Annual Review 2013/14

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Introduction

Dorset County Hospital NHS Foundation Trust has completed another challenging but successful year. High demand for our hospital services continued and we are treating more patients who are acutely unwell, frail and elderly. Caring for patients with dementia presents special issues. Overall, we have continued to meet quality standards and targets. Meeting the emergency access target has been challenging but we

achieved three out of four quarters. The Board recognised Clostridium difficile infections as a risk and we finished the year with 22 cases. There was one case of MRSA. You can find out more about infection prevention and control in the operational and quality sections of this review.

An unannounced inspection by the Care Quality Commission (CQC) in June and July identified a number of non-compliant areas and these are being addressed. Documentation is a weakness, complicated by the combined use of electronic (VitalPAC) and manual systems. Achieving timely discharge of patients has been an increasing problem but we are working on this issue internally and with our external partners. Everyone has worked hard to deliver a surplus for the year of £1.5million and we have maintained a continuity of service risk rating of 4 and a green governance rating. We have great facilities but, over 2013/14, the Board invested a further £2.7million. Our Endoscopy Suite was upgraded and the Pre-

Assessment and Surgical Admissions areas were improved. New disinfection/washer units were installed in the Sterile Services Department and a new aseptic unit was built within pharmacy. There was also £150,000 worth of replacement engineering plant. We invested £3million in new and replacement equipment including £105,000 on new beds and £360,000 on new endoscopy decontamination equipment. We also installed new Electro Cardio Graph (ECG) monitors, new ultrasounds and theatre microscopes. We pride ourselves on the quality of care we give to patients and their families but the Francis Report was a reminder that we can never be complacent. Patient feedback and the Friends and Family Test gave

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us much to feel proud about and our goal remains to provide outstanding and safe patient care. The Board’s response to the Francis Report was to set up a non-executive-led staff group which reviewed the recommendations and identified what could be improved at our Trust. Our task for the coming year is to implement the recommendations. We have invested in improving leadership skills in the organisation with an internal leadership programme and 21 staff are completing external leadership academy programmes. The hospital continues to be strongly supported by the local community and charities including the Friends of Dorset County Hospital, the Dorset Health Trust, the Fortuneswell Trust, the Dorset Kidney Fund, the National Leukaemia Fund UK and Macmillan. We thank every organisation and every individual who has contributed to this year’s success. There were many high points throughout the year and many are highlighted in this report. We were delighted to win the CHKS Top Hospital Programme Quality of Care Award 2013. The Top Hospital Awards celebrate the success of healthcare providers across the UK and are given to acute organisations for their achievements in healthcare quality and improvement. We were also pleased to be placed in the

lowest risk rating band by the CQC who take into account over 150 quality and safety indicators to determine the ratings. Our hip replacement service was rated the best in the country according to data about how well patients recover following surgery. Patient Reported Outcome Measures (PROMs) is an NHS initiative, which asks patients about their health and quality of life before and after surgery. We have the best scores in the country for hip replacement when compared with other hospitals and specialist centres. We successfully bid to be a pilot site for providing seven day services. Our first Hospital Open Day proved a great success with hundreds of visitors coming along for tours of departments, demonstrations, displays and hands-on activities. This is an event we will repeat next year as it provides our community with an opportunity to see their hospital in action. The composition of the Board changed this year with the departure of two Non-Executive Directors: Mr Peter Knell and Dr Peter Camm and the appointment of two new Non-Executive Directors: Professor Martin Earwicker and Mr Graeme Stanley. Director of Human Resources Mr Mark Power left the Trust in February and a replacement is being sought.

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We are really proud of this hospital and its staff and we are grateful for the support given by partner organisations, the Dorset Clinical Commissioning Group, Dorset County Council, charitable trusts and the local community. We are also grateful for the support and contribution provided by the Council of Governors.

As we move through a time of great change and uncertain times in the NHS, it is the commitment and dedication of all our stakeholders that allows us to make progress. The year ahead will be even more challenging but our track record of success gives us the confidence to manage the issues we face.

Dr Jeffrey Ellwood Chairman

Jean O’Callaghan Chief Executive

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The main Dorset County Hospital site is situated close to the centre of the county town of Dorchester. It opened in 1987 and is a modern, attractive 365 bed hospital.

The geographical spread of the community the Trust serves requires it to deliver community based services. This is achieved through an extensive network of community hospitals. The Trust provides the following services for patients: • Full Emergency Department

services for major and minor accidents and trauma;

• Emergency assessment and

treatment services, including critical care (the hospital has trauma unit status);

• Acute and elective (planned) surgery and medical treatments, such as day surgery and endoscopy, outpatient services, services for older people, acute stroke care, cancer services and pharmacy services;

• Comprehensive maternity services including a midwife-led birthing service, community midwifery support, antenatal care, postnatal care and home births. We have a Special Care Baby Unit;

• Children’s services, including emergency assessment, inpatient and outpatient services;

• Diagnostic services such as fully accredited pathology, liquid based cytology, CT scanning, MRI scanning, ultrasound, cardiac angiography and interventional radiology;

• Renal services to all of Dorset and parts of Somerset;

Operational Review

Dorset County Hospital NHS Foundation Trust is the main provider of acute hospital care to the residents of West Dorset, North Dorset, Weymouth and Portland, a population of approximately 215,000. We also provide specialist services to the whole of Dorset and beyond including renal services in Bournemouth and Poole, and South Somerset. We serve an area with a higher than average elderly population and lower than average proportion of school aged children. Dorset continues to experience an increasing total population.

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• A wide range of therapy services, including physiotherapy, occupational therapy and dietetics;

• An integrated service with social services to provide a virtual ward enabling patients to be treated in their own homes.

Activity Levels Here we give you an outline of the volume of inpatient, outpatient and Emergency Department (ED) activity that the Trust has experienced over the last two years. Total inpatient spells in 2013/14 increased by 2.0% to 107,000. This was due to an increase of 7.5% in non-elective inpatient cases. Elective inpatient spells decreased by 5% in 2013/14. This reduction was focused on a small number of specialties. General Surgery in particular saw a small decrease following the implementation of a more comprehensive system for managing surgical emergency admissions. With new processes now embedded elective activity levels are expected to rise in 2014/15 to those in previous years. Significant increases have been seen in specialties such as dermatology and ophthalmology following new consultant appointments and the subsequent increases in GP referrals. Service development plans in these areas have improved the quality of service offered and further developments are planned in the coming year to improve access to both outpatient and inpatient treatments.

The Trust dealt with 291,300 outpatient attendances in 2013/14, an increase of 1% compared to 2012/13. Outpatient procedures performed increased by 5%. This reflects the aim to improve patient experience and access by supporting patients to have minor procedures at the time of their outpatient appointment as opposed to returning for treatment. Emergency Department average daily attendances decreased to 112 per day in 2013/14 (2012/13: 114 per day).

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However, this masks significant variations in demand, with peak demand occurring in the second quarter of each year as a result of the large number of tourists visiting the area. The Trust experienced record ED attendances in Q2 2013/14. The overall reduction in ED attendances was due to reduced demand in the last quarter of the year. The Trust has taken a number of steps in cooperation with local health and social care partners to reduce emergency demand during the winter. This has included strengthening assessment processes, which reduces unnecessary attendances. Performance against Access Targets The Trust has again performed well against national targets. The Trust has consistently met the 18 week referral to treatment standards for both admitted and non-admitted pathways, improving access to services. Despite challenges around the length of stay for emergency patients, leading to high bed occupancy levels, the Trust

achieved the four hour emergency access standard in three of the four quarters of 2013/14. ‘Hospital at Home’ During the winter of 2013/14, the Trust started piloting a new service. Having recognised that many emergency readmissions and delays with discharges could be avoided if appropriate community services were available, the Trust has worked closely with GPs and local authority colleagues to develop a new service model. This new service has two key components. The first is a hospital at home service where patients can receive hospital treatment at home once assessed by a consultant at the hospital. Patients are supported at home by a multidisciplinary team and are discharged back to the care of their GP when appropriate. This service has not only prevented unnecessary hospital admissions, it has also enabled frail and elderly patients to remain at home and receive specialist care. The second is a home based assessment of long-term care needs. This assessment has previously been carried out in hospital.

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The result of these assessments being carried out in the patient’s home has been fewer placements in residential care. Providing a support package has enabled more patients to retain their independence at home for much longer. Cancer Services Performance against national cancer waiting time standards has remained consistently high, with all standards being achieved in each quarter of the year. Our mortality rates for patients diagnosed with cancer continue to be amongst the lowest in the country. The Trust has benefited from the support of The Fortuneswell Trust, Macmillan and the National Leukaemia Fund UK, which have provided funding for additional cancer nurse specialists in colorectal and upper gastrointestinal services. Funding has also been provided to improve facilities to enable some patients with leukaemia to be treated closer to home.

Dementia The delivery of high quality care for patients with dementia remains a key priority for the Trust. The work programme has been further strengthened during the year to ensure we meet recently published NICE Quality Standards for Dementia. There has been an increased focus on early diagnosis and improving the experience of both patients and their carers. A significant number of clinical staff have now undertaken comprehensive training in the treatment of patients with dementia and this will provide a platform for improving care standards even further in the future. The Trust has commenced a programme of capital expenditure on its elderly care wards to ensure the environment is ‘dementia friendly’. This involves removing nursing stations and remodelling facilities to reduce the potential for patients to fall or become confused by their surroundings.

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Infection Control The Trust was set a challenging target of no more than 18 cases of hospital acquired Clostridium difficile for the year. In 2013/14 there were 27 cases, of these cases five cases were successfully appealed with the Clinical Commissioning Group and adjusted against the Trust’s target; this made the total adjusted figure the same as last year, a total of 22 cases. Most notably there have been no identified cases of cross infection and no outbreaks of Clostridium difficile.

Performance against CQUIN goals Our commissioners set us goals each year based on quality and innovation and a proportion of our income is conditional upon the achievement of these goals. This system is known as the Commissioning for Quality and Innovation (CQUIN) payment framework. The Trust received £3.0 million in 2013/14 for CQUIN achievement.

Length of Stay When patients are admitted to hospital they want to return home as soon as possible once they are fit to do so. The Trust works hard to achieve this, working in particular with partners in health and social care to ensure that those patients requiring care packages are able to access them quickly. The average length of stay of 2.8 days for patients admitted for planned admissions was unchanged compared to the previous year. Our local target is for the average length of stay for planned admissions not to exceed 2.9 days. The length of stay for patients admitted as emergencies increased over the winter period. This was partly due to limited availability of beds in community hospitals, nursing homes and residential homes, to which many elderly patients need to be discharged to. Cancelled Operations The number of last minute cancellations of planned operations rose this year. This is disappointing given the improvements that were made last year. The increase in cancellations was primarily due to increases in emergency admissions and equipment failures in the cardiac catheter lab. The hospital is taking a number of actions to address these issues, namely improved proactive planning of bed capacity needed at times of increased demand and the

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Annual

Plan

2013/14

Q1

2013/14

Q2

2013/14

Q3

2013/14

Q4

2013/14 Under the compliance framework Financial risk rating 3 3 Governance risk rating Green

Amber-Red

Under the risk assessment framework Continuity of service rating 4 4

Governance rating Green Green

replacement of equipment in the cardiac catheter lab as it reaches the end of its natural life. Regulatory Ratings Monitor changed its regulatory framework during 2013/14. For the first two quarters of the year under the Monitor Compliance Framework two risk ratings are published for each NHS foundation trust: • Financial risk rating (rated 1-5,

where 1 represents the highest risk and 5 the lowest); and

• Governance risk rating (rated red, amber-red, amber-green or green).

The risk ratings are updated each quarter. The risk ratings of the Trust during the year are set out below. For the last two quarters of the financial year under Monitor’s new Risk Assessment Framework the two risk ratings for each foundation trust are:

• Continuity of service risk rating

(rated 1-4, where 1 represents the highest risk and 4 the lowest); and

• Governance risk rating (rated red if regulatory action is required, description of actions required to return to green or green).

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Annual

Plan

2012/13

Q1

2012/13

Q2

2012/13

Q3

2012/13

Q4

2012/13 Financial risk rating 3 3 3 3 4

Governance risk rating Amber-Green

Green

Green

Green

Green

● Target fully achieved ● Target partially achieved ● Target not met

Indicators

2013/ 14

Target

2013/ 14

2012/ 13

A&E access % patients discharged within 4 hours in A&E and MIU

>95.0% 94.7% ● 96.5% ●

Infection control

C.difficile acquisitions in over 2s <18 27 ● 22 ●

Referral to treatment times

% admissions within 18 weeks >90% 92.8% ● 92.9% ●

% non-admissions within 18 weeks >95% 98.1% ● 97.8% ●

% incomplete pathways within 18 weeks >92% 94.9% ● n/a

Cancer access

Urgent GP referrals seen within 2 weeks >93% 98.9% ● 99.1% ●

Breast symptomatic referrals seen within 2 weeks

>93% 98.7% ● 99.5% ●

Cancer treatments started within 31 days of decision to treat

>96% 99.2% ● 99.7% ●

Cancer treatments started within 62 days of urgent GP referral

>85% 88.5% ● 93.4% ●

Treatments started within 62 days of screening programme referrals

>90%

96.0%

●

96.8%

●

Subsequent surgical treatment within 31 days

>94% 97.8% ● 99.5% ●

Subsequent anti-cancer treatment within 31 days

>98% 99.8% ● 100% ●

Our annual performance against national standards:

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The vision for Dorset County Hospital NHS Foundation Trust is Delivering Safe and Compassionate Healthcare to all those who use our services. This means delivering excellent clinical outcomes in a caring, compassionate and safe environment. Translating this into a positive experience for every patient depends on the skill and commitment of all our staff and a strong focus at board level on all aspects that impact on the quality of services we provide. The Quality Report illustrates some of the ways in which we are working to deliver the ambitious priorities we have set and the progress we are making to achieve them. Achievements in 2013/14 include an overall

improvement in how we manage the end of life care needs of patients across all specialties, through the introduction of the Gold Standard Framework. This is particularly important following the Neuberger Review in 2013 and the subsequent national challenge relating to the use of the Liverpool Care Pathway. Supporting patients, carers and their families during the last stages of their life is at the heart of what we do and so ensuring we learn and consistently improve our services is vital to us as an organisation. The management of patients with diabetes has been a challenge across a range of specialties and so the focus this year has been on how to improve the knowledge of a patient experiencing a hypoglycaemic attack; the results of the nursing audits are encouraging and a strong focus on developing education resources to support learning in practice is continuing.

Quality of Care

Each year, the Trust produces a Quality Report, which outlines the performance of our hospital against a range of quality indicators and describes the priorities for improvement over the coming year. You can read our full Quality Report on our website at www.dchft.nhs.uk/about/standardsreports.html or you can contact us for a printed copy on 01305 254683 or headquarters@dchft.nhs.uk Here we give an outline of the main aspects of the Quality Report to show what we achieved during 2013/14 and what we are focusing on for the year ahead.

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We have continued to make progress on improving the key national safety measures included in the safety thermometer such as falls resulting in harm, development of pressure ulcers, prevention of venous thrombosis and catheter associated urinary tract infections and we ended the year with 97.4% of our patients receiving harm-free care against those measures. Our aim is to always prevent possible harm to patients and when harm does occur we ensure that we learn from it to improve care to others. The National Safety Thermometer has been a useful tool to enable us to benchmark our care against others and learn from best practice. Despite the many successes there are still areas where improvements can be made and we remain committed and determined to strengthen our efforts in areas such as our infection prevention.

We were set an ambitious target for Clostridium Difficile in 2013/14 and unfortunately we experienced an unexplained increased incidence of hospital acquired cases in the

summer months. We scrutinised our own practices and could not identify any single factor that explained the increased number of cases and so we commissioned an external review by Public Health England. The review was unable to identify any single causal factor for this increase, and found no evidence of cross contamination. The review provided us with some areas of best practice we could emulate to further improve care and through the process we challenged our own practices and robustly reviewed our antibiotic prescribing guidance for staff. The findings of the Francis Report into the failings at Mid Staffordshire NHS Foundation Trust has served as a salutatory reminder to the NHS as a whole that patients should always be at the centre of care delivery. With this at the forefront of our thinking we are continuing to make high quality, safe care and a good patient experience our top priorities. Our Trust Board established a non-executive-led staff group to discuss the Francis Report and look at how we could ensure that our hospital would always put patients at the centre of all we do. Twenty-five members of

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staff were involved and met regularly during 2013 to identify the recommendations they would make. They were formed around the following sub-groups: • Putting patients first; • A common culture; • Performance management and

oversight; • Openness, transparency and

candour; • Nursing; • Caring for the elderly; • Leadership; • Governor working group. The Francis Report Review Group reported back to the Trust Board on 12 March 2014. The Board accepted the report, with implementation of the recommendations to be overseen by the Quality Committee. We have reviewed the data available on patient safety and quality and in discussion with our partners and stakeholders have agreed the following priorities for 2014/15: • Zero tolerance to hospital

acquired pressure ulcers; • Reducing harm to patients who

fall in hospital; • Improve access to clinics; • Management of diabetes as a co-

morbidity to hospital admission; • Improve the experience of carers

of patients with dementia; • All patients will be reviewed by a

consultant within 14 hours of admission to hospital;

• Zero tolerance to preventable cancelled operations due to equipment availability;

• Friends and Family Test; • Improve the effectiveness of

discharge from hospital.

We will continue to ensure that services are developed and improved for the benefit of our patients and without the commitment and professionalism of all our staff this would not be possible. We’d like to thank each and every member of staff for all their commitment and hard work and to recognise the significant contribution individuals and teams make to continually developing and improving the services we provide to our patients and community.

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April 2013

We were delighted to win the CHKS Top Hospital programme Quality of Care Award 2013. The Top Hospital awards celebrate the success of healthcare providers across the UK and are given to acute organisations for their achievements in healthcare quality and improvement.

Consultant Ophthalmologist Edmund Murray and his eye clinic team were shortlisted for ‘Clinical Service of the Year’ in the Macular Society’s Awards for Excellence. Their nomination recognised their

exceptionally good practice in the care of people with macular degeneration. May 2013

Our hip replacement service was rated the best in the country according to data about how well patients recover following surgery. Patient Reported Outcome Measures (PROMs) is an NHS initiative which asks patients about their health and quality of life before and after surgery. We have the best scores in the country for hip replacement when compared with other hospitals and specialist centres. June 2013 Our colorectal telephone assessment service celebrated its fifth anniversary and reached a milestone, assessing 5,000 patients since its launch. The innovative

Highlights of the Year

There were many positive developments and initiatives throughout the Trust during 2013/14. Here we round up the year’s events ...

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service provides effective and timely care for people with colorectal symptoms and has greatly reduced waiting times for patients. Two of our student midwives won a national award in recognition of their work to support families who have lost a baby. Emma Knott and Jo Mockler received the Student Midwife of the Year award at the British Journal of Midwifery Awards.

A unique arts project which explores the life of renal patients culminated in the release of a film called Blood Makes Noise. The project was funded by the Wellcome Trust and British Kidney Patient Association (BKPA). Film producer Peter Snelling was an ‘artist in residence’ in our renal dialysis unit once a week for nine months to create a film, book and blog. July 2013 Our hospital restaurant received top marks for food safety and hygiene for the third year in a row. Environmental health inspectors awarded Damers Restaurant and kitchen five stars (excellent) following their inspection.

August 2013

We launched a new awards scheme to recognise exceptional customer service. Patients, visitors and colleagues can nominate hospital staff for WOW! Awards if they have been particularly impressed with the care they have received. Our housekeeping and catering teams were the first to be nominated and receive certificates. September 2013

Our first Hospital Open Day proved a great success with hundreds of visitors coming along for tours of departments, demonstrations, displays and hands-on activities. The Friends of Dorset County Hospital announced a generous donation of £50,000 to improve care

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for dementia patients. We are extremely grateful to the Friends for this funding which will be used for equipment and environmental improvements on Barnes Ward. Staff and volunteers received recognition for their hard work and dedication at our annual GEM (Going the Extra Mile) Awards and Long Service Awards. Colleagues, patients and relatives nominated staff and volunteers who have gone over and above what is expected to make a difference to people’s lives. October 2013

Three of our wards introduced gold standards of care for patients nearing the end of their lives. Day Lewis Ward, Barnes Ward and the Stroke Unit are piloting the adoption of the national Gold Standards

Framework (GSF) which is recognised as best practice by the NHS. November 2013 We were awarded The Information Standard certification for our patient information. The certification is supported by NHS England and demonstrates that we are a provider of reliable, high quality patient information.

Hospital staff, school children, students and governors pulled out all the stops for this year’s Infection Prevention and Control Week. The theme was movies and departments created an array of colourful film-inspired displays to promote the importance of good hand hygiene.

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National Medical Director Sir Bruce Keogh announced that we were to be one of 13 hospitals to drive forward providing seven day services and showcase best practice to the rest of the country. Our successful bid to the Seven Day Services Improvement Programme means we can forge ahead with our plans to provide our patients with the same access to many services throughout the week. December 2013 We launched a new computer-based infection prevention system that will help control the risk of infection and provide an integrated digital care record for infection control staff and surgeons. The system – ICNet NG – is part of an innovative software package that combines information about patient movements in the hospital with data held by the laboratory and theatre systems so that staff are alerted when patients are infected or at risk of an infection.

Local schoolchildren entered a competition to design a mascot for us. Children’s Services staff are working on new pages for the

hospital’s website and wanted to create a friendly mascot to accompany their information for youngsters. The winning design – Duncan the Dorset Dinosaur – has been developed by a graphic designer for use on the website and patient literature. January 2014 Our Director of Operations Patricia Miller was celebrated as a rising star in the NHS. She was applauded in the influential publication the Health Service Journal as part of a special supplement which highlighted 25 healthcare leaders of the future.

Orthopaedic surgeon Nick Savva joined a dedicated team of healthcare professionals from the South West of England to perform much needed operations in Kenya. He spent 10 days in Nanyuki in rural Kenya as part of an orthopaedic trauma team representing the Kenyan Orthopaedic Project. We were pleased to launch a new piece of equipment which means breast cancer patients can be x-rayed during surgery to ensure all cancerous tissue has been

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removed. The portable Faxitron machine provides instant confirmation of a successful biopsy procedure, displaying images on a high resolution monitor.

February 2014 Our maternity unit celebrated a double dose of good news. The unit was placed in the top 15 maternity services in the UK for care quality and safety by healthcare intelligence firm CHKS. It was also successful in winning £276,000 of government funding to develop facilities for mothers with complex mental health needs and build two en-suite rooms for parents with babies on our Special Care Baby Unit (SCBU). Cardiac patients are now being offered the very latest in pacemaker technology. Consultant cardiologist Dr Tim Edwards performed the first UK implantation of the new hi-tech Kora 100 pacing system, which allows implanted patients to undergo MRI (magnetic resonance imaging) safely and easily. It is also the world’s smallest system and last longer than any others in its class.

March 2014

Our new endoscopy unit was officially opened by Dr Peter Down, who established the first endoscopy department at the old Dorset County Hospital in 1989. The new unit is in its original North Wing location but extensive building work and refurbishment work has taken place to improve the facilities and service for patients.

Mum Clare Stokes, who has raised nearly £3,000 for our maternity unit, officially opened a new low-risk birth room named in her honour. The Stokes Suite offers a relaxed, less clinical environment for women who would like the feel of a home birth with the reassurance of being in a hospital.

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The total number of formal complaints received by the Trust for this year was 428, an increase of 24% on 2012/13. There were also 452 recorded contacts for informal and easily resolved issues, a decrease of 6% on 2012/13. Each formal complaint is treated as well-founded in order to investigate and a response is provided to the complainant outlining the findings of the investigation. The Trust informs patients and carers how to raise concerns in bedside folders, on our website and in the ‘Comments, Complaints, Concerns and

Compliments’ leaflet. All feedback, concerns and complaints are coordinated centrally and upon receipt are screened and triaged according to the seriousness of the issues raised. The focus is to consider each complaint from the complainant’s perspective and every complainant is offered the opportunity to discuss the way in which their complaint is handled. The responsibility for investigating complaints is devolved to the hospital’s divisions and their respective teams, who are required to provide a comprehensive response within an agreed timeframe. This outlines the response to the investigation and recommendations or actions taken for improvement where appropriate. The final response to every formal complaint is agreed and signed by the Chief Executive. The complaints process allows the Trust flexibility in arranging local resolution meetings

Listening and Learning

In this Annual Review we have highlighted a lot of the good work going on at Dorset County Hospital and we are delighted to receive many letters of appreciation from patients. But we are never complacent and know there is always room for improvement. Complaints are an integral element of improving the patient’s overall experience of healthcare and help to ensure that safe, high quality care is provided within the hospital. Each year our Patient Experience Team put together a complaints report which outlines the number and nature of complaints received, how complaints are handled, lessons learnt and changes made as a result of a complaint. Details from this report are shared here:

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with complainants. These meetings usually include the relevant healthcare professionals, including the consultant or matron, so that questions can be answered by the clinicians delivering care and a personal apology given where appropriate. This has proved to be a very positive and helpful process with the openness of the meetings being well received by all participants. This year we embarked on a project to improve our learning from complaints and the experience of the complaints process. We categorized and themed our complaints, then supported healthcare staff to focus on improving the quality of care where themes emerge and practice is

identified as poor. We then focused on improving the patient experience of the complaints process to prevent added distress to the complainant/patient/carer, rebounds to the Trust and escalation to the Parliamentary and Health Service Ombudsman. We have also used the ‘Experience Based Design’ approach to ensure we learn from patients’ experiences and develop services in response. The Trust Board receives a monthly summary of the number of complaints received and the issues raised. A more in depth analysis is provided quarterly to the Board. Complaints are coded on the ‘Datix’ system under a variety of categories. Although the subject matter may vary, the root causes which result in a complaint being

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raised can be associated to three main themes: delays, attitude and communication. The main themes are shown in the graph on the previous page. We have seen an increase in complaints around access admission, communication and discharge. The increase around access/admission can be attributed to the problems we had with patients accessing DEXA scans and ophthalmology which have now improved. There is no clear reason we can identify for the increase in communication and discharge, apart from awareness being raised in the general public through the Mid-Staffs Enquiry and the Friends and Family Test, a national initiative to find out whether patients would recommend the hospital services they have experienced to people close to them.

For the year 2013/14 the Trust received 428 formal complaints, of which one (0.25%) contacted the Ombudsman to assess their case. In this case, there was no action from the Trust required. Contact information for the Parliamentary and Health Service Ombudsman is provided to all complainants should they remain unhappy with the outcome of the Trust’s investigation and response. There are two complaints still under investigation which are potential referrals to the Ombudsman. The table below shows a significant decrease in dissatisfaction with the Trust management of complaints in the past year and therefore referrals to the Ombudsman. This is what we set out to achieve at the beginning of this year.

Complaints referred to the Ombudsman

2010/11 2011/12 2012/13 2013/14

Total number of complaints 373 352 345 428

Total number referred to om-budsman

13 (3%) 16 (5%) 8 (2%) 1(0.25%)

Further action required through local resolution

7 10 3 0

No action required 5 3 0 1

Awaiting outcome 1 3 1 0

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Learning from Complaints Complaints are an integral element of improving the patient’s overall experience of health care and help to ensure that safe, high quality care is provided within the hospital.

The quality improvement or learning outcome following investigation of a complaint is identified and action taken by the respective division. This is monitored through the Learning from Patients Committee which continues to meet quarterly. This framework enables the information gained from patient and public feedback to be owned locally whilst providing a strategic overview with a clear focus on improving service quality, ensuring that lessons are learnt and processes are changed to prevent situations recurring. As a result of the number of complaints that we received about calls not being answered by outpatients, a backroom system has been set up to manage this. As a result of complaints about access to ophthalmology, a letter was devised and sent out to keep

patients informed and complaints regarding cancelled appointments have decreased significantly. As a result of complaints received about care and attitudes on Ilchester Ward, the matron and sister have begun a project to use experience based design to understand their complaints in more depth to make service improvements. As a result of complaints received about DEXA scans, a communication has been sent out to all patients to keep them informed. A plan has been put in place to train other members of staff to use the scanner so that delays do not happen again. Following a complaint relating to a visit made to the maxillofacial department and a miscommunication that occurred involving a locum doctor, all staff have been reminded that bridge work will need to be completed at the general dental practitioner, prior to maxillofacial treatment. This is now part of the induction for locum staff. PALS and Complaints Environment The environment outside of the Patient Advice and Liaison Service (PALS) office, was improved significantly this year, with the removal of the vending machines outside the door and utilizing the space to provide privacy and dignity

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for complainants and staff engaged in the complaints process. This is being furnished with funding from Macmillan and will also provide a health information resource and training area. Priorities for 2014/15 We will continue to roll out training across the organisation in using the experience based design approach and clinical human factors to learn from and respond to complaints. We will work with the education department to provide training for Foundation Year 2 doctors in using the experience based design approach and clinical human factors to learn from and respond to complaints. We will continue to work with sisters and matrons in using the experience based design approach and clinical human factors to learn from and

respond to complaints. We will continue to categorize complaints according to the NICE quality standard for patient experience in adult NHS services and use these as indicators for service improvement work. Positive comments from our Patients The positive feedback we receive from our patients is much appreciated. It is wonderful for the staff to know their efforts have made such a difference to patients’ experiences of coming into hospital and we can also learn from areas of good practice. We’ve included some comments here from the many letters of appreciation we have received over the year ...

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I cannot praise the team who cared for me too highly. This was an example of NHS treatment at its very best.

The staff were so caring and everyone was so kind and helpful. I was in very good hands.

The staff could not have been more kind and attentive. They all worked hard to make the whole experience as stress-free as possible. I have never had cause for a complaint as a patient.

Their understanding of the problem I had was superb. Because of their care I am now able to live a much better lifestyle. They are a credit to the hospital.

I have got to heap praise on the way I was treated in every department.

The staff gave me such peace of mind and their kindness and empathy was beyond compare. I am so grateful to them for their care.

The nurses were kind and professional, they answered our questions with great patience as well as being cheerful.

The receptionist was helpful and polite and went the extra mile to assist which was much appreciated.

The nurses did everything to put me at ease. Their kindness was beyond the call of duty.

I am really grateful to everyone involved in my care, from beginning to end. I was looked after by so many wonderful people.

Friendly, helpful staff, all very professional, procedures explained and carried out efficiently. Very impressed.

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We aim to deliver our strategy through: • Consolidating our role as the

acute service provider of choice; • Delivering high quality, safe

services that meet our patients’ expectations;

• Delivering our commissioners’ and regulators’ requirements;

• Developing our workforce and facilities to assist in maximising our productivity and efficiency.

Our vision is to deliver compassionate and safe healthcare and we plan to deliver this through eight strategic goals as follows: To be a compassionate patient centred organisation - ‘The hospital of choice’ We are focusing on improving the experience that patients have at our hospital and making it a safer place in which to be treated. The implementation of the national Friends and Family testing will enable us to get feedback from those using our services. This information can then be used to improve the experience that patients have at our hospital. We have set out our values to reflect those of the NHS Constitution and these include: respect and dignity; commitment to quality of care; compassion;

improving lives; working together with and for patients; everyone counts. Be uncompromising on quality and safety – ‘We do no harm’ At the heart of everything we do is the provision of the best possible care for our patients. Our Quality Report sets out our priorities. Achieve financial sustainability – ‘Value for money’ The current economic climate is increasing the demands on the NHS and we must continue to deliver year on year savings of around £6million. We will continue to focus on improving efficiencies, reviewing service models and looking for opportunities to generate alternative income sources. We will make savings through working with our clinicians to ensure the safety of services is not compromised. Be a high performing and efficient provider – ‘Efficient and effective’ We will continue to focus on providing high quality core acute services whilst looking for opportunities to expand into markets that complement the current services we provide. The majority of

Strategic Direction

We developed our Strategic Direction for 2012-2015 founded on a desire to provide the best possible care for patients.

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our services are provided around the hospital but we will work closer with partnering organisations to ensure more streamlined services are delivered across the local health economy. Be recognised as a great place to work – ‘The employer of choice’ We are working towards the staff charter where we will ensure all of our staff are valued and listened to. We are committed to ensuring all staff are developed so they can deliver their role to the highest possible standard to enable high quality services to be delivered to our patients. We are working towards strengthening the role of the clinical leaders to ensure our services are clinically led with decisions being made closer to the patient. Become a collaborative and learning organisation – ‘A learning organisation’ With our focus being on the safety and experience of our patients we

will continue to develop systems that allow us to learn from feedback we receive from both patients and staff. Be responsive to the changing NHS environment – ‘Well positioned for the future’ We will develop our skills to ensure we are in a position to provide a wider range of services to our patients outside of the hospital setting. We will focus on identifying new income generating opportunities to support the core services we provide. We are developing an ICT Strategy that ensures we can meet the requirements set out by Government to become a paper light organisation. Maintain the reputation of the hospital and the NHS – ‘Open and honest’ We will continue to uphold our values and work to maintain the reputation of the hospital and the NHS.

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Dorset County Hospital NHS Foundation Trust Trust Headquarters Dorset County Hospital Williams Avenue Dorchester, DT1 2JY Telephone: 01305 254645 E-mail: headquarters@dchft.nhs.uk Fax: 01305 254185 Website: www.dchft.nhs.uk Minicom: 01305 254444 Main switchboard: 01305 251150

Patient and Customer Services Foundation Trust Membership Freephone: 0800 7838058 Telephone: 01305 255419 E-mail: PALS@dchft.nhs.uk E-mail: foundation@dchft.nhs.uk

If you would like this document in another format or in another language please call 01305 255419 or e-mail headquarters@dchft.nhs.uk

Our full Annual Report and Accounts for 2013/14 are available on our public website at www.dchft.nhs.uk If you do not have access to the internet and would like a printed copy please call 01305 255419 or email headquarters@dchft.nhs.uk

Further Information and Contacts