Quality Accounts 2010/2011 - Barts Health NHS Trust

Quality Accounts 2010/2011

2 Whipps Cross University Hospital | Quality Accounts 2010/2011

Whipps Cross University Hospital | Quality Accounts 2010/2011 3ContentPageChief Executive’s statementPriorities for Improvement in 2011/12Our performance against our 2010-11 prioritiesConsulting on our priorities for improvementReview of our servicesParticipation in clinical audits and National Confidential EnquiriesResearch and EducationGoals agreed with our commissioners and use of the CQIN0506101414172022payment frameworkWhat others say about Whipps Cross HospitalData qualityReview of quality performanceSupporting statements from our local partners24262838

4 Whipps Cross University Hospital | Quality Accounts 2010/2011

Whipps Cross University Hospital | Quality Accounts 2010/2011 5Chief Executive’s statementI am very pleased to present our QualityAccounts for 2010-11. The report is avaluable opportunity for us todemonstrate to our patients, localcommunity, staff and commissionershow we are working to put patientsafety and service quality at the forefrontof everything we do. Like all NHSorganisations, we face a challengingagenda in the light of necessary financialsavings across the public sector andthe need to increase our efficiency.We are very clear, however, that localpeople will not be well served if wemeet these challenges at the expenseof safety and quality. This is why wecontinuously focus on both issues toensure that we always put the patient’sneeds and wellbeing at the centre ofevery decision we take.The Trust Board is fully behind ourquality and safety agenda. Every month,we review a range of indicators whichassure us of our performance in a widevariety of areas. These range from thenumber of stroke patients admitteddirectly to our specialist stroke unitand the percentage of patients withfractured hips who have surgery within36 hours of admission to the numberof outpatients waiting more than 13weeks for a first appointment and thenumber of inpatients suffering falls.These are not measurements formeasurement’s sake – they are indicatorswhich make a real difference to thesafety and quality of patient care, andultimately to how quickly and howwell our patients recover and canregain a meaningful quality of life.Since we published our first report in2010, we have achieved much inimproving both our quality performanceand also in external recognition forour work. Our Patient ExperienceRevolution, which is changing the waywe approach patient care at WhippsCross, received further recognitionduring the year. It won the Acute Carecategory of the NHS London Healthand Social Care Awards in November2010, and it also featured in a reportby the NHS Confederation entitledFeeling better? Improving patientexperience in hospital as an exampleof how hospital boards can prioritiseand lead improvements in patientexperience. Our Hospital StandardisedMortality Rate (HSMR) has consistentlyfallen during the year and is currentlyat 87 against a national average of100. Work to promote research andinnovation amongst our staff receiveda further boost through the running ofa “Dragon’s Den” style competition toencourage teams to put their ideas forchange forward. The winner was an ITsolution to create an electronic orderingsystem for histopathology tests.We recognise there is still work to doin areas where our achievements didnot meet either our own standards orour targets for 2010/11. This includesensuring more patients feel involvedin decisions about their treatment andcare and that they feel treated withdignity and respect. We have a clearstrategy to improve our end of lifecare across the Trust in order to ensurethat, where appropriate, patients dieon a planned and agreed end of lifepathway.While good progress has been madein improving quality and safety, thereis still room for further improvement.This is reflected in our continued focusin these areas for 2011/12.We also laid some key foundations totake forward improvements in the waywe work with and support our staff.Through a series of listening events, welearned much about what it feels liketo work at the Trust and what we cando to better support people to deliverthe standards of care our patientsshould expect. We have now launcheda organisational development strategyto help us ensure that we become anorganisation which supports its frontlinestaff by listening and responding to theirneeds and concerns through adopting a“Here For You” management style.Our work to promote enhancedrecovery was recognised through avisit from the NHS’s Medical DirectorProfessor Sir Bruce Keogh in December2010, whilst Jim Easton, NationalDirector for Efficiency and Innovationvisited our Histopathology service inMarch 2011 to see first hand theimprovements we have made to ourservice levels. Finally, we were able tomake financial savings and reductionsin costs of £15million over the year,with no reduction in the quality offrontline care.We are now actively pursuing aproposed merger with Barts and TheLondon and Newham UniversityHospital NHS Trusts. We believe thiswould bring us the biggest opportunitywe have ever had to improve healthcarefor the people of east London andfurther afield, and would give localpeople easy access through their localhospital to one of the largest and mostcomprehensive healthcare services inthe UK. We also believe that WhippsCross is in a stronger position thanever to play a key role in the proposednew organisation, where quality andexcellence will continue to be the mostimportant priorities for all of us.This report is an accurate reflectionof our performance against all ourquality indicators, and I hope that youfind it interesting. We are committedto continuous improvement and wewelcome your feedback.Cathy GeddesActing Chief Executive

6 Whipps Cross University Hospital | Quality Accounts 2010/2011Priorities for Improvement 2011/12Our four improvement priorities for 2011/12 have all been chosen because they can make a real difference to the quality ofcare our patients receive. Quality is defined as a combination of safety, patient experience and effectiveness, and this runsthrough all four priorities. We consulted with our partners in the local community over the priorities they wanted to see usconcentrating on, and their input is reflected in the final selection.In choosing the priorities, we have also considered the following factors:• All four cover areas where we know our current performance needs to improve• All four cover areas which we believe will have a positive impact on patient experience and the quality and safety of our services• All four can be clearly monitored and measured, so we will be able to clearly demonstrate the improvements we intend to make• They all have a strong connection with our Trust strategic priorities for 2011/12We have also included a priority on staff experience, as we know that the wellbeing and motivation of our staff is a keyelement to delivering the high quality of service which local people deserve.Improvement Priority 1:Patient Experience• Increase the number of patients who report that theywere involved in decisions about their treatment andcare at the hospital to above the national average.• Increase the number of patients who report that theyreceived clear answers to their questions from clinicalstaff to above the national average.• Increase the number of hospital staff who patients canspeak to about their worries, concerns, cultural beliefsand needs.Improvement Priority 2:Clinical Effectiveness• Ensure that at least 50% of patients who die at WhippsCross do so on an end of life care pathway.• Reduce delayed transfers of care to less than 3% of theinpatient bed number.• Reduce the rate of readmissions for emergency generalsurgical patients, measured against both the 14 and 28day national targets.Improvement Priority 3:Patient Safety• Risk Assesing more than 90% of admitted patients forVenous Thromboembolism (VTE).• Reduce the rate of post operative sepsis in accordancewith Dr. Foster indicators for 2011.• Reduce the Trust’s organisational rate of harmfrom 117 per 1000 bed days to less than 100 per 1000bed days.Improvement Priority 4:Staff Experience• Increase the number of staff who feel valued by theirwork colleagues.• Increase the number of staff who would recommendWhipps Cross as a place to work and be cared for.• Reduce the number of staff experiencing harassment orbullying from their colleagues.We will continue to monitor, measure and report progress throughout the year through regular updates to our Board and byregular reporting to appropriate committees.The next pages set out how we plan to deliver improvements against each priority area in 2011/12.

Whipps Cross University Hospital | Quality Accounts 2010/2011 7Improvement Priority 1:Patient ExperienceTo increase the number of patientswho report that they are involved indecisions about treatment and careat the hospital to above the nationalaverage, so that our results move usinto the middle 60% of hospitalsWe know from concerns raised throughour Patient Advice and Liaison Service(PALS) and from the complaints wereceive that patients and their relativesdo not always feel that they have beenadequately involved in decisions abouttheir care and treatment.This issue has also been highlightedin our listening events, In Your Shoes,where our patients share theirexperiences of services at WhippsCross and how this has made themfeel. In particular with Women’sHealth, many women felt that theirbirth plan had not been considered oradhered to, disempowering them atan important time in their life. Patientinvolvement in care and treatment isone of the strongest drivers of patient‘satisfaction’, as identified by PickerInstitute Europe.Using hand held devices for real timefeedback to provide benchmark data,the Trust surveyed 270 patients in thefirst quarter of 2010. 54% of patientsreported that they had ‘definitely’ beeninvolved in decision making.In the final quarter of 2010, 201patients were surveyed and the resultshad improved to 86%. The Trust isstriving to ensure that patientinvolvement in treatment decisionsis at the centre of its improvementprogramme.This priority will be measured using avariety of methods, including handheld devices to capture real timepatient feedback directly at the bedside.This method will be extended intoWomen’s Health during 2011/12.Patients will be asked whether theyfeel they are involved as much as theywant to be in decisions about theircare and treatment. A key componentof whether patients feel involved is thegiving of information at an appropriatetime, and using different methods toexplain a patient’s care and treatmentplans.The priority will be included in theNursing and Midwifery Quality AuditTool which is presented to the TrustBoard every quarter. Rigorous PALSand complaints analysis assists theTrust in monitoring patientinvolvement in treatment decisions,which is also reported to the TrustBoard.Through our Service Standardsmandatory training for all staff, we willcontinue to emphasise how importantit is for everyone to listen to ourpatients and to keep them informedat every step, so that they are alwaysconfident in their treatment and care.Improvement Priority 2:Clinical EffectivenessEnsure that at least 50% of patientswho die at Whipps Cross do so onan end of life care pathwayApproximately 1,500 people die atWhipps Cross every year. Whilst not allof these deaths are predictable, ourintention is to ensure that a greaterpercentage of patients who are reachingthe end of their life receive care whichtakes into account their wishes andthose of their families.At Whipps Cross, an audit of data forpatients who died at the hospital during

8 Whipps Cross University Hospital | Quality Accounts 2010/20112009/10 showed that 73% of patientswho could have been cared for on anend of life pathway did receive thatcare. However, we recognise that agreater number of patients could andshould be cared for in this way, includingmore of those patients who come intothe hospital with an acute illness orinjury from which they are likely to diein a short period of time.The Trust has set up an end of lifesteering group to help staff across allour services identify people who arewithin the last six to twelve months oftheir lives. The group currently includeskey staff such as the lead doctor andnurse for palliative care, the Director ofNursing and Quality, the senior palliativecare nurse, the hospital chaplain andthe social worker, and its membershipwill expand during the year to includeall Hospital Matrons and our PatientExperience Team. Its work will ensurethat patients’ care can be proactivelyplanned, and that our staff can haverelevant and appropriate conversationswith them and their families abouthow to do this.The work includes ensuring thatpatients who come into this categoryare adequately identified on ourpatient administration systems so thattheir wishes are known to all staff whothey may come into contact with, andalso ensuring that the patient’s ownwishes are fully documented in theirnotes. At the same time, a further subgroup is being established to reviewthe Trust’s bereavement pathway,including the information we give tobereaved relatives and friends.Our Trust Board regularly hears frompatients or relatives who have raisedaspects of their care or their relatives’care with us, and who are willing toshare their experiences with our seniorteam. An end of life case which waspresented to the Board in February2011 is now being used as the basis ofan improvement platform for the endof life steering group to work from.The Trust implemented the LiverpoolCare Pathway (LCP) in 2009. The LCPis a nationally recognised best practicemodel for the care of patients in thelast stages of life, and helps to ensurethat care is provided in an appropriateand consistent way, involving allrelevant disciplines, from pain relief toemotional support.The steering group will now be evaluatingtwo new models of end of life care:• The NHS’s Gold Standard Framework for Acute Hospitals – avariation on a model which is wellestablished within communitysettings such as nursing homes.It aims to improve the knowledge,understanding and skills of end oflife care amongst staff who providegeneral care to a wide range ofpatients, so that high quality endof life care can become the normfor every patient.• The AMBER care bundle which iscurrently being piloted at Guy’s andSt Thomas’ NHS Foundation Trust.AMBER stands for Assessment,Management, Best Practice,Engagement of patients and carersfor patients whose Recovery isuncertain. It focuses on improveddecision making, multi-professionalteam communication and working,increasing nurses’ confidence aboutwhen to approach medical colleaguesto discuss treatment plans andincreasing junior nurses’ and healthcare assistants’ confidence to approachsenior nurses for treatment plans.Improvement Priority 3:Patient SafetyEnsure that more than 90% of allpatients admitted to Whipps CrossHospital are risk assessed for venousthromboembolism (VTE)Venous Thromboembolism (VTE) is theimmediate cause of death in 10% of allpatients who die in hospital, and thereare approximately 25,000 deaths eachyear in hospitals from VTE in England. Itis a key safety imperative nationally toreduce harm and deaths from VTE.The Trust implemented a process forVTE risk assessment in August 2010.Currently, around 27% of all inpatientsare assessed. For 2011/12, the Trustaims to ensure that all patients areassessed on admission to hospital inorder to immediately identify those whorequire preventative treatment for VTE.We have agreed a target with our localcommissioners of ensuring that morethan 90% of inpatients are risk assessedfor VTE on admission. This is measuredthrough our patient information systemand we submit monthly data on ourperformance to the Department ofHealth. Patients will receive writteninformation on admission and dischargeexplaining the risks associated with VTE,both during their hospital stay and afterdischarge.We will undertake regular audits toensure that patients who are identifiedas high risk for VTE receive the requiredpreventative treatment. We havedeveloped a new prescription chartincorporating the VTE risk assessmentsto be undertaken on admission andafter 24 hours of admission, and thiswill be implemented in June 2011.Existing measures already in place toprevent VTEs include:• A mandatory VTE training packagefor all doctors to undertake as partof their induction programme.• Identifying trained nursing and midwifery VTE champions from acrossthe Trust to ensure this initiative isembedded and monitored.• Monitoring and investigating anyinpatient VTE event through clinicalincident reporting and escalatingsuch events to the Trust’s ClinicalGovernance Committee.• Reporting the percentage ofpatients who are risk assessed forVTE to the Executive Team monthly.From March 2011, these figureshave been included in the QualityAccounts Trust Board report.

Whipps Cross University Hospital | Quality Accounts 2010/2011 9Improvement Priority 4:Staff ExperienceIncrease the number of staff whofeel valued by their work colleaguesThe results from the 2010 NationalStaff Survey are consistent with thosefrom previous surveys in demonstratinga very clear need to change theorganisation from one which ischaracterised by a top-down style ofmanagement to one which is in serviceof front-line staff and their delivery ofour patient promises.Too many of our staff still report thatthey feel undervalued, are not treatedequally and that they are in service oforganisational priorities.At the same time, we know that thereis a strong link between staff motivationand wellbeing at work, and the standardof care which staff are then able to deliverto patients. Encouraging and supportingstaff to be able to provide care andtreatment which is always in line withour patient manifesto and servicestandards is therefore a key priority.In order to take this work forward inthe context of our OrganisationalDevelopment Strategy, a core workinggroup has been established. It hasmembers from key departments withinthe Trust, including Human Resources,Nursing, Education and Training,Communications, Staff Side and seniormanagement, in order to ensure thatit is representative of the range of staffemployed at the Trust. The group isalready looking at specific commentsraised by staff in the 2010 survey andhow we can continuously listen to staffand communicate results of the surveyand our actions to make improvements.Key activities for 2011/12 include:• Holding 30-minute briefing sessionsfor staff on the results of the surveyand what we are doing to addressthem.• Inviting staff to take part in thedevelopment of action plans toaddress the issues raised.• Developing a Dignity at Work charter.This will include a clear approach todealing with bullying, harassment,discrimination and victimisation,along with a “safe haven” facilityfor staff to voice their concerns, inthe knowledge that they will beadequately heard and dealt with.We regognise that this is a priorityarea and welcome the involvementof staff in developing the charter. Weare committed to consulting widelybefore we implement the charter.• Continuing with our rollingprogramme of listening events,where staff have the chance to talkabout issues which affect wellbeingand dignity at work with othercolleagues in a small group. We areparticularly encouraging attendancefrom staff who have experiencedunwanted conduct at work becauseof their ethnicity, disability, religion,gender, age, belief or sexualorientation, as well as anyone whofeels they have been bullied orharassed by other colleagues atwork. These sessions are facilitatedwith experienced coaches who actas ‘listeners’ for our staff. One toone sessions are also offered to anystaff who wish to talk about theirconcerns privately.• The outputs from these sessions willhelp to shape our overall action planto improve our survey results, moveforward and develop our staffengagement approach and ensurethat we can effectively tackle thecontinuing incidence of reportedbullying and harassment.• Developing the Trust’s Equality andHuman Rights Committee. Chairedby a Non-Executive Director withexpertise in this area, this committeehas a responsibility to provide thefocus and improvement for bothpatients and staff. It provides thestrong leadership and co-ordinationnecessary to help us deliver ourequality and human rights agenda.This committee is supported by theEquality and Diversity Working Group.• Developing our Trust Equality andDiversity Working Group. The group’smembership includes representativesfrom across all clinical directoratesand other key departments withinthe hospital.• Continuing with our annual Employeeof the Year awards, which recognisesexcellence and commitment acrossthe Trust.

10 Whipps Cross University Hospital | Quality Accounts 2010/2011Our performance againstour 2010/11 prioritiesPatient experienceIncrease the percentage of patientswho feel they are treated with dignityand respect, and achieve a score forthis indicator within the top 20% ofall Trusts in England for the 2010National Inpatient SurveyWe did not achieve this target. In the2010 National Inpatient Survey results,we are still ranked in the bottom 20%of Trusts in England for this indicator.Patient experience and feedback stillremains a key priority at Whipps Cross.Our Patient Experience Revolution,launched in March 2010, continues toform the foundation of our work tomake improvements.Between April 2010 and March 2011,out of 779 patients whose feedbackwas collected via our hand held trackerdevices, 636 (82%) stated that theyhad been treated with privacy anddignity when being examined orreceiving care. When asked whetherthey were given enough privacy whendiscussing their condition or treatment,595 (76%) said this was the case.Between July 2010 and March 2011,there was a consistent fall in patientcomplaints across the Trust. Overall theTrust demonstrated an 11.5% reductionin patient complaints for 2010/11 incomparison with the previous year.During 2010, the Trust complimentsdatabase demonstrated a 40% increasein letters from patients who said thatthey had been treated with kindness,compassion and consideration.We are constantly striving to improvethe quality and safety of care we providefor all patients. As reported in our2009/10 Quality Accounts, ourTrustwide ward quality assessmenttool measures agreed standards ofcare and safety indicators in ten keyareas, including pain management,patient observations, falls management,nutritional management and patientinvolvement. Our performance againstthese standards is reported to the TrustBoard on a quarterly basis. During2010/11, we increased the target forcompliance against these measuresfrom 85% to over 90%, and we willcontinue to review this measure during2011/12.We have continued to implement anduse a range of methods to encourageand collect real-time patient and visitorfeedback, within both inpatient andoutpatient areas.These include:• The use of hand held tracker devicesto collect feedback from 160 patientsper month.• “Just a Minute” cards – whereanyone using our services can tellus what went well and what wecould improve on. These are collatedand analysed by the Patient ExperienceTeam, and feedback is reporteddirectly to each directorate and service.• Asking patients and carers to presenttheir stories to the Trust Board on aquarterly basis, in the presence ofrelevant service leads, who are thenrequired to report back to the TrustBoard the following month on theirstrategies for improvement.• “In Your Shoes” events continue tobe held across the Trust in order forthe Executive Team and staff to listento patients’ experiences of our servicesand how we made them feel, and toprovide a platform for improvement.• The patients and staff of the ChestClinic ran a collaborative experiencebased design approach by listeningto all representatives and thenredesigning their service to improve“We aim to learn lessons from everycomplaint received”patient experience and workingprocesses for staff.• Hourly rounding was implementedin 2009 in order to address patientcare and comfort needs, provide amethod for listening and respondingto patients and monitor privacy anddignity issues. Throughout 2010 theTrust has consolidated this initiativeand can demonstrate up to a 20%reduction in patient falls in someareas.• Whipps Cross has coached andprovided 20 other Trusts with hourlyrounding information, and has beenidentified nationally as the lead forthis initiative via the NHS Institute,NHS Confederation and the King’sFund.• The Trust has now started to use theNet Promoter Score (NPS) system toidentify the percentage of patientswho would recommend WhippsCross as a place to be cared for andtreated. The NPS is a simple andeffective way of measuring serviceuser satisfaction. During 2011/12,all services at Whipps Cross will beginpublishing their NPS on a monthlybasis. The information will be takenfrom our Just a Minute patientfeedback cards which are used widelythroughout the hospital.• We have carried out internal patientexperience and satisfaction surveysin individual clinical areas, includingour eye treatment centre, dermatologyand heart failure services in orderto address specific concerns withthe quality of service provision andpatient experience in these areas.We aim to learn lessons from everycomplaint received, and recognise thateach complaint represents anopportunity to improve our services,particularly in those situations whereit is clear that the complainant hasreceived poor service or suffered someform of injustice or maladministration.It is not always possible to return acomplainant or patient back to theposition they would have been in had

Whipps Cross University Hospital | Quality Accounts 2010/2011 11the issue they raised not occurred.However, we are fully committed toproviding an explanation, offering anapology where it is required and takingaction to avoid similar incidentsoccurring in the future.All Assistant Directors and complaintinvestigating officers are encouragedto adhere to the principles of theTrust’s Being Open Policy wheninvestigating complaints, so thatfailures can be acknowledged andamends made through the identificationof appropriate and proportionateremedies. The Being Open policypromotes open and honestcommunications at all times.Staff are guided by the Ombudsman’sPrinciples for Remedy which form anintegral part of our complaints handingprocedure. The Principles for Remedyare referred to in all training sessionsand are readily accessible via the Trust’sintranet.During 2011/12, the Complaints Teamwill continue to focus on improvingthe data which is captured from thecomplaints received, and refining thereporting functionality of our Datixgovernance database so that staff inthe clinical directorates will have abetter understanding of the specificcauses and issues which lead tocomplaints being submitted. Thecategories in the database are currentlybeing updated to facilitate this, andthe system now has dedicated ITsupport which is invaluable.Clinical effectivenessIncrease the number of patientswith suspected stroke who areadmitted directly to our AcuteStroke Unit to more than 90%We achieved this target. Around 93%of all stroke patients at Whipps Crossare now admitted directly to our AcuteStroke Unit (ASU). Our Stroke Unitperformed well in both the nationalstroke audits carried out in 2010. Inthe Organisational Audit, which washeld in early 2010, the Unit was withinthe top 10% of all stroke units in thecountry and in the Sentinel ClinicalAudit which was published in May2011, the Unit moved into the top 25%of all stroke units for the first time.Our performance in the Sentinel ClinicalAudit showed we are good in all areasrelating to the care provided on theStroke Unit, with high marks beingachieved for multidisciplinary working,timely therapy assessments dischargeplanning and communication withpatients and family members. Highmarks were also achieved for early CTscanning of patients with suspectedstroke.Whipps Cross was designated as anAcute Stroke Unit (ASU) in July 2009.Since then, acute stroke care at thehospital has continued to improve.95% of our stroke patients are eithernursed in the Hyper Acute Stroke Unit(HASU) at the Royal London Hospitalor within our Acute Stroke Unit (ASU)at Whipps Cross.80% of the patients who are initiallytreated at the Royal London Hospitalare transferred to the ASU at WhippsCross for the rest of their treatment.We admit 100% of all such patients toour ASU within 24 hours of receiving arequest from the HASU. Other patientsare discharged home directly from theHASU with a follow-up appointmentbooked six weeks later. Patients withmore complex issues are followed upagain in six months.Our Stroke Performance Indicator,which is set by the Care QualityCommission, measures the timepatients spend on our ASU. This hadincreased from 87.5% in March 2010to 90% by January 2011. This is in linewith the Care Quality Commission’sguidelines. Our Stroke PerformanceIndicator is monitored monthly throughour Stroke Development Group andStroke Business Meeting, as well asthrough monthly reports to the Trust’sExecutive Team.The Stroke Team hold frequentmultidisciplinary meetings to monitorpatient progress - twice weekly for ASUpatients and weekly for rehabilitationpatients. There are also regular meetingsbetween the Stroke and EmergencyMedicine teams to monitor directaccess to the ASU at Whipps Cross forpatients who do not meet the criteriafor the HASU at the Royal LondonHospital.The ASU has recently joined the SINAP(Stroke Improvement National AuditProgramme) where data is collected ona daily basis in regard to effective andrecognised treatment; this informationis recorded and held centrally by theRoyal College of Physicians.The focus for the year ahead is todevelop an early supported dischargeteam. We are working with ourcommunity and commissioning partnersto allow for a bridging of servicesbetween the acute and the communitysetting.This initiative will allow patients whorequire minimal medical input to bedischarged home sooner with thesupport of a district nurse, therapistand their GP.External reporting and involvementwork for our stroke service includes:• Providing monthly and quarterlyreports to NHS Waltham Forest andthe North East London Cardiac &Stroke Network.

12 Whipps Cross University Hospital | Quality Accounts 2010/2011• Involving a patient representativeon our Stroke Development Group,who is developing a stroke orientedpatient satisfaction survey.• The Trust has undertaken an InYour Shoes listening event withstroke patients and their carers todrive further improvements in thisservice.• Inviting community representativesto attend the Stroke Business Meeting.• Taking an active role in developinglocal patient pathways for acutestroke patients.• Running external stroke awarenessevents for local GPs.• Presenting information on strokecare to the Waltham Forest OlderPeoples’ Health Scrutiny Committee.Patient safetyReduce our Hospital StandardisedMortality Ratio to less than 85 byMarch 2011 by reducing the numberof avoidable deaths at Whipps Crossby 116 this yearWe did not fully achieve this target.However, our Hospital StandardisedMortality Ratio (HSMR) continued toreduce steadily during 2010/11, andour year end figure was 87.A HSMR of greater than 100 wouldsignify a higher than expected rate ofdeath.Dr Foster release mortality data ona monthly basis. This year, Dr Fosterhave included, alongside HSMR, twoadditional mortality measures takenfrom Secondary Uses Service (SUS)data for 2009/10. These were:• Standardised Mortality Ratios (agroup of five of the 56 conditionsthat comprise the HSMR – heartattack, stroke, pneumonia, congestiveheart failure and fractured hip –Whipps Cross score was 97.41.• Unexpected deaths after surgery –Whipps Cross score was 64.56.We formally launched our PatientSafety Strategy at the Trust PatientSafety Conference in September 2010,with a keynote speech from StephenRamsden OBE, Director of the NationalPatient Safety Campaign. The eventwas attended by over 150 membersof staff from all disciplines at the Trust,including doctors, nurses, midwives,healthcare professionals and Boardmembers.The aim of the Strategy is to lower ourHSMR through reducing incidents ofavoidable harm and creating a cultureof safety awareness and improvementthroughout the Trust. The work onearly detection and response to acutelyill patients has continued.As we reported in our 2009/10 QualityAccounts, patient safety training iscarried out in the Trust’s award-winningmedical simulation and training suiteand uses case studies based on realpatient safety incidents which haveoccurred in the hospital. This helps toensure that key learnings from theseincidents are reinforced and translatedinto practice.The Trust has implemented a newpatient observation chart which usescolour coding to identify acutelydeteriorating patients and the requiredescalation and response from clinical staff.We have also established a Trust PatientSafety Committee which examines allincident reports, identifies themes andensures that these are taken forwardinto the clinical improvement groupswithin each clinical speciality.Our programme of improvement andour commitment to reducing avoidableharm, particularly failure to identifyand treat deteriorating patients andinpatient cardiac arrest rates hasattracted much national interest,especially as we have introduced amandatory requirement for all nursingstaff to have a competency assessmentin the recognition and management ofacutely ill adult patients.As reported in our 2009/10 Accounts,the Trust uses the Institute of HealthImprovement’s Global Trigger Tool(GTT), an internationally recognisedtool to assist hospitals in establishingan organisational rate of harm andidentifying potential and missedincidents through monthly reviewsof patient case notes in each clinicalspeciality.In September 2010, the Trust undertooka benchmark case note review of 50cases, using the GTT, which establishedour organisational rate of harm as 117per 1,000 occupied bed days (a standardmeasure which is used to enablemeaningful comparisons of data such asinfection and harm rates in relation tothe actual numbers of patients treatedin a given period). This is slightly abovethe national average of 100 per 1,000bed days.Every month, each clinical directoratecarries out its own case note reviewwhich is reported to the relevant clinicalimprovement group.During 2011/12, we will begin to reportthis information to the Trust ClinicalGovernance Committee, which ischaired by our Medical Director andattended by the Director of Nursingand Quality.To continue to support our learningand improving from incidents, theTrust has adopted the latest extendedlist of Never Events, published by theDepartment of Health in February 2011.Never Events are defined as ‘serious,largely preventable patient safetyincidents that should not occur if theavailable preventative measures have“patient safety training is carried outin the Trust’s award-winning medicalsimulation and training suite”

Whipps Cross University Hospital | Quality Accounts 2010/2011 13been implemented by healthcareproviders’* and were introduced intothe NHS in England in April 2010* National Patient Safety Agency, ‘NeverEvents – Framework: Update for 2010-11’,March 2010.Available at: http:// www.nrls.npsa.nhs.uk/resources/?entryid45=68518In 2009/10 the Trust reported twonational Never Events - a retained swabduring surgery and a misplacednasogastric feeding tube - and oneinternal locally agreed incident – a lossof unencrypted computer data.In 2010/11 the Trust has reportedthree national Never Events – twoseparate incidents of retained foreignbodies following surgery and oneincident of wrong site surgery.The Trust also declared one grade 4pressure ulcer which is a locally agreedNever Event and exceeded our targetof zero.The number of Serious IncidentsRequiring Investigation (SIRIs) reportedin 2010/11 was 83, compared to 46during 2009/10.The main reason for this increase is therequirement to report all communityacquired pressure ulcers within the first72 hours of admission as well as allgrade 3 and grade 4 pressure ulcerswhich are acquired in the hospital. Inaddition, the 2009/10 national mandateto report post partum haemorrhage hasalso contributed to the increase in SIRIs.The most frequently reported clinicalincidents in 2010/11 were pressureulcers (1259), slips, trips and falls (738)and communication failures (346).The improved patient safety culture atWhipps Cross and our commitment tothe reduction of avoidable harm hasattracted national attention, and theTrust has been invited to present casestudies and its safety improvementstory to the National Patient SafetyAgency (NPSA) conference and NHSLondon. The NPSA have used ourimplementation of pressure ulcerassessment, skin care bundles and our“The improved patient safety cultureat Whipps Cross and our commitmentto the reduction of avoidable harmhas attracted national attention”patient safety leadership approach as anational beacon of improvement ontheir website. The Trust Board iscommitted to ensuring patient safetyis a priority.Staff experienceReduce the incidence of bullyingand harassment against staff, andimprove our score in the NationalStaff Survey for this indicator, fromwithin the bottom 20% of all Trustsin England to at least averageWe did not achieve this target. Ourscore for bullying and harassmentremained in the bottom 20% in the2010 National Staff Survey. During2010/11, we started work to tackle inearnest what is a longstanding issuefor the Trust. The section on page 9about the staff experience target for2011/12 sets out this work in moredetail.Improving and measuring staffsatisfaction is a very important part ofensuring that we can provide the bestcare and experience for our patients.Whipps Cross participates in the NHSNational Staff Survey each year, andthe results for the 2010 survey showedsome improvements in staff satisfactionover 2009.In the 2010 survey, we scored amongst thebest 20% of acute Trusts in England for:• The number of staff who feel thatthey have good opportunities todevelop their potential (where wescored amongst the highest of allEnglish acute hospital trusts).• The number of staff who feel theywork in a well structured environment.• The number of staff who agree thattheir work makes a difference topatients.• Rates of staff motivation at work.We also scored above average for thenumber of staff who would recommendWhipps Cross as a place to work orreceive treatment.However, we scored amongst the lowest20% of acute Trusts in England for:• The number of staff who feel valuedby their work colleagues.• The number of staff experiencingharassment or bullying from theircolleagues.• The number of staff who feel thatthe Trust takes effective actionwhen staff face violence andaggression.• The number of staff who believe theTrust provides equal access to careerprogression for everyone.

14 Whipps Cross University Hospital | Quality Accounts 2010/2011The survey questions are divided intofour categories. Although changesin the questions and structure of thesurvey between 2009 and 2010 meanthat the results are not directlycomparable, the Trust is particularlyconcerned that many of our lowscores in the 2010 survey fall underthe category of providing support andopportunities for staff to maintaintheir health, well-being and safety.The results still suggest that there isconsiderable work to do in this area,and this is why we are again makingstaff experience one of our prioritiesfor 2011/12.The results of the National Staff Survey,along with our resulting action plansand progress, are reported to the TrustExecutive Team and Board during theirregular meetings, as well as to theBoard’s Equality and Diversity Committeewhich is chaired by a Non-ExecutiveDirector.We will continue to use internalcommunications channels to reportour progress to staff, and the workinggroup will look at ways of engagingstaff and testing whether our earlystage proposals for makingimprovements in staff wellbeing atwork are likely to appeal to them.Consulting on ourpriorities forimprovementWe consulted widely on our prioritiesfor improvement for 2011/12. TheTrust’s Board of Directors consideredan initial proposal on the prioritieswe should work withFollowing their input, a discussionpaper outlining our draft prioritieswas circulated to our local communitygroups, who were asked to feed backtheir thoughts on what the Trust’spriorities should include. Feedbackwas also sought from our staff and thegeneral public via our website.We then matched this informationagainst our own strategic prioritiesand areas of concern. The groups weconsulted with are representative ofthe communities we have most contactwith, and included:• Waltham Forest Disability Action• Age Concern Waltham Forest• Waltham Forest Race EqualityCouncil• Waltham Forest Asian Seniors Club• Voluntary Action Waltham Forest• Waltham Forest Refugee AdviceCentre• Waltham Forest Carers• Bengali International• Faith Communities Forum• Hamara Family Project• Redbridge Carers’ Association• Sikh Community Care Project• Waltham Forest LINk• Redbridge LINk• Waltham Forest Noor Ul Islam Trust• Waltham Forest Somali Welfare andCultural Association• Members of our Patients’ PanelWe will also continue to focus on theimprovements cited in our 2010/11priorities where we have not achievedthem, and we will report our progressin our 2011/12 Quality Accounts.Review of servicesDuring 2010/11, Whipps Crosssubcontracted elective (planned)surgery to two independent sectorhospitals - Holly House in BuckhurstHill and Spire Roding in Redbridge –as part of plans to increase capacity tohelp the Trust achieve the national 18week referral-to-treatment target of90% for admitted patients.Patients undergoing their procedure inone of these hospitals are operated onby a consultant surgeon from WhippsCross and they receive any necessaryfollow-up care at Whipps Cross.The Trust has received no complaintsfrom patients who have undergonesurgery at either Holly House or SpireRoding. Whipps Cross has a ServiceLevel Agreement in place with bothproviders and has regular contact withthem to agree numbers of patientsand timescales for their operations.Both providers submit Patient ReportedOutcome Measure (PROMS) forms toWhipps Cross, and both return patientnotes in a timely fashion in order forthe episodes of care to be correctlycoded.(Please see page 26 for moreinformation on clinical coding).Whipps Cross regularly reviews all thedata available on the quality of careprovided by both Holly House andSpire Roding. Quality data forprocedures carried out at thesehospitals is reviewed as part of ouroverall data for elective (planned)care. The income generated by thesesubcontracted services represented1.5% of the total income generatedfrom the provision of NHS services byWhipps Cross for the reporting period1 April 2010 to 31 March 2011.

Whipps Cross University Hospital | Quality Accounts 2010/2011 15

16 Whipps Cross University Hospital | Quality Accounts 2010/2011As an acute hospital Trust, Whipps Crossprovides a full range of general andsome specialist services within thesecategories:• Breast surgery and breast care• Gastroenterology• Dermatology• Ear, Nose and Throat (ENT)• Gynaecology• Haematology• Respiratory Medicine• Cancer services• Neurology• Oral and Maxillo-facial surgery• Urology• Audiology• Cardiology• Colorectal surgery• Diabetology• Endocrinology• General surgery• Medicine for Elderly Patients• Renal medicine• Ophthalmology• Obstetrics and Maternity• Orthopaedics• Trauma medicine and surgery• Paediatric medicine and surgery• Pain management• Plastic surgery• Physiotherapy• Occupational therapy• Stroke care• Rehabilitation• Radiology and Diagnostics,including interventional radiology• Histopathology• Chemical pathology• Rheumatology• Sleep medicine• Andrology• Vascular surgery• Emergency medicine• General medicine• Clinical oncology• Anaesthetics• Orthodontics• Palliative medicine• Audiology• Critical care• Infection control• Medical microbiologyand clinical infection

Whipps Cross University Hospital | Quality Accounts 2010/2011 17Participation in clinical audits and National Confidential EnquiriesDuring 2010/11 30 national clinical audits and three national confidential enquiries covered NHS services that WhippsCross University NHS Hospital NHS Trust provides.During that period, Whipps Cross University NHS Hospital NHS Trust participated in 100% of the national clinical audits and100% of the national confidential enquiries in which it was eligible to participate.The reports of our national and local audits were reviewed. The tables on the following pages set out the actions we plan totake to improve the quality of healthcare we provide.The national clinical audits and national confidential enquiries that Whipps Cross University Hospital NHS Trustparticipated in during 2010/11 are as follows:1. Bowel Cancer (NBOCAP)2. Head and Neck Cancer (DAHNO)3. National Lung Cancer Audit (LUCADA)4. National Neonatal Audit (NNAP)5. RCP National Clinical Audit of Falls and Bone Health in Older People6. RCP/NBS National Comparative re-audit of the use of platelets7. RCP National Continence Care Audit8. RCP National Audit of Dementia9. Cardiac Arrest (National Cardiac Arrest Audit)10. CCAD Heart Failure Audit11. Myocardial Ischaemia National Audit Project (MINAP)12. Ulcerative Colitis and Crohns disease (National IBD Audit)13. RCP National Sentinel Audit of Stroke (round 7)14. Acute Stroke (SINAP)15. National Adult Diabetes Audit16. National Audit of Dementia17. Heavy Menstrual Bleeding (RCOG National Audit of HMB)18. National Hip Fracture Database19. National Vascular Database20. Trauma Audit Research Network (TARN)21. NCEPOD Peri-operative Care Case Study22. NCEPOD Peri-operative Care Organisational Questionnaire23. NCEPOD Cardiac Arrest Procedures24. National Elective Surgery PROMS Hernia25. National Elective Surgery PROMS Varicose veins26. National Elective Surgery PROMS Hips27. National Elective Surgery PROMS Knees28. College of Emergency Medicine Feverish Children29. College of Emergency Medicine Renal Colic (Adults)30. College of Emergency Medicine Vital Signs in MajorsThe reports of the following national clinical audits were reviewed by the Clinical Governance Committee during 2010/11:• NCEPOD Parenteral Nutrition – A Mixed Bag• RCP National Sentinel Audit of Stroke 2010 Organisational Report• NCEPOD Deaths in Acute hospitals – Caring to the End

18 Whipps Cross University Hospital | Quality Accounts 2010/2011AUDITNumberrequired oreligibleNumbersubmitted%submitted1 Bowel Cancer (NBOCAP) 150 85 57% (1)23Head and Neck Cancer(DAHNO)National Lung CancerAudit (LUCADA)44 17 39% (2)115 115 100%Actions/ OutcomesPart of HGQIP National Clinical Audit and Patients’ OutcomesProgramme (NCAPOP).Data submitted for national audit.Head and Neck Cancer (DAHNO) Part of HGQIP NationalClinical Audit and Patients’ Outcomes Programme (NCAPOP).Data submitted for national audit.Part of HQIP National Clinical Audit and Patients’ OutcomesProgramme (NCAPOP).Data submitted for national audit.4 National Neonatal Audit 300 300 100% Data submitted for ongoing national audit56789RCP National Clinical Auditof Falls and Bone Health inOlder PeopleRCP/NBS NationalComparative re-audit ofthe use of plateletsRCP National ContinenceCare AuditRCP National Audit ofDementiaCardiac Arrest (NationalCardiac Arrest Audit)40 30 75% (3) Data submitted for national audit. Awaiting final report.40 27 68% (4) Data submitted for national audit. Awaiting final report.80 80 100%40 40 100%Action plan developed to address improvement highlighted byaudit. Actions include publishing care pathway (April 2011) andsetting up a new user group to provide patient feedback andimprove communicationsAwaiting final localised report. Action plan will be developed inconjunction with partners.295 223 76% (5) Data submitted for national audit.10 CCAD Heart Failure Audit 240 235 98% Data submitted for national audit.111213Myocardial IschaemiaNational Audit Project(MINAP) ParticipationUlcerative Colitis andCrohns disease(National IBD Audit)RCP National SentinelAudit of Stroke (round 7)407 407 100% Data submitted for national audit project.11 11 100%60 44 73% (6)14 Acute Stroke (SINAP) 8 8 100% (7)15National Adult DiabetesAuditAction plan in place. Actions completed include:• Appointment of IBD Nurse Specialist• Weekly IBD MDT –introduced• Data base of IBD Patients in place• Daily ward rounds introducedAdditional actions on schedule for completion in 2011/12Results received in March 2011. Action plan being developedfor discussion by Executive BoardWeekly review and monthly reporting to Board in place.Actions include development of early supported dischargescheme in partnership with NHS ONEL – to reduce length ofstay and readmission rates93 93 100% Data submitted for national audit projectExplanatory notes1) Participation in this audit has increased by 100% since 2009/10 and further improvements in systems will increase this further during 2011/122) 27 patients treated at Whipps Cross were incorrectly uploaded by Barts and The London NHS Trust as part of their dataset3) Closer scrutiny of patient notes revealed that not all cases initially selected were eligible for this audit4) The number of patients seen at Whipps Cross is not great enough to meet the total required by this audit5) Data for this audit includes those patients where a cardiac arrest is reported but which is later confirmed as a false alarm6) Some patients were incorrectly coded as having a primary diagnosis of stroke on admission. These patients were subsequently excluded from the audit.7) SINAP data collected covers the period 1st January 2011 - 31st March 2011.

Whipps Cross University Hospital | Quality Accounts 2010/2011 19AUDITNumber required oreligibleNumbersubmitted%submittedActions/ Outcomes16 National Audit of Dementia 40 40 100%Awaiting final locality report. Action plan will bedeveloped in conjunction with partners.17Heavy Menstrual Bleeding(RCOG National Audit ofHMB)No set number ofpatientsData submitted for ongoing three-year national audit.18National Hip FractureDatabase247ongoingdata entryData used on ongoing basis to identify best practiceand improvements. Actions in 2010/11 includerecruitment of locum ortho-geriatrician and weekendtheatre lists to improve performance on patients seenwithin 36 hours.19 National Vascular Database 62ongoingdata entryOngoing data entry20Trauma Audit ResearchNetwork (TARN)181 35 19% (8) Data submitted to national study21NCEPOD Peri-operativeCare Case Study6 patients identified6 sets ofcasenotesreturned100% Data submitted to national study.22NCEPOD Peri-operativeCareOrganisationalQuestionnairecompletedNotapplicable100% Data submitted to national study.23NCEPOD CardiacArres Study7 patients identified7proformasreturned100% Data submitted to national study.24National Elective SurgeryPROMS Hernia240 157 65% (9)Data only available up to January 2011.Action plans will be developed.25National Elective SurgeryPROMS Varicose Vein73 49 67% (9)Data only available up to January 2011.Action plans will be developed.26National Elective SurgeryPROMS Hips149 94 63% (9)Data only available up to January 2011.Action plans will be developed.27National Elective SurgeryPROMS Knees241 116 48% (9)Data only available up to January 2011.Action plans will be developed.28College of EmergencyMedicine Feverish Children50 50 100%Achieved good results in audit. One action taken: pilotrapid assessment model starts in July in paediatricsto ensure all observations completed in requiredtimeframe.29College of EmergencyMedicine Renal Colic(Adults)50 50 100%Achieved very good results in audit. Action taken:continue successful strategy and use of ConsultantBoard rounds30College of EmergencyMedicine Vital Signs inMajors50 50 100%Achieved good results in audit. Action taken: review offindings around observations in 20 minute time frame;emphasis of best practice in junior doctor induction;inclusion of a nurse in the Rapid Assessment TeamExplanatory notes8) TARN have accepted that many of the patients who would have been classified as a trauma patient at Whipps Cross would have been transferred to anotherhospital before receiving treatment. In addition, the Trust did not have a TARN administrator until October 20109) Patients frequently complete their PROMS questionnaire before having their surgery, and this fact is reflected in the percentage return rate

20 Whipps Cross University Hospital | Quality Accounts 2010/2011The Trust continues to work to improveits use of audit data, including howdata is collected, increasing awarenessof the benefits of audit amongst clinicalstaff and changing clinical practice asa result of audit.Since the 2009/10 Quality Accountswere published, the Trust has appointedan Associate Medical Director as itsNCEPOD ambassador to increaseparticipation in national enquiries. Allclinical directorates within the Trustnow have dedicated clinical governancefacilitators to help promote closerworking relationships and a greaterawareness of the need to participatein clinical audits and enquiries.In our 2009/10 Quality Accounts,we stated that we had reported fourmaternal deaths and eight perinatal(newborn) deaths during 2009/10, allof which were investigated internally.The Trust Board agreed to focus moreon maternity services, and asked theCentre for Maternal and ChildEnquiries (CMACE) to review all thecases to ensure that the investigations’findings and methodology were robust.This review was undertaken in August2010 and CMACE issued a report ofits findings in November 2010.The report found that, in general, ourinvestigations were robust, and madea number of further recommendationsfor improvement, including:• Reviewing pre-conception advicegiven to women with risk factorssuch as diabetes or cardiac conditionsby specialists in those areas.• Improving information given tolocum staff, especially around thelocation and use of specialistequipment.• Introducing post-natal sepsisguidelines.In addition to this report, following theappointment of a new Clinical Directorfor Women’s Health in April 2010,an external review of our midwiferyservice was conducted. The resultingreport made 33 recommendations,including:• Ensuring there are embeddedgovernance systems within thematernity service.• Updating the model of communitymidwifery care so that it is in linewith current best practice.• Ensuring that the service takeswomen’s needs more directly intoaccount.An action plan was developed to addressall the recommendations and a projectmanager has been appointed to leadon them and ensure that the actionplan is fully carried out.A monthly clinical performance andgovernance scorecard for maternityservices is now in place to collect dataand monitor performance against 41key indicators, covering clinical standardsand care, workforce requirements andrisk management. This scorecard is reportedto the Trust Board each month.At the same time, the Trust is investing£3million to upgrade and update itsmaternity unit. The work includesproviding new single ensuite deliveryrooms, new operating theatres andareas for partners to relax and staywhilst their child is being born andimmediately afterwards.Each clinical directorate at the Trusthas a Clinical Improvement Group(CIG), chaired by a clinical lead – eithera doctor, consultant, nurse or otherhealth professional. A series ofsub-CIGs covers the separate clinicalareas within each directorate, whichreport to the directorate CIG.Each of the directorate CIG leads is amember of the Trust’s ClinicalGovernance Committee (CGC),chaired by the Medical Director. TheCIG leads give a monthly report to theCGC on all aspects of the clinicalgovernance agenda in their areas.This includes learning from theoutcomes of incident investigations,complaints and patient surveys.The Trust’s Patient Safety Committee isa sub committee of the CGC. Its remitcovers all patient safety workstreamsin the Trust. It is chaired by the DeputyDirector of Nursing, Patient Safety andQuality and the Medical Patient SafetyLead. and a consultant anaesthetistRepresentatives of the Trust Patients’Panel sit on both the Patient SafetyCommittee and the ClinicalGovernance Committee.The Clinical Governance Committeereports to the Board GovernanceCommittee, which is chaired by aNon-Executive Director.Three other committees – HRGovernance (chaired by the ChiefExecutive), Information Governance(chaired by the Medical Director) andEnvironmental Governance (chaired bythe Chief Executive) – also report tothe Board Governance Committee.ResearchDuring 2010/11, Whipps CrossHospital has been actively involved inresearch covering over half of the clinicaldisciplines practiced at the Trust. Thisactivity ranged from questionnairestudies through to clinical trials ofmedicinal products. The numberof patients receiving NHS servicesprovided or sub-contracted by WhippsCross University Hospital NHS Trustduring 2010/11 who were recruited toparticipate in research approved by aresearch ethics committee was 2,343.The Trust views its commitment toresearch as a key driver for improvingthe quality of care and the patientexperience, and our continuingparticipation in clinical trials makes akey contribution to wider healthimprovement. Our clinical staff stayabreast of the latest possible treatmentthe Trust is investing £3million toupgrade and update its maternity unit

Whipps Cross University Hospital | Quality Accounts 2010/2011 21A paediatric clinical trial fordermatology had a 100% success ratein the treatment of psoriasisoptions, and their active participationin research leads to successful patientoutcomes.Between January 2010 and February2011, Whipps Cross was involved inrunning 87 new open clinical researchstudies in rheumatology, cardiology,cancer, diabetes, urology, paediatrics,maternity, dermatology and stroke.Precise improvement in patient carerelated to research conducted at theTrust is yet to be measured due to thetype of research conducted. However,in the last year, 97% of patientsinvolved in clinical trials in rheumatologyhave benefited from taking part inthose trials.Benefits include relief of symptomsand the support patients receive fromresearch staff and other patientsinvolved in the trial. A paediatricclinical trial for dermatology has had a100% success rate in the treatment ofpsoriasis. The improvement in patientoutcomes at Whipps Cross demonstratesthat a commitment to clinical researchleads to better treatments for patients.53 members of clinical staff participatedin research approved by a researchethics committee at Whipps Crossbetween January 2010 and February2011.In the last three years, 174 publicationshave resulted from our involvement inNational Institute for Health Research(NIHR) and non commercial research,demonstrating our commitment totransparency and our desire to improvepatient outcomes and experienceacross the NHS.Collaboration with commercial andnon-commercial sponsors gives ourpatients the opportunity to haveaccess to novel treatments which areotherwise not yet available, includingmedical devices and new drugs. Ourengagement with clinical researchalso demonstrates our commitment totesting and offering the latest medicaltreatments and techniques.EducationWhipps Cross provides a wide rangeof clinical and non-clinical education.High quality education for our staff isa vital part of ensuring that we deliverour quality agenda. Our MedicalEducation Training (MET) Suite providesstate-of-the-art clinical skills,communications and simulation training.The simulation laboratory facility hasaudio-visual links to two theatres andour endoscopy and radiologyintervention suites. It provides theopportunity for doctors to performvirtual reality practical procedures in arealistic operating theatre set-up, andit also enables clinical educators to usecase studies from actual patientincidents to provide training in issuessuch as the care of deterioratingpatients.In December 2010, the MET Suite wasawarded a Commendation forEducational Productivity by the LondonDeanery, for being one of the mostproductive medical education facilitiesin London. This compliments a previousDeanery award for excellence ineducation in 2009. The awardrecognises the volume and diversity ofthe courses offered, includinginter-disciplinary teaching and learning.During 2010/11, we also establishedinduction and mandatory training fordoctors and dentists through aprogramme of online learning modules.At the same time, handover systems inour Emergency Department, Women’sHealth and acute medicine serviceshave been reviewed in order toimprove the opportunities they presentfor education and learning.Our non-medical education serviceprovides a wide range of learning anddevelopment for staff across the Trust,including induction courses for newstaff and mandatory and refreshertraining for existing staff, coveringissues such as health and safety atwork, infection control and childprotection awareness.During 2010/11, we implemented twomajor new training systems:• The Oracle Learning ManagementSystem, which records and monitorstraining attendance for all staff.• The National Learning ManagementSystem, which provides a databaseof over 230 online learningmodules.We are currently the third highest userof this service amongst London NHSTrusts, and we are now developinglocal programmes for organ donation,slips trips and falls, consent andcapacity and venous thromboembolism.Safeguarding Adults andChildren: working inpartnershipA high safeguarding profile has beenmaintained throughout the Trustduring 2010 / 2011. This is vital giventhat safeguarding vulnerable adultsand children is everyone’s responsibility.The Trust’s Safeguarding StrategyGroup, which was set up in March2010, acts as the overarching groupwithin the hospital responsible formonitoring the safeguarding ofchildren and vulnerable adults.This group reports to the TrustGovernance Committee on a quarterlybasis and to the Clinical GovernanceCommittee as requested

22 Whipps Cross University Hospital | Quality Accounts 2010/2011Safeguarding AdultsChallenges in 2010/11 included asignificant increase in referrals due tothe increased profile and nature ofsafeguarding work. Specific actionshave included the introduction oftissue viability guidelines and newgovernance guidelines aroundsafeguarding investigations.Whipps Cross is a key member of theWaltham Forest SafeguardingVulnerable Adults Partnership. TheTrust is represented at Director levelon the Waltham Forest SafeguardingAdults Board, with senior managersparticipating in key sub committees,panels and in strategy meetings thatrelate to Whipps Cross safeguardingincidents.The Trust’s Safeguarding Adults TrainingStrategy has been enhanced by theintroduction in 2010/11 of a mandatorye-learning package for new doctors.Individual training sessions have alsobeen provided for staff in areas suchas catering, maintenance and cleaningand for volunteers.The Safeguarding education programmeis being extended to provide trainingon additional issues including forcedmarriage. A level three programmeaimed at managers, senior sisters andmedical staff will start from July 2011.Waltham Forest Council has supportedWhipps Cross with the training of afurther five Safeguarding Champions,in A&E, EMC, EAU, Surgery and DMEP.We are devising a support networkwith the aid of the champions for theirdirectorates.Safeguarding ChildrenWhipps Cross is a key member of theWaltham Forest Safeguarding Children’sBoard (WFSCB)The Trust views the Child DeathOverview Panel (CDOP) as a goodexample of effective partnershipworking. Currently we have activemembership to the panel which meetson a monthly basis to discuss all childdeaths in Waltham Forest. It is amulti-disciplinary meeting involvingprofessionals from social care, acuteand community health, police,safeguarding teams and public health.In addition to this in addition there areprocesses embedded within the Trustto ensure that CDOP and communitycolleagues are alerted to all paediatricdeaths. In the case of unexpecteddeaths, a multi-disciplinary rapidresponse meeting is convened by theCDOP co-ordinator, attended by thePaediatric Consultant caring for thechild at the time of death and theNamed Nurse for Safeguarding Children.Partnership working with WFSCB hasalso been evident in our jointpreparatory work prior to a mockOfSTED inspection earlier this year, andalso our continuing work in preparingfor a formal inspection. This hasresulted in a review of out-of-hourschildren’s social work provision and theneed for the Emergency Duty Teamand hospital staff to work together toensure appropriate information sharing,enabling effective interventionto safeguard children.Guidelines are currently being drawnup between children’s social care andTrust to strengthen this process. TheTrust has also updated its safeguardingchildren training strategy.Partnership working is also apparentthrough the Serious Case Review (SCR)process. A SCR is undertaken if a childdies or is seriously injured and abuseor neglect is suspected to be acontributory factor.Partnership working is also fosteredwith external agencies and with thepolice Child Abuse Investigation Teams.Such partnership working enablesshared decision-making which enhancesthe safeguarding and promotion ofchildren’s welfare. It also provides mutualsupport, particularly when cases areextremely uncertain or traumaticThe Munro reviews (2010, 2011) of serviceprovision to safeguard children haveled to a number of recommendationsthat are currently being consideredlocally and nationally. Key to effectivesafeguarding children is referral to theappropriate agency when concerns arise.Goals agreed with ourCommissioners and useof the CQUIN paymentframeworkWhipps Cross has agreed a range ofCommissioning for Quality andInnovation (CQUIN) and KeyPerformance Indicators (KPIs) withinits 2011/12 contract. The Trust meetsmonthly with its commissioners toreview progress against the CQUINand other quality indicators.The Trust views CQUIN targets as apositive tool for improving safety andquality. This is why, although we didnot meet the VTE CQUIN target for2010/11, it is now a Quality Accountssafety indicator in order to achievethe national standard. In addition, theunmet CQUIN indictors form part ofthe Quality and Safety improvementprogramme for the Trust for 2011/12.In common with many other NHSorganisations, we have also developeda Quality, Innovation, Productivityand Prevention (QIPP) programme inresponse to the 20% efficiency savingsneeded by the NHS over the nextfour years. QIPP focuses on providinghigher quality care at lower cost.During 2010/11, we reviewed ourcosts and the way in which we work inorder to increase our efficiency anddeliver better value for both patients andtaxpayers. We successfully met our“The Trust viewsCQUIN targets asa positive tool forimproving safetyand quality”

Whipps Cross University Hospital | Quality Accounts 2010/2011 23Business Efficiency Programme for theyear, delivering savings of £15millionwith no detrimental effect on patientcare.For 2011/12, we will be focusing ourefforts through QIPP on areas whereimproved performance (measuredagainst other hospitals nationally) willprovide better patient care and reducecosts. These areas include:• Reducing the length of timepatients need to stay in hospital.• Reducing the number of emergencyreadmissions.• Reducing the number of occasionswhen patients need to stay in hospitalthe night before a procedure oroperation.• Reducing the number of patientswho do not attend their appointments.• Reducing the number of times newpatients need to be seen again forfollow up appointments.Workstreams are now in place to focusin detail on these areas and to rankour performance within them, so thatwe achieve results within at least thetop 25% of acute hospital Trusts inEngland.The workstreams represent newinitiatives which are in addition towork we have already carried out toidentify opportunities to increaseefficiencies during 2011/12.This includes retendering services andworking on collaborative procurementplans with colleagues in neighbouringNHS Trusts to increase buying powerand to help ensure that we can achievebest value for money at all times.The range of CQUINS agreed with ourcommissioners for 2011/12 include:• Increasing the percentage ofaudited adult inpatients having adocumented venous thromboembolism(VTE) risk assessment on admissionusing the national tool to greaterthan 90% of inpatients.• All patients identified following VTErisk assessment as at risk of VTEand requiring prophylaxis are offered,with their carer, verbal and writteninformation on VTE prevention aspart of the admission and dischargeprocesses.• Responsiveness to personal needs- responses to five key questionsthrough the national patient survey.• Agree a trajectory improvement inthe incidence of grade 2 and 3pressure ulcers to achieve an 80%reduction by 2013, along with evidenceof zero grade 4 pressure ulcers.• Evidence of delivering a reduction ofin-hospital falls amongst older peopleand a 50% reduction in falls resultingin harm to patients.• Ensuring that no more than 5%of patients with an indwellingcatheter develop a bloodstreaminfection (bacteraemia) as a result.• Introducing an enhanced recoveryprogramme for eight specific surgicalprocedures, including recordingresults on a national database,identification of patients who havesurgery on day of admissions, fluidtherapy and reduction of length ofstay.• Achieving a reduction in thenumber of cardiac arrest calls forpatients who are being cared forin areas other than the intensivecare unit, operating theatres andcardiac wards.• Ensuring that 75% of patientsadmitted as an emergency are seenby a senior clinician within 12 hoursof admission and by a consultantwithin 24 hours of admission.The range of KPIs agreed with ourcommissioners for 2011/12 include:• Emergency Department - reductionin ambulance turnaround times(the time between an ambulancearriving at the hospital with apatient and that patient beinghanded over to the EmergencyDepartment).• A maximum two-week wait standardfor the rapid access chest pain clinic.• Guaranteed access to a genito-urinarymedicine clinic within 48 hours ofcontacting a service.• Demonstrate an increase in thepercentage of short stay admissionscompared with long stay admissionsas a result of implementing anambulatory care pathway.• Ensure that cervical smear testresult letters are sent out topatients within two weeks of thepatient attending.• Ensure that all women receive oneto one care during labour.• Ensure that all pregnant womenhave a named midwife.• Increase the number of birthsoutside obstetric units, either ashome births or in midwife led units.• A Trustwide plan for the eliminationof mixed sex patient accommodationto the agreed national milestone.A proportion of Whipps Cross UniversityNHS Trust income in 2010/11 wasconditional on achieving qualityimprovement and innovation goalsagreed between Whipps Cross UniversityNHS Trust and any contract, agreementor arrangement with for the provisionof NHS services, through the Commissioningfor Quality and Innovationpayment framework.Further details of the agreed goalsfor 2010/11 and for the following 12month period are available electronicallyat http://www.institute.nhs.uk/world_class_commissioning/pct_portal/cquin.htmlOur performance against agreed CQUINsand KPIs for 2010/11 included:• Prevention of venous thromboemolism– not met.• Reduction of length of stay forinpatients – met.• Reducing the number of follow-upappointments a patient needs –partially met.

24 Whipps Cross University Hospital | Quality Accounts 2010/2011• Reduction in ambulance turnaround times (the time between anambulance arriving at the hospitalwith a patient and that patient beinghanded over to the EmergencyDepartment) – not met.• Reduction in the time taken forpatients to be reviewed by a doctor– not met.• Implementation of the Institute ofHealthcare Improvement’s (IHI)Global Trigger Tool - met.• Surgical programme of improvementusing the enhanced recoveryprogramme initiative – met.• Reducing re-admission rates intothe hospital for the same illness – met.• Increasing the number of pregnantwomen who have a midwife astheir first point of contact - met.• Increasing the number of normaldeliveries (including assisteddeliveries/ forceps) – not met.• Maintaining our 100% record ofoffering women a referral tosmoking cessation services duringtheir pregnancy – met.• Increasing our breast feeding rates– partially met.• Further improving our perinatalmortality rates (babies who die priorto birth) – met.• Reducing our rate of babies bornwith a birth weight of less than2.5kg or 5lb 8oz - not met.• Reducing length of stay for traumaand orthopaedic patients – not met.• Increasing the number of traumapatients, especially those withfractured hips, who receive surgerywithin 36 hours of their admissionto the hospital (changed during theyear from 24 hours) – partially met.• Improving our performance againstthe national 18 weeks referral-totreatmenttargets for orthopaedicpatients – almost fully met.• Reducing rates of stroke-relateddeath and disability – not met.• Increasing the number of strokepatients who spend all of their timeon our dedicated Acute Stroke Unit– met.• Increasing the number of TBpatients who complete theirtreatment within one year – met.• Increasing the number of organdonation referrals for patients inthe Emergency Department andIntensive Care Unit – not met.What others say aboutWhipps Cross HospitalWhipps Cross University HospitalNHS Trust is required to register withthe Care Quality Commission (CQC).The Trust was granted a licence inMarch 2010 by the CQC to providea service with no conditions.The Care Quality Commission (CQC)carried out a routine unannouncedreview visit in December 2010, whenCQC inspectors visited our elderly carewards, the Emergency Departmentand Maternity Unit.In their report following the visit, theCQC stated that: “Patients who spoketo us overwhelmingly felt that medicaland nursing staff listened to them.Patients felt that they could speak tostaff.‘I have not met any expert who isabrupt or anything, they are allexcellent’, ‘I feel they are doing theirbest for me’, ‘very happy with thenursing. I call them and they come,I couldn’t want better’, were typicalcomments. On the whole, maternitypatients felt that the midwives anddoctors understood them, felt involvedin their plan of care and were satisfiedwith their care.Overall, patients were complimentaryabout the care and treatment they hadreceived and complimentary about theattitude and helpfulness of staff.However, seven areas of concern wereidentified in the report, five of whichwere minor and two were moderate.These are listed in the table on page25 along with:• The relevant outcome from theCQC’s essential standards of qualityand safety for all providers of healthand adult social care; and• The actions we are taking to addresseach concern, all of which will becompleted by the end of July 2011.In March 2011, the CQC carried outan unannounced inspection visit atWhipps Cross into standards of carefor elderly patients, as part of theirreview of standards following thepublication in February 2011 of theParliamentary and Health ServiceOmbudsman’s report Care andCompassion? which is based on tenindependent investigations into complaintsabout NHS care for people over theage of 65 across England.The inspection measured performanceagainst two of the CQC’s essentialstandards:• People should be treated with respect,involved in discussions about theircare and treatment and able toinfluence how the service is run.• Food and drink should meet people’sindividual dietary needs.The inspection report found that theTrust was meeting both these essentialstandards.The CQC did raise minor concernswith our provision of food and drinkto meet individual and cultural dietaryneeds. These concerns centre onproviding sufficient choice of mealsand ensuring that the choices patientsmake are always acted upon by wardstaff.The Trust’s Nutrition Action Teamcomprises of clinical staff who areexperts in nutrition.Following the CQC recommendations,the team are driving the nutritionimprovements forward to meet thediverse needs of our patients.Action plans are in place to improveour catering service following the visit.

Whipps Cross University Hospital | Quality Accounts 2010/2011 25Issues raised by the CQC’s unannounced inspection visit in December 2010OutcomeIssues raised by the CQCAction being taken by theTrust to address the issueOutcome 1 – respecting and involving peoplewho use services (Maternity)Maternity staff are not always aware of thegaps or their involvement in giving or receivinginformation.The Trust’s Patient Experience Revolution is beingrolled out within Women’s Services, includingquarterly In Your Shoes events where service usersare invited to share their experiences with Truststaff. Outcomes from these events will assist inthe development of local standards.Outcome 8 – cleanliness and infection controlStaff were observed not following Trust policy onhand hygiene when entering and leaving wardsand not observing rules on being bare below theelbow when on the wards.Additional measures have been introduced whichare over and above the evidence-based WorldHealth Organisation’s recommendations andare included in the recently reviewed Trust handhygiene policy. A hand hygiene action plan hasbeen developed to address performance, includingeducation and training, leadership by examplethrough hand hygiene champions and increasedmonitoring with action to be taken in the eventof compliance failure by staff members. The Trusthas also retendered its cleaning contract, whichincludes increasing service standards so that theyare in line with those set out in the NationalStandards of CleanlinessOutcome 10 – safety and suitability of premises(Maternity)There are risk management issues during therefurbishment works, particularly on the laboursuite, which impact on people’s privacy and dignity,including access to bathroom facilities.Risk management arrangements are beingreviewed, along with the risk assessment process,to take account of the concerns identified. Riskassessments and arrangements in place will bereviewed and monitored on a monthly basis atthe Maternity Estates Governance Group.Outcome 13 – staffingCommunity (maternity) staff were found to beeither working excessive hours or had unsustainablecaseloads in their attempts to balance alldemands on the service. But the concern mayreduce if the Trust successfully brings all its plansto fruition.The staff consultation for reviewing the communitymidwifery services is complete, and theprocess to recruit into the proposed eight teamshas begun. An additional six midwife posts havebeen agreed for 2011/2012.Outcome 14 – supporting workers (Maternity)It is not always possible to release staff to attendmultidisciplinary meetings or to allow staffinvolvement in clinical audits or reviews.The annual plan for staff to attend mandatorytraining and in-house specialist training willensure that sufficient cover is maintained in theclinical areas.Outcome 17 – complaintsBy employing a Customer Services Manager andtwo Customer Service Facilitators to address concernsraised on an individual and daily basis, thetrust demonstrates that it is taking patient/publiccomments seriously and makes genuine effortsto resolve these. There is a potential unintendedconsequence in that if patients feel reassuredby virtue of having someone to talk to, theunderlying root cause of their concern may notbe addressed, particularly if the number of formalcomplaints/comments received by the Trust falls.Customer Service Facilitators will produce amonthly report for their directorate, which will beincluded within the monthly PALS reports that arereviewed at the Operations Board and the PatientExperience Improvement Board.Outcome 21 – RecordsIt was unclear if maternity staff worked to thesame record management system as the rest ofthe Trust, or if staff understood exisiting systems.A review of the antenatal clinic administrationstaff and records storage is being undertaken.

26 Whipps Cross University Hospital | Quality Accounts 2010/2011Data qualityWhy data quality is importantA great deal of data is created andused by the NHS. This includesinformation which helps hospitals andGPs to track patients and to make surethat all relevant information aboutthem and their treatment, such as testresults, is in the right place and can befound by the relevant staff. It is veryimportant that the data is accurateand up to date, and hospital trusts arerequired to report on data collectionand accuracy every year.Hospital Episode StatisticsHospital Episode Statistics measurehow hospitals collect and useinformation from patients when theyare referred for treatment or attendhospital. All UK residents are allocatedan NHS number which identifiesthem anywhere within the NHS, andhospitals must include this numberon all the records they hold on apatient. The patient’s General MedicalPractice code identifies the patient’sGP and the practice the GP works in.The National Patient Safety Agencyregards both pieces of information askey patient safety tools, as they helpto ensure that the correct treatmentis given to the correct patient, andthat data such as test results andinformation on a patient’s treatmentare sent to the right GP at the rightpractice. Whipps Cross UniversityHospital NHS Trust submitted recordsduring 2010/11 to the Secondary UsesService for inclusion in the HospitalEpisodes Statistics.The percentage of records with thepatient’s valid NHS number for theperiod April 2010 to March 2011 was:• 97.4% for admitted patient care• 98.2% for outpatient care• 80.90% for accident and emergencycareThe percentage of records submittedwith the patient’s valid General MedicalPractice code for the period April 2010 toMarch 2011 was:• 100% for admitted patient care• 10% for outpatient care• 100% for accident and emergencycareInformation GovernanceToolkit attainment levelsThe Information Governance Toolkit isa national framework which measurescompliance with data protection andsecurity standards. It helps to ensurethat confidential information on apatient, such as their home addressand details of their medical history,can only be seen by people who areauthorised to view it. Whipps CrossUniversity Hospital NHS Trust’s score for2010/11 for Secondary User Assurance(the initiative that measures Data Qualityprogress assessed using the InformationGovernance Toolkit) is 70%, giving theTrust a red rating for this measure.When measured against Version 7 ofthe toolkit, we achieved a green rating,but Version 8, which was introducedin early 2011 and included newindicators, caused our rating to fall.The Trust will introduce the Sharepointdocument management system during2011/12, which will further improveour compliance. The Trust has alsomade significant progress in the deliveryof information governance training,with over 1,100 members of stafftrained during 2010/11. Data quality‘drop in’ training sessions and ‘goodpractice’ sessions are held regularlywithin the Trust.Duplicate registrationsThe Trust has made a great deal ofprogress in the identification andresolution of duplicate registrations.From August 2010, daily reports havebeen run to identify instances andtimely corrective action is then taken.In January 2011, 433 duplicateregistrations were created and 370(85%) were resolved, resulting in onemerged patient record for each ofthese patients. Linked to this programmeis the delivery of targeted training andproduction of data collection bestpractice scripts for use in key operationalareas such as our Emergency Department.Electronic Discharge SummariesGreat improvements in electronicdischarge summary compliance havebeen made throughout 2010/11. Inweek ending 13th March 2011, 84%of discharge summaries sent to GPswithin 24 hours of a patient’s dischargewere electronic, compared to only36% in week ending 4th April 2010.Clinical coding error rateClinical coding is the process whereinformation on a patient’s treatmentand medical conditions is recorded,using a standard set of codes for everyprocedure and medical condition thepatient has. Coding helps to ensurethat accurate information about apatient’s treatment and conditions isavailable electronically to the patient’sGP and other healthcare professionals,and it is also the process through whicha hospital Trust is paid correctly for eachpatient’s care under the nationalPayment by Results finance system.Every hospital Trust has a clinical codingteam who record this information foreach patient. Whipps Cross achieved100% coding completeness for allmonthly Secondary User Servicedeadlines in 2010/11.Whipps Cross was not required toundertake a Payment by Results Auditby the Audit Commission during theyear, as only the 20 poorest performingTrusts in England were selected forthis. However, regular internal auditstake place within our clinical codingdepartment, and our error rates in2010/11 were:• Incorrect primary diagnoses 7.3%• Incorrect secondary diagnoses 3.1%• Incorrect primary procedures 2.9%• Incorrect secondary procedures 1.4%

Whipps Cross University Hospital | Quality Accounts 2010/2011 27

28 Whipps Cross University Hospital | Quality Accounts 2010/2011Review of QualityPerformanceEmergency care pathwayEmergency care has always been astrong focus for Whipps Cross, andthe hospital sees an average of 300patients in its Emergency Departmentevery day. However, we have consistentlynot been able to meet the emergencyperformance standard. 98% ofattending patients must be assessedand either treated and discharged oradmitted to an inpatient bed withinfour hours, and our overall performanceagainst the standard during 2010/11was just under 97%. Whilst quality ofcare remains high, our performancestandard has impacted on the qualityof patient experience provided withinthe Emergency Department and ouremergency assessment beds. At thesame time, a number of new nationalparameters for emergency care cameinto force on 1st April 2011, includingthe time taken for patients to receivea first assessment by a suitably experiencedteam member and ambulanceteam handover times.To help address these issues, a newEmergency Medicine directorate wasestablished in January 2011 with anew senior team of a full time ClinicalDirector, an Assistant Director and aLead Nurse. These new posts all havea specific remit within emergencymedicine to ensure that sufficientsenior resource is available to deliverthe clinical quality agenda and ensurethat our patients receive excellent careat all times.We have set ourselves a number ofkey improvement objectives for ouremergency care pathway which follow.Rapid assessment and treatment ofpatients in the Emergency DepartmentWe introduced a new Rapid Assessmentand Treatment (RAT) team in December2010, made up of a receptionist, anexperienced nurse and doctor, aphlebotomist and a porter. Patientsarriving by ambulance are immediatelyreceived by the waiting team in aprivate cubicle and a handover takenfrom the ambulance crew.Within the first 15 minutes:• The patient is rapidly checked in andexamined by the medical team. Bloodsamples are taken and a cannula (adevice which is placed in a patient’svein to give fluids directly into thebloodstream) is inserted if needed.• The patient is given any essentialdrugs they may need, includingstrong pain killers, oxygen, fluids,antibiotics and drugs to helpbreathing. A heart trace can also becarried out if required.• The patient’s observations are checkedand then graded according to ourexisting Early Warning System whichhighlights how severe a patient’scondition may be.Once the RAT team has finished itsinitial assessment and treatment, thepatient is transferred to the main partof the Emergency Department, viaXray if needed, where the rest of themedical team can review their progressand investigations.The RAT team was initially establishedas a pilot, and patients and Trust staffwere questioned on its effectiveness.Feedback was very positive. Patientsfelt reassured and confident in theteam and felt that things were beingexplained to them. During the pilotperiod, more than 97% of patientswere being assessed and treated withinten minutes of arrival by ambulance.The RAT team became a permanentfeature in January 2011, and nowoperates from 9am to 9pm every day.Since December 2010, the number ofpatients in the Emergency Departmentwho are assessed and treated withintwo hours of arriving has risen fromless than 70% to more than 90%.A new Ambulatory Care UnitWe opened a new Ambulatory CareUnit (ACU) within our EmergencyMedical Centre in February 2011.The ACU is designed to rapidly assess,diagnose and treat patients withcertain conditions, meaning that theycan be discharged on the same dayrather than having to stay in hospitalovernight waiting for tests, results or amedical opinion.This model of care helps to improveclinical outcomes through faster decisionmaking and treatment, and frees upinpatient beds for people who reallyneed a stay in hospital.Early feedback from patients has beenvery positive, with people describingthe service as “exemplary” and “theNational Health Service at its best”.Staff in the new unit are also closelylinked to the RAT team, who candecide if a patient they have assessedwould benefit from immediate referralto a medical consultant, for examplepatients with certain types of chestpain, fits, diabetes, stroke, blood clotsand bleeding. After an initial assessmentby the RAT team, suitable patientscan be immediately transferred to theACU which is located very near to theEmergency Department.“Patients felt reassured and confidentin the team and felt that things werebeing explained to them”Changes to the management of ourAcute Medicine serviceWe have also made improvements toour Acute Medicine service. Fouradditional acute physicians wereappointed to enable us to run more

Whipps Cross University Hospital | Quality Accounts 2010/2011 29assessment beds and to provide moreconsultant cover and support earlierdischarges at weekends. The resultingimprovements have already deliveredsignificant benefits to patients, withmore senior doctors now availableto assess and treat patients at weekends,speeding up their treatment andincreasing the number of patients whocan be discharged at weekends.This helps us to ensure that patientscan leave hospital when they are medicallyfit, reducing un-necessary staysin hospital and reducing the chance ofpatients acquiring a hospital acquiredinfection. Standards have been agreedto ensure that patients are seenpromptly and that consultant adviceis available on a daily basis. Local GPsare also able to call the hospital andreceive prompt advice from anexperienced acute physician who canhelp them to assess a patient anddecide whether they need to beadmitted to the hospital or whetherthey can be treated in the community.We are continuing to measure theimpact of these changes in a numberof ways:• Implementing the new emergencyclinical indicators set out by NHSLondon. This is a national changeto the way that information aboutEmergency Department performanceis measured, and moves away froma focus on targets to a focus onclinical care and outcomes.• Each stream of work producesa performance dashboard whichincludes average length of stay bycondition, re-attendance rates andambulance handover times. Thedashboards are monitored by theTrust’s Emergency ServicesPerformance Review team whichmeets on a weekly basis and ischaired by the Chief Executive.• Measuring patient experience byusing questionnaires and analysingcomplaints and incidents. Thisinformation is monitored on amonthly basis by the ClinicalImprovement Groups (CIGs) withinthe Emergency Medicine Directorate.Each CIG within the Trust includes apatient representative within itsmembership.

30 Whipps Cross University Hospital | Quality Accounts 2010/2011Caring for patients with dementiaIn 2009, the Department of Healthpublished its National DementiaStrategy, and this was followed inSeptember 2010 by a further framework,Quality outcomes for people withdementia. The framework has fourpriorities:• Good quality early diagnosis andintervention for all patients.• Improved care in general hospitals.• Allowing people in care homes tolive well with dementia.• Reducing the use of antipsychoticmedication for patients withdementia.In response to these publications, theTrust produced an action plan toimplement a new dementia carepathway which can be applied toall patients admitted with existingdementia as well as those who arenewly diagnosed with dementia, eitherduring an emergency admission or aroutine admission for another condition.To support this work, a number ofinitiatives have been put in place:• Completing a national dementiaaudit to give the Trust baselineinformation on how we currentlytreat patients with dementia. Thisdemonstrated that we are alreadyperforming well in the low use ofantipsychotic drugs and in carryingout nutritional assessments• Designating a medical lead fordementia – a consultant with aspecialism in the care of elderlypeople.• Creating a new post of NurseConsultant for Dementia.• Introducing mandatory training forall staff, including at induction. Over340 staff have received this trainingto date.• Increasing awareness of dementiaamongst medical staff, which hashelped to support an increase in thenumber of patients who have adiagnosis of delirium recorded ontheir discharge summary.• Improving the clinical coding ofdementia for newly diagnosed andexisting patients.• Introducing a new proforma in ourEmergency Department whichincludes the mental test score forpatients who are likely to be at riskof dementia.Infection Prevention and ControlThe control of all avoidable healthcareassociated infections continues tobe one of our highest priorities. In2009/10, we recorded the lowestnumber of hospital-acquired MRSAbloodstream infections (known asbacteraemias) of all acute hospitals inLondon.In 2010/11, we recorded only onesuch case, our best performance ever,making us one of the best performingTrusts in the country. We have alsomaintained a good performance forcases of Clostridium difficile infection,recording 48 cases in 2010/11 againsta target of 118 cases. This is a lowerrate than most other acute hospitals,both in London and nationally.As we reported in our 2009/10 AnnualReport, we faced a very significantchallenge in January 2010 with a largeoutbreak of Norovirus, often known asthe winter vomiting bug. The outbreakhad a significant effect on our operation,with 22 wards closed at one point.During the year, a detailed analysis ofthat outbreak was undertaken. Wehave used the lessons learned to reviseour outbreak management processesin order to reduce the impact of anyfuture outbreak.Key learnings include:• Ensuring that potential cases areidentified early on when a patienthas symptoms.• Improving risk assessment ofpatients in the EmergencyDepartment.• Maintaining a tight focus on closuresof wards or ward bays to helpminimise transmission to otherpatients or members of staff.During the winter period of 2010/2011,we put in place heightened vigilanceand awareness arrangements forNorovirus and other winter infectionsincluding flu. Enhanced cleaning of allhigh risk areas and communication to allgroups of staff, patients and the publicall played a key role in helping to containa virulent outbreak of Norovirus inJanuary 2011.Commitment and co-operation fromeveryone helped prevent widespreaddisruption to our services. No morethan six wards were closed to admissionsat any one time, and all ourservices continued to run normallythroughout.We increased availability of laboratorytesting for all suspected Noroviruscases to seven days a week, and thishelped us to use our isolation resourcesmore effectively and to keepward closure durations to a minimum.Our experience this year showedthat, whilst Norovirus was once againintroduced into the hospital fromwithin the community, we were ableto considerably restrict its impact.In January 2011, the Department ofHealth introduced a new requirement“In 2009/10, we recorded the lowestnumber of hospital-acquired MRSAbloodstream infections(known as bacteraemias) of all acutehospitals in London”

Whipps Cross University Hospital | Quality Accounts 2010/2011 31for all acute hospitals to report casesof Meticillin Sensitive StaphylococcusAureus (MSSA) bloodstream infections.MSSA is carried by a significant numberof the general population and it isstraightforward to treat. We weremonitoring levels of this infectionahead of the national deadline, andour surveillance shows that almost allsuch cases at Whipps Cross to datewere acquired in the community, andvery few were avoidable.No national targets or criteria have yetbeen set for MSSA reporting. We arerunning a programme of enhancedsurveillance for cases of the infectionand each case is investigated thoroughlyto help determine the cause, sothat remedial action can be taken toprevent other cases.During 2010/11, we continued withour programme of improvement worksto our estate, which have contributedto our success in managing outbreaksof infection. The programme includesincreasing the number of single patientrooms which can be used to isolatepatients with a suspected or confirmedinfection in order to minimise the riskof transmission to other people.“While Norovirus was once againintroduced into the hospital, we wereable to considerably restrict its impact.”At the same time, significantimprovements have been made to anumber of wards, particularly in ourMedicine directorate. Two wards,Faraday and Nightingale, have beencompletely refurbished and allpatients are now cared for in smallbays or individual rooms, again makingit much easier for us to manage casesof infections quickly and effectively.The Infection Prevention and Controlteam was further strengthened in2010 with the appointment of a newsenior nurse who is leading our workto promote awareness of andcompliance with all infectionprevention and control requirementsand to ensure that we are followingbest practice.Other key priorities for 2011/12include:• Continuing to reduce rates ofhealthcare associated infections,particularly for Clostridium difficileand MRSA bloodstream infections.• Meeting and sustaining othermandatory reporting requirementsand external targets.• Introducing surveillance for otheralert organisms (any infection whichis easily passed from one person toanother and could cause an outbreak) such as E. coli bloodstreaminfections.• Increasing surveillance for surgicalsite infections (infections whichoccur in an incision point whilst it ishealing).• Continuing to promote the need forsurveillance and vigilance in dealingwith any infection across the hospital.• Ensuring all areas and equipmentare cleaned to a high standard andthat all staff adhere to our stricthand hygiene procedures.The graph below shows the rate ofC Diff infections at the Trust during2010/11.

32 Whipps Cross University Hospital | Quality Accounts 2010/2011Rolling out our Patient ExperienceRevolution in Women’s HealthThe Care Quality Commission’s 2010survey of women’s experiences ofmaternity services at Whipps Crossquestioned 145 women who hadgiven birth at the hospital duringFebruary 2010, prior to the launch ofthe Trust’s Patient Experience Revolutionin March 2010.Of the 24 indicators that Trusts aremeasured on as part of this survey,Whipps Cross scored “About thesame” for 15 and “Worse” for nineindicators when compared with otherTrusts. Indicators where we were rated“Worse” include:• Care and treatment during labourand birth.• Women’s involvement in decisionsabout their care during labour andbirth.• Active support and encouragementfrom midwives and other carers.• The overall level of care provided towomen during labour and birth.Using the same methodology from ourwork with inpatients in the mainhospital, we launched a Women’sHealth Experience Revolution, involvingwomen who have given birth atWhipps Cross, their partners and ourmaternity staff in October 2010.We have since held three “In YourShoes” listening events, attended byover 60 women and 80 staff. Two ofthese events were held in communitysettings in order to encourageattendance from harder to reachgroups, and two further such eventsare planned in 2011.The philosophy of the programme isto involve women, their partners, staffand managers in the continuousimprovement of the quality of theexperience women and their partnersreceive, to jointly create a vision forthat improvement and support ourstaff to successfully deliver it.In order to move this work forward,we are concentrating on empoweringand enabling staff to deliver the prioritieswhich women, their partners and ourstaff have said matter most to them.This model will then be rolled out toother clinical services within the Trustduring 2011/12.

Whipps Cross University Hospital | Quality Accounts 2010/2011 33Significant improvements in ourHistopathology department usingLean MethodologyHistopathology is core to the diagnosisand monitoring of a wide range ofconditions. It involves expertexaminations of cell and tissue samples,and it has a particularly important rolein the diagnosis of cancer and inproviding information on whichtreatment decisions are based.Because of this, our ability to turnround test results and provide them tothe requesting clinician is vital inproviding prompt diagnosis – it reducesthe period of uncertainty for patientsand helps to ensure that treatment canbe started as soon as clinicallyappropriate.In September 2009, Whipps Cross wasone of nine hospitals selected to takepart in a year long pilot programmerun by NHS Improvement to increaseefficiency and reduce turnaroundtimes in its Histopathology services inpartnership with the Department ofHealth’s Pathology Programme.Our Histopathology department receivesand tests around 40,000 tissue andfluid samples every year from local GPsand hospital clinicians, as well as fromthe private sector.Lean methodology improves flow acrossthe specimen pathway by removing‘waste’. This approach was endorsedby Lord Carter in the Review ofNHS Pathology Services in England(2006/2008) as the method of choicefor improving processes in pathologyservices. An effective, streamlinedservice also supports the delivery ofthe Cancer Reform Strategy (2007).We took a “whole pathway” approach,examining all stages of the processfrom specimen collection and transportthrough the laboratory processes toproduction of the final report. Staffempowerment, local ownership, clinicalleadership and user engagement werevital for the implementation andsustainability of the improvements.As a result of the improvements, theaverage overall turnaround time fellfrom 11 to 4 calendar days. This wasaccompanied by a marked reductionin variation, resulting in a guaranteed,predictable service for users andultimately patients.The team has achieved sustainableturnaround times of under threecalendar days for 40% of specimensand under seven calendar days for90% of specimens (Fig 1) on page 37.The targets for the coming year areto increase these turnaround times tounder three calendar days for 50% ofspecimens and under seven calendardays for 95% of specimens, and tomake these improvements sustainable.For service users (our hospital cliniciansand local GPs) and patients, thebenefits are:• Earlier communication of results.• Prompt discussion at multidisciplinaryteam meetings, where patients’cases are discussed by a range ofmedical experts.• Earlier management plans, includingtreatment and referral to otherspecialties or the regional cancercentre.• A reduction in the number ofoutpatient appointments required,as results can be given at an earlierappointment or by an alternativemethod such as in a telephone call.The quality and safety of the servicehas improved, with a significantreduction in errors across the pathway.By eliminating ‘waste’ andensuring appropriate use of staff skillsand matching capacity with demand,we have been able to maximiseproductivity. Effective use of technologyand innovation has helped us to makefurther service redesigns andimprovements, including:• The inclusion of specimenphotographs in reports and atmultidisciplinary team meetings(including real-time projection ofimages so that they are accessiblevia teleconferencing by participantsinvolved in patient care who arelocated at other sites).• The use of digital dictation to reducethe time from dictation to typing.• Use of a web-based application tostreamline part of the pathway (theteam was awarded first prize at theTrust’s “Dragon’s Den” styleinnovations challenge for this).• The design and use of an electronicdashboard which is based onreal-time data and monitorsindividual and departmentalperformance.• Other visual managementtechniques, designed to improveflow, safety and productivity.“By eliminating ‘waste’ and ensuringappropriate use of staff skills andmatching capacity with demand, wehave been able to maximise productivity.Effective use of technology andinnovation has helped us to makefurther service redesigns”

34 Whipps Cross University Hospital | Quality Accounts 2010/2011Turnaround times of under three calendar days for 40% of specimens and under seven calendar days for 90% ofspecimens (Fig 1).

Whipps Cross University Hospital | Quality Accounts 2010/2011 35

36 Whipps Cross University Hospital | Quality Accounts 2010/2011Using enhanced recovery techniquesto bring benefits for surgical patientsIn our 2009/10 Quality Accounts,we reported on how we were usingenhanced recovery techniques to helppatients recover faster from majorsurgery and spend less time in thehospital after their operation.Enhanced recovery involves a seriesof interventions which have a biggerimpact on a patient’s recovery whenthey are used together, including:• Working with colleagues in primarycare to maximise the patient’shealth before their surgery.• Advising the patient about issuessuch as physiotherapy and stomacare (an artificial opening in theabdomen to collect waste) so thatthey are fully informed beforetheir operation.• Helping the patient makeinformed decisions about theircare and ensuring they knowwhat to expect.• Admission on day of surgery.• Increasing the patient’sconsumption of carbohydratesbefore surgery and avoidingdehydration after surgery.• Using short-acting anaesthetic drugs.• Removing equipment such ascatheters and intravenous lines assoon as possible after surgery.• Planning the patient’s dischargedate with them in advance of theirsurgery.Clinical staff at Whipps Cross originallyworked to introduce enhanced recoverytechniques for patients having surgery forcolorectal cancer. This work involvedstaff from many different disciplines,including dieticians, physiotherapists,occupational therapists, specialistnurses, ward staff, surgeons, theatrestaff and anaesthetists.By combining enhanced recovery withadvanced keyhole surgical techniques,the colorectal team were able toreduce our average length of stayfrom 11.6 days in 2008/09 to 6.1 daysin 2009/10 for patients undergoingcolectomy operations (where a diseasedsection of bowel is removed and thehealthy bowel reconnected).Healthcare for London’s Cancer Services– Case For Change report, publishedin March 2010, showed that WhippsCross performed 55% of colectomiesusing keyhole techniques, against anational average of 30%. This is thesecond highest percentage rate of allLondon hospitals who carry out thistype of surgery.• An emphasis on managing lengthof stay rather than beds, whichhelps the Trust make more effectiveand efficient use of its bed capacity.• Identifying gaps in the serviceswhich support surgical patients,which can then be addressed.• Improved documentation andpatient education which encouragespatients to manage their ownsymptoms.• Improved communications betweendifferent specialities within the Trust.In December 2010, the Trust’scommitment to enhanced recoverywas recognised during an official visitfrom Professor Sir Bruce Keogh, theNHS Medical Director, Celia InghamClarke, National Clinical Lead forCancer Service Improvement and MattTagney, Deputy Director of the Quality,Innovation, Productivity and Prevention(QIPP) team at the Department of Health.• Using keyhole surgery techniqueswhen possible.• Minimal or no use of drains/tubeswhere there is no supportingevidence.• Getting the patient out of bedand moving around more quicklyafter surgery.Key benefits and achievements fromusing enhanced recovery techniques atWhipps Cross include:• Reducing mortality and morbidityrates.• Shorter length of stay.• Improved quality of care for patientsand a fulfilled patient experience.“In December 2010, the Trust’scommitment to enhanced recoverywas recognised during an officialvisit from Professor Sir Bruce Keogh,the NHS Medical Director”Also in December, Trust staff presentedat a King’s Fund event which helpedto promote the benefits, achievementsand approaches to enhanced recoveryat different hospitals.In February 2011, the colorectal teamparticipated in a masterclass withthe NHS London Enhanced RecoveryPartnership Programme. We are alsoplanning to host an enhanced recoverylaunch day later in 2011, promotingthe quality of patient care which thesetechniques can bring.The colorectal team’s approach hasnow been formalised as an EnhancedRecovery Programme (ERP) which isbeing extended to other areas of surgery.

Whipps Cross University Hospital | Quality Accounts 2010/2011 37Patients undergoing operationsincluding hysterectomies, bladderand prostate resections and hip andknee replacements are now starting tobenefit.Treating cancer patients in a timelyfashionWhipps Cross works hard to ensurethat all patients with a suspectedcancer are reviewed and treated asquickly as possible. This helps us toprovide treatment as soon as a cancerhas been identified, and also helpsto reduce the length of time that apatient has to wait for a definitiveanswer on their condition and theanxiety that this can understandablycause.We are required to meet two nationallyset targets for cancer treatment:• 85% of patients who are referredto us by their GP with a suspectedurgent cancer must receive theirfirst definitive treatment within 62days of that referral. Definitivetreatment can include any appropriatetreatment for a patient’s particularcondition, including hormonetherapy, radiotherapy, chemotherapyor surgery.• All patients who are assessed by aclinician - either as part of a routineappointment or an attendance inour Emergency Department - whoare then found to have a cancermust receive their first definitivetreatment within 31 days of thecancer being identified.Historically, we have not consistentlymet the 62 day target, mainly becauseof data quality and submission problems.However, improvements in our systemsand processes over the last two yearsmean that we achieved the target forall applicable patients in 2010/11. Wealso achieved the 31 day target for allbut one applicable patient in 2010/11.During 2010/11, we further strengthenedour cancer management systemsby adopting the Somerset DataCancer Registry, which is used by NHSTrusts to manage patient pathways. Thissystem brings considerable clinical andadministrative benefits to the Trustand ultimately to patient care. TheSomerset Registry also allows Truststo upload information directly fromits database into the national OpenExeter cancer database, which enablesTrusts to share information with otherorganisations, including GPs.We are currently using the systemto track patients through the cancerpathway and are now starting to useit to record clinical information onthese patients. However, we aim toimplement the system in full during2011/12.Cancer patients’ information ismaintained and monitored throughthe Patient Tracking List (PTL)spreadsheet. Improvements were madeto recording and reporting systemsduring 2010/11, as recognised in aninternal audit reported to the Board inlate 2010.The data recording system will befurther strengthened by the fullimplementation of the Somerset systemwhich will address any outstandingissues with data input and quality.Child Health – using survey resultsto improve care and environmentalstandardsWhipps Cross provides a wide range ofhealthcare services for local children,including emergency surgical andmedical admissions for generalconditions, day case surgery(including ear nose and throat, urologyand general surgery) a medical dayunit for children who requiretreatments such as blood transfusionsor dressing changes, a full range ofdiagnostic services including CT andMRI scans, and outpatientappointments for the diagnosis andreview of new and existing conditions.With the Patient Experience Revolutionnow embedded in services across theTrust, the paediatrics team were alsokeen to seek the views of patients andfamilies to ensure that the experienceof paediatric patients is consistent withthat across the rest of the hospital.It is traditionally more difficult to obtainfeedback from children and adolescentsand to gain a true reflection of theirviews, so we asked the Picker Instituteto undertake a paediatric patientsatisfaction survey during 2010 inorder to set a benchmark for standardsand improvements.Although a survey was carried out inthis area in 2004 (the last time thatTrusts had been required to take partin a compulsory survey for paediatrics),no formal local or national exercisehad been run in the meantime.The survey was conducted amongstchildren and adolescents and theirfamilies who were cared for at WhippsCross during May 2010.Feedback from patients and familiescentred mostly on the environmentand facilities, communication andensuring that patients and theirfamilies feel fully informed about theirtreatment, and the process fordischarging patients when they areready to go home.An action plan is now in place, ledby the Lead Nurse for Paediatrics, toensure that improvements identified inthe survey are made. The action planincludes the following points:• Improve general cleanliness withparticular attention to bathrooms/shower rooms and toilets - a newdomestic team is already in placefor paediatrics with noticeableimprovements, including a “good”rating following a PEAT (PatientEnvironmental Action Team)inspection in January 2011.• Improve signage and informationto ensure patients and visitors areaware of the facilities available forthem on the paediatric unit – postersare already in place by each inpatientbed to help improve awareness ofbasic information.• Improve admission information

38 Whipps Cross University Hospital | Quality Accounts 2010/2011so that parents are fully aware ofimportant safety information,particularly around security and fireprocedures.• Review of the food on AcornWard with the Trust NutritionAction Group.• Install CCTV in the main corridorsto improve safety and communication.• Develop a nursing/child/parentcommunication standard to ensurepatients and families are fullyaware of treatment being provided.• Develop a strategy to involve patientsand their families in making decisionsabout their treatment and care andthe options available to them.• Review and further embed the“hourly rounding” concept (whichis used on our adult wards to ensurethat patient safety, comfort andconcerns are monitored throughoutthe day) and adopt a more meaningfultool for use with children.• Review doctors’ ward rounds anddevelop a consistent multi-disciplinaryapproach for all patients.• Reduce time between the decisionbeing given that a patient can gohome and their actual discharge.• Improve communication aroundthe timing of patients’ discharge• Monitor use of the Trust’selectronic discharge process.• Review the information which isgiven to patients on discharge, andprovide each patient with generalinformation and advice followingdischarge.Supporting statementsfrom our local partnersAll NHS Trusts who provide QualityAccounts are required to submit theirdraft Accounts to local partnerorganisations for comment. WhippsCross sent a copy of its QualityAccounts to the following local partnerorganisations for their comments on 6May 2011.• NHS Outer North East London(ONEL) cluster of Primary Care Trusts.• NHS West Essex.• Whipps Cross University HospitalNHS Trust Staff Side.• Outer North East London Joint HealthOverview and Scrutiny Committee.• Whipps Cross Hospital’s Patients Panel.• Waltham Forest Local InvolvementNetwork (LINk).• Redbridge Local InvolvementNetwork (LINk).Each partner organisation was askedto comment on the content of theaccounts by 3 June 2011, including:• Stating whether the Accounts are afair reflection of the healthcareservices and activities provided bythe Trust over the 2010/11 year;• Highlighting any areas where theyfelt changes were required.• Providing a summary statement oftheir opinion on the Accounts.A summary of each organisation’sresponse follows, together with a list of“We are particularly impressed with theeffort the trust is making to improvepatient experience and the systems ithas put in place to successfully avertthe threat of a major Norovirusoutbreak” NHS ONELthe key changes the Trust has made tothe Accounts to reflect these responses.Dr Jane Moore,Director of Public HealthNHS Outer North East London (ONEL)NHS Outer North East London Cluster,on behalf of the cluster PCTs and allNHS Commissioners in London, hasreviewed the draft Quality Account for2010/11.We consider that the document containsaccurate information in relation to theservices provided by Whipps CrossUniversity Hospital.Overall the Quality Account providesan open and honest account of thequality improvements the trust wasable to achieve during 2010/11 andthose which it did not. We would liketo know what additional and specificactions the trust will take in 2011/12to improve those areas where it didnot achieve the aspired improvements.We are particularly impressed with theeffort the trust is making to improvepatient experience and the systems ithas put in place to successfully avertthe threat of a major Norovirusoutbreak which had led to temporaryhospital closure last year. We welcomethe Trust’s continuous focus onimproving the patient experiencethrough the patient revolutionprogramme and the plans to extendthis to improving the experience ofstaff.However, it is disappointing to seethat the initiatives have not had asignificant impact on the outcomeof improving patient experience atWhipps Cross as demonstrated in theresults of the in-patient survey during2010-2011.An improvement in quality ofmaternity services, care of the elderlyand emergency care would synergiseimprovement in patient experience.Therefore in 2011/12 we would likethe Trust to have a focus on improvingquality of maternity services, care

Whipps Cross University Hospital | Quality Accounts 2010/2011 39of the elderly and emergency careand measure the improvement withoutcome indicators which would beeffortlessly understood by patients andtheir carers.NHS West EssexClare Morris - Deputy Chief Executive“The aim of increasing the number ofstaff who feel valued by colleagueswill have a positive impact on patientexperience.” NHS West EssexNHS West Essex welcomes the opportunityto respond to the QualityAccount presented by Whipps CrossUniversity Hospital. We believe thatthe Account demonstrates the Board’saccountability for the quality measureswithin the organisation.We agree with the four identifiedpriorities and are impressed once againthis year with the wide range of localcommunity groups who were involvedwith consulting and agreeing on thekey priorities for improvement.Statement of Assurance Priorities forImprovement 11/12Priority One: Patient ExperienceThe PCT is encouraged to know thatthey are being responsive to thelistening events and the “In YourShoes” exercise with the aim ofimproving the patient experience. Wesupport the fact that the Trust haschosen to continue to keep PatientExperience as a priority for 2011/12.NHS West Essex would welcome workingwith the Trust in improving patientinvolvement supporting the focus onthe population living in West Essexwho use the services at Whipps Cross.Priority Two: Clinical EffectivenessThe PCT welcomes the identifiedpriority to improve the End of LifeCare pathway. This will provide furtheropportunities to work collaborativelywith our GPs and local communityservices supporting preferred prioritiesof care at the end of life.Priority Three: Patient SafetyWe welcome that the Trust hasacknowledged the need for prioritisingVTE risk assessments. We note thata series of existing measures are inplace to prevent VTEs and the PCT willbe keen to review the monthly auditresults and will seek assurance thatthe target of 90% is met on an agreedtrajectory throughout the year.Priority Four: Staff ExperienceThe PCT is encouraged to see that theTrust has taken note of the NationalStaff Survey for 2010 acknowledgingthe link between staff motivation andthe standard of care delivered.The aim of increasing the number ofstaff who feel valued by colleagueswill have a positive impact on thepatient experience. NHS West Essex iskeen to monitor the outcomes of thekey activities reflected in the QualityAccount.Whipps Cross University HospitalNHS Trust Staff Side unionsCharlotte Monro, Staff Side Co-Chair(UNISON)Staff Side welcomes the opportunity torespond to this year’s Quality Accounts.They are written in a way that explainsthe issues clearly. We support thepatient and clinical priorities identifiedfor 2011/12, and will continue tocontribute in our various capacitiesto achieving these. In particular wewelcome the commitment to improvestaff experience, Priority 4. It is on thispriority we wish to comment.We appreciate the Trust’sacknowledgement of its failure toachieve the 2010/11 staff experienceimprovement priority to reduce theincidence of bullying and harassment.But this failure is of great concern andwe consider achieving this targetimprovement in 2011/12 must bea priority, along with improving theother areas of particularly poorperformance (shown in the staffsurvey) compared to other Trusts. Thismay be a more challenging butperhaps more urgent target to prioritise?The actions identified to achieve Priority4 are welcomed and are also part ofaddressing the above. Staff Side havebeen involved in discussing anddeveloping these and will continue tocontribute actively to this work. Thestaff Dignity at Work Charter will be akey step and needs to have the widestpossible consultation and involvementof staff in developing it.All the other actions identified are inthe category either of informationgathering / sharing and understandingthe problems, or of planning, most ofthese actions are already well underway by now. We would wish to see inthis year (2011/12) actions to implementthe changes required and begin toembed these into the organisation.We would expect such actions toinclude for example:• Training provided to managers thatwill enable them to play their keyrole in changes to address the keyproblems identified in the staffsurvey.• Review of policies and proceduresand their implementation to ensurethey are supporting the changesrequired and in line with the staffdignity at work charter.If concrete measures to implementchanges to awareness, understandingethos and practice are not implementedduring this year we believe last year’sfailure to achieve the key improvementsin staff experience we so much needmay be repeated.

40 Whipps Cross University Hospital | Quality Accounts 2010/2011Anthony ClementsClerk to the Outer North EastLondon Joint HealthOverview and Scrutiny CommitteeI am writing on behalf of the OuterNorth East London Joint HealthOverview and Scrutiny Committee.The Committee has now reviewed theTrust’s Quality Account document andthanks you for the opportunity to dothis. The Committee however has nodirect comments on the QualityAccount at this time.Colin Anderson BEMChair, Patients’ PanelWhipps Cross University HospitalNHS TrustThe Patients’ Panel are a group ofvolunteers that are unique to WhippsCross University Hospital. They have aremit of seeking the views of patients,carers, local community groups andthe general public. The Panel plays avery active part in ensuring that theviews of patients are represented andacts as ‘critical friends’ of the hospitalin order to improve the patientexperience.Many of our members have taken partin the ‘In Your Shoes’ project discussionsleading to the Patient ExperienceRevolution which has been recognisedby the NHS for improving the patientexperience within Whipps CrossHospital. Much of this work seeks tohighlight areas that cause concerni.e. the nutritional needs of patients;the closing at night of the PaediatricA & E for example, areas that requireattention and improvement. It alsoidentifies areas of excellence which thehospital has achieved and can be trulyproud of. This work is a continuingprocess throughout the departmentsand wards at this hospital.We are pleased to see and note therolling out of the Patient ExperienceRevolution in Women’s Health andMaternity Services. Listening to patientsand noting their concerns will helpconsiderably to improve the way inwhich these very busy departmentsoperate.Our members very much appreciatedthe opportunity to comment andrespond to the first set of QualityAccounts presented by this Trust for2009/2010 and are now pleased to dothe same for the 2010/2011 Accounts.Members have also taken part in theselection process for the priorities forthis year which are as follows:-Priority 1: Patient ExperienceAs a group we feel that it is veryimportant that patients are involved inall decisions about treatment and careat this hospital. This process willinevitably lead to a better understandingof patient needs, patient satisfactionand confidence with the staff treatingthem.Priority 2: Clinical EffectivenessIt is essential for the patients who fallinto this category, that they areidentified early and placed on an endof life care pathway so that they aretreated with care, dignity andcompassion. This is a very importantpriority for these patients and for theirrelatives.Priority 3: Patient SafetyPreviously venous thromboembolism(VTE) risk assessment process has beenrelatively low key. However, with thenew procedures in place led by thePatient Safety Management Team andthe priority that all patients areassessed on admission to hospital willhelp to identify those who requirepreventative treatment. Our membersare very pleased to see this highlightedand look forward to seeing a considerableimprovement during this year.Priority 4: Staff ExperienceWe feel that it is extremely importantto increase the number of staff whofeel valued by their work colleagues.This is a very important aspect as itgreatly improves staff morale, makesfor a happier and more productivework place that will help improvethe patient care pathway. The annualEmployee of the Year awards togetherwith the Nurse, Midwifery andSupport Worker awards recogniseexcellence and commitment andsupport this process.Our members are pleased to note thatInfection Prevention and Controlcontinues to play an important andsignificant role within the hospitalwhich has one of the lowest numberof hospital acquired MRSA infectionrates in the country. The Clostridiumdifficile infection rate has also beenkept lower than most other acutehospitals, both in London and nationally.This is an excellent achievement.Early in 2010 members of the Patients’Panel took part in a presentation fromthe Histopathology Departmentexplaining ‘Lean Methodology’ andtheir aims to improve the turnaroundtimes for examining specimens.“We are pleased to see and note therolling out of the Patient ExperienceRevolution in Women’s Health andMaternity Services. By listening topatients and noting their concerns willhelp considerably to improve the wayin which these very busy departmentsoperate” Patients panel

Whipps Cross University Hospital | Quality Accounts 2010/2011 41We are very pleased to note thesuccess of this project. The fasterturnaround times have ablydemonstrated the good team workof this department which has resultedin improved benefits for patients andservice users.As a patient and user group we arepleased to note the changes in theEmergency Care Pathway that will helpto ensure that patients receive a newRapid Assessment by an experiencedteam followed by excellent care at alltimes. We are also pleased to see theefforts that are being taken to improvethe ambulance turnaround times inthis very busy Emergency Department.Child Health Care is another importantarea for the hospital and we arepleased to see and note the results ofthe Picker Institute survey of paediatricpatients and the action plans that havebeen put in place to improve services.The Quality Accounts for 2010/2011present a thorough overview ofthe considerable work that is beingundertaken at the hospital to improveservices and to improve the patientexperience. Our Panel members valuebeing involved with the hospital andbeing consulted in the decision makingprocess. We continue to look forwardto working closely with the Managementand Staff at Whipps Cross.

42 Whipps Cross University Hospital | Quality Accounts 2010/2011Key changes made to the Accounts to reflect responsesfrom partner organisationsWhipps Cross acknowledges and appreciates written statementsand responses received from our local partner organisations.As a result of the feedback received, the Trust has made thefollowing changes to the Accounts:• Added additional information on how we learn frompatient feedback, complaints and incidents to makeimprovements to the review of performance against ourPatient Experience priority on page 11.• Added specific details of our work with partners toimprove safeguarding of children and adults on page 21and 22.• Added information that clarifies how we will deal withCQUIN targets not met in 2010/2011 on page 22.• Added clarification to the graph on page 34 regardingspecimen testing and deleted an additional graphicincluded in a draft version, as this was not found to beuseful or easy to understand.• Underlined our commitment to reducing incidencies ofbullying and harassment of staff, and to consultwidely on a new Dignity at Work charter (page 9).Further information:For further information about our Quality Accounts and ourcommitment to quality improvements, email:qualityaccounts@whippsx.nhs.ukOr write to:Miss Susan Osborne CBE, Director of Nursing and Qualityat the address below:Whipps Cross University HospitalWhipps Cross RoadLeytonstoneLondon E11 1NRTel. 020 8539 5522www.whippsx.nhs.uk

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