WHHT - Annual Report 07/08

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Annual Report 2007-08

Service Developments

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Stroke care service

Stroke services in west Hertfordshire received an excellent report in the 'National Sentinel Audit for Stroke' funded by the Healthcare Commission. The report, which covers 203 Trusts, gives a very detailed insight into Stroke Services around the country. The Watford Stroke Unit scored 88 out of 100 in the audit, coming 8th in the country. The sentinel audit is made up of two phases, phase 1 - organisational audit and phase 2 - clinical audit. Hemel Hempstead Stroke Unit has improved dramatically from being in the lower 25% of the country in 2004 to the top 25% performing stroke units in the country. This is a remarkable achievement for everyone involved in caring for stroke patients.

Specialist Cancer Surgery

The Trust successfully bid for the centralisation of specialist cancer surgery for Upper GI cancer and Gynaecology cancer at Watford General Hospital for the Mount Vernon Cancer Network. This is excellent news for patients of west Hertfordshire, as they will no longer have to travel to other hospitals for these specialist cancer services. The Cancer Network is in the process of organising a number of working groups to implement the changes required in patient care pathways in order for the clinical teams to deliver these services to patients by summer 2008.

Local maternity services

Mother cradling a newborn surrounded by 2 childrenIn January 2008, the Healthcare Commission (HcC) published a national review of maternity services where the Trust was assessed in the 'Least Well Performing' category. The data for this report was collected over the summer 2007. Although the Trust felt that the HcC had failed to report on the maternity services accurately, we recognised that some improvements were required.

Professor Graham Ramsay, Director of Patient Services and Medical Director, said: "The report does not mean that the unit is unsafe. Quite the contrary, a recent report 'Confidential Enquiry into Maternal and Child Health' showed that the Trust provides one of the safest services in the country. Mortality rates of newborn babies born at Watford General Hospital are amongst the lowest in the country less than one death per thousand births compared with a national average of around one in 300. As a result many women from outside the Trust's immediate catchment areas choose to come to Watford."

Nursing and Midwifery Strategy

The Nursing and Midwifery Strategy (2007-2010) 'Valuing Patients: Inspiring Staff' was developed following six months work undertaken by Trust nurses and midwives and patient representatives and launched in May 2007.

The Strategy is crucial in defining a coherent direction for nurses and midwives. It provides a clear statement of intent and generates a process by which standards of care can be described, initiated, maintained and enhanced, using a sound evidence base so that the patient is truly central to all care delivery.

Many of the priorities identified within the Strategy are drawn from existing frameworks developed by the Department of Health and reflect the recommendations of the Chief Nursing Officer, as detailed in Modernising Nursing Careers (2006).

The Core Principles of the Strategy are:

These Core Principles provide strategic direction for Trust nursing and midwifery staff and reflect the need for healthcare professionals to adopt a multi-professional approach in order to deliver high quality care to the users of our service. Progress on delivering the targets outlined in the Core Principles are reported six-monthly to the Trust Board.

Essence of Care Framework

The Essence of Care Benchmarking initiative was launched by the Department of Health in February 2001. It offers a practical toolkit for nurses, midwives and other team members to focus on aspects of care identified as crucial to the quality of care and patients' experience.

The Trust has been actively implementing and auditing the Essence of Care Benchmarks since 2002. The Strategy has evolved over time to best capture and influence practice, incorporating the new benchmarks launched in 2007.

A new approach to embed the fundamentals of care in day-to-day practice has been revised by the Director of Nursing and the Head of Practice and Innovation. The revised Strategy framework promotes a continuous quality improvement programme whereby a multi level approach is adopted, encompassing organisational, divisional and local focus. The collective aim is to get the fundamentals of care right for our patients, drive quality care provision across the organisation and to celebrate, share and sustain best practice.

Dignity in Care

Dignity in Care cardThe Trust responded positively to the National Dignity Challenge, part of a wider Department of Health campaign to promote dignity for older people in the health and social care sectors and established a multi professional Patient and Public Involvement and Experience Group, chaired by the Director of Nursing, to progress this work. The identification and collation of examples of good practice already in place within the Trust are summarised in a single document 'Dignity in Care - Examples of Excellence in Practice', which is updated quarterly and circulated widely.

In September 2007, the Trust launched 'Best Practice Standards for Privacy and Dignity'. Our success in meeting these standards is evaluated six monthly through the Trust's Privacy and Dignity Patient Surveys.

As part of the Department of Health's Dignity in Care Campaign, 60 Trust staff have registered as Dignity Champions and have joined a National network of people who are committed to taking action to improve Dignity in Care. In order to share the positive work undertaken within the Trust, a Dignity in Care Conference, hosted by the Director of Nursing took place on the 14 December 2007.

Bowel cancer screening programme

People across west Hertfordshire will benefit from bowel cancer screening. This follows clinical staff at Hemel Hempstead and Watford General hospitals being accredited to deliver the national screening programme locally. The programme is part of a three-year nation-wide initiative led by the Department of Health, the rollout of which is planned to be completed in 2009. From March 2008 the local NHS will be offering every resident aged 60-69 free screening once every two years to catch the disease before it has a chance to take hold. There are currently around 46,000 people aged between 60 and 69 in west Hertfordshire. The aim is to invite around 25,000 people every year to be screened.

Dignity patient hygiene packs

Dignity patient hygiene packsHygiene and personal appearance is extremely important to patients, especially when maintaining dignity for older people. Staff at the Trust noticed that some patients were being admitted without suitable washing provisions or access to families or friends to help provide these items. The Voluntary Services Manager, together with a small group of staff, through their involvement with the Trust's Dignity in Care Group, worked with a number of organisations including the League of Friends and NHS supplies to produce hygiene packs for these elderly and vulnerable patients to use.

Patient Focus

To ensure that patients continue to be involved and receive an experience that not only meets but also exceeds their physical and emotional needs and expectations, the Trust has fully implemented the Patient Involvement and Experience Strategy in consultation with patients, carers, Trust staff, PCT colleagues, and external bodies. In doing so, the Trust seeks to support ongoing, meaningful involvement and engagement in its work and services.

Hospital volunteers

Hospital volunteersThe Trust organised a series of events to update its volunteers on current health issues and to say thank you for all the hard work and commitment they have shown to the Trust, in some cases for over twenty years. This event was also an opportunity for them to meet each other and to discuss with health professionals specific issues and developments.

Each week hundreds of volunteers give their time to support the Trust in a wide variety of ways, from helping in outpatients, running the hospital library service, providing volunteer driving services and offering clerical help. The Women's Royal Voluntary Service (WRVS) and the Leagues of Friends also provide invaluable services and support to the hospitals. Pat Schofield and Vivienne Payne, the Trust's Voluntary Services Managers, are always looking for extra pairs of hands.

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Patients have their say

Patients' Panel

Since the establishment of the Patients' Panel four years ago they have gone from strength to strength in respect of their ongoing enthusiasm and commitment in ensuring that all service improvements and re-design have patient and carer involvement within the Trust.

The Panel continue to be involved in all meetings and committees, including the Patient Involvement and Experience Group, Equality and Diversity, Infection Control and the new Environment Improvement Group that identifies areas requiring improvement, which will have a positive impact on the patient and staff experience. The Panel have also been involved in the internal Hospital User Groups (iHUGS) in respect of the new Acute Admissions Unit (AAU) at Watford General Hospital, including choosing colours and furnishings and taking part in an assimilation event. The Chair and members have also signed up to the Department of Health's Dignity in Care initiative to become 'Dignity Champions'.

The Trust presented its declaration for Standards for Better Health to both the Patients' Panel and the Patient and Public Involvement Forums (PPIF) as part of our general consultation process prior to its final presentation to the Trust Board.

The Patient Involvement and Experience Group

The Chair of the Patients' Panel, Jessie Winyard together with the Head of Patient Services launched the Patient Involvement and Experience Strategy 2007 2010 Ensuring a Voice: Offering Choice at this year's 'Celebrating our Success' Nursing and Midwifery conference on 18 May 2007.

The Patient Involvement and Experience Group with its key stakeholder members continues to drive forward the ten key areas identified in the strategy that collectively impact on the patient experience. This Strategy seeks to detail where and how patients and the public will be involved. There is a clear expectation within the Trust that all staff, both corporately and within the Divisions, will embrace this strategy ensuring that all patients can fully benefit from improved care and services as a result.

Following a meeting with external stakeholders a staff 'Code of Conduct Regarding Patient Care' was developed, on how we should treat our patients and visitors. This 'Code of Conduct' not only states what the Trust's aims are but also what our patients and carers have asked for. The Code of Conduct will be appraised through the six monthly Evaluation of Practice days utilising in particular the Patient Survey and Observation of Care elements of the review.

Two innovative projects have been initiated within the Trust thanks to the funding by the League of Friends at both Hemel Hempstead Hospital and Watford General Hospital. They have kindly donated money to support both the 'Sloppy Slipper' and 'Personal Emergency Hygiene Packs' for our patients.

The Trust has been able to purchase 50 pairs of male and female slippers that are given out to all patients who arrive in the Trust without slippers or for those whose slippers are of a poor fitting quality. This incentive will help to reduce the risk of slips, trips and falls and has been well received by the patients.

Personal Emergency Hygiene Packs containing shampoos, combs, creams, washing products etc. have been purchased to ensure that all patients who have been admitted in an emergency, or for patients who do not have any next of kin to visit them, receive a pack to make sure that their standard of personal care as a patient is maintained. Packs are also available for patients from ethnic backgrounds.

The Acute Patient and Public Involvement Forums

The Trust has continued to support and work closely with the PPI Forum during this last year.

Patient and public involvement forumThe Forum, like the Patients' Panel, have continued in supporting the Internal Patient Involvement and Experience Group Patient Environment Action Team (iPEAT), Think Clean Days, Essence of Care: Observation of Care and the new Environment Group. The PPI Forum and the Panel met regularly with the Chief Executive Officer. This has been an opportunity for the CEO to update them on what is happening in the Trust and also for the Forum to advise the CEO on health issues raised in their public meetings and within local communities.

The Director of Corporate Affairs, together with the Head of Patient Services accepted an invitation from the Community Development Agency (CDA for Herts) to attend its evening reception to mark the end of the Patient and Public Involvement Forums in Hertfordshire. The Trust took the opportunity to thank the PPI Forum members for their interest and support during their time as members. The Trust is looking forward to working with the Transitional LINks until a host organisation is appointed in September when LINks will be fully developed. The Trust welcomes the opportunity to support and jointly work with LINks to ensure future patient, carer and public involvement in respect of both Health and Social Care.

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