Northampton General Hospital NHS Trust (RNS) · Northampton General Hospital NHS Trust is an acute trust with 800 consultant led beds. It provides general acute services to a population

Northampton General

Hospital NHS Trust

(RNS)

Data Pack

10th January 2014

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CQC │

If you have 5-10 minutes ‘At a glance’: 3-15

Context: 16

Safe: 30-31

Effective: 45-47

Caring: 54-55

Responsive: 72-73

Well-led: 78-80

If you have 2-3 hours All of the report

At a glance

To help you navigate

through the report,

here is some

guidance on which

sections of the report

you should read

depending on the

time you have

available.

Reading this report

Northampton General Hospital NHS Trust Page 2

CQC │

Executive Summary Northampton General Hospital NHS Trust (RNS) has been selected as one of the first trusts to be inspected under the CQC’s revised inspection approach. The trust was selected for inspection as an example of a ‘high risk’ trust.

This data pack is designed to provide the CQC’s inspection team with an overview of the trust in order to guide their investigation.

Context Northampton General Hospital NHS Trust is an acute trust with 800

consultant led beds. It provides general acute services to a population of 380,000, and hyper-acute stroke, vascular and renal services to people living throughout whole of Northamptonshire, covering a population of 691,952.

The trust’s main hospital site is based at Northampton General Hospital, which is located close to Northampton town centre. The trust also provides services at the following sites in the county: Corby Community Hospital, Danetre Hospital in Daventry, Isebrook Hospital, Hazelwood Ward and Weston Favell Health Centre.

Approximately half of the Executive Directors, as well as the Chairman and Chief executive, are fairly new, having been appointed to these positions in the last few months. Many posts are interim and there are two Chief Operating Officers.


Source: Office for National Statistics; 2011 Census for England and Wales; Public

Health Observatories – Area Health Profiles

Context Safe Effective Caring Responsive Well-led

Trust overview

Sites 1 main site plus several satellite sites all over

Northamptonshire

Beds 800

Population Served 684,00

Actual Net Surplus (Deficit) £0.4m (2012/13) £0.5m (2011/12)

Source: NHS Choices; Bed Availability and Occupancy, Department of Health

Transparency Website, Jul 2013 - Sep 2013; Trust Website; Trust Annual

Reports, 2012/13

Source: HES data, 2010-11 and 2012-13

Note: The HES A&E data is experimental data

Area overview Northamptonshire

Population 691,952

GP Registered 97%

Deprivation (Out of 326 LAs) 119

Ethnicity (Non-white minority) 8.55%

Life Expectancy Worse than average or average

Urban/Rural Urban

Activity Type 2010-11 2011-12 2012-13

Inpatient N/A 95,691 96,237

Outpatient 323,748 331,114 356,320

Accident & Emergency 83,187 91,283 N/A

CQC │

Safe Never Events

A serious incident known as a Never Event is classified as such because they are so serious that they should never happen. There were no never events reported by the trust between 1 December 2012 and 31 November 2013.

Serious Incidents

Between December 2012 and November 2013, 104 Serious Incidents occurred at the trust. Ward areas accounted for 85.5% of the serious incidents reported – a total of 89 incidents. A&E was second with five incidents reported.

Incident reports to the NRLS

An analysis of the number of patient safety incidents reported to the NRLS, against the number of incidents expected to occur at a trust, based on the number of bed days, can indicate any potential under-reporting. The largest number occurred in medical specialties , which accounted for 57% of all incidents. Surgical specialties had the second most amount of incidents reported along with A&E third.


Source: Strategic Executive Information System (STEIS) Data,

Dec 2012 – Nov 2013


Source: National Reporting Learning System (NRLS) July 2012 – June 2013

Specialty Moderate Severe Abuse Death Total

Medical specialties 129 16 36 8 189

Surgical specialties 41 7 7 5 60

Accident and

Emergency (A) 22 1 4 2 29

Anaesthesia Pain

Management and

Critical Care

21 1 0 2 24

Obstetrics and

gynaecology 7 0 4 3 14

Diagnostic services 4 0 0 1 5

Other specialties 1 0 0 0 1

Other 5 0 2 3 10

Grand total 230 25 53 24 332

CQC │

Safety thermometers

Often the safety thermometer measures are good indicators of how nursing staff are performing. It is also worth exploring how the trust uses the patient safety thermometer to support the provision of safe care.

The proportion of patients with new pressure ulcers has fluctuated throughout the year with a sharp increase in September 2013. The trust also reported double the England average for people over 70 in November 2013. This requires investigation to ensure the trust has measures in place to reduce levels.

The Safety Thermometer data shows that the trust reported no new

cases of VTE since March 2013, but the trust have confirmed that this is because they do not collect this data.

The proportion of patients suffering from UTIs on the date of a monthly survey among patients with a catheter has been consistently above the England average.

The proportions of patients suffering from falls with harm , including patients over 70, are below the England average for most of the period.

The trust’s infection rates for C. diff and MRSA lie within a statistically acceptable range after taking into account the trust’s size and the national level of infections.

It must be noted that caution should be used when comparing trust Safety Thermometer results to the national average as this does not account for trust-to-trust variation in the demographic make-up of the population, though they may be an area for further investigation.

Infection rates for both C.difficile and MRSA are both within a statistically acceptable range.


Safety Thermometer Trust median National median

New pressure

ulcers

All patients 1.3% 1.2%

Patients over 70 1.6% 1.4%

New VTEs All patients 0.0% 2.5%

Catheter and

New UTIs

All patients 0.9% 0.5%


Falls with Harm All patients 0.3% 0.9%


Source: Safety Thermometer November 2012 – November 2013


Bacterial indicators Total Range

C. difficile 32 Within acceptable

MRSA 1 Within acceptable

MSSA 10 N/A

Source: Health Protection Agency (HPA) data August 2012 – July 2013

CQC │

Effective Tier 1 Indicators

There were 4 Tier 1 indicators flagged as ‘risk’ or ‘elevated risk’.

Mortality

The mortality indicators flagged above have been refined to include ‘Composite Indicators’.

In-hospital mortality-Gastroenterological and hepatological conditions and procedures is a ‘Composite Indicator’ formed of 14 sub-indicators. Of the 14 sub-indicators, 1 sub-indicator is rated as a ‘risk’:

Composite indicator: In-hospital mortality - Gastroenterological and hepatological conditions and procedures

Maternity

Maternity and women's health is a ‘Composite Indicator’ formed of 3 sub-indicators. Of the 3 sub-indicators, 1 sub-indicator is rated as an ‘elevated risk’:

Maternity outlier alert: Elective Caesarean section

The table below shows the total number of deliveries at Northampton General Hospital NHS trust compared to the total number of deliveries in England:



Framework section RAG

Summary Hospital-level Mortality Indicator

Composite indicator: In-hospital mortality - Gastroenterological and

hepatological conditions and procedures


The number of cases assessed as achieving compliance with all nine

standards of care measured within the National Hip Fracture Database.

England Northampton General

Hospital NHS trust

Total number of deliveries 695,378 4,576 (0.65%)

Elevated risk Risk

CQC │

Sources: NHS Friends and Family Survey, July 2013 – Oct 2013. Cancer Patient

Experience Survey, National Cancer Intelligence; NHS Choices Network, Oct 2008 and

Nov 2013

Caring The trust has no risks or elevated risks in this domain.

Friends and Family Test

The overall performance for the trust is in line with the England score. A&E performance is higher than the England score. Response rates for A&E are higher than the England response rate and inpatient areas are in line with the England figure.

Cancer Patient Experience Survey

Out of 70 questions the trust was in the bottom 20% nationally on five questions.

The main issues are around pain control, choice of treatment and patients who would give a rating of care of excellent or very good.

NHS Choices

The trust has an overall score of 3.5 stars out of 5 stars. The main positives are excellent care, professional staff and being treated with respect and dignity. The issues raised are waiting times, communication, and misdiagnosis.

CQC’s Adult Inpatient Survey 2012

From the Adult Inpatient Survey the trust performed ‘About the same’ as other trusts for all 10 areas of questioning.

There are 2 questions where the trust is in the worst 20% nationally:

• Were you ever bothered by noise at night from other patients?

• Were you ever bothered by noise at night from hospital staff?


Area of questioning RAG

The Emergency/A&E Department

Waiting List and Planned Admissions

Waiting to Get to a Bed on a Ward

The Hospital and Ward

Doctors

Nurses

Care and Treatment

Operations and Procedures

Leaving Hospital

Overall Views and Experiences


Source: CQC Adult Inpatient Survey 2012

Better than other trusts

About the same as other trusts

Worse than other trusts

CQC │

Responsive Accident and Emergency

Trusts in England are tasked by the government with admitting, transferring or discharging 95% of patients within four hours of their arrival in the A&E department. Northampton General Hospital NHS Trust is consistently failing to meet this target, dropping to 76% in April 2013. In the last few months their performance has improved but they remain below the target.

Cancelled Operations

Delayed Discharges

The trust was rated as ‘low amber’ or ‘medium risk’ for access to secondary care through A&E, and ‘low green’ or ‘low risk’ for access to elective secondary care (diagnostics and treatment) from general practice.

There are three areas where the trust shows to be worse than others. All are questions taken from the A&E survey:

• percentage of admitted patients who wait in A&E less than 4 hours

• percentage of non-admitted patients who wait in A&E less than 4 hours

• transitions from the ambulance to A&E


Framework sections RAG

Number of patients not treated within 28 days of last minute cancellation

due to non-clinical reason

The proportion of patients whose operation was cancelled

Source: Cancelled Operations: DoH QMCO January 2013 – March 2013


The proportion of respondents to the adult inpatient survey who stated they

were not given enough notice about when they were to be going to be

discharged

The proportion of respondents to the adult inpatient survey who stated that

their discharge was delayed for more than four hours, due to waiting for

medicine, to see a doctor or for an ambulance

Source: CQC Analysis of Secondary Care – February 2013


Better than expected

Similar to expected

Worse than expected

75%

80%

85%

90%

95%

100%

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% of A&E attendances less than 4 hours from arrival to admission, transfer or discharge

Englandaverage

Trust

CQC │

Well-led Number of staff

Overall sickness

Sickness absence rates

Agency spend

FTE nurses per bed day

Audit Commission - Payment by Results Data (PbR) Assurance 2011/12

Payment by Results aims to support NHS modernisation by paying hospitals for the work they do, rewarding efficiency and quality. It also carries risks that need to be managed effectively both locally and nationally. Since 2007, the Audit Commission has delivered an assurance programme for Payment by Results looking at the quality of clinical coding.

For the 2011/12 financial year, there were a number of indicators and items of qualitative intelligence for the trust from this audit:

Northampton General

Hospital NHS Trust

East Midlands SHA

average National average

4.5% 4.5% 4.2%


Northampton General Hospital NHS Trust National average

Medical Staff 1.5 1.1

Nursing Staff 4.4 4.0

Midwife Staff 4.4 4.3

Other Staff 4.1 3.9

Trust agency spend (£m) As % of total staff cost Median within EM SHA

£7m 4.3% 4.2%

Source: Health and Social Care Information Centre (HSCIC), Apr 12 – Mar 13

Source: Acute Trust Quality Dashboard, Methods Insight, Autumn 2013/14

RAG NGH NHS Trust National

FTE Nurses per Bed Day 1.6 1.9

Total staff 4,200

Source: Trust website

Source: Monitor, Expenditure on Agency Staff in Acute Trusts, 2011-12


Indicator RAG

8.5% of primary diagnoses were recorded incorrectly in the period. Against

an expected rate of 9%.

13.2% of secondary diagnoses were recorded incorrectly in the period.

Against an expected rate of 8%.

6.3% of primary procedures were recorded incorrectly in the period.


12.2% of secondary procedures were recorded incorrectly in the period.


Source: Audit Commission - Payment by Results Data (PbR) Assurance (2011/12)



Tending towards better than expected

Within expectations

Tending towards worse than expected

Risk or elevated risk

CQC │

Well-led NHS Staff Survey

The results of the 2012 NHS Staff Survey are organised into 28 key findings.

Twenty four of the 28 key findings were placed within the bottom 20% of trusts nationally, including the percentage of staff feeling satisfied with the quality of work and patient care they are able to deliver.



*Note: Because of changes to the format of the survey questions, comparisons with 2011

scores are not possible in all cases. These are denoted by ‘-’

Indicators RAG Trust National* vs. 2011*

Percentage of staff having equality and diversity training in last 12 months 62% 55% Percentage of staff saying hand washing materials are always available 60% 60% -

Staff motivation at work 3.84 3.84 -

Percentage of staff reporting errors, near misses or incidents

witnessed in the last month 90% 90%

Percentage of staff working extra hours 76% 70% -

Percentage of staff experiencing physical violence from patients,

relatives or the public in last 12 months 18% 15%

Percentage of staff witnessing potentially harmful errors, near misses or incidents in last month 42% 34% -

Percentage of staff appraised in last 12 months 73% 84% -

Percentage of staff experiencing harassment, bullying or abuse from patients, relatives or the public in last 12 months 38% 30% N/A

Percentage of staff experiencing harassment, bullying or abuse from staff in last 12 months 31% 24% N/A

Percentage of staff feeling satisfied with the quality of work and patient care they are able to deliver 72% 78% -

Percentage of staff agreeing that their role makes a difference to patients 87% 89% -

Work pressure felt by staff 3.34 3.07 N/A

Percentage of staff experiencing physical violence from staff in last 12 months 4% 3% N/A

Better than expected (within top 20% of trusts nationally


Within expectations


Risk or elevated risk (within bottom 20% of trusts nationally)

Direction of change from previous year

Source: NHS Staff Survey 2012

CQC │

Well-led NHS Staff Survey

Staff at Northampton General Hospital NHS Trust are less likely to recommend the trust as a place to work or receive treatment, and report lower levels of fairness and effectiveness of incident reporting procedures or good communication with senior managers.



Indicators RAG Trust National* vs. 2011*

Percentage of staff able to contribute towards improvements at work 58% 68% -

Staff job satisfaction 3.40 3.58 -

Percentage of staff experiencing discrimination at work in last 12 months 17% 11% -

Effective team working 3.53 3.72

Percentage of staff having well structured appraisals in last 12 months 23% 36% -

Support from immediate managers 3.26 3.62

Percentage of staff suffering work-related stress in last 12 months 43% 37%

Percentage of staff feeling pressure in last 3 months to attend work when feeling unwell 35% 29% -

Percentage of staff believing the trust provides equal opportunities for career progression or promotion 79% 88% -

Percentage of staff receiving job-relevant training, learning or development in last 12 months 76% 81% N/A

Percentage of staff receiving health and safety training in last 12 months 63% 74%

Fairness and effectiveness of incident reporting procedures 3.41 3.50 -

Percentage of staff reporting good communication between senior management and staff 20% 27% N/A

Staff recommendation of the trust as a place to work or receive treatment 3.37 3.57 -



Within expectations




*Note: Because of changes to the format of the survey questions, comparisons with 2011

scores are not possible in all cases. These are denoted by ‘-’

Source: NHS Staff Survey 2012

CQC │

Well-led General Medical Council – National Training Scheme Survey 2013

The trust performed worse than expected in the GMC National Training Scheme Survey in two or more areas in clinical oncology, GP programme (medicine) and respiratory medicine. Measures that the trust did well in include access to educational resources, local teaching and feedback.

Northampton General Hospital NHS Trust


Page 12

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Anaesthetics

CMT

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Cardiology

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GP Prog - Emergency Medicine

GP Prog - Medicine

GP Prog - Paediatrics and Child

Health

GP Prog - Surgery

General Practice F2

Medicine F1

Obstetrics and gynaecology

Paediatrics

Respiratory medicine

Urology


Similar to expected

Worse than expected

No Data

Source: gmc-uk.org

CQC │

CQC Framework Key


Safe Page 30

Effective Page 45

Caring Page 54

Responsive Page 72

Well-led Page 78

CQC │ Northampton General Hospital NHS Trust

Key facts

Northampton General

Hospitals NHS Trust

RNS Inspection pack prepared:

December 2013

Reason for inspection:

The trust was selected for inspection as an

example of a ‘high risk’ trust.

Page 14

What is a Tier 1 Indicator?

Tier 1 Indicators are the key metrics the CQC uses to help decide where and what to inspect. These Tier 1 indicators have been selected on the basis of statistical robustness, ability to identify poorly performing trusts, and their ability (as a group) to cover multiple dimensions of quality, and are constantly being refined as we learn more.

Within each of the five domains (Safe, Effective, Caring, Responsive and Well-led), there are a number of indicators (items) that have been assessed for each trust. For each indicator, the trust will be rated as ‘within expectations’, ‘risk’ or ‘elevated risk’. A summary of the ‘risks’ and ‘elevated risks’ for Northampton General Hospital NHS Trust are on the following page.

.

0

2

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10

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18Risks and Elevated Risks for all trusts

Northampton General Hospital NHS Trust Elevated RisksNorthampton General Hospital NHS Trust RisksElevated RisksRisks

CQC │

Safe Effective Caring Responsive Well-led Total

Number of Items 8 76 8 10 10 112

Number of Risks 0 2 0 1 1 4

Number of Elevated risks 0 2 0 0 2 4

Domain risk rating 0 6 0 1 5 12

Tier 1 Risks by Domain (Trust level)


CQC │

Context


Bed occupancy between July and

September 2013

84%

Population for

Northamptonshire

is 691,952

Northamptonshire is

the 119th most

deprived area out of

326 local

authorities.

97% of the population

of Northamptonshire

is registered to a GP

CQC │

Trust Profile Northampton General Hospital NHS Trust is an acute trust with 800 consultant led beds, and provides general acute services for a population of 380,000. It also provides hyper-acute stroke, vascular and renal services to people living throughout the whole of Northamptonshire, which has a population of 691,952. The trust was registered with the CQC on 1 April 2010, and the latest certificate of registration was generated on 9 August 2011. It has had no enforced conditions applied to it. The trust is registered to provide the following regulated activities:

• Accommodation for persons who require nursing or personal care

• Assessment or medical treatment for persons detained under the

MHAC 1983

• Diagnostic and screening procedures

• Maternity and midwifery services

• Surgical procedures

• Termination of pregnancies

• Treatment of disease, disorder or injury

In addition to the main hospital site, which is located close to Northampton town centre, the trust also provides services at the following sites in the county:

• Corby Community Hospital: In-patient rehabilitation services

• Danetre Hospital in Daventry: Diagnostic and/or screening

services, Services for everyone and Surgical procedures

• Isebrook Hospital Hazelwood Ward: Dementia, Diagnostic and/or

screening services, Learning disabilities, Caring for adults under

65 years of age and Caring for adults over 65 years of age

• Northampton General Hospital: Diagnostic and/or screening

services, Maternity and midwifery services, Services for everyone,

Surgical procedures and Termination of pregnancy

• Weston Favell Health Centre: Diagnostic and/or screening

services and Services for everyone

The trust is also an accredited cancer centre and provides cancer

services to a wider population of 880,000 who live in

Northamptonshire and parts of Buckinghamshire.

A list of services provided by Northampton General Hospital NHS Trust can be found in the appendix.


Finance information 2011-12 2012-13

Actual Net Surplus (Deficit) £0.5m £0.4m

Source: Trust Annual Reports, 2011/12 and 2012/13


Source: HES data, 2010-2011 to 2012-2013.

Note: The HES A&E data is experimental data

Activity Type 2010-11 2011-12 2012-13

Inpatient N/A 95,691 96,237

Outpatient 323,748 331,114 356,320

Accident & Emergency 83,187 91,283 N/A

CQC │

Bed Occupancy Between July and September 2013 the trust’s bed occupancy was 83.92%, compared to the England average of 85%. It is generally accepted that, when occupancy rates rise above 85%, it can start to affect the quality of care provided to patients and the orderly running of the hospital. The Department of Health also publishes separate occupancy rates for critical care beds, the results of which are detailed in the table below:

The graph below details the bed occupancy as a percentage of available beds occupied overnight for the time period between April 2011 and Sept 2013. Over the two year period, 2011 to 2013, the trust’s average has been above the England average with few exceptions. However, there has been a downward trend since the start of 2013 with the July to September 2013 figure below the England average.

CQC view

The trust’s bed

occupancy has often

been above the

England average in

the past, but more

recent levels (July to

September 2013)

are below the

England average.

Occupancy of adult

critical care beds

slightly exceeds that

of the national

average.

Neonatal critical care

beds seem to be

under utilised, with a

bed occupancy of

26.7%.


Source: NHS England Unify2 Data Collection, Apr 11 – Sept 13


Source: Critical Care Bed Capacity and Urgent Operations Cancelled,

Department of Health Transparency Website, (Aug 13 – Oct 13)

75%

80%

85%

90%

95%

100%

Ap

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Jul-S

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Oct-

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Average total daily percentage of available beds occupied overnight

Northampton General Hospital NHS Trust England average

Source: Bed Availability and Occupancy, Department of Health

Transparency Website, (Jul 13 – Sep 13)

Service area

Beds

available

Percentage

occupied National average

Total 811 83.9% 85.2%

General and Acute 742 86.5% 86.4%

Maternity 69 55.9% 58.7%

Service area

Beds

available

Percentage

occupied

National

average

Adult critical care 16 83.3% 82.1%

Paediatric intensive care N/A N/A 75.3%

Neonatal critical care 5 26.7% 71.5%

CQC │

Trust board and organisation structure The trust board is accountable for setting the strategic direction, monitoring of performance against objectives and ensuring high standards of corporate governance as well as helping to promote links between the trust and the local community. Approximately half of the Executive Directors, as well as the Chairman and Chief executive, are fairly new, having been appointed to these positions in the last few months. The following pages detail the members of the trust board and their roles, while the table to the right lists the trust’s Clinical Directors, as detailed on the trust’s website. The Appendix provides detail on the non-

executive directors.

Chair and Chief Executive

Chairman – Paul Farenden Paul Farenden was appointed as Chairman on 1 March 2012, and is a local man who was previously chief executive at the Dudley Group of Hospitals NHS Foundation Trust. He has some 40 years of experience in healthcare finance, management and leadership. A qualified accountant, he has been chief executive in three NHS trusts over the last 20 years, where he has led large scale organisational change. His experience has provided him with an in-depth understanding of both the NHS and the wider healthcare system.

Chief Executive – Dr Sonia Swart

Dr Sonia Swart was appointed as Chief Executive on 20 September 2013, having been the trust's Medical Director since September 2007, and acting Chief Executive since June 2013. Dr Swart

qualified from the University of Cambridge and went on to train in general medicine and clinical haematology. She worked as a consultant haematologist in North Warwickshire before joining Northampton General Hospital in 1994. Prior to becoming Medical Director, Dr Swart combined an active clinical role with a number of managerial activities, including head of pathology, clinical director for diagnostics and clinical lead for the foundation trust application.



Page 19


Clinical Area Clinical Director

Nursing, midwifery and patient services Suzie Loader

Medical Mike Wilkinson

CQC │

Trust board and organisation structure continued… Executive Directors

Director of Nursing, Midwifery and Patient Services – Suzie Loader

Suzie Loader is responsible for providing professional nursing & midwifery advice to the board, and for the facilitation of quality management issues, patient and public involvement and ensuring effective complaints systems are in place. She is also the Director of Infection Prevention and Control and provides the board with regular updates in this area. She also shares responsibility for clinical governance.

Suzie Loader joined the trust in April 2012 from the United Lincolnshire Hospitals NHS Trust, where she was interim Nurse Advisor leading the turnaround in the quality of nursing care following regulator inspections. Previously she has been Head of Case Management at the Nursing and Midwifery Council relating to fitness to practice, joint lead in support of the Prime Ministers Commission on the Future of Nursing and Midwifery, Project Director for Modernising Nursing Careers at the Department of Health and Director of Nursing at Heatherwood and Wexham Park NHS Foundation Trust. Acting Director of Finance – Andrew Foster

Andrew Foster is a qualified accountant who has worked for 25 in the NHS in a range of finance roles, and joined the trust in 2006 as Deputy Director of Finance. Prior to this he held senior positions at the Strategic Health Authority and Birmingham Women's Hospital.

Interim Chief Operating Officer – Deborah Needham

Deborah Needham trained as a Registered General Nurse in Lancashire where she held positions in both respiratory and emergency medicine units, before moving to London in 1998 as a ward manager. Moving from Nursing into Management in 1999, she has experience in operational and strategic management. Deborah Needham joined the trust in 2008 as a Directorate Manager and has held the posts of Deputy Director of Operations, Acting Operations Director and most recently Medical Care Group Director within the trust.

Interim Chief Operating Officer – Rebecca Brown

Rebecca Brown has 24 years operational and strategic experience in the NHS, starting as a nurse in 1989 before moving into general management in 2001. Since then she has worked in many different specialities and led some large scale service reconfigurations. She was awarded an MBE for her services to nursing in 2000. She began working at the trust in 2010 when she was appointed as deputy director of operations. Subsequently she was appointed to the role of care group director, before taking up the role of acting chief operating officer in October 2013.

Acting Medical Director – Mike Wilkinson

No biography from trust’s site




CQC │

Trust board and organisation structure continued… Executive Directors

Director of Facilities and Capital Development – Charles Abolins

Charles Abolins is responsible for the trust’s estates and facilities, capital development, purchasing and supply. After graduating in hospitality management from Birmingham College of Food and Tourism, Charles has held a number of facilities management posts in the NHS. Since joining trust, Charles has been responsible for leading and implementing complex, major capital building programmes and managing a wide range of facilities support

services.

Director of Strategy and Partnerships – Chris Pallot

Chris Pallot came to work for the trust in January 2010, initially on secondment from NHS Northamptonshire, before being appointed as the trust's director of planning and performance in September 2010. Chris Pallot has held positions at Kettering General Hospital, the NHS Modernisation Agency and NHS Northamptonshire. In previous roles, Chris Pallot has been responsible for operational management, service improvement and commissioning and contracting.

Director of Workforce and Transformation – Janine Brennan

Janine Brennan was on 2nd April 2013, having worked previously as director of workforce and organisational development at Royal Berkshire NHS Foundation Trust. Janine Brennan qualified in law and human resources management and has worked in a number of acute trusts, as well as the public sector and not-for-profit

organisations.




CQC │ Page 22

Trust board structure

Non-Executive Directors

Nicholas

Robertson Phil Zeidler

Graham

Kershaw

Chief Executive

Dr Sonia Swart

Chairman

Paul Farenden

Elizabeth Searle

Appointed Sep 2013

Appointed Mar 2012

Executive Directors

Acting Medical

Director

Mike Wilkinson

Acting Director

of Finance

Andrew Foster

Interim Chief

Operating Officer

Deborah

Needham

Interim Chief

Operating Officer

Rebecca Brown

Appointed Oct 2013 Appointed 2008 Appointed 2006

David Noble




Director of Nursing,

Midwifery and

Patient Services

Suzie Loader

Appointed Apr 2012

Director of Facilities

and Capital

Development

Charles Abolins

Director of Strategy

and Partnerships

Chris Pallot

Appointed Sep 2010

Director of

Workforce and

Transformation

Janine Brennan

Appointed Apr 2013

CQC │

Area overview Northampton is a non-metropolitan district of Northamptonshire in the East Midlands region of England. The 2010 Indices of Deprivation showed that Northampton was the 127th most deprived local authority (out of 326 local authorities, with 1st being the most deprived). There has been an increase of deprivation for all of Northamptonshire districts in national terms than previously.

Census data shows an increasing population for both the district and county, and a lower than average proportion of Black, Asian and Minority Ethnic (BAME) residents.

Life expectancy is 10.5 years lower for men and 6.4 years lower for

women in the most deprived areas of Northampton than in the least deprived areas.

Area demographics

The area demographic pyramid below details the combined population distribution for Northamptonshire. It has an evenly distributed population, but has a larger proportion of the population found between the age group 40 – 49 similar to the England averages.


Fact box

Population According to the 2011 census, the population of Northampton

is 212,100 (Northamptonshire is 691,952) with 97% of the

overall population that are registered with a GP.

The Royal College of Surgeons recommend that the "...catchment population size...for an

acute general hospital providing the full range of facilities, specialist staff and expertise for

both elective and emergency medical and surgical care would be 450,000 - 500,000."

Index of Multiple

Deprivation

Of 326 local authorities, Northampton is the 127th most

deprived (with 1st being the most deprived).

Ethnic Diversity In Northampton, 15.4% belong to non-White minorities. Of

these, Black African constitutes the largest ethnic group with

3.1% of the population.

Rural or Urban Region Northampton is a largely urban region.

Disease and Poor Health In Year 6, 18.4% of children are classified as obese. Levels of

teenage pregnancy and smoking in pregnancy are worse than

the England average. An estimated 23.3% of adults smoke

and 24.1% are obese. Rates of hip fractures and smoking

related deaths are worse than the England average.

Life Expectancy and

Causes of Death Life expectancy for both men and women is lower than the

England average. The early death rate from heart disease

and stroke has fallen but is worse than the England average.

Sources: Office for National Statistics, statistics.gov.uk, Royal College of Surgeons, data.gov.uk;

2011 Census for England and Wales, Public Health Observatories – area health profiles


10% 8% 6% 4% 2% 0% 2% 4% 6% 8% 10%

0-9

10-19

20-29

30-39

40-49

50-59

60-69

70-79

80 and over

England Male England FemaleNorthamptonshire Male Northamptonshire Female

CQC │

Area overview continued… The map on this page shows the location of Northampton General Hospital NHS Trust, the main hospital of the trust. In addition, hospitals from other trusts (Northamptonshire Healthcare NHS Foundation Trust) within a 5 mile radius are also shown.


Source: © Google Maps

Trust Sites

Other NHS Hospitals

Northampton

General Hospital

The Sett

Page 24


Berrywood

Hospital

CQC │

CQC inspection history Northampton General Hospital NHS Trust has had four inspections since registration and these include three inspections at Northampton General Hospital and one inspection at Isebrook Hospital, Hazelwood Ward.

The locations that have been inspected since registration are listed below along with their level of compliance.

Northampton General Hospital (RNS01)

Three inspections, including a ‘themed’ inspection, have been carried out in July 2011, March 2012 and July 2012. The site is found to be compliant for some outcomes with no further action needed, requires improvements for other outcomes which were found compliant and non-compliant in other outcomes.

Isebrook Hospital, Hazelwood Ward (RNS7M)

One inspection has been carried out at this location in January 2012, and the location was found to be compliant for the outcomes but with minor concerns for one of the outcomes.



CQC │

CQC inspection history continued… The current compliance of Northampton General Hospital NHS Trust by outcome is detailed in the table below:


Location Outcome Latest judgement Date of judgement

Isebrook Hospital, Hazelwood

Ward (RNS7M)

Outcome 1 (R17) Respecting and involving people who use services Compliant 14/03/2012

Outcome 4 (R9) Care and welfare of people who use services Compliant 14/03/2012

Outcome 7 (R11) Safeguarding people who use services from abuse Compliant 14/03/2012

Outcome 10 (R15) Safety and suitability of premises Compliant but with minor

concerns 14/03/2012

Outcome 13 (R22) Staffing Compliant 14/03/2012

Outcome 16 (R10) Assessing and monitoring the quality of service provided Compliant 14/03/2012

Northampton General Hospital

(RNS01)

Outcome 1 (R17) Respecting and involving people who use services Compliant 04/09/2012

Outcome 2 (R18) Consent to care and treatment Compliant 04/09/2012

Outcome 4 (R9) Care and welfare of people who use services Compliant 04/09/2012

Outcome 7 (R11) Safeguarding people who use services from abuse Compliant but requires

improvement 04/09/2012

Outcome 9 (R13) Management of medicines Non-compliant 04/09/2012

Outcome 13 (R21) Staffing Non-compliant 04/09/2012


Outcome 4 (R9) Care and welfare of people who use services Compliant with minor concerns

09/08/2011

Outcome 7 (R11) Safeguarding people who use services from abuse Compliant 09/08/2011


Page 26


CQC │

CQC inspection comments The tables on the following pages detail the comments relating to each of the inspections of Northamptonshire General hospital NHS Trust.


Section Outcome name Hospital Comment Nature of

comment

Date of

comment

Section 1:

Involvement

and

information

Outcome 1 (R17)

Respecting and

involving people

who use services

Isebrook

Hospital,

Hazelwood

Ward

On inspection day, CQC observed that staff spoke to patients in a respectful way and gave explanations

when assisting people. One patient said, "the rehabilitation is very good" saying that the staff "explain

things and work with you.“ One relative said that staff had asked her for information about her family

member when he was first admitted to the ward so that they were aware of his needs and preferences.

She explained that she was also involved in planning for her family members future care arrangements

with hospital staff.

31/01/2012

Outcome 2 (R18)

Consent to care

and treatment

Northampton

General

Hospital

Before people received any care or treatment they were asked for their consent and the

provider acted in accordance with their wishes.

Seven people were spoken to about the process for consenting to their care and

treatment. CQC found that all had been aware of the implications of any tests or

treatment before giving their consent. The majority were satisfied that their treatment

and any tests had been fully explained by staff and the risks and benefits had been

discussed and that their wishes followed.

04/09/2012

Section 2:

Personalised

care

Outcome 4 (R9)

Care and welfare

of people who use

services

Isebrook

Hospital,

Hazelwood

Ward

One patient spoken to during inspection said that she, "had nothing to complain about" since being

admitted to the ward. She told us that "the rehabilitation is very good.“ Another patient who was

transferred from one of the acute hospitals mentioned that, he was being kept informed about his

treatment. He said that, staff had explained the reasons for the transfer to him and that he was

expecting to see the doctor that morning and they would explain his treatment plan.

31/01/2012

Northampton

General

Hospital

During inspections CQC spoke with patients and/or their relatives about their experiences in the

accident and emergency (A&E) department, emergency assessment unit and wards. One patient and

their relative said that there had been a real improvement in A&E since their last visit earlier in the year.

The relative said, "The care has been excellent this time, staff have communicated with me every step

of the way, we have not been left alone for very long".

04/07/2012

Northampton

General

Hospital

During the inspection 10 wards were visited patients, some of their family members and staff providing

care were spoken to. Patients made a lot of positive comments to us about their care and treatment. For

example, one patient said that they had been dealt with promptly on arrival in the accident and

emergency department and had confidence in the doctors who they described as "knowing what they

were doing".

04/07/2011

Page 27


Positive Comment Negative Comment

CQC │

CQC inspection comments



comment

Date of

comment

Section 3:

Safeguarding

and safety

Outcome 7 (R11)

Safeguarding

people who use

services from

abuse

Isebrook

Hospital,

Hazelwood

Ward

One relative spoken to during inspection said that she felt her family member was safe on the ward and

that she had no concerns about his care. She explained that if she did have concerns she could

approach staff. 31/01/2012

Staff were aware of the different types of abuse and were able to discuss how they would manage a

safeguarding vulnerable adults' allegation. They were aware that they had an individual

responsibility to report any allegations and that there was a safeguarding lead within the

trust that they could contact if necessary for advice.

31/01/2012

Northampton

General

Hospital

One person spoken to during inspection said, they had raised a concern about a member of staff and

that this had been dealt with appropriately and to their satisfaction. Another person said, they had talked

about a safeguarding concern with one of the staff on the ward and that the way the team responded to

the concerns was excellent and prompt.

16/07/2012

Outcome 16 (R10)

Assessing and

monitoring the

quality of service

provided

Isebrook

Hospital,

Hazelwood

Ward

During CQC’s inspection visit, staff were asked about the quality assurance systems.

Staff said that staffing levels had been increased as a result of them raising concerns

that there were not enough staff to meet the needs of patients. 31/01/2012

Northampton

General

Hospital

During the inspection it was found that comprehensive systems were in place to assess and monitor the

quality of care and services. Speaking to a member of staff in the complaints department and reviewing

complaint and quality assurance documentation, it was found that appropriate systems were in place to

identify and address recurring themes or concerns regarding patient care. Systems were also in place

to help ensure that lessons were learnt from things that went wrong.

16/07/2012

Page 28



CQC │

CQC inspection comments



comment

Date of

comment

Section 4:

Suitability of

staffing

Outcome 13 (R22)

Staffing

Isebrook

Hospital,

Hazelwood

Ward

Two relatives spoken to during inspection said that, the staff were "very busy" particularly at weekends.

One relative said that sometimes when her family member rang their call bell "nothing happens." She

explained that the ward used several temporary staff from an agency. One patient told us that staff

"may take longer to get to you when they are busy.“ Another patient said she was very happy with her

care but hated having to wait for assistance to go to the toilet. She said that when she asks for help

"there is always something else having to be done."

31/01/2012

Northampton

General

Hospital

During inspection some patients and their relatives on each of the nine wards and departments visited

were spoken to . All the patients commented how busy staff were and said they thought there was not

enough staff. Comments included; "Getting washed and dressed can be a bit of a rush in the morning,

they are very busy especially for the first hour. Staff have to leave you and attend to others. I have a call

bell but can wait a long time if staff are busy". "I rang my bell because I was feeling sick but had a long

time to wait".

07/2012

Section 5:

Quality and

management

Outcome 16 (R10)

Assessing and

monitoring the

quality of service

provided

Isebrook

Hospital,

Hazelwood

Ward

Minutes from clinical governance meetings showed that quality issues were discussed and monitored at

different levels within the trust. These included learning from incidents. An example was the minutes of

a meeting attended by ward managers and matrons throughout the trust. It was agreed that part of that

meeting would be used to share experiences and learn from complaints and incidents.

31/01/2012

Northampton

General

Hospital

During inspection patients said that they are asked for their views about their care and treatment during

their stay in hospital. They are asked to answer a set of questions generated on a hand

held electronic device which is left with a sample of patients. This is referred to as a

patient tracker system and provides senior managers with an overview of patients'

experiences on the wards.

04/07/2011

Page 29



CQC │

60%

65%

70%

75%

80%

85%

90%

95%

100%

Ea

st M

idla

nds

Ea

st of E

ngla

nd

Isle

of W

ight

London

Nort

h E

ast

Nort

h W

est

So

uth

Centr

al

So

uth

East C

oast

So

uth

Weste

rn

West M

idla

nds

Yo

rksh

ire

Category A (Red 2) incidents: Presenting conditions which may be life threatening but less

time-critical - National Target 75%

Aug-13 Sep-13 Oct-13 Target

Performance of local health care providers To give an informed view of trust’s performance it is important to consider the service levels of non-acute local providers. For example, slow ambulance response times will greatly increase the risk of mortality. NHS England collects data on three key performance indicators for England’s Ambulance services. These are:

• Category A (Red 1) incidents: presenting conditions, which may be immediately life threatening. National target 75%

• Category A (Red 2) incidents: presenting conditions, which may be life threatening but less time-critical. National target 75%

• Category A calls (Red 1 and Red 2) resulting in an ambulance arriving at the scene of the incident within 19 minutes. National target 95%

The graph to the right shows the performance of ambulance services in England over a three month period (Aug 2013 – Oct 2013, for the percentage of Category A (Red 1) incidents responded to within eight minutes. Between Aug 2013 – Oct 2013 the proportion of Red 1 calls resulting in an emergency response within 8 minutes was less than the national target of 75%. Graphs representing the further two indicators, for which the East Midlands Ambulance Service did not meet the national targets, can be found in the Appendix.



Source: NHS England

CQC │

Safe


0 Never Events reported by the trust

between December 2012 and November

2013

Four questions in the

staff survey are in the

bottom 20% of all trusts

Infection rates are

within statistically

acceptable limits

Catheter and new

UTIs are above

England average for all

patients and those over

70 for most of the

period

New pressure ulcer

proportions are above

England average for all

patients and patients

over 70

CQC │

Framework section Tier 1 Indicator RAG

Deaths in low risk

diagnosis groups

Dr Foster: Deaths in low risk diagnosis groups

(April 2012 – March 2013)

Never Events Never Event Incidence (July 2013 – September 2013)

Venous

Thromboembolism

Proportion of patients risk assessed for Venous

Thromboembolism (VTE) (April 2013 – June 2013)

Avoidable

infections

Incidence of Clostridium difficile (C. difficile)

(August 2012 – July 2013)

Incidence of Meticillin-resistant Staphylococcus aureus

(MRSA) (August 2012 – July 2013)

Patient safety

incidents

Proportion of reported patient safety incidents that are

harmful (July 2012 – June 2013)

Potential under-reporting of patient safety incidents

resulting in death or severe harm

(July 2012 – June 2013)

Potential under-reporting of patient safety incidents

(July 2012 – June 2013)

Additional information Additional information has been included in this domain to provide a more holistic view of the trust’s performance. These are listed below:

Safe Dashboard


Additional information

STEIS Never Events

STIES Serious Incidents

NRLS notifications

Pressure ulcers

VTE

Catheter and UTI Infections

Falls

Staff survey

Complaints Handling

Schedule 5


Elevated Risk

Risk

Within expectations Source: CQC Intelligent Monitoring Report, Oct 2013

CQC │

The following pages detail indicators related to patient safety, including the prevalence of Never Events and Serious Incidents, patient safety incidents reported to the National Reporting and Learning System (NRLS), type of incident harm and infection rates.

STEIS data Never Events

A serious incident known as a Never Event is classified as such because they are so serious that they should never happen.

The trust reported no Never Events between December 2012 and December 2013.

The table to the right details the number of Never Events that occurred at trusts of similar size (with respect to number of bed days) to the Northampton General Hospital NHS Trust between November 2012 and December 2013. As can be seen, the trust, with no Never Events, has not reported noticeably more or less than trusts of a similar size (in regard to number of bed days). It is crucial to note that Never Events are not acceptable.


Safety indicators

Page 33

Trust name Number of Never

Events reported

Bed days

Trust A 1 270,073

Trust B 2 268,861

Trust C 3 268,793

Trust D 4 268,694

Trust E 0 266,370

Trust F 0 264,396

Trust G 4 263,854

Trust H 1 256,339

Trust I 3 256,146

Northampton General Hospital NHS Trust 0 255,044

Trust J 0 251,028

Trust K 0 251,027

Trust L 1 250,474

Trust M 2 250,369

Trust N 4 249,599

Trust O 0 247,447

Trust P 2 243,816

Trust Q 4 242,149

Trust R 3 241,408

Trust S 2 241,266

Trust T 4 240,573

Trust U 3 239,062

Trust V 3 235,879

Trust W 2 232,191

Trust X 2 232,111



Dec 2012 – Nov 2013

CQC │

STEIS data continued… Never Events continued…

No Never Events have occurred at the trust in the last 12 months. The graph below details the number of Never Events reported versus trust size (with respect to number of bed days), for the time period December 2012 to November 2013.

Between December 2012 and November 2013, a total of 355 Never Events occurred at 150 trusts in England.




Dec 2012 – Nov 2013

31

61

49

26

6 6

2 2 0 0 1

0

10

20

30

40

50

60

70

0 1 2 3 4 5 6 7 8 9 10

No

. o

f T

rusts

No. of Never Events

Distribution of Never Events across England trusts

0

1

2

3

4

5

6

7

8

9

10

0 100 200 300 400 500 600 700

Co

un

t o

f N

ever

Even

ts

Estimated bed days (thousands)

Never Events compared with trust size

Other acute trusts Statistical outliers Northampton General Hospital NHS Trust

CQC │

STEIS data continued… Serious Incidents

The Strategic Executive Information System (STEIS) records Serious Incidents and Never Events. Serious Incidents are those that require an investigation. Never Events are incidents that should never occur, and there is a defined list of 28 incidents which are classified as Never Events.

Since 2004, trusts have been encouraged to report all patient safety incidents to the NRLS. The notifications of patient safety incidents are classified by the degree of

harm: no actual harm, low, moderate, severe, abuse and death. Since 2010, it has been mandatory for trusts to report all death or severe harm incidents to the CQC via the NRLS.

If a trust is accurately reporting, a single incident will be reported via both NRLS and STEIS (assuming the incident was a Serious Incident/Never Event).

Between December 2012 and November 2013, 104 Serious Incidents occurred at the trust. The table to the right details the location of the Serious Incidents that occurred at the trust. Ward areas accounted for 85.5% of the serious incidents reported.

CQC view

There were 104

Serious Incidents

that were reported at

the trust between

December 2012 and

November 2013.

These occurred in

eight different areas,

with the majority on

wards.


Location of incident Number of serious incidents

Ward areas 89

Accident and emergency 5

Outpatient department 4

Operating theatre 2

Radiology department 1

Labour ward and delivery 1

Laboratory 1

Patient's home 1

Total 104



Dec 2012 – Nov 2013

CQC │

Incident reports to the NRLS Since 2004 trusts have been encouraged to report all patient safety incidents to the NRLS and since 2010, it has been mandatory for them to report all death or severe harm incidents to the CQC via the NRLS. An analysis of the number of incidents reported to the NRLS, against the number of incidents expected to occur at a trust, based on the number of bed days, can indicate any potential under-reporting.

There were 332 incidents reported by the trust to the NRLS between July 2012 to June 2013:

Incidents reported between July 2012 to June 2013

NRLS z-score analysis

For any set of values, a z-score is a measure of how far any single value is from the mean of all of the values. It is expressed in standard deviations, with zero indicating a value equal to the mean, a negative z-score indicating a value less than the mean, and a positive z-score indicating a value greater than the mean.

The NRLS z-score analysis in this data pack is based on three indicators proposed and defined by NHS England.

The indicators are:

• Death and Severe Harm notifications as a rate per bed days, used to identify potential under-reporting

• All incidents (including low and no harm) as a rate per bed days, used to identify potential under-reporting

• Proportion of low, moderate, severe and death incidents out of all incidents reported, used to identify trusts with high proportions of harmful events

The table below details the trust’s NRLS z-scores and corresponding RAG rating.

Analysis of the NRLS notification z-scores (time period July 2012 to June 2013) across all specialties indicates that the trust’s reporting is within statistically acceptable limits.


Abuse Moderate Severe Death Total No. of

Incidents

53 230 25 24 332

NRLS z-score indicator type Z-score value RAG

Death & severe harm – under reporting -0.4 All incidents (including low and no harm) – under reporting -0.1 Low, moderate, severe death incidents – high proportions of

harmful events -0.4


H Significantly high number of notifications

L Significantly low number of notifications

Within expectations Source: National Reporting Learning System (NRLS) July 2012 – June 2013

CQC │

Incident reports to the NRLS continued… Death

Between July 2012 and June 2013, the trust submitted 24 patient safety alerts which were classified as deaths. There were 17 of the 24 deaths which took place in inpatient areas of acute / general hospitals. Seven of the deaths were categorised as ‘implementation of care and on-going monitoring / review’, of which six were subcategorised as ‘other’. Four deaths were categorised as ‘treatment / procedure’. The categories of ‘access, admission, transfer, discharge’, ‘clinical assessment’ and ‘other’ accounted for three deaths each.

In addition, ‘patient accident’, ‘medication’, ‘medical device / equipment’ and ‘documentation’ accounted for the remaining four deaths.

Severe Harm

The majority (72%) of the 25 severe incidents occurred in inpatient areas of an acute hospital setting with the remaining 28% split between four hospital locations including three in support services and two in the outpatient department. There were 52% categorised as ‘patient accident’. The remaining 48% of incidents were split between four different categories including four in ‘clinical assessment’, four in ‘implementation of care’ and ‘ongoing monitoring / review’, three in ‘treatment / procedure’ and the remaining incident in ‘medical device / equipment’.

Medical specialties made up 64% of the 25 severe incidents and surgical specialties made up 28%. Of the severe incidents categorised as medical specialties, five were subcategorised as occurring in the cardiology department. There were three severe incidents each in general medicine and care of older people.

Three of the seven incidents in the surgical specialty were subcategorised as trauma and orthopaedics with the others split between four different subcategories including urology, vascular surgery, ophthalmology and general surgery.

Moderate harm

The majority (72%) of the 230 moderate harm incidents occurred in inpatient areas of general / acute hospital settings.

Medical specialties was the most common location for moderate harm incidents - accounting for 56% of the 129 moderate incidents reported. Of these, 57% were attributed to general medicine and 17% were care of older people with cardiology and gastroenterology

making up the majority of the remaining moderate harm medical incidents.

Surgical specialties was the next highest specialty with 18% of moderate incidents (41), of which general surgery accounted for 38% and trauma and orthopaedics accounted for 32%.

Accident and Emergency (22) and anaesthesia pain management and critical care (21) made up the majority of the remaining incidents, however the subcategories were either ‘other’ or un-coded.

Abuse

Of the 53 incidents reported as abuse, 41 (77%) resulted in no harm to the patient with the remaining 10 (13%) causing a low level of harm. The majority of incidents occurred in medical specialties (68%) whilst there were also seven incidents in surgical specialties. The remaining incidents were split between three different specialties at the trust.



Source: National Reporting Learning System (NRLS) July 2012 – June 2013

CQC │

Incident reports to the NRLS continued… Specialty in which incidents occurred

The table below details the specialties in which the 332 incidents reported to the NRLS took place. The largest number occurred in medical specialties, which accounted for 57% of all incidents.

Location of incidents

The graph below shows that the vast majority of the incidents reported to the NRLS by the trust occurred in inpatient areas. The remaining incidents were distributed between eight other locations with A&E coming second.

CQC view

The majority of

incidents were

classified as

occurring in medical

specialties, surgical

specialties, accident

and emergency and

anaesthesia pain

management and

critical care.

Medical specialties

had the most

moderate, abuse,

deaths and severe

harm incidents.



Source: National Reporting Learning System (NRLS)

July 2012 – June 2013

Specialty Moderate Severe Abuse Death Total

Medical specialties 129 16 36 8 189

Surgical specialties 41 7 7 5 60

Accident and

Emergency (A) 22 1 4 2 29

Anaesthesia Pain

Management and

Critical Care

21 1 0 2 24

Obstetrics and

gynaecology 7 0 4 3 14

Diagnostic services 4 0 0 1 5

Other specialties 1 0 0 0 1

Other 5 0 2 3 10

Grand total 230 25 53 24 332

2

1

1

1

8

13

48

258

0 50 100 150 200 250 300

(blank)

Private house / flat etc.

General areas

Day care services

Outpatient department

Support services

Accident (A) / minor injury unit /medical assessment unit

Inpatient areas

CQC │

New pressure ulcers This page outlines the percentage of patients in hospital on the date of a monthly survey who acquired a pressure ulcer after their admission to the trust. Due to the effects of seasonality on hospital acquired pressure ulcers, the England averages have been included.

All patients and patients over 70

The proportion of all patients with new pressure ulcers and those for patients over 70 show a similar pattern with regular spikes and fluctuations above the England average. The recent rise in percentages for both

categories must be investigated. In November 2013 the proportion of patients over 70 with new pressure ulcers was more than double the England average at 3%.

CQC view

The proportion of

patients with new

pressure ulcers has

fluctuated with a

sharp rise from

September 2013 and

double the England

average reported for

people over 70 in

November 2013.

This requires

investigation to

ensure the trust has

measures in place to

reduce this increase

and stabilise levels.

Caution should be

used when

comparing trust

Safety Thermometer

results to the

national average as

this does not

account for trust-to-

trust variation in the

demographic make-

up of the population,

though they may be

areas for further

investigation.



Source: Safety Thermometer Nov 2012 – Nov 2013

New pressure ulcers

(All)

New pressure ulcers

(Patients over 70)

Month Trust

(%)

National Avg.

(%)

Trust

(%)

National Avg.

(%)

Nov-12 1.0 1.2 1.6 1.5

Dec-12 1.7 1.1 2.0 1.4

Jan-13 0.7 1.3 1.3 1.6

Feb-13 0.7 1.3 1.3 1.6

Mar-13 1.8 1.3 2.2 1.6

Apr-13 1.5 1.3 1.8 1.6

May-13 1.2 1.2 1.6 1.5

Jun-13 1.3 1.2 1.0 1.4

Jul-13 1.0 1.2 1.8 1.4

Aug-13 1.5 1.1 1.5 1.3

Sep-13 0.9 1.1 0.9 1.3

Oct-13 2.0 1.1 2.9 1.3

Nov-13 1.9 1.0 3.1 1.2

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

Nov-1

2

Dec-1

2

Jan

-13

Fe

b-1

3

Ma

r-13

Ap

r-13

Ma

y-1

3

Jun

-13

Jul-1

3

Au

g-1

3

Se

p-1

3

Oct-

13

Nov-1

3

Perc

en

tag

e o

f P

ati

en

ts

New pressure ulcers All patients

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

Nov-1

2

Dec-1

2

Jan

-13

Fe

b-1

3

Ma

r-13

Ap

r-13

Ma

y-1

3

Jun

-13

Jul-1

3

Au

g-1

3

Se

p-1

3

Oct-

13

Nov-1

3

Perc

en

tag

e o

f P

ati

en

ts

New pressure ulcers Patients over 70


CQC │

New Venous Thromboembolisms (VTEs) This page outlines the percentage of patients suffering from new VTEs on the date of a monthly survey. A case of new VTE is considered such if the case of VTE started after the patient was admitted.

All patients

The proportion of patients with new VTE was above the England average between November 2012 and March 2013, after which there are no cases of new VTE on the particular day of the monthly VTE survey. The trust

report that this is because they do not collect this data.

CQC view

The trust report that

that they do not

collect data on new

VTEs for the Safety

Thermometer and

this is why their

figures are zero from

April 2013 to

November 2013.




0.0%

0.2%

0.4%

0.6%

0.8%

1.0%

1.2%

1.4%

Nov-1

2

Dec-1

2

Jan

-13

Fe

b-1

3

Ma

r-13

Ap

r-13

Ma

y-1

3

Jun

-13

Jul-1

3

Au

g-1

3

Se

p-1

3

Oct-

13

Nov-1

3

Perc

en

tag

e o

f p

ati

en

ts

New VTE


New VTE

Month Hospital (%) National Avg. (%)

Nov-12 0.6% 0.7%

Dec-12 1.0% 0.7%

Jan-13 0.7% 0.7%

Feb-13 0.7% 0.7%

Mar-13 1.3% 0.7%

Apr-13 0.0% 0.7%

May-13 0.0% 0.7%

Jun-13 0.0% 0.6%

Jul-13 0.0% 0.6%

Aug-13 0.0% 0.6%

Sep-13 0.0% 0.6%

Oct-13 0.0% 0.6%

Nov-13 0.0% 0.6%

CQC │

Catheters and New Urinary Tract Infections (UTIs) This page outlines the proportion of patients suffering from new urinary tract infections on the date of a monthly survey among patients with a catheter.

All patients and patients over 70

The proportion of patients with a catheter who suffered from a UTI at the trust has been above the England average for the majority of the period between November 2012 and November 2013. There are noticeable spikes in percentages during January, March

and September 2013 for all patients. UTI infections in patients over 70 show a similar pattern of proportions above the England average for most of the period.

CQC view

The trust ‘s total

percentage of

patients suffering

from UTIs on the

date of a monthly

survey among

patients with a

catheter has been

consistently above

the England

average.

An investigation is

required to

understand what

measures the trust

has in place to

reduce the high

proportions and

stabilise for both

patient groups.




Catheter and New UTIs

(All patients) Catheter and New UTIs

(Patients over 70)

Month Trust

(%)

National Avg.

(%)

Trust

(%)

National Avg.

(%)

Nov-12 0.3 0.5 0.5 0.6

Dec-12 0.4 0.5 0.5 0.6

Jan-13 1.0 0.5 1.8 0.6

Feb-13 0.3 0.5 0.5 0.6

Mar-13 1.7 0.5 1.4 0.6

Apr-13 1.2 0.5 1.3 0.6

May-13 0.9 0.5 1.6 0.6

Jun-13 0.6 0.5 1.0 0.6

Jul-13 0.4 0.5 0.5 0.6

Aug-13 1.0 0.5 1.5 0.5

Sep-13 1.3 0.5 0.9 0.6

Oct-13 1.0 0.4 1.6 0.5

Nov-13 0.9 0.4 1.3 0.5

0.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

1.6

1.8

2.0

Nov-1

2

Dec-1

2

Jan

-13

Fe

b-1

3

Ma

r-13

Ap

r-13

Ma

y-1

3

Jun

-13

Jul-1

3

Au

g-1

3

Se

p-1

3

Oct-

13

Nov-1

3

Perc

en

tag

e o

f P

ati

en

ts

Catheters and new UTIs All patients

0.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

1.6

1.8

2.0

Nov-1

2

Dec-1

2

Ja

n-1

3

Fe

b-1

3

Ma

r-13

Ap

r-13

Ma

y-1

3

Ju

n-1

3

Jul-1

3

Au

g-1

3

Se

p-1

3

Oct-

13

Nov-1

3

Perc

en

tag

e o

f P

ati

en

ts

Catheters and new UTIs Patients Over 70


CQC │

Falls with harm Each month the trust records the number of harmful falls within a three day period – this page details the corresponding data.

All patients

A pattern of below England average proportions is visible in all falls with harm with a slight peak in percentages in May 2013.

Patients over 70

Falls with harm in patients over 70 have remained below

the England average for almost all of the period, following a similar pattern to all patients.

CQC view

For both categories

of patients, the

proportions of

patients suffering

from falls with harm

are below the

England average for

most of the period.




Falls with Harm

(All patients) Falls with Harm

(Patients over 70)

Month Trust

(%)

National Avg.

(%)

Trust

(%)

National Avg.

(%)

Nov-12 0.4 1.0 0.3 1.3

Dec-12 0.3 1.0 0.5 1.3

Jan-13 0.1 0.9 0.0 1.2

Feb-13 0.3 1.0 0.5 1.2

Mar-13 0.4 0.9 0.5 1.2

Apr-13 0.6 1.0 0.8 1.2

May-13 1.0 0.9 1.4 1.4

Jun-13 0.3 0.9 0.5 1.2

Jul-13 0.4 0.9 0.8 1.2

Aug-13 0.3 0.9 0.3 1.2

Sep-13 0.6 0.8 0.9 1.1

Oct-13 0.0 0.8 0.0 1.0

Nov-13 0.2 0.8 0.0 1.0

0.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

1.6

Nov-1

2

Dec-1

2

Jan

-13

Fe

b-1

3

Ma

r-13

Ap

r-13

Ma

y-1

3

Jun

-13

Jul-1

3

Au

g-1

3

Se

p-1

3

Oct-

13

Nov-1

3

Perc

en

tag

e o

f P

ati

en

ts

Falls with harm All patients

0.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

1.6

Nov-1

2

Dec-1

2

Jan

-13

Fe

b-1

3

Ma

r-13

Ap

r-13

Ma

y-1

3

Jun

-13

Jul-1

3

Au

g-1

3

Se

p-1

3

Oct-

13

Nov-1

3

Perc

en

tag

e o

f P

ati

en

ts

Falls with harm Patients Over 70


CQC │

Infection control data

MRSA infections

During the 12 months from August 2012 to July 2013, the trust reported one case of MRSA infection.

Statistical analysis of MRSA infection data over the period August 2012 to July 2013 indicates that the number of infections reported by the trust lies within a statistically acceptable range relative to the trust’s size and the national level of infections.

MSSA infections

During the 12 months from August 2012 to July 2013, the trust had a total of 10 MSSA infections, seven of which occurred in January 2013.

It should be noted that MSSA is a relatively new infection control indicator, for which the relationship to the quality of care is yet to be fully established. Statistical analysis has therefore not been carried out to determine the statistically acceptable range of performance for this indicator.

C. difficile infections

During the 12 months from August 2012 to July 2013, the trust reported 32 cases of C. difficile infections. The

month with the highest number of cases (seven) was April 2013.

Statistical analysis of C.diff infection data over the period August 2012 to July 2013 shows that the number of infections reported by the trust is within a statistically acceptable range, taking into account the trust’s size and the national level of infections.

CQC view

The trust’s infection rates for C. diff and MRSA lie within a statistically acceptable range after taking into account the trust’s size and the national level of infections.


Bacteria 2012 2013

Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul

C. difficile 0 2 1 2 4 2 2 5 7 2 4 1

MRSA 0 1 0 0 0 0 0 0 0 0 0 0

MSSA 1 0 2 2 1 1 0 0 1 0 1 1


Source: Health Protection Agency (HPA) data August 2012 – July 2013

CQC │

Staff survey data items relevant to the safe domain The 2012 Department of Health NHS staff survey was open to 202,000 NHS staff and had a response rate of 50%. The results are primarily intended for use by NHS organisations to help them review and improve staff experience so that staff can provide better patient care.*

The General Medical Council National Training surveys asked 54,000 doctors in training in the UK to give their opinions on the quality of the training they received.

The results of questions relating to patient safety from these two surveys are displayed below.

CQC view

The trust scored in

the bottom 20% of

all trusts for four of

the six questions in

the staff survey

relating to safety.


Data item source Data item RAG

Picker Institute

Europe on behalf of

the Department of

Health, NHS Staff

Survey 2012*

58% of staff said hand washing materials were always available

75% of staff worked extra hours

41% of staff witnessed potentially harmful errors, near misses or incidents in the last month

72% of staff felt satisfied with the quality of work and patient care they are able to deliver

The proportion of staff who would recommend the trust as a place to work or receive treatment

89% of staff reported errors, near misses or incidents witnessed in the last month

General Medical

Council, National

Training Surveys

(Mar 13 – May 13

Trainees rated their clinical supervisor on whether they felt forced to cope with clinical problems beyond their

competence or experience

This measures the quality of educational supervision by asking trainees about the support and management they

were getting in their training from their educational supervisor

This asked trainees to assess their overall workload to establish how appropriate it was to learning and developing

experience and skills during their training

*More detail on these staff survey questions can be found in the ‘Well-led’ section.




Within expectations


Worse than expected Sources: NHS Staff Survey, 2012;

GMC National Training Surveys, Mar 13 – May 13

CQC │

Medication Errors Data held about the trust shows that they are performing similar to expected:

:

Complaints handling Data returns to the Health and Social Care Information

Centre showed 538 written complaints were submitted to the trust in 2012-13, however no data is available on the number that were upheld. This was a 4.1% increase from the 517 complaints in 2011-12. The number of complaints is not necessarily an indicator of poor performance, as the best trusts may encourage comments from patients.

Schedule 5 (formerly Coroner’s Rule 43) Every six months, the Ministry of Justice publishes a summary of Schedule 5 recommendations which have been made by the local coroners with the intention of learning lessons from the cause of death and preventing deaths.

No reports were present for Northampton General Hospital NHS Trust.

CQC view

The trust received

538 written

complaints in the

2012-13 time period,

representing an

increase of 4.1%

from the 2011-12

period.

Medication errors

per 1,000 were

within statistically

acceptable limits.



RAG Northampton General Hospital

NHS Trust

National

Mean

Medication errors

per 1,000 7.7 7.2

Source: Acute Trust Quality Dashboard, Apr 2012 – Sep 2012

Source: HSCIC, 2011-12 and 2012-13

Source: Schedule 5 (formerly Summary of Reports and Responses

under Rule 43 of the Coroners Rules), October 2012 – March 2013



Within expectations


Worse than expected

CQC │

Effective


4 Tier 1 indicators identified

as being a ‘risk’ or ‘elevated

risk’

Elevated Risk:

Summary Hospital-

level Mortality Indicator

Risk:

The number of cases

assessed as achieving

compliance with all

nine standards of care

measured within the

National Hip Fracture

Database.

Elevated Risk:

Maternity outlier alert:

Elective Caesarean

section

Risk:

Composite indicator:

In-hospital mortality -

Gastroenterological

and hepatological

conditions and

procedures

CQC │


Maternity and

women’s health


Maternity outlier alert: Emergency Caesarean section

Maternity outlier alert: Puerperal sepsis and other

puerperal infections

Re-admissions

Maternity outlier alert: Maternal readmissions

Maternity outlier alert: Neonatal readmissions

Emergency readmissions following an elective admission

Emergency readmissions following an emergency

admission

PROMs

(EQ-5D score)

Groin Hernia Surgery

Hip Replacement

Knee Replacement

Varicose Vein Surgery

Audit

The number of cases assessed as achieving compliance

with all nine standards of care measured within the

National Hip Fracture Database.

Key Indicator 1: Number of patients scanned within 1

hour of arrival at hospital

Key Indicator 8: Number of potentially eligible patients

thrombolysed

Surgical revisions

outlier alert

Hip revisions N/A

Knee revisions N/A

Effective Dashboard



Elevated risk

Risk

No evidence of risk

Source: CQC Intelligent Monitoring Report, Nov 2013

CQC │

Additional Information Additional information has been included in the pack to provide a more holistic view of the trust’s performance. These are listed below:

Framework section Tier 1 Composite Indicator RAG

Mortality: Trust

level


Dr. Foster: Composite of Hospital Standardised Mortality

Ratio indicators

Mortality

(Composite

indicator: In-

hospital mortality)

Cardiological conditions and procedures

Cerebrovascular conditions

Dermatological conditions

Endocrinological conditions

Gastroenterological and hepatological conditions and

procedures

Genito-urinary conditions

Haematological conditions

Infectious diseases

Conditions associated with Mental health

Musculoskeletal conditions

Nephrological conditions

Neurological conditions

Paediatric and congenital disorders and perinatal

mortality

Respiratory conditions and procedures

Trauma and orthopaedic conditions and procedures

Vascular conditions and procedures

Effective Dashboard continued…



Additional Information

Mortality Indicators

Maternity Indicators


Elevated risk

Risk

No evidence of risk

CQC │

S

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Mortality tree This page shows the revised Tier 1 Mortality Indicators within the CQC Surveillance Programme.

Composite indicators are indicators that are formed of multiple sub-indicators. Further details of the composite indicator measures can be found in the Appendix.

CQC view

The SHMI was

flagged as an

Elevated Risk while

Gastroenterological

and hepatological

conditions and

procedures was

flagged as a Risk -

both would require

further investigation.


Mortality

Overall trust

Composite

indicator

SHMI HSMR In-hospital mortality


Elevated risk Risk No evidence of risk

CQC │

Mortality sub-tree Gastroenterological and Hepatological conditions and procedures was flagged as a Risk.

In-hospital mortality: Gastroenterological and hepatological conditions was flagged as a Risk.

CQC view

The Composite

Indicator

Gastroentological

and hepatological

conditions was

flagged as a Risk

and should be

investigated further.



Mortality

Overall trust

Composite

Indicator

Gastroenterological and

hepatological conditions and

procedures

Indicator RAG

In-hospital mortality: Gastroenterological and

hepatological conditions

Mortality outlier alert: Liver disease, alcohol-related Mortality outlier alert: Biliary tract disease Mortality outlier alert: Gastrointestinal haemorrhage Mortality outlier alert: Noninfectious gastroenteritis Mortality outlier alert: Intestinal obstruction without hernia Mortality outlier alert: Other gastrointestinal disorders Mortality outlier alert: Other liver diseases Mortality outlier alert: Operations on jejunum Mortality outlier alert: Peritonitis and intestinal abscess Mortality outlier alert: Therapeutic endoscopic procedures

on biliary tract

Mortality outlier alert: Therapeutic endoscopic procedures

on lower GI tract

Mortality outlier alert: Therapeutic endoscopic procedures

on upper GI tract

Mortality outlier alert: Therapeutic operations on jejunum

and ileum


CQC │

Mortality The table below details the mortality related data items that were rated as comparatively ‘better’ or ‘worse’.


Data item source Data item Comparison with expected

Information Centre for Health & Social Care

(IC), Hospital Episode Statistics (HES)

(1 January 2011 to 31 December 2012)

Total 30 day mortality rates by Health Resources Group chapters: C - Mouth, head, neck,

and ears Better than expected

Total 30 day mortality rates by Health Resources Group chapters: M - Female

reproductive system

Tending towards better

than expected

Total 30 day mortality rates by Health Resources Group chapters: B - Eyes and periorbital Tending towards worse

than expected

Total 30 day mortality rates by Health Resources Group chapters: G - Hepato-biliary &

pancreatic system

Tending towards worse

than expected

Total 30 day mortality rates by Health Resources Group chapters: D - Respiratory system Much worse than

expected

Information Centre for Health & Social Care

(IC), Hospital Episode Statistics (HES)

(1 January 2011 to 31 December 2011)

Standardised in-hospital mortality rates by CCS diagnosis group: Paediatrics and

congenital disorders

Much better than

expected

Standardised in-hospital mortality rates by CCS diagnosis group: Musculoskeletal Tending towards better

than expected

Standardised in-hospital mortality rates by CCS diagnosis group: Endocrinology Tending towards worse

than expected

Standardised in-hospital mortality rates by CCS diagnosis group: Dermatology Tending towards worse

than expected

Standardised in-hospital mortality rates by CCS diagnosis group: Gastroenterology and

hepatology Worse than expected


Much better/better than expected



Much worse/worse than expected

CQC │

Overview of Maternity Indicators The analysis within this report, is based on births that took place in-hospital. Home births are excluded, as the level of information recorded in HES for these births is not detailed enough to be used in our analysis.

Deliveries that are privately funded but take place in an NHS setting are included in this analysis.

Please note that the analysis of perinatal mortality and caesarean sections includes discharges up until July 2013. However, the analysis of neonatal readmissions only includes discharges up until June 2013. Discharges in July 2013 cannot be analysed, as data is

not yet available.

The analysis of the maternal readmissions and puerperal sepsis and other puerperal infections indicators will only look at discharges up until May 2013 as this is the latest available.

Level of Neonatal Unit at the trust

Northampton General Hospital NHS Trust has a Local Neonatal Unit (LNU). This type of unit was previously called a Level 2 unit.

LNUs provide neonatal care for their own catchment population, except for the sickest babies. They provide all categories of neonatal care, but they transfer babies who require complex or longer-term intensive care to a Neonatal Intensive Care Unit as they are not staffed to provide longer-term intensive care. The majority of babies over 27 weeks of gestation will usually receive their full care, including short periods of intensive care, within their Local Neonatal Unit. Some networks have agreed variations on this policy, due to local requirements. Some Local Neonatal Units provide high

dependency care and short periods of intensive care for their network population. Local Neonatal Units may receive transfers from other neonatal services in the network if they fall within their agreed work pattern.

Deliveries at the trust per Quarter

The graph below shows the numbers of deliveries by quarter at the trust between April 2010 and June 2013.



Source: Royal College of Paediatrics and Child Health

940

960

980

1,000

1,020

1,040

1,060

1,080

1,100

1,120

1,140

Ap

r-Ju

n 1

0

Jul-S

ep 1

0

Oct-

Dec 1

0

Jan

-Mar

11

Ap

r-Ju

n 1

1

Jul-S

ep 1

1

Oct-

Dec 1

1

Jan

-Mar

12

Ap

r-Ju

n 1

2

Jul-S

ep 1

2

Oct-

Dec 1

2

Jan

-Mar

13

Ap

r-Ju

n 1

3

Nu

mb

er

of

de

liveri

es

CQC │

Proportions of delivery methods

The table below shows the profile of delivery methods at the trust between July 2012 and July 2013, as derived from the recorded primary procedure. The trust had a slightly lower normal delivery rate (58.8%) when compared to the national rate (60.9%).

Profile of deliveries

The table below shows the profile of all deliveries at the trust between July 2012 and July 2013.

This analysis shows that the trust has a broadly similar profile of deliveries compared to the national profile.


Delivery method England

deliveries (%)

Trust

deliveries (%)

Trust

deliveries (n)

Elective caesarean delivery 10.7% 13.8% 631

Other/Emergency caesarean delivery 14.5% 14.6% 668

Breech Extraction delivery 0.0% 0.2% 10

Other Breech delivery 0.4% 0.2% 7

Low Forceps cephalic delivery 3.2% * *

Other Forceps Delivery 3.6% 5.8% 264

Ventouse (Vacuum) delivery 5.9% 6.5% 297

Spontaneous other delivery 0.4% * *

Normal delivery (Spontaneous vertex) 60.9% 58.8% 2,690

Other/unrecorded method of delivery 0.5% 0.2% 7

Total deliveries 100% 100% 4,576

England

deliveries (%)

Trust

deliveries (%)

Trust

deliveries (n)

Births Single 98.5% 98.5% 4,506

Multiple 1.5% 1.5% 70

Gestation

period

Under 24 weeks 0.6% 0.2% 8

Pre term 24-36

weeks 7.4% 6.4% 282

Term 37-42 weeks 91.8% 93.2% 4,119

Post Term >42

weeks 0.3% 0.2% 9

Mother’s age

Under 20 4.5% 4.8% 218

20-34 76.1% 77.3% 3,539

35-39 15.5% 14.6% 670

40+ 3.9% 3.3% 149

*Note: Delivery methods are derived from primary procedure. For reasons of

confidentiality, low numbers and their associated proportions have been removed and

replaced with ‘*’.


England Trust

Median length of stay 2 days 2 days

Total number of deliveries 695,378 4,576

Source: Hospital Episode Statistics

Page 53 Page 53

CQC │

Cross-sectional analysis of standardised maternity indicators at Northampton General Hospital NHS Trust

Below shows the outcomes of cross-sectional standardised analysis for each of the indicators used as part of the maternity outlier surveillance programme. The table on this page shows the outcomes of cross-sectional standardised analysis for each of the indicators used as part of the maternity outlier surveillance programme.

The trust’s elective caesarean section rates were significantly higher than expected. Please note that the trust has alerted as part of the

maternity outlier surveillance programme for significantly high rates of elective caesarean sections using CUSUM time series analysis.

This was the second alert for this indicator at the trust and therefore our initial questions to the trust asked for an explanation for why

elective caesarean section rates have remained significantly higher than expected. We did not ask the trust to carry out a case note review, but asked for an update on the actions put in place following the earlier alert.

The trust reported that they had implemented all NICE guidance and carry out regular quality audits but that their elective caesarean section rate remains high. The trust stated that exclusion of home births from our analysis may raise their rate as the trust has a higher proportion of these compared to nationally. In March 2013, the trust

had an external review conducted by the Royal College of Obstetricians and Gynaecologists that concluded that the trust’s maternity services complied with the majority of the standards they were assessed against. The trust’s current action plan was also reviewed and evidenced during this visit; this includes several measures, including the development of a Birth Centre, which the trust is taking to reduce their elective caesarean rate.

The trust response was considered by the maternity outliers panel on 27 November 2013. The panel decided that this case could now be passed to the local compliance team for follow-up of progress against their action plan.

The trust’s perinatal mortality rate was also significantly higher than expected, however it did not meet the criteria for an outlier using time series analysis. The trust’s maternal readmission rate was

significantly lower than expected.

The table below shows the outcomes of cross-sectional standardised analysis for each of the indicators used as part of the maternity outlier surveillance programme.

Northampton General Hospital NHS Trust Page 54 Source: NHS Neonatal Networks website


Indicator Time period Observed

number

Expected

number

Standardised

Ratio (SR)

Maternal readmissions July 2012 to

May 2013 49 87.8 55.8 (z = -2.6)

Perinatal mortality

July 2012 to

July

2013

49 25.9 189.1 (z = 2.7)

Emergency caesarean

sections

July 2012 to

July

2013

668 661.0 101.1 (z = 0.1)

Elective caesarean

sections

July 2012 to

July

2013

631 481.5 131.0 (z = 2.4)

Neonatal readmissions July 2012 to

June 2013 205 188.2 108.9 (z = 0.4)

Puerperal sepsis and

other puerperal infections

July 2012 to

May 2013 38 77.7 48.9 (z = -1.5)

CQC │

Caring


The trust performs

“within the expected range” for

10 of the 10 Adult Inpatient Survey domains

A&E scores from the

friends and family

test have exceeded

the England average

for three out of the past

four months

Significantly

decreased on five

questions compared to

the 2011 CQC Adult

Inpatient Survey

In the top 20% in

England for eight

questions from the

cancer patient survey,

but the worst 20% for

five questions

In the bottom 20% for

seven questions from

the bereavement

survey

CQC │


Compassionate

care

“Did you find someone on the hospital staff to talk to

about your worries and fears?”

(CQC Adult Inpatient Survey 2012)

“Do you feel you got enough emotional support from

hospital staff during your stay?”


Meeting physical

needs

“Did you get enough help from staff to eat your meals?”


“Were you involved as much as you wanted to be in

decisions about your care and treatment?”


“Do you think the hospital staff did everything they could

to help control your pain?”


Overall experience

“Overall…”(I had a very poor/good experience)


NHS England inpatients score from Friends and Family

Test (CQC Adult Inpatient Survey 2012)

Treatment with

dignity and respect

“Overall, did you feel you were treated with respect and

dignity while you were in hospital?”


Trusting

relationships

"Did you have confidence and trust in the doctors treating

you?“(CQC Adult Inpatient Survey 2012)

"Did you have confidence and trust in the nurses treating

you?“(CQC Adult Inpatient Survey 2012)


Additional information has been included in this domain to provide a more holistic view of the trust’s performance. These are listed below:

Caring Dashboard

Page 56




Further Sources (Qualitative Information)

National Bereavement Survey


Source: CQC Intelligent Monitoring Report, December 2013 –

CQC Adult Inpatient Survey 2012



CQC │

CQC’s Adult Inpatient Survey 2012 Analysis of data from the CQC’s Adult Inpatient Survey 2012 shows that the trust scored about the same as other trusts in all 10 areas of questioning.

Comparison with 2012 results

Compared to results from 2011, the trust’s performance has significantly decreased on five questions, as shown in the table below.

CQC view

The trust has

performed similarly

to other trusts on all

of the CQC Adult

Inpatient Survey

questions.

However, the trust

has shown a

significant decrease

on five questions

compared to 2011.


Source: CQC Adult Inpatient Survey 2011, 2012


Area of questioning RAG

The Emergency/A&E Department

Waiting List and Planned Admissions

Waiting to Get to a Bed on a Ward


Doctors

Nurses

Care and Treatment

Operations and Procedures

Leaving Hospital

Overall Views and Experiences





Question 2012 2011 Trend

3. While you were in the A&E

Department, how much information

about your condition or treatment was

given to you?

7.9 8.5

9. From the time you arrived at the

hospital, did you feel that you had to

wait a long time to get to a bed on a

ward?

7.3 7.9

53. How long was the delay? 7.1 7.7

67. Overall, did you feel you were

treated with respect and dignity while

you were in the hospital?

8.6 9.0

69. During your hospital stay, were

you ever asked to give your views on

the quality of your care?

1.2 1.7

CQC │

CQC’s Adult Inpatient Survey 2012 The full results of the CQC Adult Inpatient Survey 2012 are shown below. For each question in the survey, the standardised responses are converted into a scale from 0 to 10, with a higher score representing better performance.


Area of questioning Question RAG Trust 2012 Trust 2011

The Emergency/A&E

Department

While you were in the A&E Department, how much information about your condition or treatment was given to

you? 7.9 8.5

Were you given enough privacy when being examined or treated in the A&E Department? 8.7 8.80

How do you feel about the length of time you were on the waiting list? 8.3 8.4

Was your admission date changed by the hospital? 9.2 9.4

Had the hospital specialist been given all necessary information about your condition/illness from the person

who referred you? 9.7 -

From the time you arrived at the hospital, did you feel that you had to wait a long time to get to a bed on a

ward? 7.4 7.9


Did you ever share a sleeping area with patients of the opposite sex? 9.5 9.3

Did you ever use the same bathroom or shower area as patients of the opposite sex? 9.0 9.3

Were you ever bothered by noise at night from other patients? 5.1 5.0

Were you ever bothered by noise at night from hospital staff? 7.3 7.2

In your opinion, how clean was the hospital room or ward that you were in? 8.6 8.7

How clean were the toilets and bathrooms that you used in hospital? 8.3 8.4

Did you feel threatened during your stay in hospital by other patients or visitors? 9.6 9.6

Were hand-wash gels available for patients and visitors to use? 7.9 8.5

How would you rate the hospital food? 9.6 9.7

Were you offered a choice of food? 4.7 4.8

Did you get enough help from staff to eat your meals? 8.6 8.8


Source: CQC Adult Inpatient Survey 2011, 2012 Better than other trusts ‘About the same’ as other trusts Worse than other trusts

CQC │

CQC’s Adult Inpatient Survey 2012 This page further details the results of the CQC Adult Inpatient Survey 2012.



Doctors

When you had important questions to ask a doctor, did you get answers that you could understand? 8.0 8.0

Did you have confidence and trust in the doctors treating you? 8.7 8.9

Did doctors talk in front of you as if you weren't there? 8.5 8.3

Nurses

When you had important questions to ask a nurse, did you get answers that you could understand? 8.1 8.1

Did you have confidence and trust in the nurses treating you? 8.6 8.8

Did nurses talk in front of you as if you weren't there? 8.8 8.7

In your opinion, were there enough nurses on duty to care for you in hospital? 7.2 7.1

Care and Treatment

Did a member of staff say one thing and another say something different? 7.8 7.7

Were you involved as much as you wanted to be in decisions about your care and treatment? 7.2 7.1

How much information about your condition or treatment was given to you? 7.8 7.9

Did you find someone on the hospital staff to talk to about your worries and fears? 5.6 6.2

Do you feel you got enough emotional support from hospital staff during your stay? 7.0

Were you given enough privacy when discussing your condition or treatment? 8.4 8.3

Were you given enough privacy when being examined or treated? 9.5 9.5

Do you think the hospital staff did everything they could to help control your pain? 8.0 8.1

After you used the call button, how long did it usually take before you got help? 5.9 6.1



CQC │




Operations and

Procedures

Did a member of staff explain the risks and benefits of the operation or procedure? 8.8 8.9

Did a member of staff explain what would be done during the operation or procedure? 8.4 8.4

Did a member of staff answer your questions about the operation or procedure? 8.5 8.5

Were you told how you could expect to feel after you had the operation or procedure? 6.7 7.1

Did the anaesthetist or another member of staff explain how he or she would put you to sleep or control your

pain? 9.0 9.2

Afterwards, did a member of staff explain how the operation or procedure had gone? 7.6 7.6

Leaving Hospital

Did you feel you were involved in decisions about your discharge from hospital? 6.6 -

Were you given enough notice about when you were going to be discharged? 6.8 -

Discharge delayed due to wait for medicines/to see doctor/for ambulance. 5.9 6.3

How long was the delay? 7.1 7.7

Before you left hospital, were you given any written or printed information about what you should or should

not do after leaving hospital? 6.6 6.4

Did a member of staff tell you about medication side effects to watch for when you went home? 8.0 8.1

Were you told how to take your medication in a way you could understand? 4.3 4.8

Were you given clear written or printed information about your medicines? 8.1 8.3

Did a member of staff tell you about any danger signals you should watch for after you went home? 7.5 -

Did a member of staff explain the purpose of the medicines you were to take at home in a way you could

understand? 5.3 5.0

Did hospital staff take your family or home situation into account when planning your discharge? 7.3 -

Did the doctors or nurses give your family or someone close to you all the information they needed to care

for you? 5.5 5.7



CQC │




Leaving Hospital

Did hospital staff tell you who to contact if you were worried about your condition or treatment after you left

hospital? 8.5 -

Did hospital staff discuss with you whether additional equipment or adaptations were needed in your home? 8.4 -

Did hospital staff discuss with you whether you may need any further health or social care services after

leaving hospital? 8.1 8.2

Did you receive copies of letters sent between hospital doctors and your family doctor (GP)? 8.7 8.7

Were the letters written in a way that you could understand? 8.6 9.0

Overall Views and

Experiences

Overall, did you feel you were treated with respect and dignity while you were in the hospital? 7.6 -

Overall impression of stay 1.2 1.7

During your hospital stay, were you ever asked to give your views on the quality of your care? 1.8 -

Did you see, or were you given, any information explaining how to complain to the hospital about the care you

received? 8.5 -



CQC │

Friends and Family Test Since April 2013, patients have been asked whether they would recommend hospital wards to their friends and family if they required similar care or treatment, the results of which have been used to formulate NHS Friends and Family Tests for Accident & Emergency and Inpatient admissions.

Scores are calculated as follows:

• The proportion of respondents who state that they would be “extremely likely” to recommend the service to their friends and family, minus those who

responded “neither likely or unlikely,” “unlikely,” or “extremely unlikely” to do so.

• Scores can range from -100 to 100, with a higher score indicative of better performance. It should be noted that this score is not a percentage.

Further guidance is available via NHS England.

It should be noted that response rates can be influenced by many factors and are provided here for context only. Hence, low response rates are common across the country for both A&E and Inpatient Friends and Family Tests.

Overall Performance

The tables on the following pages detail the performance of the trust in the A&E and Inpatient Friends and Family Tests for July 2013 - October 2013.

As the table below shows, the trust scored 67 overall in the October Inpatient Friends and Family Test, which is in line with the England average.

The trust scored 67 for the A&E department and 68 for inpatient areas.

CQC view

The Friends and

Family Tests have

been introduced to

give patients the

opportunity to give

feedback on the

quality of care they

receive. The trust

can be seen to be

performing below the

England average for

the inpatient average

component of the

test, whilst the A&E

score is significantly

above the England

average.


Source: NHS Friends and Family Survey, July 2013 – October 2013


England Northampton

General Hospital

Inpatient response rates 33.6% 32.1%

Inpatient scores 74.1 68.0

A&E response rates 14.0% 18.5%

A&E scores 56.4 67.0

Overall response rate 23.9% 22.2%

Overall score 68.5 67.0

CQC │

Friends and Family Test Inpatient performance

In August, 454 people completed the test. 96.4% of patients asked were either ‘likely’ or ‘extremely likely’ to recommend the ward they stayed in to friends or family.

Inpatient Friends and Family Test, July 2013 – October 2013

Accident and Emergency performance

In August 346 people completed the test. 93.3% of patients asked were either ‘likely’ or ‘extremely likely’ to recommend the trust’s A&E department to friends or family.

A&E Friends and Family Test, July 2013 – October 2013

CQC view

The trust has

consistently scored

below the England

average for the

Inpatient test from

July onwards.

However, the trust’s

A&E scores have

exceeded the

England average for

three of the four

months since the

Friends and Family

Test's began.


Source: NHS Friends and Family Survey, July 2013 – October 2013

Indicator Month

July Aug Sept Oct

Score Trust 55 61 55 67

England 55 54 54 56

Response Rate Trust 12.9% 6.2% 13.1% 18.5%

England 10.3% 11.3% 13.0% 14.0%

Indicator Month

July Aug Sept Oct

Score Trust 69 70 74 68

England 72 72 71 74

Response Rate Trust 25.2% 17.1% 27.3% 32.1%

England 31.0% 32.1% 32.1% 33.6%


CQC │

Friends and Family Test Wards and specialties

In the October 2013 inpatient survey, 30 wards at Northampton General Hospital were included. Response rates within wards varied between 0% and 107.7%. There were 19 wards that scored less than the trust average of 65, these wards are detailed in the table below and are continued overleaf. Creaton Ward scored the least of all wards. There were two wards where people would be extremely unlikely to recommend them. These were Creaton and Dryden.

Wards that scored below trust average in the August 2013 inpatient Friends and Family Test

CQC view

Out of 30 inpatient

wards there were 19

wards that scored

less than the trust

average of 65.

Creaton Ward

scored the least of

all wards with a

score of 18. 18% of

people questioned

would be extremely

unlikely to

recommend this

ward.


Source: NHS Friends and Family Survey, October 2013


Ward Name

Res

po

ns

es

Eli

gib

le

Res

po

ns

e

Rate

Sc

ore

Ex

’ L

ike

ly

Lik

ely

Neit

he

r

Un

lik

ely

Ex

’

Un

lik

ely

Do

n't

Kn

ow

First specialty Second specialty

Creaton ward 11 54 20.4% 18 5 3 1 0 2 0 General Medicine

Abington ward 16 48 33.3% 25 6 8 1 1 0 0 Trauma &

Orthopaedics

Emergency assessment

unit 20 186 10.8% 45 11 7 0 2 0 0 General Medicine

Dryden ward 27 112 24.1% 52 18 5 3 0 1 0 General Medicine

Holcot stroke unit 15 17 88.2% 53 10 3 2 0 0 0 General Medicine

Victoria ward 17 67 25.4% 56 10 5 1 0 0 1 General Medicine

Allebone ward 14 54 26.0% 57 9 4 0 1 0 0 General Medicine Cardiology

Compton ward 14 13 107.7% 57 8 6 0 0 0 0 Geriatric Medicine

Finedon ward 15 56 26.8% 57 9 4 1 0 0 1 Nephrology

Spencer ward 31 133 23.3% 57 19 9 1 1 0 1 Gynaecology

Brampton ward 12 40 30.0% 58 8 3 1 0 0 0 Geriatric Medicine

Rowan ward 43 182 23.6% 58 27 14 2 0 0 0 General Surgery

CQC │


Wards that scored below trust average in the August 2013 inpatient Friends and Family Test

CQC view

Out of 30 inpatient

wards there were 19

wards that scored

less than the trust

average of 65.

Creaton Ward

scored the least of

all wards with a

score of 18. 18% of

people questioned

would be extremely

unlikely to

recommend this

ward.



Source: NHS Friends and Family Survey, October 2013

Ward Name

Re

sp

on

se

s

Eli

gib

le

Re

sp

on

se

Ra

te

Sc

ore

Ex

’ L

ike

ly

Lik

ely

Ne

ith

er

Un

lik

ely

Ex

’

Un

lik

ely

Do

n't

Kn

ow

First specialty Second specialty

Benham Ward 50 125 40.0% 60 34 12 2 2 0 0 General Medicine

Cedar Ward 9 69 13.0% 63 5 3 0 0 0 1 Trauma &

Orthopaedics

Corby Community 8 8 100.0% 63 5 3 0 0 0 0 Geriatric Medicine

DISNEY WARD

(Aged 16yr & Over) 0 8 0% NA 0 0 0 0 0 0 Paediatrics

Emergency Observation

Area 0 30 0% NA 0 0 0 0 0 0 General Medicine

High Dependency Unit 0 2 0% NA 0 0 0 0 0 0 General Surgery

PADDINGTON

(Aged 16yr & Over) 0 5 0% NA 0 0 0 0 0 0 Paediatrics

CQC │

Cancer Patient Experience Survey The Cancer Patient Experience Survey (CPES) is designed to monitor national progress on cancer care. 155 acute hospital NHS trusts took part in the 2012/13 survey, which comprised of a number of questions across 13 different cancer groups. Of the 70 questions for which the trust had a sufficient number of survey respondents on which to base findings, Northampton General Hospital NHS Trust was rated by patients as being in the bottom 20% of all trusts nationally for five of the 70 questions. The results of the questions are displayed over the following pages.

CQC view

The trust performed

‘Better than other

trusts’ nationally for

eight of the

questions in the

2012/2013 Cancer

Patient Experience

Survey. There were

six questions where

the trust performed

‘worse than other

trusts’ nationally.

These were around

communication

between staff and

patients, hospital

staff and community

staff working

together, and the

number of people

who would rate the

treatment as

‘excellent or very

good.


Question RAG Trust 2013 (%) National Average

2013 (%) Trust 2012 (%)

Saw GP once/twice before being told had to go to hospital 74.8% 73.8% 73.8%

Patient thought they were seen as soon as necessary 85.9% 83.3% 84.2%

% ans. less than 12 months 96.4% 95.7% 94.5%

Patient's health got better or remained about the same while waiting 82.1% 80.0% 82.9%

% ans. they've had diagnostic tests for cancer in last 12 months 88.8% 88.1% 85.7%

Staff gave complete explanation of purpose of test(s) 83.9% 83.1% 85.6%

Staff explained completely what would be done during test 86.8% 86.5% 85.2%

Given easy to understand written information about test 89.6% 86.4% 86.2%

Given complete explanation of test results in understandable way 81.6% 77.8% 77.8%

% ans. that they were first told by a doctor (incl GP) or nurse 96.4% 95.8% 97.7%

Patient told they could bring a friend when first told they had cancer 79.3% 73.2% 68.3%

Patient felt they were told sensitively that they had cancer 84.0% 83.7% 85.3%

Patient completely understood the explanation of what was wrong 72.4% 73.3% 72.8%

Patient given written information about the type of cancer they had 76.5% 70.7% 76.7%

Patient given a choice of different types of treatment 77.1% 84.1% 82.2%

Patient’s views definitely taken into account by doctors and nurses discussing

treatment 68.3% 70.8% 68.6%

Source: Cancer Patient Experience Survey, National Cancer Intelligence

Network, 2011/12 and 2012/13


Better than other trusts About the same as other trusts


CQC │


The following table further details the trust’s performance on the Cancer Patient Experience Survey.


Source: Cancer Patient Experience Survey, National Cancer Intelligence Network, 2011/12 and 2012/13

Question RAG Trust 2013 (%) National Average 2013 (%) Trust 2012 (%)

Possible side effects explained in an understandable way 77.4% 74.3% 73.8%

Patient given written information about side effects 87.0% 80.2% 84.5%

Patient definitely told about treatment side effects that could affect them in the future 53.2% 54.8% 71.3%

Patient definitely involved in decisions about care and treatment 70.7% 72.1% 84.6%

Patient given the name of the CNS in charge of their care 90.8% 87.1% 75.1%

Patient finds it easy to contact their CNS 72.5% 75.5% 91.0%

CNS definitely listened carefully the last time spoken to 90.7% 91.0% 89.5%

Get understandable answers to important questions all/most of the time 91.9% 90.5% 79.0%

Hospital staff gave information about support groups 81.8% 81.0% 58.5%

Hospital staff gave information about impact cancer could have on work/education 73.6% 73.1% 78.9%

Hospital staff gave information on getting financial help 65.0% 52.6% 22.5%

Hospital staff told patient they could get free prescriptions 85.9% 75.2% 95.5%

Patient has seen information about cancer research in the hospital 94.8% 83.6% 53.8%

Taking part in cancer research discussed with patient 24.6% 28.9% 60.9%

Patient has taken part in cancer research 54.6% 59.8% 90.9%

% ans. they've had an operation in last 12 months 64.0% 57.8% 83.6%

Staff gave complete explanation of what would be done 83.8% 87.0% 76.9%

Patient given written information about the operation 74.5% 72.9% 71.8%

Staff explained how operation had gone in understandable way 73.0% 76.7% 71.2%

% ans. they've stayed overnight for cancer care in last 12 months 73.5% 67.4% 79.2%

Got understandable answers to important questions all/most of the time 85.1% 82.1% 83.7%

Page 67





CQC │






Patient had confidence and trust in all doctors treating them 84.3% 84.5% 82.1%

Doctors did not talk in front of patient as if they were not there 83.0% 82.7% 63.0%

Patient’s family definitely had opportunity to talk to doctor 65.7% 66.4% 71.4%

Got understandable answers to important questions all/most of the time 79.9% 73.9% 67.8%

Patient had confidence and trust in all ward nurses 66.1% 68.5% 79.7%

Nurses did not talk in front of patient as if they were not there 81.0% 83.8% 56.0%

Always / nearly always enough nurses on duty 60.1% 60.7% 85.4%

Patient did not think hospital staff deliberately misinformed them 90.1% 87.3% 77.5%

Patient never thought they were given conflicting information 80.3% 79.5% 54.6%

All staff asked patient what name they preferred to be called by 54.2% 56.4% 83.2%

Always given enough privacy when discussing condition/treatment 83.9% 84.2% 96.0%

Always given enough privacy when being examined or treated 93.3% 93.6% 61.4%

Patient was able to discuss worries or fears with staff during visit 67.4% 63.8% 80.3%

Hospital staff did everything to help control pain all of the time 79.9% 84.1% 80.6%

Always treated with respect and dignity by staff 81.1% 82.5% 81.8%

Given clear written information about what should / should not do post discharge 84.2% 83.3% 90.5%

Staff told patient who to contact if worried post discharge 93.2% 92.7% 63.1%

Family definitely given all information needed to help care at home 60.4% 60.5% 61.1%

Patient definitely given enough care from health or social services 64.1% 58.3% 75.8%

Staff definitely did everything to control side effects of radiotherapy 78.2% 78.6% 80.9%

Staff definitely did everything to control side effects of chemotherapy 78.7% 81.2% 81.4%

Staff definitely did everything they could to help control pain 78.2% 80.9% 68.0%

Page 68





CQC │






Hospital staff definitely gave patient enough emotional support 68.4% 70.2% 94.5%

% ans. they've had an OP appt with a cancer doctor in last 12 months 95.2% 92.8% 77.9%

Doctor had the right notes and other documentation with them 94.7% 95.4% 95.1%

GP given enough information about patient`s condition and treatment 95.1% 94.2% 95.1%

Practice staff definitely did everything they could to support patient 68.8% 67.8% 95.9%

Hospital and community staff always worked well together 60.6% 64.3% 67.8%

Given the right amount of information about condition and treatment 89.3% 87.7% 60.3%

Patient offered written assessment and care plan 23.1% 22.3% 89.1%

Patient did not feel that they were treated as a `set of cancer symptoms` 81.3% 80.4% 27.0%

Patient`s rating of care `excellent`/ `very good` 85.7% 87.5% 78.4%

Page 69





CQC │

Further sources Patient opinion

Patient Opinion is an independent non-profit feedback platform for health services, which aims to facilitate honest and meaningful conversations between patients and providers.

There are 337 comments on the trust’s section of the Patient Opinion website; there is some overlap with the comments on the NHS Choices website.

The service has scores of

• 3.7 stars out of 5 stars ‘cleanliness’ (126 ratings) • 5 stars out of 5 stars ‘environment’ (3 ratings) • 4.3 stars out of 5 stars ‘information’ (3 ratings) • 3.9 stars out of 5 stars ‘involved’ (128 ratings) • 4.3 stars out of 5 stars ‘listening’ (3 ratings) • 4.1 stars out of 5 stars ‘medical’ (127 ratings) • 4 stars out of 5 stars ‘nursing’ (127 ratings) • 2.7 stars out of 5 stars ‘parking’ (124 ratings) • 4 stars out of 5 stars ‘respect’ (130 ratings) • 3.7 stars out of 5 stars ‘timeliness’ (129 ratings) Good things patients are saying about the hospital relate to Cleaners, Healthcare assistants, Medical care, Nurses and Staff. What could be improved about the hospital includes A&E and care in general.

Share your experience

Share Your Experience is a service organised by the Care Quality Commission, whereby patients are asked to provide feedback on the standard of care they have received.

There were eight Your Experience comments for this trust, of which all were negative.

The eight negative comments cover the following themes; Poor care, Waiting times, Staff levels, Cancelled surgeries and Food.

The National Bereavement Survey 2011

The National Bereavement Survey 2011 was collected at Primary Care Trust cluster-level. Northampton General NHS Trust formed part of the Milton Keynes and Northamptonshire PCT cluster.

The Milton Keynes and Northamptonshire PCT cluster can be seen to be performing in the bottom 20% for seven indicators, these can be found in the appendices. The results for Hospital Nurses and Doctors are shown below.

The full results for the National Bereavement Survey 2011 can be found in the appendices.

CQC view

Comments and

reviews posted via

Patient Opinion and

share your

experience highlight

a number of areas

for further review

including poor care

and waiting times.


Staff Respect and Dignity Quality of Care

Hospital Nurses

Hospital Doctors


Sources: Patient Opinion; NHS Share Your Experience;

National Bereavement Survey 2011 Top 20% of PCT clusters Middle 60% of PCT clusters

Bottom 20% of PCT clusters

CQC │

Further sources NHS Choices

Northampton General Hospital has 249 ‘reviews’ on the NHS Choices website. 10 of these reviews are included in the analysis below dated Jan 2013 to Dec 2013.

There were 25 positive comments rated 5 stars. Themes included excellent A&E Care, professionalism, waiting times, respect & dignity and cleanliness. There were six negative comments rated 1 star. Themes from this included: communication, lack of care & treatment, mis-diagnosis, waiting times and unprofessional staff.

The stars ratings on the NHS Choices website give Northampton General Hospital a score of 3.5 stars out of 5 overall with the following:

• 4 stars for ‘cleanliness’ (based on 60 ratings) • 4 stars for ‘staff co-operation’ (59 ratings) • 4 stars for ‘dignity and respect’ (62 ratings) • 4 stars for ‘involvement in decisions’ (61 ratings) • 4.5 stars for ‘same-sex accommodation’ (48 ratings)

CQC view

Comments and

reviews via NHS

Choices praise

excellent care

received in A&E.

However reviews

also flag lack of care

and treatment as a

concern.


Source: NHS Choices


CQC │

Further sources Patient-Led Assessments of the Care Environment (PLACE)

The 2013 Patient-Led Assessments of the Care Environment (PLACE) programme replaced the former Patient Environment Action Team (PEAT) programme from April 2013.

These self-assessments are undertaken by teams of NHS and private/independent health care providers and for the first time include at least 50% members of the public (known as patient assessors). They focus on the

environment in which care is provided, as well as supporting non-clinical services such as cleanliness, food, hydration, and the extent to which the provision of care with privacy and dignity is supported.

The table below depicts Northampton General Hospital’s PLACE scores in the four metrics that were assessed:

CQC view

Patient-Led

Assessments of the

Care Environment

(PLACE)

Assessment scored

Northampton

General above 90%

for three out of the

four metrics -

Cleanliness, Privacy,

dignity and wellbeing

& Facilities.

However the trust

only scored 89.6%

for Food.


Source: Sources: Patient-Led Assessments of the Care Environment (PLACE),

England – 2013 (Experimental statistics published)

PLACE metric Northampton

General

Hospital

Scores (%)

Cleanliness 99.4%

Food 89.6%

Privacy, dignity and

wellbeing 94.1%

Facilities 95.3%


CQC │

Responsive


CQC analysis rated the trust as

‘medium risk’ for access to secondary care

through A&E

The trust is failing to

meet A&E targets for

95% of patients being

seen within 4 hours

The trust is worse than

average for unplanned

re-admittance and

patients leaving A&E

without being seen

The trust performed

within expectations

for cancelled

operations

Transitions from the

ambulance to A&E are

‘worse than

expected’

CQC │

Additional information Additional information has been included in this domain to provide a more holistic view of the trust’s performance. These are listed below:

Responsive Dashboard



Access Measures

A&E waiting times under 4 hours (January 2013 – March

2013)

Referral to treatment times under 18 weeks: admitted

pathway (April 2013)

Referral to treatment times under 18 weeks: non-admitted

pathway (April 2013)

Diagnostics waiting times: patients waiting over 6 weeks

for a diagnostic test (April 2013)

All cancers: 62 day wait for first treatment from urgent GP

referral (January 2013 – March 2013)

All cancers: 62 day wait for first treatment from NHS

cancer screening referral (January 2013 – March 2013)

All cancers: 31 day wait from diagnosis (January 2013 –

March 2013)


(January 2013 – March 2013)

The number of patients not treated within 28 days of last

minute cancellation due to non-clinical reason (January

2013 – March 2013)

Proportion of ambulance journey where the ambulance

vehicle remained at hospital for more than 60 minutes N/A

Discharge and

Integration

Ratio of the total number of days delay in transfer from

hospital to the total number of occupied beds (January

2013 – March 2013)


A&E wait from decision to admit to being admitted

Distribution of A&E wait times (within 4 hours)

Cancelled Operations

Delayed Discharges

CQC Analysis of Secondary Care



Source: CQC Intelligent Monitoring Report, October 2013.

CQC │

A&E wait times A&E wait times and referral to treatment (RTT) times may indicate the effectiveness with which demand is managed. Trusts in England are tasked by the government with admitting, transferring or discharging 95% of patients within four hours of their arrival in the A&E department.

The chart below shows Northampton General Hospital NHS Trust’s performance in meeting this four hour target, it looks at wait times between 08 April 2013 and 08 October 2013. The trust is persistently failing to meet

the national target and is well below the England average. The 2013 summer months showed some improvement however attendances with less than 4 hours from arrival to admission, transfer or discharge with still fell below target during that period.

Last year the trust was performing better than the England average in relation to patients waiting between four and twelve hours to be admitted. However since January 2013 their performance has decreased and in April around 12% of patients were waiting over four hours to be admitted.

CQC view

The trust is regularly

not meeting the four

hour target in A&E.

Their performance

has improved since

it’s lowest A&E

attendances in April

but is still below

95%. The trust

should be taking

steps to alleviate

increased pressures

over winter to ensure

their performance

continues to

improve.

A large proportion of

patients are waiting

over four hours from

the decision to admit

until being admitted.

This is often higher

than the national

average.


Source: NHS England, April 2012 – October 2013


75%

80%

85%

90%

95%

100%

Ap

r-12

Jun

-12

Au

g-1

2

Oct-

12

Dec-1

2

Fe

b-1

3

Ap

r-13

Jun

-13

Au

g-1

3

Oct-

13

% of A&E attendances less than 4 hours from arrival to admission, transfer or discharge

Englandaverage

Trust

0.0%

3.0%

6.0%

9.0%

12.0%

15.0%

Ap

r-12

Jun

-12

Au

g-1

2

Oct-

12

Dec-1

2

Fe

b-1

3

Ap

r-13

Jun

-13

Au

g-1

3

Oct-

13

% of emergency admissions via A&E waiting 4-12 hours from the decision to admit until

being admitted

England average Trust

CQC │

Distribution of A&E waiting times Whilst the national target is that all patients be admitted or discharged within four hours of arriving at A&E, it is important to see how long patients are waiting within this target time.

The percentage of patients still waiting in A&E at the trust is in line with the national average, until between three and five hours when they perform worse than the average. The graph to the right shows the percentage of patents leaving A&E, this increases after the four hour target.

The trust is performing worse than the average in relation to patients leaving A&E without being seen, the highest percentage occurred in

March 2013 with 5% of patients not being seen. Since last November the trust has been worse than the national average for unplanned re-admittance.


Source: CQC analysis, February 2013


Source: Health & Social Care Information Centre (HSCIC) September 2012 – August 2013


0%

20%

40%

60%

80%

100%

0 1 2 3 4 5 6 7 8 9 10 11

% o

f p

ati

en

ts s

till

wait

ing

in

A&

E

Time waited (hours)

Percentage of patients still waiting in A&E


-20

-10

0

10

20

30

0 1 2 3 4 5 6 7 8 9 10 11

-ve v

alu

es =

lo

wer

tha

n

avera

ge

+ve v

alu

es =

hig

he

r th

an

avera

ge

Time to depart A&E (hours)

Number of patients departing A&E at each time Interval, compared to the national average

0.0%1.0%2.0%3.0%4.0%5.0%6.0%7.0%8.0%9.0%

Se

p-1

2

Oct-

12

Nov-1

2

Dec-1

2

Jan

-13

Fe

b-1

3

Ma

r-13

Ap

r-13

Ma

y-1

3

Jun

-13

Percentage of patients that left A&E before being seen for treatment

0.0%1.0%2.0%3.0%4.0%5.0%6.0%7.0%8.0%9.0%

10.0%

Se

p-1

2

Oct-

12

Nov-1

2

Dec-1

2

Jan

-13

Fe

b-1

3

Ma

r-13

Ap

r-13

Ma

y-1

3

Jun

-13

Percentage of unplanned re-admittance within seven days of a previous attendance at A&E


CQC │

Cancelled operations The Department of Health monitor the proportion of cancelled elective operations. This can be an indication of the management, efficiency and the quality of care within the trust. The trust performed similar to expected in comparison to other similar trusts.

.

Delayed discharges The ability for a trust to conduct safe and timely discharges is important for the overall patient flow through the hospital. Patients need to be discharged when ready and any information and support provided to ensure the patient does not need to be re-admitted into hospital.

Within the Adult Inpatient Survey, there are two questions that refer to the process of discharge. The trust was rated as similar to expected in comparison to other similar trusts for both.

CQC view

The trust is

performing similarly

to expected in

relation to cancelled

operations and

delayed discharge

information is not

applicable, therefore

the trust is not

considered to be at

risk in this area.



Number of patients not treated within 28 days of last minute

cancellation due to non-clinical reason



The proportion of respondents to the adult inpatient survey who

stated they were not given enough notice about when they were

to be going to be discharged

The proportion of respondents to the adult inpatient survey who

stated that their discharge was delayed for more than four hours,

due to waiting for medicine, to see a doctor or for an ambulance


Similar to expected

Worse than expected

Source: Cancelled Operations DoH QMCO January 2013 – March 2013

Source: Delayed discharges CQC Survey of Adult Inpatients June 2012

– March 2012



Similar to expected

Worse than expected

CQC │

CQC analysis of secondary care February 2013

Northampton General Hospital NHS Trust was rated as ‘low amber’ or ‘medium risk’ for access to secondary care through A&E and ‘low green’ or ‘low risk’ for access to elective secondary care (diagnostics and treatment) from general practice.

The ratings are based on aggregate z-scores to identify the risk bands. Low green ratings are given to measures with a low z score and therefore no/very low risk and vice versa for high red.

The table below provides a summary for individual measures for the trust. It shows that the trust scored ‘worse than expected’ in regards to three questions about waiting times in the NHS A&E survey.

These are Percentage of admitted and non-admitted patients who wait in A&E less than 4 hours and transitions from the ambulance to A&E.

Measure topic Measure name RAG

Ambulance handover Percentage of patients whose ambulance handover time is more than 30 minutes

A&E wait time

Percentage of admitted patients who wait in A&E less than 4 hours

Percentage of non-admitted patients who wait in A&E less than 4 hours

Leaving A&E without being seen Percentage of patients who leave A&E without being seen

Unplanned re-attendances to A&E Percentage of patients with unplanned re-attendance at A&E within 7 days of original attendance

Waiting times in NHS A&E survey

First conversation with a doctor or nurse

Being examined

Information about waiting for an examination

Length of time in A&E

Transitions from the ambulance to A&E

CQC view

The trust is

performing within

expectations for

most areas relating

to waiting times.

However the

transitions from the

ambulance and the

percentage of

admitted and non-

admitted patients

waiting less than

four hours is worse

than expected.

Waiting times within

A&E are a risk for

this trust and their

winter planning

should ensure they

maintain and ideally

improve their

performance without

affecting patient

care.




Better than expected Tending towards better than expected Within expectations Tending towards worse than expected Worse than expected

CQC │

Well-led


The trust’s sickness

absence rates and

agency staff spending

are higher than the

those for the East

Midlands SHA

Three Tier 1 indicators

are flagged as a risk or

elevated risk for the

trust

The trust performed

worse than expected

for 24 of the 28 key

findings from the 2012

NHS Staff survey

The trust took part in all

of the clinical audits it

was eligible for

CQC │

Framework section Indicator RAG

Reporting Culture

Consistency of reporting to the National Reporting and

Learning System (NRLS) (October 2012 – March 2013)

Data quality of trust returns to the HSCIC

(April 2013 – June 2013)

Inpatients response rate from NHS England Friends and

Family Test (April 2013 – August 2013)

Partners

Monitor – Governance risk rating (as on 30/09/2013) N/A

TDA – Escalation score (as on 3/10/2013) GMC National Training Survey – Trainee’s overall

satisfaction (March 2013 – May 2013)

Staffing

Composite

risk rating

of ESR

items

relating to:

Staff sickness rates

(August 2012 – July 2013)

Staff registration (as on 31/07/2013) Staff turnover (August 2012 – July 2013)

Staff stability (August 2012 – July 2013)

Staff support/ supervision

(as on 31/07/2013)

Ratio: Staff vs bed occupancy

(September 2012 – January 2013)

Healthcare Worker Flu vaccination uptake (September

12 – January 13)

Framework section Indicator RAG

Staff Survey

(NHS Staff Survey

2012)

Percentage of staff who would recommend the trust as a

place to work or receive treatment

(September 2012 – December 2012)

Percentage of staff appraised in last 12 months


Support from immediate managers


Percentage of staff receiving health and safety training in

last 12 months (September 2012 – December 2012)

Fairness and effectiveness of incident reporting

procedures (September 2012 – December 2012)

Percentage of staff reporting good communication

between senior management and staff


Qualitative

Intelligence

Serious Education concerns

(November 2011 – August 2013)

Safeguarding concerns

(September 2012 – September 2013)

Your Experience

(September 2012 – August 2013)

NHS Choices (July 2012 – July 2013)

Patient Opinion (August 2012 – August 2013)

CQC complaints (September 2012 – September 2012)

Provider complaints (April 2012 – March 2013)

Well-led Dashboard




Source: CQC Intelligent Monitoring Report, October 2013

CQC │

Well-led Dashboard





Audit Data

NHS Staff Survey

Other External Reviews

Source: CQC Intelligent Monitoring Report, October 2013

Additional Information Additional information has been included in the pack to provide a more holistic view of the trust’s performance. These are listed below:

CQC │

Workforce Staff sickness

The trust’s staff sickness absence rates are broadly in line with the England average for the majority of the time period between April 2011 and March 2013. Between February and October 2012 the trust’s staff sickness absence rates were above the England average, with a noticeable peak around May 2012.

The overall sickness for the trust between April 2012 and March 2013 is the same as for the East Midlands SHA area, but slightly above the national average.

In Autumn 2013/14 the trust’s sickness rates by staff group are all slightly above their respective national averages.

Number of staff

Overall sickness

Sickness absence rates

Agency spend

FTE nurses per bed day

CQC view

Apart from a period

between February

and October 2012,

the trust’s staff

sickness absence

rates are mostly in

line with the England

average between

April 2011 and

March 2013.

In Autumn 2013/14

the trust’s sickness

rates by staff group

are all slightly above

their respective

national averages.

Agency spend by the

trust in 2011/12 was

in line with the East

Midlands SHA

median.

Nurses per bed day

are lower than the

national average, but

within a statistically

acceptable range.


Northampton General Hospital

NHS Trust (%)

National

average (%)

Medical Staff 1.5 1.1

Nursing Staff 4.4 4.0

Midwife Staff 4.4 4.3

Other Staff 4.1 3.9

Trust agency spend

(£m)

As % of total staff

cost

Median within East

Midlands SHA

£7m 4.3% 4.3%

Source: Health and Social Care Information Centre (HSCIC), Apr12 – Mar 13


RAG Northampton General

Hospital NHS Trust

National

FTE nurses per

bed day 1.6 1.9

Total staff 4,200


Source: Monitor, Expenditure on Agency Staff in Acute Trusts, 2011/12


Northampton General

Hospital NHS Trust (%)

East Midlands

SHA average (%)

National average

(%)

4.5 4.5 4.2

Source: NHS England, Apr 11 – Mar 13


0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

Ap

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Jun

-11

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Dec-1

1

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Dec-1

2

Fe

b-1

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Sic

kn

ess a

bs

en

ce r

ate

Staff sickness absence rates


CQC │

NHS Staff Survey The results of the 2012 NHS Staff Survey are organised into 28 key findings.

The following details trust’s rating for each of these key findings, as well as noting where there has been a significant change in performance from the 2011 survey.

CQC view

There were only two

key findings in the

2012 NHS Staff

Survey where the

trust performed

within expectation or

better:

• Percentage of

staff having

equality and

diversity training

in last 12 months

• Percentage of

staff saying hand

washing materials

are always

available


Indicators RAG Trust National* vs. 2011

Percentage of staff having equality and diversity training in last 12 months 62% 55% Percentage of staff saying hand washing materials are always available 60% 60% -

Staff motivation at work 3.84 3.84 -

Percentage of staff reporting errors, near misses or incidents witnessed in the last month 90% 90%

Percentage of staff working extra hours 76% 70% -

Percentage of staff experiencing physical violence from patients, relatives or the public in last 12 months 18% 15%

Percentage of staff witnessing potentially harmful errors, near misses or incidents in last month 42% 34% -

Percentage of staff appraised in last 12 months 73% 84% -

Percentage of staff experiencing harassment, bullying or abuse from patients, relatives or the public in last

12 months 38% 30% N/A

Percentage of staff experiencing harassment, bullying or abuse from staff in last 12 months 31% 24% N/A

Percentage of staff feeling satisfied with the quality of work and patient care they are able to deliver 72% 78% -

Percentage of staff agreeing that their role makes a difference to patients 87% 89% -

Work pressure felt by staff 3.34 3.07 N/A

Percentage of staff experiencing physical violence from staff in last 12 months 4% 3% N/A

Note: Because of changes to the format of the survey questions, comparisons with 2011 scores are not possible in all cases. These are denoted by ‘N/A’


Source: NHS 2012 Staff Survey



Within expectations




CQC │

Indicators RAG Trust National* vs. 2011

Percentage of staff able to contribute towards improvements at work 58% 68% -

Staff job satisfaction 3.40 3.58 -

Percentage of staff experiencing discrimination at work in last 12 months 17% 11% -

Effective team working 3.53 3.72 Percentage of staff having well structured appraisals in last 12 months 23% 36% -

Support from immediate managers 3.26 3.62

Percentage of staff suffering work-related stress in last 12 months 43% 37%

Percentage of staff feeling pressure in last 3 months to attend work when feeling unwell 35% 29% -

Percentage of staff believing the trust provides equal opportunities for career progression or promotion 79% 88% -

Percentage of staff receiving job-relevant training, learning or development in last 12 months 76% 81% N/A

Percentage of staff receiving health and safety training in last 12 months 63% 74%

Fairness and effectiveness of incident reporting procedures 3.41 3.50 -

Percentage of staff reporting good communication between senior management and staff 20% 27% N/A

Staff recommendation of the trust as a place to work or receive treatment 3.37 3.57 -

NHS Staff Survey

The following table further details the trust’s performance on the NHS Staff Survey.

CQC view

The trust performs

within the bottom

20% of trusts for 24

of the 28 key

findings. It is strongly

recommended that

there is a line of

enquiry around what

action the trust is

taking around these

results.


Source: NHS 2012 Staff Survey


Note: Because of changes to the format of the survey questions, comparisons with 2011 scores are not possible in all cases. These are denoted by ‘N/A’



Within expectations




CQC │

General Medical Council – National Training Scheme Survey 2013 The table summarises the output from the General Medical Council National Training Scheme 2013 Survey Results. Given the volume of data, only specialties with red and green outliers are noted. Grey dots note results not published.

Ove

rall

Sa

tis

fac

tio

n

Cli

nic

al

Su

pe

rvis

ion

Han

do

ve

r

Ind

uc

tio

n

Ad

eq

ua

te

ex

pe

rie

nc

e

Wo

rklo

ad

Ed

uc

ati

on

al

Su

pe

rvis

ion

Ac

ce

ss

to

Ed

uc

ati

on

al

Res

ou

rce

s

Fe

ed

ba

ck

Lo

ca

l

tea

ch

ing

Reg

ion

al

tea

ch

ing

Stu

dy l

ea

ve

Anaesthetics

CMT

CST

Cardiology

Clinical oncology

GP Prog - Emergency Medicine

GP Prog - Medicine

GP Prog - Paediatrics and Child

Health

GP Prog - Surgery

General Practice F2

Medicine F1

Obstetrics and gynaecology

Paediatrics

Respiratory medicine

Urology

CQC view

The trust performed

worse than expected

in two or more areas

in Clinical oncology,

GP Prog – Medicine

and Respiratory

medicine

The trust performed

worse than expected

in two or more

clinical specialties in

the following areas:

• Overall

satisfaction

• Clinical

supervision

• Induction

• Workload

• Access to

educational

resources

• Local teaching

• Study leave


Source: gmc-uk.org


Better than expected Similar to expected Worse than expected No Data

CQC │

Eligible / Did participate Not Eligible / Not Applicable Did not participate Data not available

Clinical audit participation For the 2012/2013 quality reports, trusts were required to report on participation/eligibility for 45 national clinical audits and confidential enquiries (selected by the Department of Health) that were conducted during that year. These, along with the trust’s participation and eligibility status are detailed below and on the following pages.


Indicators Eligibility Participation

Acute coronary syndrome or Acute myocardial infarction (MINAP) Adult asthma (British Thoracic Society) Adult bronchiectasis (British Thoracic Society) Adult cardiac surgery audit (ACS) Adult community acquired pneumonia (British Thoracic Society) Adult critical care (Case Mix Programme – ICNARC CMP) Bowel cancer (NBOCAP) Cardiac Arrest Audit (NCAA) Cardiac arrhythmia (HRM) Carotid interventions audit (CIA) Child health programme (CHR-UK) Comparative Audit of Blood Transfusion programme Congenital heart disease (Paediatric cardiac surgery)

Coronary angioplasty Dementia (NAD) Diabetes (Adult) ND(A) (NADIA) Elective surgery (National PROMs Programme) Emergency use of oxygen (British Thoracic Society) Epilepsy 12 audit (Childhood Epilepsy) Fractured neck of femur Heart failure (HF)


Source: Trust Website: Quality Account 2012/13

CQC view

The trust took part in

all of the clinical

audits it was eligible

for. There was

however not data

available for nine of

these audit.

Page 86

CQC │

Clinical audit participation continued… CQC view

(As per previous

slide) The trust took

part in all of the

clinical audits it was

eligible for. There

was however not

data available for

nine of these audit.



Head and neck oncology (DAHNO) Hip fracture database (NHFD) Inflammatory bowel disease (IBD) Intra-thoracic transplantation (NHSBT UK Transplant Registry)

Joint Registry (NJR) Maternal, infant and newborn programme (MBRRACE-UK)

Lung cancer (NLCA) National Vascular Registry Neonatal intensive and special care (NNAP) Non-invasive ventilation - adults (British Thoracic Society) Oesophago-gastric cancer (NAOGC) Paediactric bronchiectasis (British Thoracic Society)

Paediatric asthma (British Thoracic Society) Paediatric fever (College of Emergency Medicine) Paediatric intensive care (PICANet)

Paediatric pneumonia (British Thoracic Society) Pain database Parkinson's disease (National Parkinson's Audit) Patient Outcome and Death (NCEPOD) Potential donor audit (NHS Blood & Transplant) Psychological therapies (NAPT) Pulmonary hypertension (Pulmonary Hypertension Audit)




CQC │

Clinical audit participation continued… CQC view

As per previous

slide, the trust took

part in all of the

clinical audits it was

eligible for. There

was however not

data available for

nine of these audit.



Renal colic (College of Emergency Medicine) Renal replacement therapy (Renal Registry) Renal transplantation (NHSBT UK Transplant Registry)

Review of Asthma Deaths (NRAD)

Sentinel Stroke National Audit Programme (SSNAP)

Severe trauma (Trauma Audit & Research Network, TARN)

Suicide and Homicide for people with Mental Illness (NCISH)




CQC │

National Clinical Audit Support Programme National Bowel Cancer Audit Project

The National Bowel Cancer Audit Project aims to improve the quality of care and survival of patients with bowel cancer, and meets the requirements as set out in the NHS cancer plan, NICE guidelines and the report of the Bristol Royal Infirmary inquiry. Information in the audit includes audit participation by NHS trusts and data completeness for key fields, measures about the process of care given to patients and information about care outcomes and treatment.

The results presented in the National Bowel Cancer Audit 2013 are based upon patients diagnosed with bowel cancer between 1 April 2011 and 31 March 2012.

Providers must ensure that service users are protected against risks of unsafe or inappropriate care and treatment arising from a lack of proper information about them, by maintaining accurate and complete records.

CQC view

The trust performed

within expectations

for all five of the

indicators from the

National Bowel

Cancer Audit

Project.


Indicators RAG

97% of cases reported to the audit were discussed at

multidisciplinary team (MDT) meetings. The national level was

97%.

90% of cases had a CT scan reported. The national rate was

83%.

145 cases were identified in HES, meaning a case ascertainment

rate of 85%. The national rate was 95%.

There were 70 cases having major surgery. For these cases, the

level of data completeness was 88%. This is considered ‘good’.

The national level was 71%.

87% of patients were seen by a clinical nurse specialist. The

national rate is 82%.

Source: National Clinical Audit Support Programme - National Bowel

Cancer Audit Project 2013




Within expectations


Worse than expected

CQC │

National Institute for Clinical Outcomes Research - Myocardial Ischaemia (MI) National Audit Project

The Myocardial Ischaemia National Audit Project (MINAP) began in late 1998 when a broadly based Steering Group developed a dataset for acute myocardial infarction. The dataset has been further expanded to cover the management of other acute coronary syndromes. The Steering group represents key stakeholders including professional bodies, national government and patient representation, in conjunction with the British Cardiovascular Society. It is the long term aim of the project to continue to provide, for all interested groups, including patients, commissioning bodies, cardiac networks of care, and academic researchers, first class data on the care for acute coronary syndromes within England and Wales.

Data held about trust for the 2011/12 financial year is shown in the table to the right.

CQC view

The trust performed

within expectations

for four of the five

Myocardial

Ischaemia National

Audit Project

indicators.

For the fifth, ‘the

proportion of eligible

patients with an

initial diagnosis of

nSTEMI who receive

primary angiography

within 150 minutes

of calling for

professional help’,

there was no data

available.


Indicator Performance RAG

The proportion of eligible patients with a

discharge diagnosis of nSTEMI (non-ST

segment elevation myocardial infarction) who

were seen by a cardiologist or member of their

team

Northampton

General

Hospital


discharge diagnosis of nSTEMI who were

admitted to a cardiac unit or ward

Northampton

General

Hospital


discharge diagnosis of nSTEMI who were

referred for or had angiography

Northampton

General

Hospital

The proportion of eligible patients with an initial

diagnosis of nSTEMI who receive primary

angiography within 150 minutes of calling for

professional help

Northampton

General

Hospital

No

data

Proportion of eligible patients with an initial

diagnosis of STEMI who receive primary

angioplasty within 90 minutes of arrival at the

Heart Attack Centre

Northampton

General

Hospital

Source: National Institute for Clinical Outcomes Research - Myocardial

Ischaemia National Audit 2011/12 Project




Within expectations


Worse than expected

CQC │

Royal College of Physicians - Audit of Falls & Bone Health in Older People

The national audit of falls and bone health was a programme of work which examined the organisation and commissioning of service provided to older people for falls prevention and bone health, the clinical care delivered to people that have fallen and fractured a bone and patients’ experiences of fall services.

In 2010 both an organisational and clinical audit were performed together as part of the falls and bone health audit programme. Data for the overall trust shows:

CQC view

The trust was found

to be performing

within expectations

for all but three of

the indicators from

the Royal College of

Physicians Audit of

Falls & Bone Health

in Older People

2010.

For the remaining

three indicators, the

trust was rated as

tending towards

worse than

expected.


Indicator RAG

Was adequate analgesia administered within 60 minutes of

hospital attendance, or prior to attendance by ambulance

personnel (Hip)?

Is it documented within medical/nursing/therapist notes that

written falls prevention information has been given to the patient

or their carer (Hip)?

Was the patient prescribed bisphosphonate or other appropriate

anti-resorptive therapy for osteoporosis (Hip)?

Was the patient prescribed bisphosphonate or other appropriate

anti-resorptive therapy for osteoporosis (Non-Hip)?

Has trust calculated its serious injuries in-patient falls rate

against activity (e.g. per admission or occupied bed day)?

Is there a mechanism to record patients’ views of the falls and

bone health service using questionnaires and/or interviews?

Indicator RAG

Was home hazard assessment performed in the patient's own

environment (Hip)?

Was home hazard assessment performed in the patient's own

environment (Non-Hip)?

Was a formal assessment of cognitive function, including where

indicated a delirium screen (performed within 72 hours of surgery

(Hip)?

Is it documented within medical/nursing/therapist notes that

written falls prevention information has been given to the patient

or their carer (Non-Hip)?

Are older people who fall and attend EDs or MIUs routinely

screened for risk of future falls?

Is there further assessment and management of all appropriate

fracture patients coordinated by a fracture liaison nurse/similar

designated person?

Does an occupational therapist routinely assess for potential

hazards within the patient's home?

Are evidence based therapeutic exercise programmes (Otago or

FaME) used for falls prevention, with standard duration of 12

weeks+?

Was an attempt made within 24 hours of surgery to mobilise the

patient (Hip)?

Are there documented lying and standing blood pressure

readings (Hip)?

Are there documented lying and standing blood pressure

readings (Non-Hip)?

Did the patient attend an exercise programme within 12 weeks of

the fall (Hip)?

Did the patient attend an exercise programme within 12 weeks of

the fall (Non-Hip)?

Source: Royal College of Physicians - Audit of Falls & Bone Health in Older

People, 2010


Better than expected Tending towards better than expected

Within expectations

Worse than expected Tending towards worse than expected

CQC │

UK National Screening Committee - Antenatal and New-born Screening Education Audit

The Trust Education & Training For Screening Annual Audit Tool 2011/12 was developed by the National Screening Committee’s (NSC) Regional Screening Teams assist Trust Screening Coordinator’s (LCO) to assess the appropriateness, effectiveness, and accessibility of locally held educational initiatives pertaining to antenatal and the new-born screening programmes. This audit tool assists in the continuing development of quality evidence-based training initiatives and feeds into regional and national education

and training strategy for screening.

Data held for the 2011/12 audit shows the trust to be performing within expectations for the following indicators:

• Does the trust have a named individual responsible for (antenatal and new-born) screening education and audit?

• Does the trust use the National Screening Committee antenatal and new-born induction resource for all relevant new staff?

• Does the trust have a designated person responsible for co-ordination and education regarding antenatal screening programmes?

Audit Commission - Payment by Results Data (PbR) Assurance 2011/12

Payment by Results aims to support NHS modernisation by paying hospitals for the work they do, rewarding efficiency and quality. It also carries risks that need to be managed effectively both locally and nationally. Since 2007, the Audit Commission has delivered an assurance programme for Payment by Results looking at the quality of clinical coding.

For the 2011/12 financial year, there were a number of indicators and items of qualitative intelligence for trust

from this audit:

CQC view

The trust was found

to be performing

within expectations

for all three of the

indicators from the

Antenatal and New-

born Screening

Education Audit.

The trust was found

to be performing

within expectations

for all four of the

indicators from the

Audit Commission

Payment by Results

Data (PbR)

Assurance 2011/12.


Indicator RAG

8.5% of primary diagnoses were recorded incorrectly in the

period. Against an expected rate of 9%.

13.2% of secondary diagnoses were recorded incorrectly in the


6.3% of primary procedures were recorded incorrectly in the


12.2% of secondary procedures were recorded incorrectly in the


Source: UK National Screening Committee – Antenatal and Newborn

Screening Education Audit

Source: Audit Commission - Payment by Results Data (PbR) Assurance

(2011/12)


Tending towards worse

than expected

Worse than expected



Within expectations

Appendices

CQC │ Northampton General Hospital NHS Trust

Map of Northampton General Hospital

Page 94



CQC │

Trust profile continued…


Departments and services at Northampton General Hospital NHS Trust

Northampton General Hospital NHS Trust provides the following services:

• Accident and emergency services

• Cardiology

• Children's & Adolescent Services

• Diagnostic Physiological Measurement

• Disability services

• Dentistry and Orthodontics

• Dermatology

• Diabetic Medicine

• Ear, Nose & Throat

• End of life care services

• Endocrinology and Metabolic Medicine

• Gastrointestinal and Liver services

• Genetics

• Geriatric Medicine

• Gynaecology

• General Surgery

• Haematology

• Maternity service

• Minor injuries unit

• Minor Injuries Unit - Northampton -

• Neurology

• Nephrology

• Neurosurgery

• Ophthalmology

• Orthopaedics

• Oral and Maxillofacial Surgery

• Plastic surgery

• Pain Management

• Respiratory Medicine

• Rheumatology

• Surgery - Vascular

• Sleep Medicine

• Surgery – Breast

• Urology



Page 95

CQC │

Trust board and organisation structure continued… Non-Executive Directors

Nicholas Robertson

Nicholas Robertson left Royal Dutch Shell in 2009 after 32 years, in which he worked in many countries, mainly in finance roles but also in general management and human resources. From 2000 he was Vice President of Group Risk Management and Insurance. He is now acting as a consultant on risk management for industrial companies and on finance for smaller oil and gas companies. He is a trustee director of Mental Health Matters, which is a charity. Nicholas Robertson has a degree in engineering and economics, is

a chartered accountant and chairs the audit committee.

Phil Zeidler (Vice Chairman)

Phil Zeidler had a successful career as an entrepreneur in financial services, building three business, the most recent of which became the largest independent outsourced distributor of general insurance in the UK. Currently Chairman of an insurance business, a music fund and board member of the charity Pilotlight, his core skills lie in strategic planning, innovation and developing strategic relationships.

Graham Kershaw (Senior Independent Director)

Graham Kershaw holds a first class honours degree in business from Leeds Metropolitan University and has an MBA. He is a fellow of the Chartered Institute of Secretaries and Administrators and a fellow of the Chartered Institute of Personnel and Development. Graham Kershaw also holds a professional marketing qualification, and has been a main board director of a number of major UK retail

companies including: Lloyds Pharmacy, Capio UK and Joshua Tetley’s. He is currently managing director of Cogniscence Ltd, a business mainly providing change management and business turnaround input to the public sector.

Elizabeth Searle

After qualifying as a nurse and working in cancer and palliative care, Elizabeth Searle held posts in higher education developing palliative care courses, with Macmillan as Director of Education Development and Support and at Sue Ryder Care as Head of Palliative Care, working with their hospices.

David Noble

David Noble’s career has been in finance covering both the public and private sectors. Most recently David Noble has spent nine years as Finance Director of the Equipment Procurement and Support sector of the Ministry of Defence, leading change programmes to improve the performance of the organisation.




CQC │

Area overview continued… Health profiles are designed to help local government and health services identify problems in their areas and decide how to tackle these issues. They provide a snapshot of the overall health of the local population and highlight potential differences against regional and national averages.

The tables below outline Northamptonshire’s health profile information in comparison with the rest of England.

CQC view

Northamptonshire’s

deprivation is

significantly worse

than the England

average in nine out

of 32 area measures

for the health profile

of an area.


Source: Public Health Observatories – Area Health Profiles

Page 97


CQC │

Area overview continued… The table below further details the health profile information for Northamptonshire.

CQC view

Northamptonshire’s

deprivation is

significantly worse

than the England

average in nine out

of 32 area measures

for the health profile

of an area.


Source: Public Health Observatories – Area Health Profiles

Page 98


CQC │

60%

65%

70%

75%

80%

85%

90%

95%

100%

Ea

st M

idla

nds

Ea

st of E

ngla

nd

Isle

of W

ight

London

Nort

h E

ast

Nort

h W

est

So

uth

Centr

al

So

uth

East C

oast

So

uth

Weste

rn

West M

idla

nds

Yo

rksh

ire

Category A calls (Red 1 and Red 2) resulting in an ambulance arriving at the scene of the incident

within 19 minutes - National Target 95%


60%

65%

70%

75%

80%

85%

90%

95%

100%

Ea

st M

idla

nds

Ea

st

of

En

gla

nd

Isle

of W

ight

London

Nort

h E

ast

Nort

h W

est

So

uth

Centr

al

So

uth

East C

oast

So

uth

Weste

rn

West M

idla

nds

Yo

rksh

ire

Category A (Red 2) incidents: Presenting conditions which may be life threatening but less

time-critical - National Target 75%


Performance of local health care providers continued…


Source: NHS England


CQC │

Media reports The hospital trusts that pose a 'high risk' 24 October 2013

In a new report the Care Quality Commission (CQC) have categorised trusts across England according to the risk they pose, here is the list of how different trusts fared…

The trusts were placed into six bands - band 1 is considered the highest risk and band 6 the lowest. Northampton general hospital NHS trust featured in Band 1. Source: The Telegraph

Northampton General Hospital midwife-led maternity unit opens 24 October 2013

Northamptonshire's first midwife-led maternity unit has opened as part of a £480,000 project. The four-room Barrett Birth Centre at Northampton General Hospital includes three birthing pools, kitchenettes and en-suite bathrooms. The hospital said it provides an alternative for women who do not want home births and do not require consultant-led care. It is predicted about 1,000 babies will be born in the new centre each year. Source: BBC

Hospital staff in Northampton raise concerns about child abuse ‘four times a day’ 15 November 2013

Abuse alerts about children are being spotted by staff at Northampton General Hospital at a rate of more than four a day. A report from the hospital showed that in 2012/13, staff raised the alarm over concerns about babies and unborn children 887 times and 648 times about other children. It resulted in 51 unborn children being placed on child protection plans.

In all, 12 babies were removed from their parents at birth.

The report gave some details of three anonymous case studies of

children whose abuse was spotted at NGH and turned out to be serious case reviews. Source: Northampton Chronicle

Legal high’ cases on the rise at Northampton General Hospital 21 November 2013

One person a week is being taken to Northampton General Hospital suffering from the effects of ‘legal highs’, an accident and emergency consultant has warned. Source : Northampton Chronicle



CQC │

STEIS Serious Incidents Definition A serious incident requiring investigation is defined as an incident that occurred in relation to NHS-funded services and care resulting in one of the following:

• Unexpected or avoidable death of one or more patients, staff, visitors or members of the public;

• Serious harm to one or more patients, staff, visitors or members of the public or where the outcome requires life-saving intervention, major surgical/medical intervention, permanent harm or will shorten life expectancy or result in prolonged pain or psychological harm (this includes incidents graded under the

NPSA definition of severe harm);

• A scenario that prevents or threatens to prevent a provider organisation’s ability to continue to deliver healthcare services, for example, actual or potential loss of personal/organisational information, damage to property, reputation or the environment, or IT failure;

• Allegations of abuse;

• Adverse media coverage or public concern about the organisation or the wider NHS;

• One of the core set of ‘Never Events as updated on an annual basis.


Source: National Framework for Reporting and Learning from Serious Incidents Requiring

Investigation, NHS National Patient Safety Agency, 2010


CQC │ Northampton General Hospital NHS Trust Page 102

Composite indicator Tier 1 Indicator RAG

Cardiological

Conditions and

Procedures

(April 2008 – March

2011)

In-hospital mortality Cardiological conditions

Mortality outlier alert

Acute myocardial infarction

Cardiac arrest and ventricular

fibrillation

CABG (isolated first time)

CABG (other)

Adult cardiac surgery

Coronary atherosclerosis and

other heart disease

Congestive heart failure;

nonhypertensive

Cardiac dysrhythmias

Heart valve disorders

Pulmonary heart disease

Cerebrovascular

conditions

Cerebrovascular

conditions

(February 2012-

January 2013)

In-hospital mortality Cerebrovascular conditions

Mortality outlier alert Acute cerebrovascular disease

Dermatological

Conditions

(February 2012-

January 2013)

In-hospital mortality Dermatological conditions


Skin and subcutaneous tissue

infections

Chronic ulcer of skin


Endocrinological

Conditions

(1 April 2012 - 31

March 2013)

In-hospital mortality Endocrinological conditions


Diabetes mellitus with

complications

Diabetes mellitus without

complications

Fluid and electrolyte disorders

Gastroenterological

and Hepatological

Conditions and

Procedures

(1 April 2012 – 31

March 2013)

In-hospital mortality Gastroenterological and

hepatological conditions


Liver disease, alcohol-related

Biliary tract disease

Gastrointestinal haemorrhage

Noninfectious gastroenteritis

Intestinal obstruction without

hernia

Other gastrointestinal disorders

Other liver diseases

Operations on jejunum

Peritonitis and intestinal abscess

Therapeutic endoscopic

procedures on biliary tract


procedures on lower GI tract


Composite Mortality Indicators The tables over the next few pages list the indicators used to produce the composite mortality indicators contained in the Effective domain.

Source: CQC Intelligent Monitoring Report, Nov 2013 Elevated risk Risk No evidence of risk

CQC │

Composite Mortality Indicators continued…



Gastroenterological

and Hepatological

Conditions and

Procedures

(continued)



procedures on upper GI tract

Therapeutic operations on

jejunum and ileum

Genito-Urinary

Conditions

(February 2012 –

January 2013)

In-hospital mortality Genito-urinary conditions

Mortality outlier alert Urinary tract infections

Haematological

Conditions

(February 2012 –

January 2013)

In-hospital mortality Haematological conditions

Mortality outlier alert Deficiency and other anaemia

Infectious Diseases

(February 2012 –

January 2013)

In-hospital mortality Infectious diseases

Mortality outlier alert Septicaemia (except in labour)

Conditions

Associated With

Mental Health

(February 2012 –

January 2013)

In-hospital mortality Conditions associated with

Mental health

Mortality outlier alert Senility and organic mental

disorders

Musculoskeletal

Conditions

(February 2012 –

January 2013)

In-hospital mortality Musculoskeletal conditions


Pathological fracture

Spondylosis, intervertebral disc

disorders, other back problems

Nephrological

Conditions

(February 2012-

January 2013)

In-hospital mortality Nephrological conditions


Acute and unspecified renal

failure

Chronic renal failure


Neurological

Conditions

(February 2012 –

January 2013)

In-hospital mortality Neurological conditions

Mortality outlier alert Epilepsy, convulsions

Paediatric and

Congenital

Disorders and

Perinatal Mortality

(February 2012-

January 2013)

In-hospital mortality Paediatric and congenital

disorders

Maternity outlier

alert Perinatal mortality

Respiratory

Conditions and

Procedures

(1 April 2011 – 31

March 2013)

In-hospital mortality Respiratory conditions


Asthma

Acute bronchitis

Chronic obstructive pulmonary

disease and bronchiectasis

Pleurisy, pneumothorax,

pulmonary collapse

Pneumonia

Trauma and

Orthopaedic

Conditions

(February 2012 –

January 2013)

In-hospital mortality Trauma and orthopaedic

conditions


Craniotomy for trauma

Fracture of neck of femur (hip)

Head of femur replacement

Hip replacement

Intracranial injury

Other fractures


Elevated risk Risk No evidence of risk Source: CQC Intelligent Monitoring Report, Nov 2013

CQC │ Northampton General Hospital NHS Trust Page 104


Trauma and

Orthopaedic

Conditions

(continued)

(February 2012-

January 2011)


Reduction of fracture of bone

Reduction of fracture of bone

(upper/lower limb)

Reduction of fracture of neck of

femur

Shunting for hydrocephalus

Vascular Conditions

and Procedures

(January 2012-

February 2013)

In-hospital mortality Vascular conditions


Amputation of leg

Aortic, peripheral, and visceral

artery aneurysms

Clip and coil aneurysms

Other femoral bypass

Peripheral and visceral

atherosclerosis

Repair of abdominal aortic

aneurysm (AAA)

Transluminal operations on the

femoral artery

Dr. Foster: Hospital

Standardised

Mortality Ratio

(1 April 2011 – March

2012)

Hospital Standardised Mortality Ratio

Hospital Standardised Mortality Ratio (Weekday)

Hospital Standardised Mortality Ratio (Weekend)


Composite Mortality Indicators continued…

Elevated risk

Risk

No evidence of risk


CQC │

Definitions of Mortality Indicators Hospital Standardises Mortality Ratio (HSMR)

What is the HSMR?

The Hospital Standardised Mortality Ratio (HSMR) is an indicator of healthcare quality that measures whether the mortality rate at a hospital is higher or lower than you would expect.

How does HSMR work?

The HSMR is a ratio of the observed number of in-hospital deaths at the end of a continuous inpatient spell to the expected number of in-

hospital deaths (multiplied by 100) for 56 specific CCS groups; in a specified patient group. The expected deaths are calculated from logistical regression models taking into account and adjusting for a case-mix of: age band, sex, deprivation, interaction between age band and co-morbidities, month of admission, admission method, source of admission, the presence of palliative care, number of previous emergency admissions and financial year of discharge.

How should HSMR be interpreted?

Care is needed in interpreting these results. Although a score of 100 indicates that the observed number of deaths matched the expected number in order to identify if variation from this is significant confidence intervals are calculated. A Poisson distribution model is used to calculate 95% and 99.9% confidence intervals and only when these have been crossed is performance classed as higher or lower than expected.


What is the SHMI?

The Summary Hospital-level Mortality Indicator (SHMI) is a high level hospital mortality indicator that is published by the Department of Health on a quarterly basis. The SHMI follows a similar principle to the general standardised mortality ratio; a measure based upon a nationally expected value. SHMI can be used as a potential smoke alarm for potential deviations away from regular practice.

How does SHMI work?

1. Deaths up to 30 days post acute trust discharge are considered in

the mortality indicator, utilising ONS data.

2. The SHMI is the ratio of the Observed number of deaths in a Trust

vs. Expected number of deaths over a period of time.

3. The Indicator will utilise 5 factors to adjust mortality rates by: the

primary admitting diagnosis; the type of admission; a calculation

of co-morbid complexity (Charlson Index of co-morbidities); age;

and sex.

4. All inpatient mortalities that occur within a Hospital are considered

in the indicator.

How should SHMI be interpreted?

Due to the complexities of hospital care and the high variation in the

statistical models used all deviations from the expected range are

highlighted using a Random Effects funnel plot.



Source: NHS Neonatal Networks website

CQC │

Definitions of Maternity Indicators The indicators used as part of the maternity outliers surveillance programme are defined as follows:

A maternal non-elective readmission is defined as a woman who is readmitted to any acute trust within 42 days of the start of their delivery episode. The woman may have been readmitted via either the Emergency or Maternity departments. The indicator only counts readmissions where there was a length of stay of at least a day, or where the readmission resulted in a death. In addition, the indicator excludes women recorded with primary diagnoses on readmission in ICD-10 Chapter Z (Factors influencing health status and contact with

health services). This is because our analysis of previous maternal readmission cases has found that high numbers of women recorded with these primary diagnoses on readmission have tended to be related to data recording issues, for example healthy mothers accompanying their unwell babies back to hospital. Any women still in hospital within 42 days of the start of their delivery episode are excluded from the analysis. The readmission is assigned to the trust at which the delivery occurred.

Perinatal mortality is any in-hospital death within seven days of birth. It includes both stillbirths and neonatal deaths. Neonatal deaths that occur in any hospital within seven days are included in this indicator. Therefore, this will include babies readmitted to hospital, either as a planned admission or as an emergency, and babies transferred from their birth episode to a different trust for neonatal care. It does not include deaths which occur out of hospital. The death is assigned to the hospital at which the birth occurred.

Rates of emergency caesarean sections. Emergency caesareans

are identified by a primary procedure code of R18 (other caesarean delivery) within a delivery episode.

Rates of elective caesarean sections. Elective caesareans are identified by a primary procedure code of R17 (elective caesarean delivery) within a delivery episode.

A neonatal non-elective readmission is defined as a baby who is readmitted to any acute trust within 28 days of birth. The babies may have been readmitted via either the Emergency or Maternity departments. The indicator only counts readmissions where there was a length of stay of at least a day, or where the readmission resulted in a death. Any babies aged over 28 days at discharge from

the birth episode are excluded from the analysis. The readmission is assigned to the trust at which the birth occurred.

Puerperal sepsis (ICD-10 O85) and other puerperal infection (ICD-10 O86) within 42 days of the start of the delivery episode. This indicator looks for puerperal sepsis and/or other puerperal infection recorded within the delivery spell, or in any subsequent hospital admission

Additional Information

Indirect standardisation is carried out for the perinatal mortality indicator to adjust for the highest level of neonatal unit at the trust.

Indirect standardisation for the readmission, caesarean and puerperal sepsis indicators is carried out to adjust for differences in the age of women delivering at the trust



CQC │

Definitions of Maternity Indicators Continued… The indicators detailed on the previous page, and the analysis within this report, is based on births that took place in-hospital. Home births are excluded, as the level of information recorded in HES for these births is not detailed enough to be used in our analysis.

Deliveries that are privately funded but take place in an NHS setting are included in this analysis.

Please note that the analysis of perinatal mortality and caesarean sections includes discharges up until April 2013. However, the analysis of neonatal readmissions only includes discharges up until March 2013. Discharges in April 2013 cannot be analysed, as data is

not yet available to look at the 28-day period following delivery needed for this indicator.

The analysis of the maternal readmissions and puerperal sepsis and other puerperal infections indicators will only look at discharges up until March 2013. Discharges in April 2013 cannot be analysed, as data is not yet available to look at the 42-day period following delivery needed for this indicator.



CQC │

The National Bereavement Survey 2011 CQC view

The Milton Keynes &

Northamptonshire

PCT cluster can be

seen to be

performing in the top

20% of all PCT

clusters nationally

for two of the 26

indicators. However

they can be seen to

be performing in the

bottom 20% of PCT

clusters nationally

for seven of the 26

indicators including

three of the six in the

‘Quality of Care’.


Area Question RAG Question RAG

Respect and

Dignity Shown

Always

District & Community Nurses GPs

Care Home Hospital Doctors

Hospital Nurses

Patient Care and

Support

Enough Help Available with Personal Needs Enough Help with Nursing Needs

Bed Area had Adequate Privacy Relief of Pain Completely, While at Home in

Last 3 Months

Relief of Pain Completely, While in Hospital in Last 3

Months Relief of Other Symptoms in Last 2 Days

Spiritual Support Excellent in Last 2 Days Emotional Support in Last 2 Days

Support to Stay Where She/he Wanted to be in Last

2 Days

Patient Preferences

and Support of the

Bereaved

No Decision Made About Care Patient Would Not

Have Wanted

Patient Had Enough Choice About Where

They Died

Respondent Involved in Decisions as Much as

Wanted Sufficient Help and Support for Family at

Time of Death

Staff Dealt with Family Sensitively After Patient Died Has Respondent Talked to Anyone Since

Patient’s Death

Quality of Care

Out of Hours District & Community Nurses

GPs Care Home

Hospital Doctors Hospital Nurses

Source: National Bereavement Survey 2011


Top 20% of PCT Clusters

Middle 60% of PCT Clusters

Bottom 20% of PCT Clusters

CQC │

NHS LA Risk Management Standards continued…

The NHS Litigation Authority (NHS LA) is a Special Health Authority responsible for handling negligence claims made against NHS bodies in England. A key function for the NHS LA is to contribute to the incentives for reducing the number of negligent or preventable incidents. They aim to achieve this through an extensive risk management programme. Healthcare organisations are regularly assessed against risk management standards which have been specifically developed to reflect issues which arise in the negligence claims reported to the NHS LA.

The tables below document the compliance of the trust.

Northampton General Hospital NHS Trust – Level 1

In November 2011 the NHS Litigation Authority (NHS LA) conducted a Level 1 assessment of the trust. The results of this assessment are displayed below.


Domain Compliant? Score

Governance Compliant 10/10

Competent & Capable Workforce Compliant x/10

Safe Environment Compliant 10/10

Clinical Care Compliant 10/10

Learning from Experience Compliant 10/10

Overall Compliance Compliant 49/50


CQC │

Trust Quality Account The following key points were taken from the trust’s 2012/13 Quality Report:

• In 2010 the ‘Aspiring to Excellence’ programme was introduced to help junior doctors understand their role in affecting change impacting on patient safety.

• The number of patients seen in A&E in 2012/13 was 96,180, which was a 10% increase from 2011/12.

• Around 2,000 patients receiving NHS services provided by the trust between April 2012 to March 2013 were recruited to

participate in research approved by a research ethics committee.

• During the 2012/13 reporting period, the trust investigated a Never Event related to wrong site vascular surgery. Following the event, a number of actions were implemented to reduce the risk of re-occurrence, as well as a review of practices and procedures relating to the WHO surgical checklist.

• The trust has launched a specialist multi-disciplinary team that provides care and support for stroke patients in their own home, with said care being tailored to the needs of each individual.

• In March 2013 staff carried out the first treatment in the country to target early stage lung cancer with a technique called ‘Stereotactic Radiotherapy’.

• One of the trust’s healthcare assistants, Chris Head, has been presented with the Hand Hygiene Champion of 2012 national award by the Infection Prevention Society for his proactive and

enthusiastic teaching of effective hand hygiene.

• The trust is a recognised National Cancer centre, and provides care to a wider population of 880,000 people living in Northamptonshire, North Buckinghamshire and South Leicestershire.

• The 2012 National Cancer patient experience survey showed the trust improved across 64% of standards in comparison to their 2010 results.

• The trust has put the following four ‘Quality Priority Actions’ in place to improve the quality and cost effectiveness of care

2013/14:

• Re-designing the emergency Care Pathway – using best practice standards.

• Caring for Vulnerable Adults – aims to continue care given to people with dementia and/or learning disabilities.

• Patient Safety Programme – high level aim is to save 300 lives over the next 3 years and to reduce avoidable harm by 50% over the same period.

• Patient Experience – aims the trust will achieve 20% response rate in the Friends and Family Test, and 10% increase in their scores.



CQC │

Glossary Cross-sectional analysis

The cross-sectional analysis measures the standardised ratio (SR) for a chosen single period and the extent to which it deviates from the norm. SRs are presented on a funnel plot. The control limits, with their distinctive funnel shape, represent a specified significance level.

CUSUM

This technique identifies persistent deviations from expected values over time. If outcomes are lower than the national average plus a predefined tolerance level then the plot will stay at zero. If higher, the

CUSUM plot will move upwards. If a significant run of high values is detected, the plot crosses a fixed ‘control limit’ and the plot is then reset to zero. Resetting the plot after an alert allows for further runs of high values to be detected.

Expected deaths

Expected numbers of deaths are calculated by comparing rates at a given trust to national rates on a quarterly basis. Within this comparison, indirect standardisation is carried out to adjust for the sex of the babies born at the trust and the highest level of neonatal unit at the trust. Please note that home births are excluded from the analysis.

Expected caesareans

Expected numbers of caesareans are calculated by comparing rates at a given trust to national rates on a quarterly basis. Within this comparison, indirect standardisation is carried out to adjust for differences in the age of women delivering at the trust. Please note that home births are excluded from the analysis.

Expected readmissions

Expected numbers of readmissions are calculated by comparing rates at a given trust to national rates on a quarterly basis. Within this comparison, indirect standardisation is carried out to adjust for differences in the age of women delivering at the trust. Please note

that home births are excluded from the analysis.

Expected puerperal sepsis and other puerperal infection rates

Expected numbers are calculated by comparing rates at a given trust to national rates on a quarterly basis. Within this comparison, indirect standardisation is carried out to adjust for differences in the age of women delivering at the trust. Please note that home births are excluded from the analysis.

HES data

Hospital Episode Statistics (HES) is a data warehouse containing details of all admissions to NHS hospitals in England. It includes private patients treated in NHS hospitals, patients who were resident outside of England and care delivered by treatment centres (including those in the independent sector) funded by the NHS. HES also contain details of all NHS outpatient appointments in England.


CQC │

Glossary continued… Outlier status

An outlier is a trust performing significantly differently than expected on a given measure - here this generally relates to standardised rates in comparison to national levels. The method used to identify outliers among the basket of maternity indicators was a type of statistical process control (a methodology that is used to identify significant deviations from a predefined standard) called CUSUM (short for Cumulative Sum).

Spells

A spell of treatment is a continuous period of treatment within a

single hospital provider (a period commencing with admission to hospital and ending on discharge) and can be made up of a number of care episodes.

Statistical process control

Statistical process control (SPC) is a methodology that uses control charts to identify significant deviations from a predefined standard. These methods originated in manufacturing industry and are now regularly applied to the monitoring of healthcare.

Z-score

The z-scoring approach enables us to measure outcomes on a common scale. The z-score measures the number of standard deviations away from the mean, preceded by a plus or minus depending on whether it is respectively above or below the mean (the mean value is commonly the average value for all trusts, or all trusts of a specific type). High z-scores indicate worse outcomes and low z-scores good outcomes. Z-scores correspond to p-values in that a p-value of 0.01 is equal to a z-score of 2.3 and a p-value of 0.001 matches a score of 3.0.


How to contact us

Call us on: 03000 616161

Email us at: [email protected]

Look at our website: www.cqc.org.uk

Write to us at:

Care Quality Commission

Citygate

Gallowgate

Newcastle upon Tyne

NE1 4PA

Follow us on Twitter: @CareQualityComm

Documents

Northampton General Hospital NHS Trust (RNS) · Northampton General Hospital NHS Trust is an acute trust with 800 consultant led beds. It provides general acute services to a population