for improvement, for example, only 14.7% of patients go direct to a stroke unit within 4 hours. While there are a range of ongoing actions being taken forward to prevent stroke, service change is needed. C. Improving the way we identify and manage a

patient whose condition deteriorates by rolling out across all hospitals and wards the 'sick patient' initiative. [Contributes to the achievement of Quality Objective 3]

Information from across the NHS from incident reports, complaints and audits indicate that there are often missed opportunities for intervention when a patient’s condition deteriorates. During 2015-16 we intend to take forward the ‘Spot the Sick Patient’ Project. The aim of this project will be to evaluate the current mechanisms that are in place to identify patients whose condition deteriorates, identify where improvements can be made and decide the best way of implementing these improvements. D. Implementing the all-Wales Do Not Attempt

Coronary Pulmonary Resuscitation (DNACPR) policy. [Contributes to the achievement of Quality Objective 3]

The Quality and Safety Committee formally agreed to the adoption of the new all Wales DNACPR policy, on behalf of the Board, in December 2014. The most significant difference to previous DNACPR policies is the inclusion of the concept of a ‘Naturally Anticipated’ and ‘Accepted Death’ where in less acute situations a gradual decline in clinical wellbeing is noted and in the context of the patient's condition death might be considered clinically inevitable. E. Implementing Electronic prescribing and

administration (EPMA) system in acute care. [Contributes to the achievement of Quality Objective 3]

Electronic Prescribing and Medicines Administration (EPMA) is the computerisation of the process of prescribing, processing, stock control and recording of the administration of medicines. EMPA will replace the current paper prescription and administration record chart normally completed for every in-patient, as well as discharge and outpatient prescription forms and will increase patient safety.

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F. Rolling-out the Big Fight campaign– Targeting Clostridum difficile infection and antibiotic resistance in primary care. [Contributes to the achievement of Quality Objective 3]

ABMU currently has the highest incidence of Clostridum difficile (C. Difficile) of all Health Boards in Wales. The Health Board also continues to have the highest Primary Care antibiotic prescribing rate in Wales. The “Big Fight Campaign” launched on the 23rd of October 2014, aims to support local GPs to promote good antimicrobial stewardship and reduce the inappropriate use of antibiotics. G. Improving risk assessment and support

mechanisms to prevent those who are known to our mental health services from attempting or completing suicide. [Contributes to the achievement of Quality Objective 3]

Accessible, high-quality mental health services are fundamental to reducing the suicide risk in people of all ages with mental health problems. Ensuring that any potential for suicide is identified and addressed before it is too late must be seen as being an integral part of good clinical care. Therefore, the intention is to, over the next twelve months, improve risk assessment and support mechanisms to prevent those who are known to our mental health services from attempting or completing suicide. In developing this Annual Quality Plan for 2015-16 (the Plan) we have been clear that, if we are to achieve the vision and objectives set out in our Quality Strategy, we must be realistic and open and honest about what we can and cannot achieve in a year; we must be ambitious but not over commit. The Plan sets out the outcomes we want to achieve and confirms the priorities we will focus on to achieve them. We have taken time and care to identify a small number of priorities that we are clear will have the biggest impact on the quality of our services, and most importantly the outcomes for our patients and communities. Alongside the priorities set out in the 2015-16 Annual Quality Plan we will continue to take forward the actions set out in the action plan developed in response to the findings and recommendations contained in the Trusted to Care report. Many of these actions will remain quality and safety priorities in future years and so in the coming months we will take steps to merge these actions into future Annual Quality Plans.

23

In addition to the Quality Strategy and Annual Quality plans we have and continue to take forward a number of initiatives and actions that are centred upon improving the quality of our services and ensuring that our governance and performance arrangements drive improvement, these include:

▪ the development of a quality impact assessment tool and process;

▪ a review of governance arrangements at directorate and locality level;

▪ taking steps to place quality at the centre of performance management arrangements by engaging clinicians in the development of outcome and patient experience measures; using the Health and Care Standards as the framework;

▪ taking steps to embed the Health and Care Standards into organisational governance and performance management processes;

▪ the development of an annual quality assurance framework; and

▪ the scoping of the content of Annual Assurance Plans which will be populated by managed units and used to hold them to account.

Challenges Faced:

The main issue in achieving this recommendation has been to develop the strategy in partnership with our patient groups and other stakeholders as well as our staff and agree a range of objectives which are understandable and supported by all.

Further Actions Planned:

Recommendation requirements met. A timeline of the work that has been taken forward and the next steps that are planned is attached.

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Appendix 3

Trusted to Care

Month 12 Report – Recommendation 3

Workstream:

Care Standards

Executive Lead:

Rory Farrelly, Director of Nursing and Patient Experience

Executive Support:

Christine Williams, Assistant Director of Nursing

Taskforce Lead:

Deborah Thomas, Strategic Nursing Lead

Recommendation: The Board should identify clear steps to generate a culture of care built on public involvement in the setting and monitoring of standards, and in the resolution of ethical issues and practical choices that arise from the need to make decisions within limited resources. The Review Team suggest that the Concern Clinics although an interesting response to the need to reconcile previous issues of concern highlighted by the public do not in themselves provide a credible enough basis for genuine public partnership. The Chief Executive should consider establishing a Professional Standards Task Force which would meet weekly to provide a new focus on supporting front-line staff with ethical/resource issues that present risk to patients. The Task Force would involve nurse, medical and finance leaders to review incidents and complaints and report on issues to the Quality Committee. Staff, the public, patients and relatives would be able to report issues which they felt compromised professional practice or care standards on a 24/7 basis. The Review Team believe that this innovative mechanism would provide a more constructive and practical approach to enabling and supporting staff than current processes with their emphasis on “whistleblowing”.

Progress & Key The Standards for the care for older people in hospital were drafted through a series of workshops involving staff,

25

Achievements against targets:

patients, carers and stakeholder groups. They were then circulated both internally and externally to ABMU for comment and final draft version approved at the August 2014 Trusted to Care Steering Group and subsequently published. Once our Organisational Values and Behaviour Framework was agreed in January 2015, the final iteration of the Standards were published, ensuring both were aligned (see Recommendation 1).

Terms of Reference for a Professional Standards Taskforce were developed and the approach is being piloted for the Princess of Wales site. The Taskforce meet on a weekly basis, review all Datix Incidents that have been raised during the previous 7 days that relate to professional standards. The hospital has not had a forum of this type before although some of the functions listed had been managed via other meetings. A formal evaluation of the Professional Standards Taskforce is due at the end of June 2015. The meetings have been held at 08:00 in the morning so that staff could attend following night shifts, during a day shift or before the start of a shift. Attendance at the meeting by the members has been good. Some of the benefits so far are as follows:-

The senior team has developed a shared awareness of the concerns, incidents and Patient Advice and Liaison Service (PALS) reports for the previous week. Before the establishment of the forum separate meetings were held with the Governance team and not all senior team members were present

The senior team has been more aware and supportive of actions being taken to address themes appearing in reports e.g. falls and pressure areas.

The reviews have supported the approach being taken in the Princess of Wales hospital to identify areas under strain and step in with support and action. It became evident that the draft terms of reference needed

to be revisited and revised to clearly reflect the terms of

reference that would be useful and effective on the Princess

of Wales site at this time. No individual members of staff

have attended with professional issues but they have asked

members of the group to raise issues on their behalf. A

newsletter is being prepared to help to raise awareness

26

with staff. It was not felt that it would be a useful forum for

patients or their families to attend and raise issues directly

as there are a range of more suitable options in operation

on the Princess of Wales site already, including:

Concerns clinics – monthly,

Meetings with families who raise concerns and are willing to meet as soon as possible after the concern is raised.

Meetings with bereaved families who have questions after the death of a loved one.

Therefore rather than individual patients or relatives attending the professional standards taskforce meeting instead information on any patient experience issues raised with wards, by formal complaints or via PALS are also considered.

In addition to the above, the Chief Nurse on the Princess of

Wales site holds open nursing forums for nursing staff,

who have stated that this provides them with a voice to

raise any concerns. Staff are also raising incidents via

Datix where they feel professional standards have been

compromised, and this is being actively encouraged.

These incidents are then reviewed by the Professional

Standards Taskforce. Staff have also verbally requested

that certain issues are discussed.

Over the past 12 months, the mechanisms within the

Princess of Wales Hospital to enable staff and patients to

raise concerns regarding professional standards have

evolved as above.

As part of the wider involvement of the public in setting

standards and developing our values we did a lot of

structured listening. Over the summer of 2014 we held a

series of staff and patient engagement events including:

66 staff listening events – “In our Shoes”, involving more than 1650 staff

leadership events

18 patient listening events – “In Your Shoes”, involving 120 patients

staff and patient surveys

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Several further events were held during November 2014

resulting in over 6000 people being involved in developing

our values and behaviours statements. As part of this, staff

and patients told us what they would like to see “more of”

and what they would like to see “less of” and our patients

and the public were asked to describe what an “ideal”

local NHS would look like. We have used this work to

agree a set of actions to improve care which is being

incorporated into the implementation plans for the roll out

and embedding of our values across the organisation (see

Recommendation 14).

The See it Say it campaign for staff and the public was

launched in Mid July 2014. This was established as a rapid

feedback mechanism for staff and the public to raise

concerns when they did not feel able to or did not know how

else to do so. This encouraged the public, relatives,

patients and our staff to email, text or leave a phone

message about any concerns they had or poor care they

had witnessed. This could be done anonymously or people

could receive feedback if they left their contact details.

Typically issues were picked up within 24-48hours and

relevant action taken. The nature of some of the issues

raised would not necessarily have warranted a formal

complaint but has provided patients and their carers with a

single point of access to raise low level concerns at an early

stage thus potentially avoiding escalation. Staff have raised

some issues regarding their immediate line managers

which would have been difficult for them to raise via other

routes. In addition concerns have been raised by staff that

had previously been raised with line managers but had not

been resolved. It has been possible as a result of the

campaign to nip issues in the bud, particularly on the

Princess of Wales site where the support of the Patient

Advice and Liaison Service (PALS) has been vital. Those

non-anonymous individuals, both staff and the public, who

have raised issues have been grateful for the prompt action

and feedback received.

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The See it Say it Campaign has now been succeeded by a single feedback mechanism for the public “Let’s Talk” and the “Raising Concerns” process for staff, which replaces the All Wales Whistleblowing policy. A subgroup of the Partnership Forum was approached to get the views of staff on the proposed Staff poster to address the requirements of the new All Wales Raising Concerns policy. The poster was agreed by staff-side and approved by the Trusted to Care Steering Group.

The potential replacement for the Patients, families and public posters were discussed at the Stakeholder Reference Group, the Third Sector Network and the Disability Reference Group to check wording, suitability, accessibility and plain language. These groups felt the posters needed to be more balanced and encourage more positive feedback as well as concerns, and also needed to reflect the organisation’s values. They were therefore revised and approved by the Trusted to Care Steering Group and have now been formally launched throughout the organisation.

The central theme to our Quality Strategy for 2015-18 is that we put the people of Bridgend, Neath Port Talbot and Swansea, our wider communities and the experiences of all our patients at the heart of our services by promoting and encouraging patient and carer decision-making and involvement in everything that we do.

Challenges Faced:

Some negativity around the “See it, Say it” campaign from the public and staff

Staff have not attended the Professional Standards Taskforce meetings though issues raised via incident report and indirectly with members of the PST are discussed

Other mechanisms relating to obtaining feedback from the public have been developed on the Princess of Wales site and these are fed through to the PST

Further Actions Planned:

Formal review of the Professional Standards Taskforce in June 2015 so that the Trusted to Care Steering Group can consider the appropriateness of its roll out to other hospital sites.

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Professional Standards Taskforce

Terms of Reference

Purpose

To provide support to front line staff with ethical/resource issues that present a risk to patients

To review incidents and complaints and report on issues to the Quality and Safety Committee

To review and revise local plans to reflect the changing needs within the hospital site

To influence local policy and procedures to ensure that the quality of care to patients is maintained or improves, in particular to our most vulnerable frail and elderly patients

Safeguard professional standards so that hospital staff can justifiably take pride in their profession and promote concern for high professional standards as the responsibility of all staff

Outline of Functions

To support, develop and maintain a visible and accessible forum for staff and patients and/or their carers to raise concerns/issues where professional practice or care standards may have been compromised and to take action on issues raised as necessary

To review and act upon, where required, all reported incidents which relate to risk for patients, compromised care standards or professional standards reported during the previous 7 working days

To review and act upon, where required, all complaints relating to compromised professional practice and care standards received during the previous 7 working days

To review the adequacy and security of the hospitals arrangements for its employees and contractors to raise concerns, in confidence, about possible compromising of professional standards, care standards or risk to patients. The Taskforce shall ensure that these arrangements allow proportionate and independent investigation of such matters and appropriate follow up action

Membership/Representation The Professional Standards Taskforce shall be appointed by the Chief Executive

Office and membership will consist of senior representatives from medicine, nursing,

governance and general management as follows:

Assistant Medical Director

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Chief Nurse

Head of Governance and Patient Experience

Hospital Director

Head of Finance

Staff side representation The Chair of the Professional Standards Taskforce shall be the Hospital Director.

Quorum In order for meetings to go ahead and actions to be agreed, all professional

standards taskforce members, or a nominated deputy, should attend meetings

Sub Groups There may be occasion to undertake sub-group meetings to complete a specific

piece of work, or where data or preparation needs to be undertaken. Any formed

sub-groups will report to the main Professional Standards Taskforce, who will agree

and lead on the strategic direction of the activity being undertaken.

A nominated individual or individuals will be identified to be responsible for ensuring

that reports for the Professional Standards Taskforce relating to incidents raised,

complaints received and any other papers are prepared and available for each

meetings.

Frequency The frequency of meetings will be weekly at a set time to enable staff or patients to

attend and raise issues in a face to face manner. The frequency of meetings

should be reviewed by the Group within a three month period initially, and as part of

the annual review thereafter.

Reporting

Reporting lines will be established within existing local strategic decision making structures

The Professional Standards Taskforce must report to each Quality and Safety Committee

Action notes and records of discussions will be made and as per template in appendix 1 and will be available for reference if required.

Review of Terms of Reference This will be undertaken after the first three months initially, then annually thereafter,

to ensure continuing relevance and ongoing development of the Professional

Standards Taskforce.

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Appendix 4

Trusted to Care

Month 12 Report – Recommendation 4

Workstream:

Learning, Skills & Knowledge

Executive Lead:

Bev Edgar, Director of Human Resources

Executive Support:

Louise Joseph, Assistant Director Workforce & OD

Taskforce Lead:

Jayne Combe, Workforce Lead, Action after Andrews Taskforce

Recommendation: The Board should implement a skills and knowledge programme to ensure all staff operating in its hospitals are equipped to meet their obligations to older frail people. The Programme should cover all permanent and temporary clinical staff working with older people. The Board should set its own timeline for this, but it is suggested that the Programme should be completed by all relevant staff within 6 months. The Programme should include the following elements: For all currently employed clinical staff – a recognised, mandatory programme combining core clinical, care and nursing standards (including pain management, hydration, continence, mobility, restraint, medication) and practical legal and ethical issues relating to older people and their families For all new staff (including junior doctors on rotation) - inclusion of mandatory standards on those issues and information in induction For temporary staff (including agency staff) - the Board must put in place arrangements which provide audited assurance that those staff working temporarily are fully aware of their obligations towards older people and the specific standards operating in their working areas Seminar series – we recommend a seminar series on patient-recording, medication and legal and ethical issues involved in care of older people.

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Progress & Key Achievements against targets:

The term ‘relevant staff’ in the recommendation is interpreted as those clinical staff who are located within the priority areas as identified as part of the Ward Assurance Framework. The Frailty Education Development Group recommended 2 levels of training which was supported by the Steering Group. Level 1 – Awareness of our Standards of Care for Older People To be operationally driven by existing mechanisms such as team brief, team meetings, email and staff bulletins Level 2: Mandatory training programme for all clinical staff. The content of this education programme has been developed by clinical experts in Care of the Elderly. It is delivered as a MDT workshop over 3 hours using a series of case studies and patient stories to enhance adult learning and improve transferability of skill to clinical practice. This case study approach is used at both POW and NPTH, with NPTH staff combining this session with frailty clinical skills development as a one day programme, featuring frailty assessment, simulation and management of clinical deterioration. Training Delivery Plan Within POWH & NPTH, a total of 623 staff (POWH & NPTH) were identified as requiring training at Level 2. The original delivery plan was to complete the training by May 2015; due to operational pressures to release staff additional training sessions have been added to the programme to be completed by the end of June. In NPTH all nursing and nursing HCSWs have completed their training. In POWH, 290 staff out of a total of 459 staff have competed the training leaving a gap of 169 staff. These staff have been scheduled to attend the additional training sessions with a focus on targeting staff from the priority ward areas. As a contingency against release of staff due to operational pressures further sessions will be factored in to run throughout July. The facilitation of the programme in POWH is via pool of 6 clinical facilitators, ANPs and lead therapists. Evaluation & Impact A dual approach to evaluation at the point of delivery has been used to obtain feedback from attendees and clinical facilitators: 100% of respondents rated the sessions positively and answered yes, that they learned something new about frailty, 92% of these indicated that all of the learning outcomes were met. Feedback from clinical facilitators was designed to elicit the ongoing training needs in preparation for

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the proposed seminar series. Key training needs were consistently highlighted in relation to safeguarding, DoLS, Capacity and consent and pain management. This feedback will directly feed into the development or signposting to our ‘Seminar Series’ Additional feedback from the dementia sessions delivered on the same day also identified problems in relation to overlap of learning content with dementia sessions and this will be addressed for future sessions.

Challenges Faced:

Staff release for level 2 training due to operational constraints and competing training priorities. To counteract this, dementia level 2 training has been combined with frailty training as a full study day and this has helped with staff release. However, we continue to closely monitor staff attendance. Contingency plans in place to run additional Frailty Study days during July if required to ensure all staff are trained. Medical staff attendance is being monitored and we continue to look at ways to specifically address how we engage with medical staff e.g. through audit days etc. Skilled facilitation from within existing clinical resource due to operational constraints and clinical demands. A pool of facilitators has been identified and backfill arrangements are in place to support staff release

Further Actions Planned:

Plans to combine frailty and dementia level 2 training into one seamless study day ‘Caring for the Older Person in Hospital’ to align learning outcomes, ensure cohesion and improve learning experience allowing staff to explore and test learning and understanding through case studies. MDT facilitation and team approach continues to be strongly supported as it aids translation of learning into practice. Plans to work closely with clinical leads in Swansea to determine a realistic training delivery plan which acknowledges operational constraints but also maintains momentum for training delivery. Working with clinical leads in Swansea to identify most appropriate clinical facilitators and mechanisms to support their release.

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Appendix 5

Trusted to Care

Month 12 Report – Recommendation 5

NB There are two sections to the progress report on

Recommendation 5 (a) Delirium & Dementia (b) Dying in Hospital

Workstream:

Learning, Skills & Knowledge

Recommendation

Delirium & Dementia

Executive Lead:

Bev Edgar, Director of Human Resources

Executive Support:

Louise Joseph, Assistant Director of Workforce & OD

Taskforce Lead:

Jayne Combe, Workforce Lead, Action after Andrews Taskforce

Recommendation: The Board should run an intensive education programme on delirium, dementia and dying in hospital. The programme should be developed and implemented within 9 months of the publication of the report.

Progress & Key Achievements against targets:

Priority areas determined by Ward Assurance Programme. Three levels of training identified as ABMU dementia training passport: Level 1 – Awareness training for all staff(Barbara’s story + personal pledge), followed by e-learning Level 2 – Skilled Practice for Clinical Staff (taught module + competency assessment in the workplace) Level 3 – Enhanced Practice – Dementia Champions As at 31.5.2015: Level 1: 10,001 staff attended Awareness Training across the Health Board, significant proportion of these from NPTH & POWH. 3,464 staff have completed e-learning. Level 2: 290 staff attended the training (127 out of 270 staff

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identified from the from priority areas) and are now being competency assessed in the workplace by the dementia champions. A further 40 staff are booked on to training scheduled between June and July for priority areas. 7 training sessions are scheduled for POWH and 4 sessions are scheduled for NPTH. Level 3: Target of 1 dementia champion per ward exceeded. ABMU supported RCN recommendation of 2/3 per dementia champions per ward. 13 dementia champions in priority areas at NPTH and 26 dementia champions in priority areas at POWH. There are a total of 249 Dementia Champions in place across all clinical areas in the Health Board. Dementia Champions training is on-going and a further 2 cohorts are scheduled for July 2015 and 2 cohorts for September 2015. Key achievements Commitment & Investment

Investment in multi professional Dementia Care Training Team and recruited 1 x Band 7 2 x Band 6 (mental health nurse, OT, Physio).

Quality Assurance

Level 2 Training Competency booklet and competencies mapped to South Tees Framework, The Sterling Best Practice Programme at QCF level 3 and the ABMU level 4 accredited programmes.

Training programme underpinned by recommendations within the NICE-SCIE (2006) Clinical Guideline 42 and the National Dementia Strategy for Wales WAG(2011)

E-learning modular programme developed by ABMU will be launched shortly by Minister for Health and available across NHS Wales.

Alzheimer’s Society accredited Level 1 Awareness training as equivalent to the Dementia Friends training

Impact & Evaluation

Evaluation at point of delivery remains positive -3617 written evaluations have been received and 97% of these rate the training as excellent or good.

Over 3,600 personal pledges, demonstrating ownership and commitment to change clinical practice.

Dementia awareness sessions successfully incorporated into junior doctor’s induction and HB corporate induction to ensure that all new staff joining the organisation are dementia aware.

Programme shortlisted for national HMPA award

Network developed for existing Dementia Champions

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as a source of CPD, support and networking to share best practice. The network is also being used to drive consistency in competency assessment across the Health Board.

Dementia awareness training featured as part of week long positive news campaign about the NHS in Wales on ITV in January 2015

Challenges Faced:

Staff release for level 2 training due to operational constraints and competing training priorities. To counteract this, dementia level 2 training has been combined with frailty training as a full study day and this has helped with staff release. However, we continue to closely monitor staff attendance.

Medical staff attendance is being monitored and we continue to look at ways to specifically address how we engage with medical staff e.g. through audit days etc.

Staff confidence levels in accessing e-learning for Level 1 training. A series of e-learning workshops have been set up to support staff and increase confidence levels.

Further Actions Planned:

Commissioned Swansea University Centre for Innovative Ageing (CIA) to undertake a longitudinal study to evaluate the impact of the dementia training passport, commencing with the establishment of focus groups for Level 1 awareness raising. This work commenced in April 2015 and is on-going

Through the dementia champions network we will monitor how competency assessment in the workplace is working in practice, both in terms of lessons learnt and protected time for champions to undertake their assessment role in practice

Continue to provide training during June and July (7 sessions booked in POWH & 4 in NPTH)

Based on our lessons learnt work with clinical leads in Swansea to roll-out dementia care training passport across the organisation.

Sharing lessons learnt across Wales

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Workstream:

Education & Training

Recommendation:

Dying in hospital

Executive Lead:

Bev Edgar, Director of Human Resources

Executive Support:

Louise Joseph, Assistant Director of Workforce & OD

Taskforce Lead:

Jayne Combe, Workforce Lead, Action after Andrews Taskforce

Recommendation: The Board shall run an intensive education programme on delirium, dementia and dying in hospital. The programme should be implemented fully within 9 months of publication of this report.

Progress & Key Achievements against targets:

Given the scale of the training required it was agreed that a separate workstream would be set up for ‘dying in hospital’ and the dementia training delivery plan. This end of year report focuses specifically on achievement of dying in hospital recommendation. The recommendation states ‘implementation’ but does not place a timescale on completing this training. Unlike dementia training, this recommendation does not identify specific staff groups for undertaking the training. Training Design & Delivery ABMU commissioned CRUSE to deliver training as a pilot and test the approach and an Education Group was established with CRUSE and palliative care clinicians to develop the content with training commencing in November 2014. An early evaluation of the programme identified uptake as low with feedback suggesting that the training was too bereavement focussed and did not address the communication aspects of dying in hospital. At this point, the training was suspended whilst the content was reviewed and redesigned to ensure its fitness for purpose. The revised programme ‘Recognising and Communicating Effectively about Dying in Hospital” was re-launched in February 2015 and decision taken to co-facilitate the training programme with CRUSE and senior clinicians within the palliative care team. As part of the programme review, the team also co-produced an emotive video resource as a partnership venture between CRUSE and palliative care specialist clinicians. The video was filmed at Ty Olwen and designed to explore

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prioritisation and communication around decision making in the last days of life. A cruse volunteer featured as a patient in the video and the palliative care team played other roles. In February 2015, the Steering Group agreed the revised target of training 300 staff which was based on the capacity of the remaining contracted hours with CRUSE. The Steering Group also agreed to an extension of the delivery plan from May 2015 to July 2015 in order to fully utilise the CRUSE contract and ensure staff at NPTH and POWH were prioritised. As at 31.5.2015, 284 staff have attended ‘Communicating Effectively about dying in hospital’ across the Health Board; 55 of these staff work within the priority areas in NPTH & POWH and a further 2 training sessions, with a capacity of accommodating 50 staff have been scheduled between June and July 2015 in NPTH & POWH. Impact & Evaluation The evaluation mechanism for this recommendation included evaluation at the point of training, followed up by a focus group approach to measure the impact of the training on clinical practice. The first focus group session took place on 29th April 2015 and included 13 staff from nursing, therapy, chaplaincy backgrounds. Feedback from the focus groups and evaluation forms has been overwhelmingly positive with all staff benefiting from the skills and knowledge of the facilitator, the multi-disciplinary team approach and increased personal confidence in dealing with communicating about dying. A second focus group is being arranged for July in Morriston and transcription/ analysis of the data is in progress.

Challenges Faced:

Ensuring the content is fit for purpose and meets the needs of staff. Leadership and engagement from senior palliative care medical and nursing staff has been pivotal to the success of this programme.

The challenges of releasing staff to attend dementia and frailty have not been experienced to the same extent with Care of the Dying, as a more flexible approach has been sanctioned, as staff outside the priority areas have been able to book on the training. However, this open access approach has potential to result in this training being perceived as less important and of a lower priority than other TTC associated training. We are monitoring this closely but positive evaluations to date do not substantiate this.

The delivery method is resource intensive, requiring 2

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clinicians and CRUSE facilitator to run each study day. Organisational commitment has enabled this happen and an end of period evaluation will determine how we will continue to roll-out this training.

Further Actions Planned:

Plans to fully evaluate the pilot and approach at the end of the CRUSE contract in July 2015. Complete focus groups and transcription of data to inform evaluation process, including attendance patterns and gap analysis to identify hard to reach staff groups. Two focus groups are scheduled for July.

Identify potential for awarding CPD points to the learning programme.

Based on pilot evaluation, develop our project plan and investment required to initiate Phase 2. Agreement in principle already reached to continue partnership agreement with CRUSE into 2015/16.

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Appendix 6

Trusted to Care

Month 12 Report – Recommendation 6

Workstream:

Care Standards

Executive Lead:

Rory Farrelly, Director of Nursing and Patient Experience

Executive Support:

Christine Williams, Assistant Director of Nursing

Taskforce Lead:

Deborah Thomas, Strategic Nursing Lead

Recommendation: Recommendation 6 required ABMU Health Board to develop more cohesive multi-disciplinary team practice in the medical wards at the two hospitals, built around shared responsibility and accountability for patient care and standards of professional behaviour. Issues to address here include the need for greater clarity of responsibility for staff, greater focus on the skills and capacity of clinical teams needed to deliver safe and effective patient care and treatment and action to maximise the benefit of the clinical “encounter” on the wards – increasing the frequency and timing of contact of senior doctors each day. The Review Team specifically recommends the adoption of a risk assessment protocol if staffing levels fall below a safe level, assessed by the nurse in charge at the time, and the options for resolution and escalation improved over current practices

Progress & Key Achievements against targets:

The Ideal Ward concept and the ward assessment toolkit were developed utilising the knowledge and skills of our front line clinical multi-disciplinary teams. They were finalised and shared with teams across the organisation through a series of facilitated multi-disciplinary workshops.

Phase 1 of the application of the ward assessment

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toolkits and implementation of associated action plans was due for completion at the end of May 2015 and included wards B2 in Neath Port Talbot Hospital and Wards 2, 10, 18, 19 and 20 in the Princess of Wales. Phase 2 areas were applying their toolkits by the end of May 2015 and will implement their action plans by the end of December 2015 and includes all other wards that deliver care to older people on both sites. Feedback has been overwhelmingly positive and it is felt by front line teams that the action plans will make a real difference to the ability of staff to deliver safe and effective care and to the patient experience. Updated action plans have been received for all phase 1 ward areas at the end of April 2015. The ward teams were asked to RAG rate their action plans identifying

Actions achieved (Green)

Actions expected to achieve by end of May 2015 (Amber)

Actions not expected to achieve and contingency plans (Red)

The majority of areas have made good progress in relation to implementing their action plans. Some progress made includes:

Refurbishing of patient bathrooms

Equipment such as soft closing bins and appropriate signage have been sourced

Notice boards renewed and de-cluttered

Introduction of flexible visiting, allowing families, carers and loved ones to provide emotional and practical support for longer periods

Nurse recruitment has enabled ward managers to work in a more supervisory capacity to monitor standards and provide leadership to their teams

Good uptake of Action After Andrews Learning Skills and Knowledge education programmes

Work has commenced on outside spaces to improve the external environment for out patients and their families

Introduction of orientation boards

Individualised and personalised care planning

Call bell and lighting improved

More nurses through new approaches to recruitment, e.g. open recruitment days on each acute site, utilising social media to advertise open days

Improved medical engagement in Board Round

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process Areas where progress will require further time or a contingency plan include:

Insufficient number of side rooms for patients at end of life

Lack of storage areas on some wards

Not all areas are 100% compliant with PDR process but plans are in place to address

Capital investment required to renew flooring in some areas

Lack of progress in implementing Board round process in some areas due to lack of social worker allocation and new medical staff

Creating more cohesive multi-disciplinary team practice was one of the expected outcomes in the Ideal Ward process. Medical engagement in this process has been generally poor, however nursing, therapies, pharmacy and managers have all participated well and found the process useful.

A risk assessment protocol for safe staffing levels has been developed and shared with staff.

Despite making good progress towards achieving Ideal Ward Status, some wards on the Princess of Wales site continue to cause a concern as below:

AMU Issues:

There are still significant issues with patient flow and capacity within AMU. This has led to increased pressure for nursing and medical staff leading to high levels of attrition.

Actions being taken to address issues on AMU:

Hospital Director reviewing service model

Directive enforce to ring-fence assessment cubicle

Trolley placed in Assessment Bay instead of beds

CD has reviewed medical model and Consultants will be covering the unit on a rota

Nurse Practitioners review patients in order to accelerate flow

Lead Nurse changed

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Vacancies are being filled but will take until September 2015 for all nurses to come into post.

Ward 2 Issues:

Has been unstable but more stable since return of Band 7

Environment of care not conducive to stroke patients due to lack of rehabilitation facility

Nurse staffing levels are compromised due to vacancies

Actions taken to address issues on ward 2:

New service model for stroke developed that will provide a rehab room and 2 trolleys rather than 6 beds in one bay – awaiting executive approval for this development.

Vacancies have been filled but will take until September 2015 for nurses to come into post.

Ward 10 Issues:

Complaints and incidents regarding standards of care and pressure ulcers

Action taken to address ward 10 issues:

Improvement group established with medical

Individual capability issues are being addressed

All of ward staff have been re-trained in tissue viability

Staffing levels being addressed as above

Ward 20 Issues:

Maintaining staff and vacancy factor Actions to address ward 20 issues:

As above

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Overall, within the Princess of Wales site registered

nursing vacancies have reduced to 28 whole time

equivalents which will be filled by September 2015.

However, turnover is such that it remains a challenge.

Sickness rates have, however, improved for the first time

in 18 months.

There are no wards on the Neath Port Talbot site that

are currently of concern.

Challenges Faced: Achieving medical staff engagement in the Ideal Ward Process has been challenging. Leadership summits for medics are planned for both sites in June 2015 and to be delivered by our Chief Executive, Medical Director, Chairman and Director of Nursing and Patient Experience

Some of the ward environmental work will take longer to implement, particular where capital investment is required

Further Actions Planned:

Further develop Silver and Gold Ideal Ward Status criteria to enable teams to further progress

Phase 2 ward action plans are due for implementation by the end of December 2015

Further roll out of the Ideal Ward Process across all acute and community hospitals within ABMU Health Board

Inclusion of the Ideal Award in the Annual Chairman’s Awards

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Appendix 7

Trusted to Care

Month 12 Report – Recommendation 7

Workstream:

Learning, Skills & Knowledge

Executive Lead:

Bev Edgar, Director of Human Resources

Executive Support:

Louise Joseph, Assistant Director of Workforce & OD

Taskforce Lead:

Jayne Combe, Workforce Lead, Action after Andrews Taskforce

Recommendation: The Board should introduce a coaching scheme for front line clinical leaders provided by senior people outside the two hospitals.

Progress & Key Achievements against targets:

For some time the Health Board has been proactively taking

steps to develop a coaching culture through the development

of more than 690 managers in coaching as a management

style. This recommendation provided a heightened focus on

coaching resulting in the development of immediate and

longer term actions to support clinical leaders in NPTH &

POWH. Immediate actions include:

- 1:1 external coaching support for 20 clinical leaders, including lead nurses, ward managers. The coaching is underpinned by a 360 appraisal tool which has been mapped to our values and behaviours framework. The tool will be used to evaluate the benefits and change in leadership behaviours as a result of the coaching programme. Coaching will be supported by a series of action learning sets to consolidate learning into practice.

- Integration of coaching into existing in-house leadership development programmes is already underway.

- Plans to advertise shortly for cohort of level 5 accredited coaches to enable us to build our pool of accredited coaches and sustain coaching capacity and

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activity in the longer term. Alongside coaching, the Health Board has also supported clinical leaders in NPTH & POWH through a range of in-house and externally facilitated leadership development and clinical supervision programmes. As examples, during 2014/15, five senior nurses attended the Empowering Ward Sisters Programme. Ten lead nurses and one lead therapist attended 3 day programme of clinician supervision. Two Lead Nurses in POWH are undertaking the Senior Leadership Experience (via Academi Wales), a further 3 lead nurses and 2 consultant medical staff from POWH (out of a total group of 9 supported across the Health Board) are attending ‘Summer School’ a week-long residential leadership programme in June facilitated by Academi Wales. ABMU also has the largest contingent of medical staff undertaking the Medical Leadership Programme (facilitated by Academi Wales). A total of 6 consultant medical staff are attending the MLP, 3 of whom are POWH based. Within Therapies, 17 lead therapists across the Health Board are undertaking MSc in Advanced Clinical Practice at Swansea University and a further 95 attended Advanced Clinical Reasoning programme during 2014/15.

Challenges Faced:

Staff have welcomed the opportunity to have 1:1 coaching as

protected time for development and reflection and evaluation

is very positive. However, the development of a pool of

accredited coaches is more of a challenge as staff will need

to balance clinical commitments with providing coaching

development for others. Our approach has been to proceed

with 1:1 coaching immediately to enable front line clinical

leaders to experience the value of coaching and thereby

unlock potential barriers. The recommendation also

suggested a twinning process with another Health Board with

reciprocal arrangements in place. Academi Wales already

provides a coaching service for public sector staff through the

All Wales Coaching Collaborative; however, this tends to be

accessed by senior staff. At more operational levels, the

potential of exploring twinning relationships with neighbouring

health boards has been discussed through the All Wales

Assistant Directors of OD network and was not supported at

this time, given the low number of accredited coaches within

each Health Board.

Further Actions Our future plans include:

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Planned: - developing a pool of accredited coaches at Level 5 to provide coaching across the organisation from September 2015

- establishing a coaching alumni for accredited coaches with regular CPD sessions

- offering 1:1 external coaching for clinical leaders across Swansea,

- creating a coaching intranet page which will enable staff to search for coaches and share best practice

- continue to work with NHS colleagues across Wales and through Academi Wales to promote coaching and collaboration

- continue to support clinical leadership development through in-house programmes and access to external provision.

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Appendix 8

Trusted to Care

Month 12

End of Year Report – Recommendation 8

Workstream:

Medicines Management

Executive Lead: Hamish Laing, Medical Director

Executive Support:

Judith Vincent, Clinical Director for Integrated Pharmacy

Taskforce Lead: Joanne Davies, Action after Andrews Taskforce Lead John Terry, Pharmacy Lead, Action after Andrews Taskforce

Recommendation: The Board should adopt a “zero tolerance” approach to the improper administration of sedation and medicines for all clinical staff, drawing a clear line in the sand within three months of the publication of this Report. A mass education project is needed where nurses, doctors and pharmacy staff are reconnected with their personal professional responsibilities and the consequences of not following professional codes and hospital policy. Each nurse should be reissued with their professional code of practice. The Board needs to decide its policy using the suggestions e.g. for disposable medication pots made in the Report.

Progress & Key Achievements against targets:

Immediately after the publication of Trusted to Care, the existing medicines management policy was reviewed and revised to address the issues raised in the report. Specifically additional or substantially revised sections and / or flowcharts have been developed from this revised medicines policy to support wards by clarifying their responsibilities. The zero tolerance approach taken to signing for medicines which have not been observed being taken was enforced immediately and any occurrences raised as an adverse incident, with appropriate action being taken as a result. As part of this work, clear guidance has been produced on

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how staff can access medicines outside of normal pharmacy hours. Medication safety metrics have been developed including unintended missed doses and critical medicines omitted. This information feeds into the Health Board’s dashboard, used for monitoring against the standards of care for older people (see Recommendations 1 and 17). Omitted doses identified by pharmacy staff are discussed with the relevant nursing and medical teams. The monthly patient safety metric data includes missed doses this is communicated to nurse managers prior to inclusion in the fundamentals of care database. Guidelines have been developed for antipsychotic use in patients with cognitive impairment and symptoms of dementia. Clear definition of “never” events, with zero tolerance to these and issues discussed and actions taken as appropriate during routine pharmacy visits and the medication safety audits. Clear guidance on administration of medicines to patients who refuse medication is now contained within the medicines policy for the Health Board and in an easy reference flowchart. Guidance issued and clarified in the medicines policy that all administration must be witnessed. All medication must be stored appropriately when not in use. Certain key rescue medications as defined and agreed by the Medical Director can be left in the patient’s possession. A powerpoint presentation on the safe administration of medicines has been delivered to ward staff and is available on the Action after Andrews section of the Health Board intranet. Guidance issued to re-iterate that administration must be witnessed and the medication box signed immediately after the patient is observed taking the medicine. Medicines administration presentation and abridged policy including this key message issued to all wards. Refresher sessions are arranged as issues arise. Patient safety thermometer data is discussed with medical and nursing staff. Input into the induction programme means that all new starters have the medicines management policy explained as well as “never” events. Guidelines have also been developed for:

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the management of pain in patients with cognitive impairment and symptoms of dementia

prescribing of antipsychotics in dementia

capacity assessment (abridged version issued to wards)

simplified self administration policy for wards to use

medicines access both within and outside normal pharmacy hours (flowcharts developed)

administration of medicines to patients who refuse medication

Some of the Pharmacy sites have technician staff that participate in the MDT meetings. Patients with considerable medicines use difficulties are identified and provided with a follow up home visit. E-learning package on completion of the in-patient medicines administration chart, prescribing and administration are available via the Health Board website. NMC code of conduct and guidance on medicines management re- issued to all registrants. Pharmacy staff re-issued with code of conduct. All registered pharmacy staff have completed a WCPPE ‘professionalism’ module.

Challenges Faced:

Differing advice has been received relating to the storage of medicines and security around this. As a result an audit of all current medicines storage at Princess of Wales and Neath Port Talbot Hospitals has been carried out. Guidance is awaited from the national steering group, the Medicine Administration, Recording, Review and Storage (MARRS) Working Group on these aspects for all welsh hospitals. This will encompass medicine storage and refrigeration specifications. In the meantime the Health Board has developed an action plan to address key areas where problems have been identified. The environments used for the storage of medicines and their preparation has been found to be insufficient in a number of wards due to the amount of medications some patients are now taking. Where this is a significant issue efforts have been made to identify alternative space for this purpose but the availability of capital will dictate how rapidly these plans can be implemented.

Further Actions A range of ongoing education relating to medicines management are planned including:

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Planned:

Ongoing medicines management training for nurses

Embedding powerpoint presentation on the safe administration of medicines into the sessions for new starters within ABMU September 2015

Review & update the content of the current nurse medicines management study day September 15.

Environment – Prior to the publication of the MARRS group recommendations ABMU Health Board has audited all its medicines storage arrangements to ensure they meet minimum standards. As part of this any unacceptable equipment has been replaced and a programme of works agreed to address improvement issues, including relocating some of the smaller medicines rooms where this is required June 15 Improved medicines security – keypads on doors to medicine storage areas June 2015 Infrastructure projects – for example appropriate accommodation on wards to facilitate medicines preparation, storage of bulk fluids and temperature regulation are currently undergoing a scoping exercise, implementation during 2015.

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Appendix 9

Trusted to Care

Month 12 Report – Recommendation 9

Workstream:

Care Standards

Executive Lead:

Rory Farrelly, Director of Nursing and Patient Experience

Executive Support:

Christine Williams, Assistant Director of Nursing

Taskforce Lead:

Deborah Thomas, Strategic Nursing Lead

Recommendation: Recommendation 9 required ABMU Health Board to address hydration, mobility and feeding practice for all older patients and publish audited results on a quarterly basis. The negative impact of prolonged (more than five hour) Nil by Mouth requirements for older people can be devastating. A review of current practice could act as a rallying point for the public and staff to work out together what would work on each ward or clinical area. The suggestions on snacking and feeding included in the Report are provided as being helpful. The further recommendation is that an approach is tested which included an automatic offer of water to patients in any clinical encounter, or offer of care.

Progress & Key Achievements against targets:

The standards for care of older people in hospital have incorporated standards on nutrition, hydration and mobility. The indicators included within the improvement dashboard monitor how we are doing and are published on a bi-monthly basis through the presentation of the dashboard at the Quality and Safety Committee. The standards for care of older people in hospital also form the basis of an education programme for staff. This programme consists of 2 levels of training : Level 1: Awareness of our Standards for Care for Older People which is operationally driven by existing mechanisms such as team brief, intranet, team meetings, email and staff bulletins. Level 2: Mandatory training programme for all clinical staff. The content of this education programme has

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been developed by clinical experts in Care of the Elderly. It is delivered as a multi-disciplinary team workshop over 3 hours using a series of case studies and patient stories to enhance adult learning and improve transferability of skill to clinical practice. This case study approach is used at both the Princess of Wales and Neath Port Talbot Hospitals. A Flexible Visiting Policy was developed, consulted on, agreed on 18th February at the Changing for The Better Delivery Board and launched on 13th April 2015. There are plans to audit the impact of the policy in July 2015 to establish the impact on care delivery as well as other issues such as parking, domestic services and patient and carer/family perspective. As part of the flexible visiting arrangements families/carers are actively encouraged to visit at mealtimes, particularly where support with eating and drinking is required. The review of current practices relating to Nil By Mouth arrangement within ABMU Health Board identified that there was not an agreed consistent approach within the organisation. Guidance relating to Nil By Mouth arrangements have been developed and implemented, having consulted with multi-disciplinary teams. Snacking arrangements for patients have been addressed through the provision of high energy snacks for the nutritionally compromised and biscuits/fruit for others. In addition, if a patient misses a meal, arrangements are now in place for nursing staff to request replacement meals at any time. The menu planning group are exploring the provision of finger food platters in conjunction with Welsh procurement. We anticipate that these will be available during 2015/2016.

The Community Health Council (CHC) ward monitoring visits include assessing the provision of assistance to patients to eat and drink where required. Feedback is given at the Food Service and Nutrition and Development Group, whose membership includes a CHC representative.

Swallow Screening training for nursing staff on both sites has been provided to equip staff with the knowledge and skills to undertake swallow screening where clinically indicated, and therefore prevent patients from unnecessary and prolonged nil by mouth arrangements.

The swallow screening protocol has been reviewed and updated.

A Hydration and nutrition screen savers have been utilised on all PCs within the organisation as a reminder to staff. Food and

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fluid chart training has been provided via e-learning.

Challenges Faced:

Achieving multi-disciplinary agreement regarding Nil By Mouth Guidance

Uptake of swallow screening training

Resistance to the introduction of Flexible Visiting arrangements in some areas

Further Actions Planned:

The development of a comprehensive Nil By Mouth Policy during 2015/2016

The provision of finger food platters in 2015/2016

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Appendix 10

Trusted to Care

Month 12 – Recommendation 10

Workstream:

Environment

Executive Lead: Rory Farrelly, Director of Nursing and Patient Experience

Executive Support:

Cathy Dowling, Acting Assistant Director of Nursing Lesley Stuart, Capital Planning Manager

Taskforce Lead:

Joanne Davies, Action after Andrews Taskforce Lead

Recommendation: The Board should review how well ward accommodation supports care for those with dementia, delirium, cognitive impairment or dying at both hospitals, covering physical design of the clinical spaces and equipment available. It is counterproductive to invest in the skills and knowledge of staff if the environment is actively harmful to care. It is suggested this should be externally validated using established international standards leading to a programme of change and development. Audit tools are available and on-line guidance.

Progress & Key Achievements:

Nicky Hayes, Consultant Nurse from Kings College Hospital, London was commissioned to support the Board in addressing a range of issues relating to care standards, particularly for older frail people. As part of this work she helped support us to develop a ward assurance process which includes assessing the environment using the Kings Fund audit tool. Capital funding was made available for the implementation of Action after Andrews environment priorities across the Health Board. Based on the findings of the environmental audits, the action plans developed from these, the Ministerial Spot Checks and the issues identified by staff and patients a number of environmental priorities have been progressed. It is recognised that some of the additional priorities are likely to cost significantly more, and

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work is underway to quantify these.

In addition it is considered that a programme of ward refurbishment needs to be put in place. In order for this to be done in a pragmatic and affordable way, there needs to be a ward to decant to so that this can be a rolling programme. It is planned to develop a business case for a demountable decant ward at Morriston and Princess Of Wales Hospitals so that this can be achieved, along with a cost for phased refurbishment of priority ward areas.

Below is a list of other environmental work that has been undertaken over the previous 12 months as a direct result of the Trusted to Care recommendations.

Purchase relevant documents from DSDC to support environmental work November 2014. Ensure call bell systems which are not working in 3 wards at POWH are replaced. April 2015 Trial wireless call bell system on Singleton wards with problematic systems. March to May 2015 Development of Ideal Ward concept and assessment toolkit (see also Recommendation 1) incorporating the Kings Fund Enhancing Healthcare Environments guidance – with external support from Consultant Nurse for Older People, Kings College Hospital and RCN National Leads for Dementia and Older People. May – Dec 2014 Review ward accommodation in Priority 1 areas against Ideal Ward toolkit and develop action plan for addressing issues in these areas. Sept – Dec 2014 Review ward accommodation in Priority 2 areas against Ideal Ward toolkit and develop action plans for addressing issues in these areas Dec 2014 to May 2015 Expand role and membership of Disability Reference Group (DRG) & linkages to Stakeholder Reference Group to ensure involvement in agreeing changes needed to environment to best take account of all patient’s needs. Nov 2014 Development of plain English ward/departmental descriptions & pictograms for use in signage across Health Board with DRG May 2015 Dementia Design school incorporating other disability groups held and key priorities for addressing in key areas agreed March 2015 Briefing materials developed for delivering key messages around design priorities for patients with dementia and other disabilities May 2015 Database of structural / non-structural environmental issues across NPTH & POWH established with implementation

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dates May 2015 Trialling of dementia aids agreed at POWH linked to careful evaluation of benefits / costs / infection control risks. May 2015 Plans developed and prioritised for structural changes at POWH June 2015 Audit of dementia friendly signage used currently within Health Board. By December 2014 Agreement of revised standardised dementia signage with external advice from DSDC May 2015 Roll out of dementia friendly signage across Neath Port Talbot and Princess of Wales Hospitals. June 2015 Agreement of required content of patient / visitor notice boards from engagement with stakeholders November 2014 – May 2015 Production of standardised notice board & content on entrance to wards for adoption across Health Board June 2015 Agree scheme for colour coding of bays / individual bed identification using ideas from Dementia Design School May 2015 Review of medicines management storage environments to ensure they are fit for purpose or formal derogations agreed May 2015 Agreement of structural changes to medicines management rooms & plans developed June 2015

Challenges faced:

The capital investment requirements of improving the existing environments in line with more recent guidance regarding bed spaces

Existing structures of our hospitals

Further Actions Planned:

Development of prioritised list of structural environmental issues from Phase 2 areas June 2015 Use of plain language terminology for departments and associated pictograms included in outpatient letters. June – July 2015 Discussion with DSDC over potential for ward accreditation for ward 20 as an Ideal Dementia Medical Ward in Princess of Wales under their scheme as whole hospital accreditation not possible. July 2015 Development of business case for decant facilities for POW and Morriston Hospitals to enable rolling programme of refurbishment August – September 2015

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Appendix 11

Trusted to Care

Month 12 Report – Recommendation 11

Workstream:

Care Standards

Executive Lead:

Paul Roberts/ Rory Farrelly

Executive Support:

Christine Williams, Assistant Director of Nursing

Taskforce Lead:

Deborah Thomas, Strategic Nursing Lead

Recommendation: The Board should simplify and strengthen management and clinical accountabilities and review ward staffing procedures to guarantee the right clinical and support staff are in the right place to meet the needs of older people at that time. This must involve a combination of increased confidence for the staff in charge of clinical areas to call upon resource when needed and for the whole clinical team to share responsibility for ensuring the right staff for patient levels of need. Workforce planning is crucial.

Progress & Key Achievements against targets:

The Chairman and Chief Executive undertook a joint review of the governance arrangements in the Health Board during 2013/14; this led to changes in the portfolios of accountabilities for Executive Directors, a review of the Board Committee structures and a recommendation to review the operational management structures.

In 2014 the Director of Nursing and Patient Experience was appointed. In response to the recommendation in Trusted to Care external support was sought to support the Director of Nursing and Patient Experience in addressing the needs of older people. Nicky Hayes, Consultant Nurse for Older People, King’s College Hospital NHS Foundation Trust was commissioned to work with the Action after Andrews Task Force to agree and implement a bespoke assurance framework focussing on care and patient experience for frail older people. Dawn Garrett, RCN Professional Lead for Older People and Rachel Thompson, RCN Dementia

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Advisor were appointed to work alongside Nicky Hayes to undertake a review of the dementia training in ABMU.

As a result of listening to our staff during the during the development of Our Values, we have taken immediate steps to review our systems and processes around nurse recruitment, Health Care Support Workers and Hotel Services staff. Open day recruitment events have taken place leading to raising the profile of ABMU as a place to work and offering a fast track recruitment process.

During 2014 the nursing team at the Princess of Wales Hospital have recruited and trained a team of dedicated staff to work with older people to undertake 1:1 support to care for enhanced needs.

Concerns were raised in the AQUA report in 2013 into quality and safety in our hospitals with particular concern about clarity of accountability and whether it was clear to patients and staff who is in charge of individual sites and services. In 2013 the management structure in the Princess of Wales Hospital was revised and saw the appointment of a Hospital Director supported by a Chief nurse and Clinical Director.

In 2015 the Health Board consulted on revised operational management arrangements which will be easier to understand and allow more devolution of responsibility decision making to local teams. There will be 6 delivery units each led by a Service Director, Unit Medical Director and Chief Nurse. The new unit structure will provide the opportunity to develop strong patients and staff engagement at a local level. These posts will be full time positions, the Unit Medical Director for each site will have minimum of 5 and maximum of 10 protected sessions.

The Health Board’s IMTP for April 2015 to March 2018 sets out plans to continue to work with our feeder universities on the development of the content of the training to reflect the needs of older people and to embed Our Values into training programmes.

To further investigate the concerns raised by staff and patients during the listening events in 2014 the Director of HR and Director of Nursing and patient Experience have been tasked with setting up a group to work directly with our staff to look for different solutions to overcome national staff shortages.

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All areas have undertaken a baseline review of nurse staffing levels in line with the Chief Nursing Officer of Wales Guiding Principles. Increased funding to support meeting the minimum staffing levels as set out in the Guiding Principles (2012) resulted in additional funded posts in our establishments over the last two years causing pressure to recruit over and above normal levels of recruitment.

A Band 5 block recruitment campaign was undertaken in September 2015. Approximately 90 nurses were recruited between September and December 2015 through this campaign. The Princess of Wales Hospital had higher degree of success but have since experienced difficulty retaining staff and turnover has left them still struggling to fill all vacancies. Neath Port Talbot Hospital has the fewest vacancies to fill and the hospital proves to be a popular choice with applicants. Further attempts were made to recruit by advertising UK wide in the RCN Bulletin and in the Irish Independent. There was very little interest UK wide and no applications from Ireland. In February 2015 the ABMU Nurse Recruitment webpage and Facebook campaign were launched. To coincide with this a series of nurse recruitment open days were arranged for Morriston Hospital (21st February & 13th June), Singleton Hospital (6th June) and Princess of Wales Hospital (9th May). 34 staff were appointed at the open day in POWH (2 for NPT) which were a mix of RNs and HCSWs. Only 7 were registered nurses available to work now, the remainder were students or HCSWs. An overseas recruitment campaign has been initiated with timescales for getting nurses into the Health Board set for mid September 2015. The aim is to recruit up to 200 nurses from within Europe for acute medical and surgical wards, and ITU (30 wte). The projection for the Princess of Wales Hospital following the nurse recruitment initiatives is that all qualified nurse vacancies will be filled.

In addition to the above, an All Wales Patient Acuity and Dependency was launched in 2014. This enables acute medical and surgical wards to assess the level of acuity and dependency of patients and which will enable the identification of areas which are nurse staffing levels are not reflective of the levels patient’s acuity.

An escalation protocol for safe staffing levels has been developed an issued to all areas in the form of a flowchart.

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The procedure to report staff shortages identified at the start of a shift has been strengthened; staff shortages that cannot be resolved are reported as an incident on the Datix system. All datix reported incidents are discussed by the Professional Standards Task Force on weekly basis.

Ward administrator roles have been introduced in a few wards at Princess Of Wales and have evaluated well. Ward administrators and hostess roles will be introduced across all wards to achieve supervisory status for ward managers following sign off in the IMTP.

There has been a significant increase in demand for the provision of 1:1 care over past 12 months largely associated with the changing composite of the ward environment and the increase of patients with cognitive impairment. The process for assessing the need is set out in the Nursing Observation Guidelines based on a framework for all observations including heightened levels of observation when patients are considered ‘at risk’ of harm to themselves and/or others and are considered to have an unstable mental condition which may deteriorate.

Challenges Faced:

Recruitment and Retention

Timeliness of implementation of new organizational structure

Sign off of IMTP due to financial implications

Further Actions Planned:

Overseas recruitment campaign

Ward administrators

Supervisory status for all ward managers

Handover of Taskforce activities to new organisational structures

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Appendix 12

Trusted to Care

Month 12 Report – Recommendation 12

Workstream:

Patient Feedback

Prepared By:

Catherine Roberts, Head of Patient Experience & Governance and Nicola Williams, Assistant Director of Nursing and Patient Experience

Sponsored by:

Rory Farrelly, Director of Nursing & Patient Experience

Recommendation: The Board should overhaul local procedures on adverse incidents and complaints to build greater staff and public trust and confidence in their effectiveness. The recommendation is for a well-organised protocol and training based around supporting staff at local level to act as key workers for issues raised with them (including formal complaints), who remain in contact with those raising issues about care and treatment even if the matter becomes a medical negligence concern. The key workers could be any clinical person with appropriate training who could increase the speed of resolution and educate the public on what can be expected, moving from a handling system to one which actively promotes resolution. This would connect to and support the national review of complaints but it could provide a distinctive rallying point for culture change around the experience of care.

Targets agreed by Steering Group:

By March 2015 to:

Transform how ABMU HB and the Princess of Wales Managed Unit and Neath Port Talbot Hospital manages, investigates and responds to complaints & serious incidents.

Implement a Ward – Board ‘real time’ patient feedback system across all secondary care services

Progress & Key Achievements

All targets agreed by Steering Group and Changing for the Better Board have been met:

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against targets:

1. Technical / Support Infrastructure Changes: Two Main

systems have been implemented through robust project management arrangements:

Fully integrated Datix Web – patient safety system – that integrates with the electronic staffing record and the patient administration system has been introduced across the Health Board. This has enhanced clinical codes to facilitate more effective themed analysis, has live dashboard ward to board reporting, and provides clinician level feedback for appraisal and revalidation purposes. A Datix Team has also been established to support the system and ensure there is continual training and support available as well as audit and review

SNAP 11 web based patient feedback system –enables patients and their friend/families to give feedback on services and care provided in a format that best suits them e.g. via smart devices, internet site, feedback zones, using QR codes, or cards which are scanned into the system. This is available in ‘real time’ to managers and includes an alert function that sends an automated email alert relating to any comments of concern that are sent through.

2. A new patient experience and governance team was

established in the Princess of Wales Hospital: This team replaced previous arrangements. A senior manager was appointed reporting to the Hospital Director. The manager reviewed the existing arrangements for the management of complaints and incidents in the unit and introduced revised arrangements with the clinical teams. This was done with close links to the work elsewhere in the health board. The main issues faced were

The backlog of 218 incidents i.e. complaints > 30 days old

The arrival of new incidents every month

The requirement for a new approach when dealing with complainants

The weaknesses in the management of incidents and learning from these events

The ownership of the complaints and incidents and learning from them in the relevant parts of the hospital

The situation in Neath Port Talbot was different with effective systems in place for the investigation and management of complaints and incidents. Princess of Wales Managed Unit Patient Experience and

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Governance Team focussed on the back log and revised their approach for working with families (see point 4). The graph below shows the impact of the work and approach in the Princess of Wales Hospital with the clinical teams.

Within the Princess of Wales a Nurse practitioner re-deployed to support with clinical expertise required for investigations. This has been a crucial addition to the team and she has clinically led further improvements. The Princess of Wales and Neath Port Talbot Teams team linked strongly with the ABMU HB Patient Experience team, a revised ABMU HB Department of Investigation & Redress and a newly established ABMU HB Serious Incident Team.

3. Increasing the ways that patients and family can tell us about their experience in person: A Patient Advisory Liaison Service (PALS) has been successfully piloted at the Princess of Wales Hospital. The Team have been instrumental in proactively ‘nipping issues in the bud’ and supporting and working with front line staff in this area of work. The impact of the PALS team who were recruited in August 2014 and following an induction started working in October 2015. The graph below sets out the number of complaints received per month in POW and the reduction per month corresponds with the introduction of the PALS service. The PALS team deal with about 60 concerns a month. A formal evaluation continues but appears to work well in the Princess of Wales managed unit.

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Both Princess of Wales and NPTH continued to deliver concerns clinics which provides an option for some patients and families who wish to discuss their experience with senior managers and executives.

4. Training:

Verbal Complaints Training has been made available to staff through a new dedicated trainer aimed at staff being better supported and equipped to ‘nip issues in the bud’ and not allowing them to escalate. Customer Care & Nipping issues in the bud and Telephone Aggression Training has been provided to over 500 staff to date.

Monthly Complaints Training for Complaint Staff, Managers and Governance Teams has been provided which includes training on NHS redress to ensure that all Complaint Staff, Governance Teams and Managers are fully congruent with how they should manage their complaints and that the Putting Things Right Legislation is fully adhered to.

5. Revised Complaints procedures: Changes have been implemented and contact is made with complainants who are raising formal complaints in relation to care and / or treatment to arrange a meeting with the senior staff overseeing care and treatment or if that is not accepted by complainant to ensure we are clear at the outset of the investigation what outcome the complainant is requiring. Concerns clinics have been established in Swansea, Bridgend and Neath Port Talbot where complainants can meet with a member of the Executive Team. The new

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Datix web system has made capturing of informal complaints easier for staff. In addition, through the immediate contact made with complainants in many instances these can be resolved on the spot and subsequently do not require a formal response and have therefore been managed informally and to the complainants satisfaction.

6. Incident management: This has been completely revised and all incidents are reviewed by a senior member of staff within 24 hours. This ensures that they are graded appropriately and allocated to an appropriate investigator. The vast majority of investigations are now carried out with feedback to the reporter within 30 days and work is undertaken to understand the themes so that action can be taken to reduce the likelihood of harm to patients in future. Topics are also identified for training and education with bespoke sessions being developed where needed in the Princess of Wales Hospital.

7. Real time feedback: iWantGreatCare pilot – in addition to the roll out of the SNAP 11 patient experience system the Princess of Wales Hospital undertook a four month pilot for Welsh Government of ‘iWantGreatCare’ which is a commercial ‘trip advisor for Health’. There were over 2,300 responses with an overall 5 star rating. In the Princess of Wales there has also been an approach to develop patient stories that can be used to share with staff teams and present a good approach for learning.

Current Status against targets:

All targets set by Steering Group / Changing for the Better Programme Board have been met.

Plans for completion of recommendation including timescales:

All targets set have been met- the Health Board is now ensuring the changes are shared and developed in all Directorates & Localities for consistent outcomes. Locality, Site & Directorate performance is monitored monthly through the performance review process. The next steps are to:

Roll the PAL Service out to Neath Port Talbot, Morriston & Singleton Hospitals- teams to be recruited to, trained and in place across all Hospitals by 30th September 2015.

Ensure a robust patient feedback structure with robust systems & processes is in place for the new Managed Units (to be agreed by Executive Team, Trusted to Care Steering Group & Quality & Safety Committee) to be agreed by 31st July 2015.

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Appendix 13

Trusted to Care

Month 12 Report – Recommendation 13

Workstream:

24/7 approach to services

Executive Lead:

Hamish Laing, Medical Director Rory Farrelly, Director of Nursing and Patient Experience

Executive Support:

Christine Williams, Assistant Director of Nursing

Taskforce Lead:

Julie Nedin, Therapy Lead Jonathan Goodfellow, Clinical Lead John Terry, Pharmacy Lead Joanne Davies, Action after Andrews Taskforce Lead

Recommendation: The Board should introduce a fully operational 24/7 approach to services including diagnostic services, pharmacy, therapies and social work. The specific action here should include the joint review by the Medical and Nurse Directors of basic care for inpatients including senior medical cover and clinical decision-making responsibility; weekend services by speech and language therapists and pharmacy; the establishment of proper bed management team with authority to act and protocols which reduce the pull of junior doctors away from wards to A&E for extended period. In respect of A&E there could be a powerful role for nurse specialists to provide connective links between specialist clinical expertise, analysis of “frequent fliers” and the introduction of more direct admission to and from care homes where patients are known to the system, but this lies beyond the remit of this Review.

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Progress & Key Achievements against targets:

1. Introduce 24/7 approach to Diagnostic services

CT service now available 7 days a week with Radiologist

cover provided on a Sunday 9.00am – 1.00pm

Out of hours reporting service now outsourced

increasing radiologist presence Mon - Fri

2. Introduce 24/7 approach to Therapies

The recommendation to introduce a 24/7 approach to

Therapies required an analysis of current status of those

services to identify deficits. Targeting priority areas and

recruitment needs were addressed.

A comprehensive baseline assessment of services

provided by the following Therapy professions was

undertaken by the AaA Therapy reference Group:

Nutrition and Dietetics service

Occupational Therapy

Physiotherapy

Speech and Language Therapy

The baseline assessment focused on deficits of 5 day

working for adult inpatient services, excluding mental

health and Nutrition Nurse service, and devolved

services such as MSK for Physiotherapy. It detailed

deficit by Therapy, clinical speciality and hospital site.

The overall deficit in staffing was identified and the

impact of extending working to 7 days which would

require substantial financial investment.

Current unscheduled care and patient flow initiatives

have provided extra resources for limited Therapy

Services and this has had a positive impact. This needs

to be sustained and developed further where benefits

can be demonstrated.

Priority areas proposed by Therapy reference group for

addressing unscheduled care pressures and

requirements of Trusted To Care Report are:

Acute medicine and rehabilitation services

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Stroke services

Urgent and emergency responses-surgical and critical care

As part of the IMTP process, Directorates and Localities

provided their proposed service developments, which

were then prioritised by the Health Board in alignment

with the Financial Framework. Within the Financial

Framework there is a planned investment to support

addressing the demand on acute services, within this,

therapy services have been identified as an investment

consideration.

An investment in Stroke Services for seven day

physiotherapy, OT and speech and language therapy

services on Ward F at Morriston has been prioritised by

the Health Board, under the demand on acute services

and quality plan elements of the Financial Framework.

Therapy recruitment issues have led to a recommendation to direct Health Board resources to improve recruitment processes and actively seek to recruit from a wider field to permanent posts.

3. Introduce 24/7 approach to social work

The lack of availability of social workers on Bank

Holidays has been raised as an issue with the Western

Bay programme (a partnership between the Health

Board and its 3 Local Authorities). Further discussions

are planned in July although there are resourcing issues

in addressing this. However through the Western Bay

partnership significant investment in rehabilitation

services to both keep older patients at home with

support and to enable them to be discharged sooner

with appropriate support has been put in place during

2015. This includes social services and health staff and

so is providing a range of services 7 days a week on an

extended working day basis for these patients.

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4. Senior medical cover and clinical decision-making responsibility

Out of hours and at weekends an additional senior

medic is available at Princess of Wales Hospital who is

charged with both reviewing patients who are giving

cause for concern or deteriorating but also those

patients who could be reviewed and discharged outside

normal working hours. This ensures that patients are

not waiting for regular working hours to be sent home if

they are fit and where appropriate care packages in

place.

5. Weekend services by speech and language therapists

Following discussions with Head of S&LT and ABMU

Health Board Medical Director risks of a plan to introduce

weekend services were identified.

The Service is under resourced so the financial burden

of expansion to a full 24/7 service is significant. There is

a fear that core services would be destabilised as a

result of the introduction of weekend work to posts,

making them unattractive, providing direct competition for

staff from neighbouring HBs who do not demand

weekend work.

Taking into account Prudent Healthcare it was felt that

screening of swallowing difficulties could and should be

undertaken by registered nurses and medical staff. More

account should be taken of the failure to escalate to

medical staff at weekends when people with swallow

difficulties were identified. The resources and expertise

of S&LT Service should be better utilised. Unless the

skills of ward based staff in screening were enhanced a

continued risk to patients from prolonged waits for

specialist assessment would continue and the risk of

prolonged periods of nil by mouth would still exist.

Baseline assessment of S&LT services as part of

Therapy exercise revealed a significant gap in provision

of services for 5 day working.

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The decision was made to introduce a plan which limited

these risks but did not rely on introduction of weekend

services of SALT by:

targeting training to enhance skills of nursing and medical staff in swallow screening,

introducing a NBM policy

review of tool for use by non S&LT.

A gap analysis of all ward staff who have received

training at POW and NPT Hospitals was undertaken, key

wards highlighted and training offered to all registered

nurses.

Swallow Screen training was introduced to the new

registrant nurse clinical induction programme from

November 2014 so all new joiners to ABMU Health

Board receive this. A nutrition and hydration workshop is

now incorporated into the programme which includes 5

practical work stations delivered by S&LT, Nutrition

specialist nurses and dietitian. Evaluation of feedback

received from nurses of this revised approach has been

exceptionally encouraging. Numbers attending have

been capped so the programme will be delivered more

frequently than in the past but resulting in better quality

and more timely periods during the year.

The Swallow Screen Tool for suspected CVA was

reviewed and altered for wider use. This was supported

by the multidisciplinary team including medical and

nursing staff and quality and safety personnel. It

incorporates prompt escalation to medical staff for

patient review and consideration of benefits of

introduction of artificial nutrition support. An out of

hours/emergency enteral feeding regimen already exists

on HB Clinical Information On-line Information Network

(COIN). The Swallow Screen Tool also emphasizes the

criteria for prompt referral to either medical staff, S&LT or

Dietetics, depending upon outcome of swallow screen.

6. Weekend services by pharmacy - currently the two acute sites at Morriston and Princess of Wales operate extended hours in the evening

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and at weekends.

Morriston Saturday – 9am to 12.30pm

Morriston Sunday – 9am- 12.30pm

Monday to Friday 8.00am to 7.00pm

Additional hours post 5pm weekdays are supported.

POW – Saturday 9am-12.30pm

POW- Sunday 9.30am – 12.30pm

Weekdays 8.30am to 7pm

Additional hours post 5pm weekdays and Sundays are

supported.

Neath and Singleton open Monday to Friday 8.30am to

5.00pm and Saturdays 9.00am to 12pm.

All sites are supported by an emergency duty pharmacist

outside these hours.

7. Bed management team at Princess of Wales Hospital

Additional 2.00wte Bed Managers in post. Lead Nurse

Management cover has also been extended until

8.00pm, Mon – Fri and between 9.00am – 5.pm ,Sat and

Sun to support Bed Managers and Out of Hours Nurse

Practitioners

Challenges Faced: The rising admissions of increasingly frail elderly

population with multiple pathologies require complex

assessment, treatment and ongoing care plans involving

all Therapy services.

The pressure on therapies to assist patient flow while

maintaining safe and sustainable quality services is

recognised across the Health Board and the review of

baseline services revealed massive deficits in the

workforce. The impact on safe and sustainable services

is such that even targeted 24/7 approach is

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compromised. Core 5 day services are in need of

support and priorities for investment have been

identified.

Extended Therapy work is largely on basis of pilot

schemes. Recruitment to extended working is more often

from core staffing so has impact on sustaining whole

services in the long term.

The need to establish appropriate benefit measures for

therapies is recognised.

Release of staff to be trained and release of S&LT to

train them has been a significant challenge. Levels of

staff sickness during the Winter meant that the funds

allocated for backfill had to be utilised to provide direct

patient care.

An e learning package was considered but was not

readily available and would have taken too long to

develop to meet timescales required for training.

Further Actions Planned:

Second CT scanner to be commissioned later this year

The deficit in therapy services is to be considered by

ABMU Executive Team in order to address safe and

effective services before any moves to expand to 7 day

working can be made.

Work to be done with Service Improvement Team to

establish appropriate benefit measures.

Embedding revised swallow screen tool in practice.

A number of presentations have been made at

performance review with a series of costed options to

support the extended hours. Updated business

plan/model for submission at the next performance

review.

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Appendix 14

Trusted to Care

Month 12 Report – Recommendation 14

Workstream:

Values and Leadership

Executive Lead:

Paul Roberts/Steve Combe

Executive Support:

Steve Combe

Taskforce Lead:

Jayne Combe

Recommendation: The Board should decide what has to be done for ABMU genuinely to “put local citizens at the heart of everything we do”, using external creative expertise. It is easy to say that the public should be at the heart of everything we do but much more difficult to make happen, especially in complex health settings. This recommendation is therefore not made lightly. It is made in the belief that ABMU, because it has now to develop a new level of trust with its local population, is ideally placed to work through what such a commitment really means with its staff and with local people. This is a different and more constructive place to start than with concerns or complaints. The Review Team believes that this process will provide a rallying point for staff to reenergise and reengage with their working relationships with local citizens and would provide a much better guarantee that standards are set and met in the way local people and the staff themselves want. The recommendation is for external support to be used to ensure that both creativity and resilience which will be needed to overcome obstacles in the way of achieving a cultural change, is supported from the outset, without the distractions from everyday responsibilities.

Progress & Key Achievements

ABMU has a good track record of effective engagement

and consultation with the public, patients, carers and our

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against targets:

staff, but also a wide range of partners as well as groups

with protected characteristics under the Equality Act.

These include

Changing for the Better, which led to the development of our clinical strategy

The Western Bay partnership with local authorities

The involvement of stakeholders in decision making, including the Stakeholder Reference Group.

Further details of this are set out in the Annual Report of the Board. We recognised there was more to do to develop a new level of trust with its local population. The Health Board commissioned April Strategy as external support to help it develop a values and behaviour framework which would be developed by listening to staff and patients about their experiences. The approach focused on the link between positive staff engagement, great patient experience, improved patient outcomes and organisational performance. This was seen as the first stage in changing the culture of the organisation which would need then to move on to developing the capabilities of our leaders, managers and staff to give them the confidence to role model values led care. As it was critical that the values and behaviour framework was owned across the organisation a Health Board wide approach was taken in engaging staff and patients in the development of values and the actions to embed them going forward. The programme of work divided into three phases,

Defining the culture by establishing leadership commitment to values transformation. Engaging leaders and managers in the transformation and involving hundreds of staff, patients and stakeholders in the development of shared values and behaviours.

Embedding behaviour and capabilities by embedding the values and behaviours into everyday practice, developing value champions and coaching front-line managers to role model values-led care and appreciation

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Align the values to organisational processes, e.g. values based recruitment, induction, appraisal recognition and reward. Establish performance metrics to measure staff and patient experience and to align the values to management processes.

During the Summer of 2014 the following actions were

taken:

66 staff listening events – “In our Shoes”, involving more than 1650 staff from across the Health Board, 282 staff attended from the Princess of Wales Hospital and 300 staff from Neath Port Talbot Hospital. The events involved all disciplines of staff across all departments talking about the expectations staff have of their behaviour with each other and patients, and about what they want to see more of and less of around the organisation.

Leading and Managing for Values events to prepare managers to support the listening events involving 425 leaders and managers including 160 leaders and managers from the Princess of Wales Hospital and 155 from Neath Port Talbot

18 patient listening events – “In Your Shoes”, involving 120 patients from across our services. The sessions involved ABMU staff listening to patients about their experience of receiving care, what was good and bad and how did the experience make them feel and what would they like to see more of and less of form ABMU staff.

staff and patient surveys to reach a wider audience of staff and users of our services. The results of the surveys provided further insight to develop the values and behaviour framework.

Third sector colleagues were extensively involved in the

development of the values and behaviour framework,

including attending events, identifying and recruiting

patients to participate and refining our values. The

above events involved extensive support from our third

sector colleagues throughout.

This resulted in over 6000 contacts and the outputs from

this were analysed and draft values were developed. The

outputs and draft values were then shared at staff and

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patient workshops in November 2014 and the value

statements were refined. The words used in the value

statements and the underpinning behaviours have all

been extracted for the words used by 6000 contacts.

The values and behaviour framework was approved by the Board in January 2015 and launched in early March 2015, with over 2 500 staff attending the events, 588 attended the events on the Princess of Wales site and 407 on the Neath Port Talbot Hospital site.

At each event staff were asked to make a pledge on a postcard. These are now being collated so that they can be fed back to staff more generally. Other key actions include:

a stakeholder event to share the values with those who participated in the values co creation, including third sector colleagues

the values and behaviour framework was included in all staff pay slips at the end of March 2015, with a joint letter from the Chairman and Chief Executive

The cascade of the values commenced at the Health Board Team Brief in May 2015. This was followed by stage 2 of the programme to embed the values into every day practice. Team Leader briefing sessions to cascade the values across all teams began in May with the aim to reach 1500 managers. The aim of these sessions is to involve Team Leaders in sharing the values with their teams and to begin to have values based conversations about what the values mean in practice. To understand the impact of their actions, words and behaviours have on work colleagues and patient care. Leaders and managers attending the briefing will be tasked with holding a values based team meeting where staff will be asked to consider what they do well and what they can build on to improve the patient experience in their areas. Managers will be required to inform the Action after Andrews Taskforce of the date the team meeting took place, the total number of people who participated and the team pledge/commitment they will focus on to improve patient care.

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A total of 55 Team Leader briefings are planned. 15 events on the Princess of Wales site and 11 on the Neath Port Talbot site.

Challenges Faced: The aim is to reach 95% across all staff groups of the 16,500 staff who work at ABMU between May and September. The challenge is to share the values message, raise awareness of the development of the values and to encourage staff to take positive action to make flexible choices to change how they behave, work together and have a positive impact on patient care. Measurement points will need to be developed to plot progress against patient experience scores and value statements and staff surveys against the values.

Further Actions Planned:

In order to take the work forward to stage 3; aligning the values to core business a Project Initiation document is now being finalised for consideration by the Executive Team. The work programme should ensure the values are embedded into practice. We will then be in position to measure the impact on the patient and staff experiences. The proposed Workstreams are:

Patient Experience

Staff Experience

Medical engagement

Stakeholder/public engagement

Communications/Governance

Leadership and management development

Service improvement

Primary Care

Strategic planning

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Appendix 15

Trusted to Care

Month 12 Report – Recommendation 17

Workstream:

Care Standards

Executive Lead:

Rory Farrelly, Director of Nursing and Patient Experience

Executive Support:

Cathy Dowling, Interim Assistant Director of Nursing

Taskforce Lead:

Deborah Thomas, Strategic Nursing Lead, Trusted to Care Taskforce

Recommendation: The Welsh Government (WG) should commission ABMU to develop a model dashboard and guidance for Board assessment of frail and elderly care for adoption across NHS Wales by the end of 2014. The idea of a dashboard on services for older people in hospital is a simple way of showing on paper what matters and what progress is being made. This being developed for every NHS Board in Wales by ABMU will provide a proper national focus for improving the governance of care of older people. It will improve Board focus and also provide a further reference point for HIW, the CHC and the public. This development would be a signal demonstration of what good can come from complaints and allow ABMU to re-establish itself as a proud local service that can show the way to others nationally.

Progress & Key Achievements against targets:

The Standards for care of older people in hospital form the basis of the Improvement Dashboard that ABMU were commissioned to develop on behalf of WG. A task and finish group of key individuals was convened to develop the dashboard. Key Performance Indicators were developed for each of the Standards and are presented within the dashboard in order to demonstrate improvement and not for the purpose of monitoring performance. The Dashboard and associated guidance were submitted to WG in October 2014.

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The Dashboard is one aspect of the overall assurance framework that the Health Board has put in place in relation to the care of older people within our hospitals. The information arising from it will be triangulated with other information such as the data we hold on incidents, complaints, patient feedback, acuity, dependency, staffing and mortality, to provide a more holistic picture of the quality of the care we provide. The auditing and publishing of the standards for care of older people in hospital occurs through the reporting of the Improvement Dashboard to the Quality and Safety Committee on a bi-monthly basis. The dashboard is currently reported on a Health Board wide basis but plans are being worked through in order to ensure a ward to board view of reporting during 2015/2016. The dashboard includes narrative on how we are doing and what we are doing to improve where there are areas of concern. All indicators in May 2015 were RAG rated as amber or green.

Challenges Faced: The timescale given for developing the dashboard

Developing the interface between different information systems within the organization

The development of new data sources for some of the indicators

Further Actions Planned:

Data is available at ward level, albeit across different IT systems such as Datix, Snap 11, Fundamentals of Care audit tool and the E-Discharge system. Options for bringing the data in to one report are currently being explored with a view to making ward level reports available in 2015/2016

Rationalization of monthly reported Fundamentals of Care Indicators.

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Trusted to Care - a follow up review of progress made by Abertawe Bro Morgannwg University Health Board (ABMUHB) in response to

the recommendations

Introduction

1. The remit for the original review conducted by Professor June Andrews and Mark Butler in 2014 concentrated on four areas: the culture of the care of older patients, particularly in the medical

wards the administration and recording of medicines, particularly how

medicines are administered to patients who are cognitively impaired or have other challenges taking medicines orally

how professional nursing standards are protected and delivered consistently and how the Health Board responds to lapses in delivery of these standards

the response to complaints, how they are handled by the Health Board and how professionals are held to account for lapses in care identified through investigation including Protection of Vulnerable Adults (POVA) investigations.

2. The resultant report from the review produced 18 recommendations: fourteen for ABMU Heath Board and four for Welsh Government, the last of which stated:

“The Welsh Government should institute a further independent review of provision for older people within a year of the date of this report.

A further review is essential for the assurance of patients, local communities and staff and to measure the progress that can be made with open acknowledgement of problems, acceptance of help and support and concerted effort.”

Remit for 12 month review

3. The 12 month review will focus on the recommendations assigned to ABMU Health Board. The review will assess the extent to which progress has beenachieved since the original report was published, and how this has and is leading to improved quality of care within the Health Board area. This assessment will need to be clear on whether the culture of caring for older patients in medical wards has changed at Princess of Wales and Neath Port Talbot Hospitals.

4. The methodology to be employed will include a review of documentary evidence provided by the Health Board and visits to both hospitals, including clinical areas to speak to staff, patients and carers; as well as senior leaders and board members and relevant stakeholders. The review should also take

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into account national developments in policy and expectation which relate to any of the specific recommendations.

5. The review is to take place during July 2015 and a report is to be submitted to the Welsh Government by September 2015.

The report should provide:

a. a summary of the progress and how the organisation has built upon the recommendations

b. identification of any areas of work where further action is requiredc. the extent to which the progress made is sufficient to provide improved

quality of care and a changed culture of caring within the Health Board in line with the Trusted to Care recommendations;

6. Following the hospital site visits there should be immediate feedback to the

Health Board executive team.

7. Any areas of concern affecting patient safety must be brought to the

immediate attention of the Health Board and reported to the Chief Nursing

Officer at Welsh Government.

8. Note that the recommendations allocated to the Welsh Government will not form part of this review as these are being monitored through the Trusted to Care Steering Group.