Health services across the whole of South Wales, while. Learning Disability services are provided from Swansea to Cardif
Annual Quality Statement An Account for our Citizens September 2014
© ABMU Health Board
Foreword Abertawe Bro Morgannwg University Health Board (ABM University HB) delivers healthcare to over 500,000 people. We are part of our local communities and serve them best by providing excellent care and improving well-being. We know that at our best we do this, because many of our patients tell us that they have received excellent care with compassion and kindness. But we do not always do it and sometimes let people down. Last year some reports from the Ombudsman, patients’ complaints, investigations and our performance information suggested we needed rapidly to improve the quality care in some of our services. We responded immediately. In October 2013 the Health Minister asked Professor June Andrews to undertake a review of the quality of care for older people at the Princess of Wales and Neath Port Talbot Hospitals. Her report, “Trusted to Care” served as a wakeup call for us all. It brought into focus aspects of our culture, our attitudes, our systems and our services. We are working hard to regain the confidence of our communities. It’s not easy and it won’t happen overnight. We are implementing all the recommendations in “Trusted to Care” and are absolutely committed to ensuring that the best care is available for all. We are renewing our focus on teamwork, training and a better partnership with our patients and families. We believe this quality statement, which should be read alongside our annual report, is an honest reflection on the quality of care that we provide for our citizens. We are very proud about the many examples of excellence and improvement contained in it. We are confident that by accepting the lessons of “Trusted to Care” and working together we can deliver the sort of care that our citizens need and deserve. This is our primary focus.
Chairman: Professor Andrew Davies
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Chief Executive: Mr Paul Roberts
Contents An introduction to your Health Board and this Annual Quality Statement 1 What we said we would do in last year’s Annual Quality Statement (2012-13)
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Quality and safety in our hospitals 6 Looking back over the last twelve months: What we did to improve the support and care we provide
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Staying healthy: “prevention is better than cure”
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Safe Care: the steps we took to improve the safety of our services
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Effective Care : how we improved the usefulness of the care and treatment we provide
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Dignified care: the importance of providing care that is respectful and personal to you
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Timely care: accessing care and treatment when you need it
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Treating people as individuals: providing care and treatment that is citizen and family/carer centred
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Our Staff: how we ensure they have the knowledge and skills to do their job 31 Looking Forward: what we will do in the year ahead so that the services we provide continue to improve ii
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An Introduction to your Health Board and this Annual Quality Statement This is our second Annual Quality Statement and it describes what we did during 201314 to meet your health needs better and improve the quality of the services we provide for you. We also include a summary of what we are planning to do in the year ahead (2014-15) to make sure that we continue to improve even more.
Meeting the health needs of our citizens Our main goal is “To fulfil our civic responsibilities by improving the health of our communities, reducing health inequalities and delivering effective and efficient healthcare in which patients and users always feel cared for, safe and confident.” We want to meet this goal for you if you live in Bridgend, Neath Port Talbot and Swansea and also for some citizens who live further away but use our services. We will do it by supporting you to make healthy life choices, manage your own health
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and by providing you with a wide range of health care services. Although some of these services are in hospitals, most are provided across local communities and in the home. We work closely with partners in local Authorities and the third and voluntary sectors to offer a range of support and services that meet your needs if you live in a community that we serve. Towards the end of last year we reviewed information about the health, age and way our citizens live their lives and published what we found in a report. It is on our website or can be requested by ringing 01639 683348.
We discovered that: • Our citizens are living longer and so many more of them are going to need care and treatment in the future. • Frail and elderly people use our services the most and this is likely to increase in coming years. • Over 5,000 people who live in ABM die each year. Heart disease, cancer and lung disease are the main reasons people die. Smoking, being very overweight, drinking too much and an unhealthy way of life often lead to such illnesses and so could be prevented if we make healthier lifestyle choices.
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To meet increasing health needs and other challenges facing us we all have to change the way we do things. In 2012, we started our “Changing for the Better” programme. Supported by over 250 people the programme takes the ideas and experiences of citizens, patients, carers, our partners and our staff and uses them to plan and improve all our services so they meet the needs of those who use them now and in the future.
CHANGING
FO R T H E B ETTER
REPORT
We also use social media such as Facebook™ and Twitter™ to gather feedback and ideas and let you know what we are doing. In May 2013 we held our first conference for children so that we could listen to what they thought about the services we provide for them. If you would like to get information on future events or provide feedback on your Health Board you can contact us on Facebook and Twitter or phone us on 01639 683348.
Annual Repo
rt 2013-4
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PROJECTS
WORKSTREA MS
April 2014
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What we said we would do in our last Annual Quality Statement We said that when you use our services you should expect us to ensure that you: • • • • • •
are not harmed by the care and treatment we provide; receive the care and treatment that will benefit you the most; are treated in a time that is right for you; are treated with dignity and respect; have your needs met; and are cared for by staff who have the right knowledge and skills.
When we are working at our best our skilled and committed staff provide excellent services centred around your needs and those of your family or carer. Here are some of the things those of you who have used our services have said about us recently. The size of the words indicate how often those things were said:
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But in last year’s Annual Quality Statement we acknowledged that we had not always delivered high quality care and highlighted some areas where improvement was needed. Here are some of the things that those who have been unhappy with our services have said. Again, the size of the words indicate how often those things were said:
Last year we said also that we needed to: • do more to reduce Healthcare Acquired Infections; • improve the way our clinical teams work together; • improve our waiting times and how the quality and safety of our services are maintained when we are busiest; • improve the way we respond to and learn from patient complaints, incidences of harm, legal claims, and reports from the Ombudsman and Coroner.
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Quality and Safety in our Hospitals Last year we also said that we were particularly worried about the quality and safety of care at the Princess of Wales Hospital. We were taking action, but early in 2013 we realised that the problem was bigger than we had first thought and so we asked external experts, the Advancing Quality Alliance (AQuA), to help us investigate. The Health Minister also asked another expert, Professor June Andrews to review the care provided specifically to older people at the Princess of Wales and Neath Port Talbot Hospitals. Both these reviews, published recently, confirm that there have been instances of unacceptable care in recent years and that despite progress in some areas, change has not been fast enough. Some of the guidance, best practice and tools for excellent care, such as the butterfly scheme for dementia, have not always been used consistently. We decided that Professor Andrews’ recommendations should be applied across all our hospitals and some also in primary care. So, since March 2014 we have been working even harder with our staff and are now seeing significant improvements. We are determined to replace any pockets of poor care in any of our hospitals with consistently excellent care and will tell you how successful we have been in next year’s Annual Quality Statement. In the first few weeks following the publication of Professor June Andrew’s report, “Trusted to Care”, we have: • been talking with hundreds of our staff, patients, carers and citizens to be certain about values and behaviours that are expected; • made clear that some types of care that will never be acceptable (“zero tolerance”); • carried out dozens of surprise “spot checks” in the day, at night and weekend ; and • set up a multi-professional taskforce with support from experts in dementia and older person’s care to advise us on what needs to be done.
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In the next pages we explain what else we have done over the last year to help you and to make sure the care we provide is safe, compassionate and centred around your needs. If you would like more detailed information about this and what we did to make sure ABM University Health Board was properly run you may wish to read our Annual Report for 2013-14 and our Annual Governance Statement. You can find copies of these and all other reports referred to in this Statement on our website: www.abm.wales.nhs.uk or you can request copies in other formats from 01639 683348. A list of the documents we refer to in this Statement is provided at Appendix 1 and short explanations of some of the more technical terms we have used can be found at Appendix 2.
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Remem walk p ber, the c you ac ast — is t are you he car cept e
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Looking back over the last twelve months: What we did to improve the support and care we provide During the year we continued to focus on improvement, under the direction and scrutiny of our Board. We have a Quality and Safety Committee whose main job is to assure the Board that arrangements are in place continuously to improve the quality and safety of our services and the care we offer you. We have summarised the main things we did in this section.
Staying healthy: “prevention is better than cure” We can all reduce the chance of developing illnesses by making better lifestyle choices; so helping everyone to make healthier choices is important. During the last year we focused on three things to help you improve your health: • Working with Stop Smoking Wales we helped 19,962 people, including mums-to-be and patients having operations to stop smoking. • Being overweight can seriously affect health. To help people stay at a healthy weight we’ve been encouraging more healthy eating by: • teaching people how to cook healthy meals for less; • encouraging mums to breast feed and explaining how it helps lower childhood obesity; and • displaying healthy eating information for children and young people.
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• We supported and encouraged more of you to protect yourselves and others by being vaccinated against illnesses such as ‘flu, measles, mumps and, rubella.
For some people having ‘flu can be very serious, so it’s really important that everyone in the “at risk” groups has their yearly ‘flu jab. Even though more people had the ‘flu jab in 2013-14, we still didn’t hit the Welsh Government target, so this year we’ll be working even harder with our GPs and local pharmacies to make it quicker and easier for you to get your vaccination. In 2013-4, 65.6% of over 65’s living in ABMU chose to have the ‘flu jab, a slight increase on the year before when it was 65.4%. In the under 65’s, 45.3% had the jab compared to 45.2% the year before. The uptake in both these age groups still remains well below the Welsh Government target of 75%, so we want to do better next year. It is vital that our front line staff are protected so they don’t give ’flu to patients and so they are well during the winter. We were aiming for at least half them to have the ‘jab but in fact 41.1% had the injection. By the end of March 2014 we had reached a key milestone with over 95% of young people living in our communities having had at least one dose of the Measles Mumps nd Rubella (MMR) vaccine. If we are to prevent another measles outbreak young people must be immunised. As well as looking at the three priorty areas above we also worked to support and improve the wellbeing of everyone working in the ABMU area. For example our partnership with Remploy “Well-being through Work” has helped thousands of people, with issues stopping them doing their job, to remain in or return to work. This free, confidential service is available to anyone living, working or volunteering in the Bridgend, Neath Port Talbot and Swansea area.
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Safe Care: the steps we took to improve the safety of our services Learning when things go wrong: “Putting Things Right” Healthcare always has risks and so our top priority is to keep reducing the number of people harmed by their care or treatment. We encourage staff to report when things do go wrong or there is a “near-miss” so we can learn from it and try to make sure it doesn’t happen to someone else. Last year we said that we needed to deal with incidents and complaints better because we were not always responding or learning quickly enough. This year we have made important changes to the way we report, manage and respond to incidents and complaints including setting up a new patient feedback team to help people with concerns, deal with any complaints and incidents and provide redress if things go wrong. We also started holding special clinics so that patients and families can meet faceto–face with senior managers and clinicians to discuss concerns in detail. If you have a concern or would like to come to a concerns clinic please contact the patient feedback team on 01639 683316 or email ABM.
[email protected]
Complaints and compliments We are always grateful to people who share their experiences of using our services with us. Whilst it is concerning if those experiences are poor or we have not done as well as we should have, we see every compliment and complaint as an opportunity to learn and improve. In 2013-14 we received 1,500 formal and 850 informal complaints. The sort of things people have complained about are summarised in the chart opposite.
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We realise that the way we used to investigate and respond to complaints was not always a positive experience for complainants. In some instances, we have taken over a year to respond to complex clinical complaints and so we need to restore trust and confidence in us about this; we know this is going to take time. However, we are committed to: • • • • •
putting citizens and their families and carers first and always; using all complaints and concerns ‘as a gift’ and ensuring we all learn from them; addressing issues quickly so that they don’t escalate and cause even greater upset and dissatisfaction; ensuring that there is Health Board wide learning from complaints; undertaking thorough investigations (independent from the clinicians who provided the direct care to the patient), in a timely way; • providing open and honest responses that give full consideration to redress (as we are required to do); and • engaging and supporting complainants through the process so that we begin to rebuild confidence in the services we provide and our ability to deal with your concerns.
As a result of our investigations, in the last year we identified 49 people who were entitled to a payment as part of redress for harm that we caused.
Patient safety incidents Last year 12,723 patient safety incidents were reported. Fortunately most of these resulted in no or only very minor harm but there were six “never events” (things that should never happen): • • • •
three of these related to a retained item following surgery; one related to wrong-site surgery; one related to failure to monitor and respond to oxygen saturation levels; and one related to a misplaced nasogastric tube.
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We investigated all the incidents reported. As a result of the ‘never events’ we took immediate action to make sure that the World Health Organisation (WHO) Safer Surgery Checklist is always used during surgical procedures. The checklist is designed to reduce the risk of surgical errors by improving team communication and ensuring essential care interventions are checked before surgery starts. WHO Surgical Safety Checklist (adapted for England and Wales)
In addition we have also: SIGN IN (To be read out loud)
• increased the number of nurses on some of our medical and surgical wards to meet the All Wales Nurse Staffing Guidance; • provided more training and development to our staff; • improved the way we complete death certificates; and • enhanced our systems for checking blood and other test results.
SIGN OUT (To be read out loud)
Before start of surgical intervention
Before any member of the team leaves the operating room
Has the patient confirmed his/her identity, site, procedure and consent? Yes
Have all team members introduced themselves by name and role? Yes
Registered Practitioner verbally confirms with the team: Has the name of the procedure been recorded? Has it been confirmed that instruments, swabs and sharps counts are complete (or not applicable)? Have the specimens been labelled (including patient name)? Have any equipment problems been identified that need to be addressed?
Is the surgical site marked? Yes/not applicable Is the anaesthesia machine and medication check complete? Yes Does the patient have a: Known allergy? No Yes Difficult airway/aspiration risk? No Yes, and equipment/assistance available Risk of >500ml blood loss (7ml/kg in children)? No Yes, and adequate IV access/fluids planned
PATIENT DETAILS Last name: First name: Date of birth: NHS Number:*
Inquests and Ombudsman Cases
TIME OUT (To be read out loud)
Before induction of anaesthesia
Procedure:
for example, skin incision
Surgeon, Anaesthetist and Registered Practitioner verbally confirm: What is the patient’s name? What procedure, site and position are planned? Anticipated critical events Surgeon: How much blood loss is anticipated? Are there any specific equipment requirements or special investigations? Are there any critical or unexpected steps you want the team to know about? Anaesthetist: Are there any patient specific concerns? What is the patient’s ASA grade? What monitoring equipment and other specific levels of support are required, for example blood? Nurse/ODP: Has the sterility of the instrumentation been confirmed (including indicator results)? Are there any equipment issues or concerns?
Surgeon, Anaesthetist and Registered Practitioner: What are the key concerns for recovery and management of this patient?
This checklist contains the core content for England and Wales
Has the surgical site infection (SSI) bundle been undertaken? Yes/not applicable • Antibiotic prophylaxis within the last 60 minutes • Patient warming • Hair removal • Glycaemic control Has VTE prophylaxis been undertaken? Yes/not applicable Is essential imaging displayed? Yes/not applicable
www.npsa.nhs.uk/nrls
*If the NHS Number is not immediately available, a temporary number should be used until it is.
There are many reasons why the Coroner may hold an inquest when someone dies. We were asked to provide evidence at 106 inquests during 2013-14. In two of these, the Coroner was very critical of the care we had provided and we have taken steps to address the concerns that were raised. If someone is not satisfied by our response to their complaint they can ask the Ombudsman to look into it. Last year 101 people did this and the Ombudsman decided to investigate 39 of these; so far eight have been upheld or partially upheld. The Ombudsman published three of his reports last year because of serious failings by us. We take every inquest and all Ombudsman’s recommendations very seriously so that we can prevent similar incidents occurring again. Further details of the cases reviewed by the Ombudsman can be found online in the Public Service Ombudsman for Wales Annual Report for 2013-14. www.ombudsman-wales.org.uk/~/media/Files/AnnualReports_en/PSOW%20Annual%20Report%202013-14%20Final%20 for%20laying%20and%20website%20English.ashx
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Working with his family we used the lessons learnt from the tragic death of Paul Ridd following surgery in ABMU to create a new patient-centred approach for adults with learning disabilities who come into hospital for an operation or other treatment. His brother Jonathan Ridd said: “We are very encouraged by the commitment from within ABMU, but it’s an all-Wales problem and it’s important everyone across Wales takes this on board.” Paul’s sister Jayne Nicholls added: “Paul’s death was a tragedy that should not have happened and we want to make sure it doesn’t happen again. — but we have met a lot of good people, and working together gets results.” Pictured: L-R, front row: Linda Bevan, Head of Nursing, Surgical Specialities; Jayne Nicholls, Paul Ridd’s sister; Jonathan Ridd, brother, and Michelle Morrison, Learning Disabilities Occupational Therapist; with other ABMU staff
Making sure that we are always making things safer We are always looking for the best ways to reduce complications of treatment. We have put a great deal of time and effort into ensuring these ways are used across all our services, such as:
Fewer harmful blood clots More of our patients are now assessed for how likely they are to get a blood clot in hospital, so that we can then reduce the risk. In March 2014, 80% of patients were assessed compared with only 50% a year earlier. By the end of 2014 every patient admitted to our hospitals will be risk-assessed for blood clots.
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Zero tolerance of pressure ulcers We have led the way in Wales in stopping patients in hospital getting pressure ulcers and have some of the best results in the UK, but we are still looking at how we can reduce the risk of pressure ulcers even more in not just our hospitals but also in nursing and residential homes.
Preventing infection You tell us that a big worry is getting an infection if you stay in hospital. We are working hard to prevent this. We have a dedicated team of infection control experts who work with our staff to keep patients safe from infections during their hospital stay. Over the past few years we have seen many fewer cases of hospital acquired infections like Clostridium difficile (“C. diff”). We had 145 cases of C.diff during the year; 10% fewer than in 2012-13. We had 29 cases of MRSA, two more than in 2012-13. We are determined to keep the number of these infections falling. Making sure that hands are clean is one of the most important ways of stopping infections spreading. We regularly check that our staff are following special guidelines on how to wash their hands thoroughly. In March 2014, excellent hand hygiene was found 90% of the time and we have improvement plans in place to do even better in the coming year. With a serious infection it’s very important that the antibiotics given are able to fight it. Unfortunately, more and more infections are becoming resistant to antibiotics. It is vital that we slow the rate at which infections develop resistance. This means using antibiotics only when absolutely necessary. We are working with our GPs so that antibiotics are only prescribed when they are really needed.
Ensuring medication is prescribed and given properly Between April 2013 and March 2014 our staff reported 1143 incidents to do with the way we prescribe and give medication. Pharmacists undertake checks of the prescriptions written by our doctors every day. We have done several things to improve outcomes for patients were taken forward during the year, such as: 14
• developing guidelines for when to prescribe antipsychotic medicines; • revising our guidelines about selfadministration of medicines (when patients take their own pills in hospital); and • reviewing our policy about medicines administration.
The “Trusted to Care” report and spot checks have identified problems with prescribing and giving medicines in our hospitals and as part of our response to the Andrews report we are carrying out a major review to resolve these problems with colleagues in the 1000Lives+ programme and our own staff.
Implementing patient safety alerts and notices We get alerts and notices about safety issues that have been identified by other health organisations quite frequently and have worked hard to make sure that we comply with them. We take these alerts seriously we have done what is required in 96% of the alerts and notices issued but still have three where more work is needed. We will address the three outstanding notices in the next few months.
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Effective Care: how we improved the usefulness of the care and treatment we provide It is very important that we provide care that is likely to make people better. We use what we learn from audits, research, feedback, incidents, complaints and mortality reviews to develop and improve our services. All new treatments and procedures are considered by our Effective Practice Approval Committee that ensures they have been properly tested and are safe before they are put into practice.
How we use Clinical Audit to make improvements Clinical Audit is a good way to make what we do more effective. It tells us what we are doing well and can point us towards areas where we need to improve or do more. In 2013-14 we took part in 43 national audits and completed 152 local audits. As a result of clinical audit: • we improved how we provide aftercare for people with an asthma attack in the Emergency Department; • we now give people the help they need to manage their asthma safely at home; • wound infection rates fell from 28% to 11% in patients with injuries to the foot or leg because of better use of antibiotics; and • our doctors are better at prescribing how much oxygen some patients need.
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The benefits of clinical trials and research We are proud of our University title. Our Joint Clinical Research Facility is a partnership with the College of Medicine at Swansea University and specialises in running trials to test new medicines and devices. It runs about 50 trials a year involving up to 1,000 patients: some are taking part in new studies while others are part of long-term trials. Many of our trials involve the main life-long conditions: heart disease, kidney problems, diabetes and nerve conditions, such as multiple sclerosis. As a result of its involvement in a UK-wide study, Morriston’s Cardiac Centre has changed its procedure for treating patients brought in with heart attacks and it’s likely other hospitals worldwide will follow. One patient to benefit from the new approach is 57-year-old Derek O’Brian who had a heart attack during the SwanseaCardiff derby match at the Liberty Stadium. Mr O’Brian, from Birchgrove, was quickly seen in Morriston’s Emergency Department before having two of his heart arteries treated. He said: “During the procedure there was a tolerable discomfort in my chest, and that was all. I felt better immediately afterwards — In fact, the next day I questioned whether I’d had a heart attack at all but the cardiac team assured me I had. I’m feeling fine now.” Skin cancer patients are benefiting from a LASER technique, developed by ABMU plastic surgeons, which removes the cancer, often without leaving a scar. Annette Cabble, from Ogmore Vale, has been treated with LASER treatment and surgery for different lesions: “I had to have surgery for a growth on my ear, which meant having part of the ear removed and a skin graft. I’ve since had laser treatment on my leg and my face and I much prefer it. It is a lot less invasive and it is quicker.“
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Mortality Reviews To make sure the care and treatment we are giving is the best it can be, we look closely at the care we provided to everyone who dies in our main hospitals. Next year we will be extending this to our community hospitals as well. By the end of March 2014 we had reviewed the case notes for 84% of patients who died in hospital between April 2013 and March 2014. So far we have discovered that: • we are not always quick enough to notice when someone is beginning to deteriorate and if they have sepsis (a serious blood infection); and • the care we are giving to people when they are approaching the end of their life is not always consistent.
We are working with the 1000 Lives+ Improvement Team to do better at these aspects of care.
Here are some of the other actions and improvements we are making: Stroke Prevention We are supporting GPs to spot patients who have treatable conditions such as blockages in blood vessels in the neck that can lead to a stroke, so that they can be referred to clinics for preventative treatment. In 2013-14 we ran many more strokepreventing clinics. Although we compare well with other Welsh hospitals for people who do suffer a stroke, we know that we can do better. We sometimes struggle to admit people with stroke to our specialist wards quickly enough and lack some specialist staff. Despite this we do offer clot-busting drugs 24 hours a day every day and have seen fewer deaths and real improvements in outcomes in survivors.
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Improving the effectiveness of primary care services During 2013-14 we continued to develop our GP and primary care services so that they provide effective support for you both in and out of working hours. We also completed plans to make significant investment to join up health and social care in our communities so that we support citizens better to live independently – preventing admission to hospital, or supporting return home quickly. All our GP practices now have access to an electronic referral system which has improved patient safety and the effectiveness of care. Progress was made in using primary care data to ensure that we better understand and manage the quality and effectiveness of primary care, however further work is needed in the year ahead.
Knee Replacement Surgery At Morriston hospital we are carrying out knee replacement surgery in a new way which not only reduces the risk of complications but also the time it takes to perform the operation. Scaffolder Gary McCarthy, of Fforestfach in Swansea, had both hips replaced before having replacement knees using the new procedure. The 54-year-old, said he was more than happy with the outcome. “My experience was fantastic. I was well looked after in hospital and the follow-up care has been brilliant. My new knees are marvellous – really strong. They are going to last me another 25 or 30 years.”
Hip Surgery In the past, elderly patients suffering from a broken hip were at major risk of complications. To reduce this we have introduced Enhanced Recovery after Surgery (ERAS) at the Princess of Wales hospital. This is a rapid recovery system that reduces pain and improves early mobility. We have also put specialist nurses on wards; all these things have meant better outcomes and a mortality rate in ABMU that is half the UK average for this injury.
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Increasing the chances of saving young lives We have introduced new technology. The Heart Rate Observation system (HeRO for short) in the Neonatal Unit at Singleton Hospital provides doctors with an early warning system. We are the first hospital in the UK to use the system which is expected to save 20 additional young lives over the next 10 years and reduce the number of cases of sepsis (blood infections) by 62. Importantly, it will improve the chances of the babies growing up as healthy as possible.
HeRO in the Neonatal Unit at Singleton Hospital
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Dignified Care: The importance of providing care that is respectful and personal In 2011, the Older People’s Commissioner’s report “Dignified Care” made 12 recommendations for improving hospital inpatient care for frail older people, highlighting the impact of a poor hospital experience on confidence and independence. In response we set up an Older Persons Steering Group to put our plans into action. Some of the key things we have completed or started include: • In 2013-14 we completed the roll out of the Butterfly Scheme which allows people whose memory is permanently affected by dementia to make their needs clear to hospital staff and provides staff with a simple, practical strategy so we can meet the needs of our patients. • We are currently writing a guide on caring for and supporting patients suffering from dementia which we are now testing to make sure it meets the needs of patients — if it doesn’t, we will make changes. • The roll-out of various tools such as the Alzheimer Society’s “This is Me” booklet to help staff to get to know patients better and learn about their lives, personality, families, likes and dislikes. • The identification of Dementia Champions for all ward areas. • With our local authority partners we delivered dementia care training to over 12,000 staff, including staff working in care-homes, social care workers, mental health staff and junior doctors.
Despite progress across many areas of our services, we acknowledge that change has not been fast enough and recognise that we still have a lot more work to do to ensure that we provide excellent dignified and patient centred care consistently and at all times
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How we did in the annual “Fundamentals of Care” audit Every year the care we provide is reviewed against a set of national standards called the “Fundamentals of Care”. When we tested ourselves against the standards in 2013 our overall score was 84% but in a number of areas we scored 75% or less. Because of this we have developed an action plan to do better on aspects of the following Standards: Rest and Sleep; Oral Health and Hygiene; Personal Hygiene, Appearance and Foot Care; Respecting People and Relationships; and Ensuring Comfort and Alleviating Pain. During the year we introduced a number of mechanisms, in addition to the Fundamentals of Care audits, to ensure that we identified possible issues at the earliest opportunity and dealt with them in a timely manner before they could impact on the quality of care we provide. These included the adoption of ward level measures “care metrics” that closely monitor issues such as infections and staffing levels.
Fundament als of Care Annual Audit Report 2013
Two of the issues most frequently commented upon by those of you who have used our services are the choice of food we offer and how warm it is; 76% of those who commented on the food we provide were satisfied with the choice they were offered. In the coming year we will be implementing a bedside menu on our wards and will be reviewing the choice of food we offer as well as its nutritional content. Menu tasting sessions have been held to get feedback from our patients on what we should include on our menus. The majority of our staff deliver excellent, dignified and compassionate care to our patients, carers and relatives each day, for example:
Elderly patients needing emergency treatment often have additional complex needs such as mental health issues,
which can make it difficult to assess them and plan the best course of treatment. So that these patients see an elderly care 22
specialist as soon as possible, advanced nurse practitioners provide an assessment service at the Princess of Wales Hospital Emergency Department and assess the medical and clinical needs, provide a diagnosis and treatment all at the same time. They can also decide if someone needs to stay in hospital.
Families suffering the loss of a child at Morriston Hospital are given some comfort through special boxes of keepsakes and information. The boxes are the work of “2-Wish-Upon-a-Star”: an organisation started by a mother, Rhian Burke, following the sudden death of her one year old son, George.
Rhian Burke (centre) presents a bereavement box to Morriston Hospital’s Emergency Department nurses In the boxes, alongside several keepsake items are leaflets designed by two ABMU “safeguarding children” clinical nurse specialists in partnership with Public Health Wales. They explain what happens after a child dies suddenly so parents and families know what to expect. Rhian, from Miskin, said: “Thank you to Morriston Hospital for supporting “2-Wish-Upon-a-Star, it gives me great comfort. Ensuring bereaved families receive the right information and support is something I am very passionate about.”
In 2001 in partnership with Age Concern Morgannwg (ACM), we started an on-call service based at the Princess
of Wales Hospital for older people in the Emergency Department who don’t need to stay in hospital, but do not have the support to get home. ACM send drivers to take them home and provide the help they need in their home. Discharge Team Manager Michelle McCarthy said “the partnership has gone from strength to strength and now covers all wards. The hospital has also established links with another charity, Care and Repair, which also helps patients get back to their homes without delay.” 23
Timely Care: Accessing care and treatment when you need it How long will you have to wait to access our services? Elective (planned) care treatment We know that to get the best out of our services we must make sure you can access them as quickly and easily as possible. In March 2014, 80,796 people were waiting to start treatment; of these 9,258 had been waiting more than 26 weeks and 2095 over 36 weeks. The number of people waiting over 36 weeks in March 2014 was much higher than that reported in March 2013 (378 people). During 2013-14 our longest waits were for orthopaedic surgery, oral-maxillofacial and general surgery. Reducing waiting time for elective care is a priority for us and some of the things we did during the year to help reduce the length of time you have to wait are described later in this section.
Cancer care and treatment While we are still not meeting the Welsh Governments targets during the year we did significantly improve the length of time that you have to wait for cancer treatment.
Measure
Target
March 2012
March 2013
March 2014
% of patients referred as a Non Urgent Suspected Cancer who started treatment within 31 days of their treatment plan being agreed following diagnosis.
98%
97.6%
94%
97%
% of patients referred as a Urgent Suspected Cancer receiving treatment within 62 days.
95%
72.5%
69%
83%
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We review patients on the waiting list weekly so that we can make sure that we are doing everything that we can to ensure they receive treatment at the earliest opportunity.
Unscheduled (emergency) Care During 2013-14, 180,190 people visited our emergency care facilities (emergency departments and minor injuries units). While we still have more work to do to meet the targets set by Welsh Government, we did improve on March 2013 figures.
Measure
Target
March 2012
March 2013
March 2014
At least 95% of patients should spend no more than 4 hours in an emergency department
95%
89.7%
82.8%
84.49%
At least 98% of patients should spend no more than 8 hours in an emergency department
98%
96.2%
90.6%
95.78%
Handover of patients from Ambulance service to emergency department within 15 minutes
100%
54.8
39%
60.3%
During the year we put many things in place to improve the way we care for and treat people needing emergency treatment. We focused on improving how you access emergency care, the timeliness of your treatment when you arrive at our emergency departments, assessment units or out-of-hour’s services. We will continue to work with the 1000 Lives+ Improvement Team to make more improvements to our unsheduled care services.
Primary Care Services As we said in last year’s Annual Quality Statement improving access to GP practices is a national priority. 96% of our GP practices are now offering an appointment after 5 pm on at least two days a week and we are working with GPs across the communities we serve to make it easier to get an early morning or late afternoon appointment.
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What we are doing so that you can access care when you need it The more we can do to avoid the need for admission to hospital the better. During the last twelve months we have worked on a ‘one-stop assessment and tests’ model so that we can decide what treatment is needed quicker, avoid admission to hospital and bring together all health services across secondary, community and primary care to deliver citizen and family centred care. Some of these are described below:
Wales’ First Acute GP Unit Based at Singleton Hospital the unit provides a fast track to diagnostic tests, consultant advice, hot clinics and other crucial care. It streamlines services for patients so well that thousands get the care they need without being admitted first. Over the past 12 months 2,300 patients from Swansea and Neath Port Talbot have avoided being admitted to hospital by using this service. Feedback from patients has been really positive. Jonathan Hudson from Swansea, said: “From referral by my GP, to having my tests, a diagnosis, and getting the treatment took just over two hours. I was subsequently reviewed by a pharmacist, and had a follow up with the Unit - I was given an up-to-date treatment regime which was very easy to manage. Overall the treatment I received was fantastic.”
A new blood transfusion service for elderly patients Sometimes those with chronic or life limiting illnesses need a blood transfusion, which can mean spending up to four days in hospital. A new service at Neath Port Talbot Hospital’s Elderly Day Unit is providing quick access to blood transfusions and means they avoid a hospital stay. Unit Manager, Lynne Hall, said: “We developed the service as we wanted to prevent as many elderly and chronically ill patients being admitted to hospital unnecessarily as possible. Also,
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local people were being admitted to Singleton Hospital and we wanted to provide something closer to home. Our unit provides older patients with easy access to diagnostic tests and treatments through different clinics, and we felt a transfusion service suited this. We have many links with primary care teams, consultants and specialist nurses who give us excellent feedback. Also, the patients’ experiences are always positive which makes it all worthwhile.”
One-stop clinics for people with progressive life limiting illnesses People who need ongoing support for advanced cancer and non-cancer conditions, such as motor neurone disease, can see all the palliative care professionals in one hospital visit, giving faster access to the whole multi-professional team – nursing, medical, physiotherapy, occupational therapy, welfare rights, counselling and complementary therapies. It also means quicker X-rays and blood tests services when needed.
The rapid access clinic For people living in Swansea who have chest pain there is a new way of getting care. Instead of having to see a doctor, they can be assessed by Morriston’s highly specialised cardiac physiologists. The clinic runs alongside a strengthened community service with patients being assessed by GPs with specialist interests in cardiology. We are already getting positive outcomes and some of the people seen are now awaiting heart by-pass surgery after they were found to have significant problems. Without the rapid access service they may still be waiting to see a doctor. Hugh Beynon could have been just a hair’s breadth away from a heart attack when he turned up for an outpatient appointment at Morriston Hospital. The 69-year-old grand- father was referred by his GP to the new rapid access clinic for Swansea people with chest pains. Hugh (pictured) was admitted there and then, had an angioplasty and stent, and was home again in no time. He said: “I was running a very serious risk of having a heart attack – but it was sorted out so quickly. I have to take it easy for a while but I feel fine in myself. I was very lucky”.
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Treating people as individuals: providing care and treatment that is citizen and family/carer centred We want to give support, care and treatments that are citizen and family or carer centred. This means that individual needs and experiences must be at the heart of what we do. Over the last year we have been improving the way we listen and act on the experiences and views of all who wish share these with us. In September 2013 we implemented the All Wales Patient Experience survey and by the end of March 2014 2,170 patients had completed this comprehensive questionnaire. At the Princess of Wales Hospital we have also been using what is called the “Friends and Family Test” which asks: “would you recommend this clinical area to your friends or family?” This will be rolled out to our other hospitals next year. Between July 2013 and March 2014, we received 4,380 responses, with between 91% and 96% of people saying that they are highly likely or likely to recommend the ward or department to their friends or family; an average of 94%. In addition a new electronic patient experience system will be used to capture views and experiences on a regular basis so that we can learn and make improvements from it. Many of those who use our services are frail and elderly, suffering from debilitating illnesses, have specific communication needs or are often just nervous and scared because they are in a strange environment. We have listened to what they need, how they feel and what they are afraid of. Working with individuals and groups of patients has identified how we can support them best. As a result we introduced a number of initiatives and a few examples of these are provided in the following pages.
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Introducing art and pictures to help support and motivate our patients Throughout the Specialist Rehabilitation Centre at Morriston Hospital pictures of patients are displayed and each patient has captioned their picture, explaining how they carry on with everyday life providing inspiration to others and highlighting what they can still achieve. Other images show patients as they go through different stages of their treatment so others know what to expect. Frazer Platts was photographed for the centre with a beach buggy he built with the help of his sons (pictured): “The message I am trying to give in my photo and quote is to try and rise above the disability you have and get on with life, then it becomes the second thing you and others think of when your name is mentioned.”
Our Speech and language therapists launched a teenage stammer support group Teenagers aged between 13 and 16 attend the sessions to meet people with similar experiences. They are able to talk openly and confidently, sharing information, advice and support. One of the teenagers said: “It is great to meet with other people who stammer and are in the same situation as you. We get the chance to share strategies and techniques with each other and play games which involve speaking. You can be your own person around people who don’t judge you.” The group meets every six weeks at the Neath Port Talbot Resource Centre and the next session takes place on Wednesday, 4th December 2014 at 4.15pm. For more information, please contact the speech and language team on 01639 862718.
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We recruited a team of puppets to help us make hospital a little less scary Hospitals can be a scary place and being away from home can make children feel a little sad. But, by using play puppets a child’s mood can be lifted and they can feel a bit better. Thanks to the generosity of the local community, staff in the children’s department at Morriston hospital were able to buy a family of puppets. The puppets are also used to show children how hospital equipment works, to distract and put them at ease and generally make hospitals a fun and less frightening place.
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Our Staff: how we ensure they have the knowledge and skills to do their job. On 31st March 2014, 15,108 people were working for us. The diagram below represents the numbers in the different staff groups. Like other Health Boards we have found it difficult to recruit some types of junior and senior doctors in 2013-4. This continues to make it difficult to provide safe and sustainable services. There are also emerging problems in recruiting and retaining enough GPs.
Supporting and developing our staff We depend on skilled and excellent staff to deliver high quality care. Developing and maintaining those skills requires attention throughout the working lives of our staff. We are investing in an education, training and development programme to make sure that we have the staff we need for the future and work closely with Swansea University and the University of South Wales so that these learning and development programmes provide what is needed. As we have said throughout this Statement we know that we need to improve many of our services if we are to deliver safe citizen-centred care consistently. We are therefore encouraging all of our staff to become involved in Improving Quality Together (IQT). IQT is all about developing skills in quality improvement and by March 2014 over 1,300 members of staff were proud holders of Bronze IQT certificates. Over 50 staff have being trained at a Silver Level which gives them additional skills in quality improvement to deliver safe, quality care.
Listening to our staff In response to the results of the most recent NHS Staff survey, we established a Staff Survey Steering Group in partnership with those organisations who represent them to ensure that we acted on the results and as a way to listen and act on what our staff told us. The group also helps us share best practice locally and nationally.
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Recognising the contribution our staff make During 2013-14 a number of our staff received awards for the quality of their teaching. Professor Jeffrey Stephens is held in such high regard by the junior doctors at Morrison Hospital that they put his name forward for a Wales Deanery award. The Welsh Centre for Burns and Plastic Surgery in ABMU, is the only one of its kind in Wales and one of the biggest in the UK. It was voted the UK’s best for training the consultants of the future, for the third year running in the GMC survey. One of its registrars, Mr Jeremy Yarrow (pictured), said: “I’ve worked throughout the UK and this is, by some distance, the best unit I’ve worked in.”
The Chairman’s Awards were introduced in 2013 when our staff told us that we needed to do more to acknowledge pub-
lically and celebrate the achievements of our colleagues. Over 137 high quality applications were submitted this year all of which demonstrated innovative approaches to improving services and the quality of care.
The NHS Wales Awards celebrate the work of individuals and teams across Wales whose innovative work is improving the quality and safety of care for patients. In the last year we won two categories.
The renal team won the category “Promoting Better Health and Avoiding Disease” with the development of a night-time home renal dialysis service for patients with chronic kidney disease. The creation of an Acute GP unit in Singleton Hospital, Swansea won in the category “Working Seamlessly across Organisations”.
Pictured (Right): The renal team from Morriston Hospital celebrating the ”Promoting Better Health and Avoiding Disease” category; (Left) the team behind the GP unit at Singleton Hospital with their “Working seamlessly Across Organisations” award. 32
Our volunteers Our volunteers are invaluable; providing support to patients across all our hospitals and services. Our 475 in-house volunteers do many things including: • providing a friendly face and support to those visiting our hospitals by manning the hospital reception desks; • befriending patients and their families and friends supporting them with tea making, running errands and accompanying patients to other departments and reading to them; • giving reassurance to those undergoing assessment and treatment in our Endoscopy, Emergency Units, Pendre Day Hospital, Cardiac Investigations Unit and Outpatients Department; and • supporting those receiving palliative care.
Volunteer Pauline said: “I feel we offer a good service. I enjoy seeing the people I volunteer with and the patients and visitors. Being from the local community I often see people I know some I have not seen for many years which is nice. I really like being a volunteer and it makes me happy that people appreciate our support”
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Looking Forward
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Looking Forward: what we will do in the year ahead so that the services we provide continue to improve There are big challenges to overcome if we are to meet the health needs of everyone in Bridgend, Neath Port Talbot and Swansea and deliver citizen-centred, safe and compassionate care in the future. We need to work with citizens and our partners to provide more care in a community, primary care or home-based setting. We also want those working in the community (such as GPs, dentists, pharmacists, opticians and nurses) to help us plan and deliver primary and community services, because they are best placed to understand local needs and opportunities. We have an ambition to deliver a truly integrated healthcare system, designed to meet the needs and priorities of citizens, comparable with the highest international standards as well as a commitment to improving well-being and helping people avoiding illness in the first place. However our highest priority must be to deliver consistently high quality care. By this, we mean safe, excellent person-centred and compassionate care that respects people’s rights and responsibilities whenever and wherever it is provided. We know that we do not yet do this every time and that we do not always listen to what patients tell us or act on what they say. So In 2014-15 we will develop and publish a quality plan involving our staff, citizens, patients and their families and carers so that improving quality and safety is at the heart of all that we do. This will draw upon best practice, published standards and citizen-centred, rights-based models of care and the work of our service redesign programme “Changing for the Better”. With help from external experts, we are reviewing with our staff and patients the values we want to see in ABMU and will then develop a behavioural framework for all those who work for us and on our behalf. We will run a programme of large-scale listening events from July 2014 onwards with priority events at Princess of Wales and Neath Port Talbot Hospitals. These will be called “in your shoes” for residents and patients and “in our shoes” for staff. If you want to be involved in these events please let us know by contacting us on 01639 683348. The information coming from these events will be used from to cocreate our values and the “ABMU way” of doing things.
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These events will help us identify clear steps to create a culture of care built on citizen involvement in the setting and monitoring of standards and in the resolution of issues as well as the practical choices that arise from the need to make prudent decisions within limited resources. This work will help us to genuinely ‘put local residents at the heart of everything we do’ and embody the principles of ‘Prudent Healthcare’. Given our commitment to co-produce our values, the quality plan and the ABMU way with you it is important that you are also given the opportunity to agree our quality and safety objectives for the year ahead. We will therefore publish clear and measurable quality objectives in late October 2014, when we have had the opportunity to learn from the listening events and test whether the priorities we set out in our first Integrated Medium Term Plan (IMTP) published in March 2014, fit with your expectations of us. In the meantime we will continue to deliver the initial priorities for 2014-17 as set out in our IMTP and the recommendations made in the ‘Trusted to Care’ report.
Listening to our citizens
Learning together
Improving today and tomorrow
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Acknowledgements We would like to thank our staff for working hard to deliver high quality care every day and our citizens for sharing their experiences with us. Special thanks go to those who sit on our patient experience forum for the help and guidance they have given us in preparing this Annual Quality Statement. We also wish to acknowledge the support that our Community Health Council continues to provide by monitoring the quality of our services and ensuring that we respond to any concerns that our citizens have. If you have any views as to what should be included in our next year’s Annual Quality Statement or want to contribute to its preparation please do not hesitate to contact us on 01639 683348.
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Appendix 1 List of reports and documents This list has been created to provide easy reference to the reports and documents referenced in this Annual Quality Statement. • Abertawe Bro Morgannwg University Health Board Mortality review (December 2013) - an external review of quality and safety in the Princess of Wales Hospital by the Advancing Quality Alliance (AQuA). • Annual Governance Statement 2013-14 - this sets out details of the arrangements that ABMU Health Board had in place during 2013-14 to ensure that it did the right things, in the right way, for the right people, in a manner that upholds the values set for the Welsh public sector. • Annual Quality Statement 2012-13 – an overview of the quality improvements we made in 2012-13. • Annual Report 2013-14 – this provides an overview of the work that ABMU Health Board undertook during 2013-14 and our plans over the longer term. • Changing for the Better Report 01: Summary (July 2013) - an overview of ABMU Health Board’s Changing for the Better programme and related projects. • Changing for the Better Report 02: Strategic Needs Assessment (November 2013) - set out the health needs of the citizens of Bridgend, Neath Port Talbot and Swansea. • Dignified Care (2011) - the Older People’s Commissioner for Wales report on a review of the experiences of older people in hospital in Wales. • Fundamentals of Care Annual Audit Report 2013 – this provides information on how well ew performed against the Fundamentals of Care Standards in 2013. • Integrated Medium Term Plan (March 2014) - Abertawe Bro Morgannwg University Health Board’s Integrated Medium Term Plan (IMTP) sets out our strategy to fulfil our civic duty, both as a commissioner and provider of services, to meet local health needs. This includes our responsibilities to deliver high quality effective and efficient services and as a major employer and contributor to the local health economy. 38
• Public Service Ombudsman for Wales Annual Report for 2013-14 – a report of the work of the Ombudsman. • Trusted to Care (2014) – A report of an external independent review of the Princess of Wales Hospital and Neath Port Talbot Hospital at Abertawe Bro Morgannwg University Health Board.
There are a range of other reports and information that you may find of interest as they provide further information on the improvements we are taking forward and the quality of our services, these include: 1.
Delivery plans and progress reports: Cancer:
Cancer Annual Report October 2013
Stroke:
ABMU Stroke Delivery Plan 2013-16
Cardiac:
Heart Disease Delivery Plan 2014; ABMU Coronary Heart Disease Progress Report 2014
Critically Ill:
Critically Ill Delivery Plan 2014; Critically Ill Progress Report 2014
End of life:
End of Life Care Delivery Plan 2013 to 2016
Oral health:
ABMU Oral Health Plan 2014
Diabetes:
Diabetes Implementation Plan 2014
Director of Public Health Report 2012-13 Copies of these can be found on our website at http://www.wales.nhs.uk/sitesplus/863/page/41077
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2.
Changing for the Better Copies of all documents and updates on the Changing for the Better project can be accessed at http://www.wales.nhs.uk/sitesplus/863/ page/60278. In addition our news page is regularly updated with information on new services and developments. http://www.wales.nhs.uk/ sitesplus/863/newslist
3.
Trusted to Care: the improvements we continue to make Regular updates on the improvements we continue to make and the consultation events that you may like to be involved in can be found at http://www.wales.nhs.uk/sitesplus/863/page/73970
4.
Quality and performance information
In order to continue to provide high standards of patient care, we constantly audit the quality and performance of our services. From http://www.wales.nhs.uk/sitesplus/863/page/73970 you will find links to the various quality and performance audits, reports and reviews carried out by us and external organisations. The information we regularly update includes: • • • • • •
5.
Mortality Information. Healthcare Associated Infection (HCAI) data. Referral to Treatment (RTT) Published Waiting Times (link to StatsWales website). Fundamentals of Care Annual Audit Report 2013. Our Corporate Risk Register. Healthcare Inspectorate Wales Reports.
My Local Health Service My Local Health Service presents information on the NHS in a user friendly way so everyone can see how the NHS is performing for the population. Information on how ABMU Health Board is performing can be found on the site. http://mylocalhealthservice.wales.gov.uk/#/en
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Appendix 2 GLOSSARY This glossary has been created to give easily understandable definitions of common terms used in this Annual Quality Statement. These definitions are not exhaustive and may not be suitable as technical definitions. We wish to acknowledge that a number of the definitions we have used have been taken from The Annual Quality Statement Guidance issued by the 1000 lives improvement team. 1000 Lives Improvement - a national service, supporting organisations and individuals in NHS Wales to deliver improved health, healthcare outcomes and user experience. More information is available at www.1000livesi.wales.nhs.uk
Carer - anyone who cares, unpaid, for a friend or family member who due to illness, disability, a mental health problem or an addiction cannot cope without their support. (Definition from Carers Trust).
Annual Quality Statement - a report that every NHS Wales health board and trust is required to produce in order to provide assurances regarding the quality of care being provided.
Co-production - working with the people using healthcare services and the general public to plan and deliver healthcare services which meet their needs.
Advancing Quality Alliance (AQuA) - an NHS organisation that works with its members and customers to improve quality and safety in the NHS with the ultimate goal of providing better, safer care for patients.
Coroner - a government official who confirms and certifies the death of an individual. A coronor may also conduct or order an investigation into the manner or cause of death. Dementia - a condition caused by a number of brain disorders which cause memory loss, decline in some other aspect of cognition, and difficulties with activities of daily living.
Blood clot - clots of blood that develop inside a vein and can travel through the bloodstream to the heart or lung causing serious illness. A thrombosis often forms in the ‘deep veins’ in legs, and is referred to as a deep vein thrombosis or DVT. If a blood clot travels to a lung it can cause a Pulmonary embolism.
Diagnosis - an explanation of nature or cause of an illness. Elective care - care that is planned in advance because it does not involve a medical emergency.
Blood transfusion - a procedure used to transfer blood (or some products based on blood) from the one person to that of another.
Fundamentals of Care - a Welsh Government initiative that aims to improve the quality of aspects of health and social care for adults.
Butterfly scheme - a method based on easy-to-learn, quicklydelivered skills-based education for all staff who come into contact with patients with dementia. 41
Health board - a regional organisation in NHS Wales providing both Primary care and Secondary care. There are seven health boards in Wales.
who have died to make sure that they received the best care possible. Motor neurone disease - a rare condition where parts of the nervous system become damaged causing weakness and difficulty with day to day activities such as walking and talking.
Healthcare associated infections (HCAI) - infections that are the result of receiving treatment, for example, a urinary tract infection as a result of a catheter being inserted without proper hygiene procedures being followed. Health inequalities - differences in the quality of health and healthcare across different populations. For example, on average, people living in communities with higher levels of poverty and deprivation tend to die younger than people living in communities that are less deprived.
Nasogastric tube - a special tube that carries food and medicine to the stomach through the nose. Ombudsman - the Public Service Ombudsman for Wales has the legal powers to look into complaints about public services in Wales.
Improving Quality Together - the national learning programme for all NHS Wales staff and contractors. It provides a common and consistent approach to improving the quality of services in NHS organisations across Wales. Incidence - the occurrence, rate, or frequency of a disease.
Oral and maxillofacial surgery - deals with the diagnosis and treatment of diseases affecting the mouth, jaws, face and neck.
Infection control - staff who concentrate on making sure procedures are followed correctly to protect people from possible infection caused by the healthcare they receive.
Out of hours - care provided when GP surgeries are not open. Most out of hours services are organised by health boards and are located in a clinic or near a hospital.
Integrated healthcare - the organisation and management of health services so that people get the care they need, when they need it and where they need it.
Oxygen saturation - the concentration of oxygen in the blood.
Orthopaedic Surgery - the treatment of bones and joints following an accident or disease.
Palliative care - care for people who are terminally ill and are unlikely to live for much longer. Sometimes palliative care covers services for the families of people, for example, bereavement counselling and advice.
Medicines management - ensuring medicines are used correctly and safely.
Pressure ulcer - often called bedsores, these are damage to the skin and underlying tissue of pressure applied to soft tissue that completely or partially obstructs blood flow to the soft tissue. Pressure ulcers most commonly happen to people who are not moving about or are confined to wheelchairs.
Medicines review - a quick check with your GP or pharmacist that you still need all the medicines you have been prescribed. This is important for people who collect a regular (repeat) prescription. Mortality reviews - analysing the patient care records of patients 42
Specialist rehabilitation - assists patients in their recovery from physical injuries or mental illness. Physical therapists, occupational therapists, psychiatrists, social workers are all specialists in rehabilitation. Respiratory therapists and speechlanguage pathologists also do rehabilitative work with patients.
Primary care - healthcare provided in the community, where people make contact with clinicians for advice or treatment. For example, visiting a GP surgery if you are ill. Prudent Healthcare - healthcare which achieves tangible benefits, quality outcomes for patients and value for money.
Spot check - an inspection carried out at random and without prior notice.
Public health - work to prevent disease, disability and illness, and to promote healthy lifestyles. Public health work includes monitoring environmental danger to health such as pollution, the spread of diseases like measles, and encouraging people to live more healthily, for example by not smoking cigarettes.
Stop Smoking Wales - a service delivered by Public health Wales that provides guidance; advice; information; and free access to counseling and support groups across Wales for those who want to stop smoking.
Putting Things Right - the Welsh Government’s guidance for members of the public who are raising a concern or making a complaint about the healthcare they receive from NHS Wales.
Surgical complications - unintended consequences arising as a result of surgery. For example, a blood clot (Thrombosis) forming after surgery that then needs treatment.
Quality improvement - a systematic approach that uses specific techniques to improve quality. More information is available in the Quality Improvement Guide published by 1000 Lives Improvement. Renal Dialysis - replicates many of the kidney’s functions. It removes harmful waste, extra salt, and water from the body. Secondary care - specialist medical care, often provided after referral from a primary care clinician because treatment requires more knowledge, skill, or equipment than is available in community. For example, a GP may refer a person with chest pains to a cardiologist in a hospital. Sepsis - a potentially life-threatening effect of an infection. Chemicals released into the bloodstream to fight the infection trigger inflammation throughout the body, which can damage organs, causing them to fail.
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In preparing this Annual Quality Statement we have welcomed the input of our staff and the guidance we have received from our citizens who sit on our patient experience forum. If you have any views as to what should be included in our next year’s Annual Quality Statement and want to contribute to its preparation please don’t hesitate to contact us on 01639 683348
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