THE Trust that runs Grimsby's Diana, Princess of Wales Hospital has been placed into special measures by the Government.
Health Secretary Jeremy Hunt made the announcement in the Commons this afternoon following an inquiry into higher than expected hospital deaths.
It means the work of the Northern Lincolnshire and Goole Hospitals Trust, and 10 others found to have serious shortcomings, will come under intense scrutiny in a bid to improve performance.
Mr Hunt said: "For these 11 trusts, special measures means each hospital will be required to implement the recommendations of the Keogh review and external teams will be sent in to help them do this.
"Progress will be tracked and made public."
Mr Hunt said the hospitals in question would be partnered with high-performing NHS organisations in a further bid to improve standards.
Some of the key points from the full report- which can be read here - include:Governance and LeadershipOverview The two key lines of enquiry in the area of governance and leadership were focussed on the governance processes for assuring the quality of treatment and care, including the use of information locally. The panel sought to gain assurance that data was used to drive clinical improvements and raise the overall quality of the patient experience. The effectiveness of governance and leadership was assessed by reviewing documentation supporting key governance processes and through interviews with key senior managers and leaders, including Non-Executive Directors and Governors. The panel also spoke to staff in different settings and observed conditions in clinical areas to understand whether there was effective Board to ward communication and quality assurance. Interviews and observations were also used to test and challenge the effective implementation of strategies and initiatives.Summary of findings The following good practice was identified: - Recent establishment of a Mortality Performance Committee (replacing the Mortality Task Group which was established November 2011) to identify areas for improvement in order to reduce or minimise excess and avoidable mortality where relevant. - Good visibility of the Chief Executive and Chief Nurse. - Good examples of strategic documents produced by the Chief Nurse regarding nursing and patient experience strategy. The following areas of concern were identified: - A lack of senior clinical leadership in relation to clinical issues. - Lack of sufficient implementation of clinical strategies. Data reporting and governance processes are in place, but there was little evidence of data being used to drive widespread clinical change. Implementation of key strategies and initiatives requires an added sense of urgency, alongside demonstrable leadership skills and change management. - A disconnect between the Board and clinical staff. Many clinicians were unclear about the discussions around mortality, or the existence of the mortality groups and the recommendations coming from them. The Board communicates with staff, but does not fully engage them in development and discussion of key initiatives and clinical strategies; this applies in particular to senior medical staff. - More needs to be done to focus on the quality agenda throughout the organisation. There was a lack of transparency regarding the process whereby the tension between achievement of targets and quality of care is resolved. - Initial reluctance to accept the mortality problem, leading to delays in improvement.Clinical and Operational EffectivenessOverview The panel explored a key line of enquiry for clinical and operational effectiveness covering the processes the Trust uses to monitor and address clinical and operational performance data. In particular, the panel sought to ascertain the steps the Trust is taking to improve mortality performance, with a focus on general medicine and respiratory diseases, stroke, diabetes and overall care of the elderly. A second key line of enquiry for this area addressed the consistency between sites. As for the review of other aspects of governance and leadership, the panel used a combination of documentation and data review, interviews and observations.Summary of findings The following good practice was identified: - Recent implementation of the National EarlyWarning Scores (NEWS) for monitoring patients. - Improvements made during 2013 in stroke care at Scunthorpe General Hospital. - Piloting of a new hydration system for patients which aims to decrease the risk of dehydration and therefore improve fluid balances. - Initiatives being implemented by Diagnostics, including seven day working. - Out of hours outreach service at Grimsby led by senior nurses responding promptly to ward demands. - Matrons with designated role for quality covering three sites. The following areas of concern were identified: - Poor patient flow management, multiple bed moves and poor management of outliers, particularly at the Diana, Princess of Wales Hospital. - Concerns relating to capacity and flow of patients in Accident and Emergency, and the impact on patient safety. - Lack of senior medical involvement out-of-hours which is expected to result in lower standards of care and delayed discharges in emergency and acute medicine. - Lack of consistency across and within sites in the implementation of pathways that would reduce mortality. - Concerns over the approach to medical handovers. - Examples of poor standards of clinical documentation.Patient ExperienceOverview The panel focused on how the Trust engages with patients, families and carers, and understands and responds to patient feedback. This area was addressed through discussions with patients and staff during ward observations and at the public listening events, together with reviewing Board and ward level information on patient experience.Summary of findings The following good practice was identified: - Patients expressed loyalty towards their local hospital. - The panel received positive feedback about the care received across a number of the Trust's wards. The following areas of concern were identified: - The Trust is using interpretations of the single sex accommodation standards in certain areas which are no longer deemed acceptable. This panel considered that this is compromising patients' dignity in these areas. - Concerns regarding hydration and nutrition. - Concerns over the use of the Liverpool Care Pathway in some parts of the Trust. This was highlighted specifically by feedback from the public which highlighted concerns over use of the Liverpool Care Pathway without appropriate consultation with patients or relatives. However, from discussions with staff, the pathway appeared to be well-implemented in Goole. - Patients who, whilst happy with the level of care, felt that the nursing staff were too busy to help in moments of need. - Gaps in communication with patients and families, for example due to delayed surgeries and multiple patient moves. - Patient concerns over the number of times they were moved during their stay in hospital, as well as discharge processes. - The panel identified that appointments for surgeries, particularly elective, were delayed and cancelled with poor levels of communication between staff and patients of why this had happened. - Process of responding to complaints which is seen by patients as inaccessible and slow. - Lack of accommodation for families.
254 'excess deaths' at northern Lincolnshire hospitals
Some of the key points from the full report- which can be read here - include:Governance and LeadershipOverview The two key lines of enquiry in the area of governance and leadership were focussed on the governance processes for assuring the quality of treatment and care, including the use of information locally. The panel sought to gain assurance that data was used to drive clinical improvements and raise the overall quality of the patient experience. The effectiveness of governance and leadership was assessed by reviewing documentation supporting key governance processes and through interviews with key senior managers and leaders, including Non-Executive Directors and Governors. The panel also spoke to staff in different settings and observed conditions in clinical areas to understand whether there was effective Board to ward communication and quality assurance. Interviews and observations were also used to test and challenge the effective implementation of strategies and initiatives.Summary of findings The following good practice was identified: - Recent establishment of a Mortality Performance Committee (replacing the Mortality Task Group which was established November 2011) to identify areas for improvement in order to reduce or minimise excess and avoidable mortality where relevant. - Good visibility of the Chief Executive and Chief Nurse. - Good examples of strategic documents produced by the Chief Nurse regarding nursing and patient experience strategy. The following areas of concern were identified: - A lack of senior clinical leadership in relation to clinical issues. - Lack of sufficient implementation of clinical strategies. Data reporting and governance processes are in place, but there was little evidence of data being used to drive widespread clinical change. Implementation of key strategies and initiatives requires an added sense of urgency, alongside demonstrable leadership skills and change management. - A disconnect between the Board and clinical staff. Many clinicians were unclear about the discussions around mortality, or the existence of the mortality groups and the recommendations coming from them. The Board communicates with staff, but does not fully engage them in development and discussion of key initiatives and clinical strategies; this applies in particular to senior medical staff. - More needs to be done to focus on the quality agenda throughout the organisation. There was a lack of transparency regarding the process whereby the tension between achievement of targets and quality of care is resolved. - Initial reluctance to accept the mortality problem, leading to delays in improvement.Clinical and Operational EffectivenessOverview The panel explored a key line of enquiry for clinical and operational effectiveness covering the processes the Trust uses to monitor and address clinical and operational performance data. In particular, the panel sought to ascertain the steps the Trust is taking to improve mortality performance, with a focus on general medicine and respiratory diseases, stroke, diabetes and overall care of the elderly. A second key line of enquiry for this area addressed the consistency between sites. As for the review of other aspects of governance and leadership, the panel used a combination of documentation and data review, interviews and observations.Summary of findings The following good practice was identified: - Recent implementation of the National EarlyWarning Scores (NEWS) for monitoring patients. - Improvements made during 2013 in stroke care at Scunthorpe General Hospital. - Piloting of a new hydration system for patients which aims to decrease the risk of dehydration and therefore improve fluid balances. - Initiatives being implemented by Diagnostics, including seven day working. - Out of hours outreach service at Grimsby led by senior nurses responding promptly to ward demands. - Matrons with designated role for quality covering three sites. The following areas of concern were identified: - Poor patient flow management, multiple bed moves and poor management of outliers, particularly at the Diana, Princess of Wales Hospital. - Concerns relating to capacity and flow of patients in Accident and Emergency, and the impact on patient safety. - Lack of senior medical involvement out-of-hours which is expected to result in lower standards of care and delayed discharges in emergency and acute medicine. - Lack of consistency across and within sites in the implementation of pathways that would reduce mortality. - Concerns over the approach to medical handovers. - Examples of poor standards of clinical documentation.Patient ExperienceOverview The panel focused on how the Trust engages with patients, families and carers, and understands and responds to patient feedback. This area was addressed through discussions with patients and staff during ward observations and at the public listening events, together with reviewing Board and ward level information on patient experience.Summary of findings The following good practice was identified: - Patients expressed loyalty towards their local hospital. - The panel received positive feedback about the care received across a number of the Trust's wards. The following areas of concern were identified: - The Trust is using interpretations of the single sex accommodation standards in certain areas which are no longer deemed acceptable. This panel considered that this is compromising patients' dignity in these areas. - Concerns regarding hydration and nutrition. - Concerns over the use of the Liverpool Care Pathway in some parts of the Trust. This was highlighted specifically by feedback from the public which highlighted concerns over use of the Liverpool Care Pathway without appropriate consultation with patients or relatives. However, from discussions with staff, the pathway appeared to be well-implemented in Goole. - Patients who, whilst happy with the level of care, felt that the nursing staff were too busy to help in moments of need. - Gaps in communication with patients and families, for example due to delayed surgeries and multiple patient moves. - Patient concerns over the number of times they were moved during their stay in hospital, as well as discharge processes. - The panel identified that appointments for surgeries, particularly elective, were delayed and cancelled with poor levels of communication between staff and patients of why this had happened. - Process of responding to complaints which is seen by patients as inaccessible and slow. - Lack of accommodation for families.
254 'excess deaths' at northern Lincolnshire hospitals
