ANALYSIS
Best-practice partnerships are seeking to reverse the underperformance at other trusts by sharing their skills and knowledge. Christian Duffin reports
Nurses in successful trusts helping ‘special measures’ hospitals improve
A record number of trusts were placed in special measures last year in what health secretary Jeremy Hunt has described as the worst year in the NHS’s 65-year history. Mr Hunt said earlier this month that more trusts were likely to follow, as a result of the appointment of a chief inspector of hospitals, a new role. Monitor, which regulates foundation trusts, and the Trust Development Authority (TDA) decided to placed 14 English trusts in special measures, 11 of which had been investigated for high death rates by NHS England medical director Sir Bruce Keogh. A progress report has now been published by Monitor and the TDA. The trusts have recruited an extra 650 nurses between them. Four trusts have new directors of nursing; all have been partnered with those
What are special measures? Trusts are placed in special measures when there are ‘serious and systemic failings’ relating to care quality. Regulators impose improvement directors, external appointees who oversee trusts’ performance plans. Foundation trusts may loose some of their autonomy. Organisations are removed from special measures once they have achieved agreed improvements. Jeremy Hunt has said he wants trusts to be out of special measures within one year. In response to Sir Bruce Keogh’s review of 14 trusts, teams that included some of England’s most senior nurses drew up improvement action plans with each of the trusts. 14 february 26 :: vol 28 no 26 :: 2014
judged to be high-achieving, and nurses are being supported by peers at these organisations. George Eliot Hospital NHS Trust in Warwickshire was placed in special measures in October 2013. Concerns included low doctor numbers, frequent shunting of inpatients to different beds during their stay and treating patients on inappropriate wards. Eighteen of 23
NURSES WANT TO GO THE EXTRA MILE FOR THEIR TRUST – Kay Fawcett
improvement actions, which have to be achieved within a year, have been met. The trust is taking advice from University Hospitals Birmingham NHS Foundation Trust on issues including nursing and medicine, says George Eliot director of nursing Dawn Wardell. Birmingham’s IT system for enabling instant drug prescribing checks for interactions, contraindications and dose limits has already caught Ms Wardell’s eye. She is interested in introducing it at George Eliot. ‘Nurses have handheld tablets and they do the prescribing of drugs by the bedside, so it is recorded on the computers straight away,’ she says. ‘You can analyse the prescribing to see how well it is working, and check the records easily if there is a patient incident.’ Ms Wardell also hopes to introduce an electronic incident reporting system, Datix, used in Birmingham. It allows anyone with computer access to submit an incident form online. The George Eliot trust opened a 41-bed acute medical unit in December, which has helped tackle the problem
of patients being sent from A&E to inappropriate non-specialist wards. Ms Wardell is looking at how Birmingham manages patient flows in its acute medical unit. ‘Before, we had a small emergency ward of 18 beds, and patients could be moved twice if the wards they needed became full,’ she says. ‘We want to look at Birmingham’s pathways from A&E to acute medical unit and through ambulatory care – and to see what we can learn from sisters’ and matrons’ roles there.’ Ms Wardell has regular meetings with Birmingham’s strategic adviser for nursing Kay Fawcett. The pair have set up a ‘buddy’ system: George Eliot ward sisters, matrons and other senior nurses spent a day at the Birmingham trust to meet their opposite numbers, comparing roles and sharing best practice. Safe staffing through good rostering was one important topic for discussion. Ms Fawcett says: ‘We have been highlighting aspects like not having too many bank staff on certain nights, and organising holiday cover better. We have emphasised the nurse in charge of a shift has to do this well.’
Staff loyalty
The partnerships represent a certain irony; trusts are being asked to co-operate closely even though, as neighbours, they are effectively in competition, particularly as employers. However, Ms Fawcett does not believe George Eliot’s nurses will want to leave their struggling trust and apply for jobs in Birmingham. ‘The nurses at George Eliot are incredibly proud and passionate about their hospital,’ she says. ‘It saddens them that some people think they are not doing the best they can. They want
NURSING STANDARD
Downloaded from RCNi.com by ${individualUser.displayName} on Oct 16, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
DANIEL MITCHELL
ANALYSIS
to go the extra mile for George Eliot – they are not looking to jump ship.’ North Cumbria University Hospitals NHS Trust has recruited 67 nurses and support staff since being on special measures, and has met six of 19 actions set out in its Keogh plan. Chris Platton, associate director of nursing development for Northumbria Healthcare NHS Foundation Trust as well as North Cumbria says both trusts are working on staff shortages, infection control and better serious incident response times. Senior nurses at North Cumbria are undertaking leadership development training. Basildon and Thurrock University Hospitals NHS Foundation Trust in Essex was placed in special measures in July 2013. It has since recruited 141 extra nurses and nursing support staff and has fulfilled three of 15 urgent actions. It is partnered with the Royal Free London NHS Foundation
NURSING STANDARD
Trust. Royal Free director of nursing Diane Sarkar says her trust is helping Basildon with patient falls, sepsis and medication errors. There will be ‘mutual shadowing’ for nurses, she added. A nurse from the Royal Free’s resuscitation team is on a one-year secondment at Basildon to share ideas about tackling patient deterioration.
Valuable lessons
Queen Elizabeth Hospital King’s Lynn NHS Foundation Trust in Norfolk was placed in special measures in October 2013. Nurses at Guy’s and St Thomas’ NHS Foundation Trust are advising on staffing levels, dementia care and nurse leadership mentoring. This week Guy’s and St Thomas’ will show a training film called Barbara’s Story to Kings Lynn staff. The film depicts an older woman with dementia’s distressing day at hospital. She cannot find her way round, is ignored and
denied privacy. About 12,500 trust staff, from porters and administration staff to nurses and doctors, have already seen the film. ‘Barbara’s Story has had a huge effect on how we provide care at our own trust – and there are valuable lessons to be learned by everyone,’ says chief nurse Eileen Sills. King’s Lynn deputy director of nursing Val Newton says: ‘We want to show the film to all our staff. Group discussions will help them know what to do if they see a person with dementia who is lost.’ It is too early to say what impact the partnerships will have on mortality, but in the meantime nurses are certainly benefiting from their exchange visits. Ms Fawcett says: ‘Our buddying system means that one of the pair can phone or email the other for a listening ear if ever they are not sure how to deal with a situation. The NHS does not do this sort of thing enough’ NS february 26 :: vol 28 no 26 :: 2014 15
Downloaded from RCNi.com by ${individualUser.displayName} on Oct 16, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
Best-practice partnerships are seeking to reverse the underperformance at other trusts by sharing their skills and knowledge. Christian Duffin reports
Nurses in successful trusts helping ‘special measures’ hospitals improve
A record number of trusts were placed in special measures last year in what health secretary Jeremy Hunt has described as the worst year in the NHS’s 65-year history. Mr Hunt said earlier this month that more trusts were likely to follow, as a result of the appointment of a chief inspector of hospitals, a new role. Monitor, which regulates foundation trusts, and the Trust Development Authority (TDA) decided to placed 14 English trusts in special measures, 11 of which had been investigated for high death rates by NHS England medical director Sir Bruce Keogh. A progress report has now been published by Monitor and the TDA. The trusts have recruited an extra 650 nurses between them. Four trusts have new directors of nursing; all have been partnered with those
What are special measures? Trusts are placed in special measures when there are ‘serious and systemic failings’ relating to care quality. Regulators impose improvement directors, external appointees who oversee trusts’ performance plans. Foundation trusts may loose some of their autonomy. Organisations are removed from special measures once they have achieved agreed improvements. Jeremy Hunt has said he wants trusts to be out of special measures within one year. In response to Sir Bruce Keogh’s review of 14 trusts, teams that included some of England’s most senior nurses drew up improvement action plans with each of the trusts. 14 february 26 :: vol 28 no 26 :: 2014
judged to be high-achieving, and nurses are being supported by peers at these organisations. George Eliot Hospital NHS Trust in Warwickshire was placed in special measures in October 2013. Concerns included low doctor numbers, frequent shunting of inpatients to different beds during their stay and treating patients on inappropriate wards. Eighteen of 23
NURSES WANT TO GO THE EXTRA MILE FOR THEIR TRUST – Kay Fawcett
improvement actions, which have to be achieved within a year, have been met. The trust is taking advice from University Hospitals Birmingham NHS Foundation Trust on issues including nursing and medicine, says George Eliot director of nursing Dawn Wardell. Birmingham’s IT system for enabling instant drug prescribing checks for interactions, contraindications and dose limits has already caught Ms Wardell’s eye. She is interested in introducing it at George Eliot. ‘Nurses have handheld tablets and they do the prescribing of drugs by the bedside, so it is recorded on the computers straight away,’ she says. ‘You can analyse the prescribing to see how well it is working, and check the records easily if there is a patient incident.’ Ms Wardell also hopes to introduce an electronic incident reporting system, Datix, used in Birmingham. It allows anyone with computer access to submit an incident form online. The George Eliot trust opened a 41-bed acute medical unit in December, which has helped tackle the problem
of patients being sent from A&E to inappropriate non-specialist wards. Ms Wardell is looking at how Birmingham manages patient flows in its acute medical unit. ‘Before, we had a small emergency ward of 18 beds, and patients could be moved twice if the wards they needed became full,’ she says. ‘We want to look at Birmingham’s pathways from A&E to acute medical unit and through ambulatory care – and to see what we can learn from sisters’ and matrons’ roles there.’ Ms Wardell has regular meetings with Birmingham’s strategic adviser for nursing Kay Fawcett. The pair have set up a ‘buddy’ system: George Eliot ward sisters, matrons and other senior nurses spent a day at the Birmingham trust to meet their opposite numbers, comparing roles and sharing best practice. Safe staffing through good rostering was one important topic for discussion. Ms Fawcett says: ‘We have been highlighting aspects like not having too many bank staff on certain nights, and organising holiday cover better. We have emphasised the nurse in charge of a shift has to do this well.’
Staff loyalty
The partnerships represent a certain irony; trusts are being asked to co-operate closely even though, as neighbours, they are effectively in competition, particularly as employers. However, Ms Fawcett does not believe George Eliot’s nurses will want to leave their struggling trust and apply for jobs in Birmingham. ‘The nurses at George Eliot are incredibly proud and passionate about their hospital,’ she says. ‘It saddens them that some people think they are not doing the best they can. They want
NURSING STANDARD
Downloaded from RCNi.com by ${individualUser.displayName} on Oct 16, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
DANIEL MITCHELL
ANALYSIS
to go the extra mile for George Eliot – they are not looking to jump ship.’ North Cumbria University Hospitals NHS Trust has recruited 67 nurses and support staff since being on special measures, and has met six of 19 actions set out in its Keogh plan. Chris Platton, associate director of nursing development for Northumbria Healthcare NHS Foundation Trust as well as North Cumbria says both trusts are working on staff shortages, infection control and better serious incident response times. Senior nurses at North Cumbria are undertaking leadership development training. Basildon and Thurrock University Hospitals NHS Foundation Trust in Essex was placed in special measures in July 2013. It has since recruited 141 extra nurses and nursing support staff and has fulfilled three of 15 urgent actions. It is partnered with the Royal Free London NHS Foundation
NURSING STANDARD
Trust. Royal Free director of nursing Diane Sarkar says her trust is helping Basildon with patient falls, sepsis and medication errors. There will be ‘mutual shadowing’ for nurses, she added. A nurse from the Royal Free’s resuscitation team is on a one-year secondment at Basildon to share ideas about tackling patient deterioration.
Valuable lessons
Queen Elizabeth Hospital King’s Lynn NHS Foundation Trust in Norfolk was placed in special measures in October 2013. Nurses at Guy’s and St Thomas’ NHS Foundation Trust are advising on staffing levels, dementia care and nurse leadership mentoring. This week Guy’s and St Thomas’ will show a training film called Barbara’s Story to Kings Lynn staff. The film depicts an older woman with dementia’s distressing day at hospital. She cannot find her way round, is ignored and
denied privacy. About 12,500 trust staff, from porters and administration staff to nurses and doctors, have already seen the film. ‘Barbara’s Story has had a huge effect on how we provide care at our own trust – and there are valuable lessons to be learned by everyone,’ says chief nurse Eileen Sills. King’s Lynn deputy director of nursing Val Newton says: ‘We want to show the film to all our staff. Group discussions will help them know what to do if they see a person with dementia who is lost.’ It is too early to say what impact the partnerships will have on mortality, but in the meantime nurses are certainly benefiting from their exchange visits. Ms Fawcett says: ‘Our buddying system means that one of the pair can phone or email the other for a listening ear if ever they are not sure how to deal with a situation. The NHS does not do this sort of thing enough’ NS february 26 :: vol 28 no 26 :: 2014 15
Downloaded from RCNi.com by ${individualUser.displayName} on Oct 16, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
