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While 2015/16 has been a challenging year for Leicester’s Hospitals Emergency Department, there have also been some positives with progress on the new Emergency Floor and the return of the Urgent Care Centre to Leicester’s Hospitals’ management.
Leicester’s Hospitals have not met the target to treat and discharge a minimum of 95% of patients within four hours, with attendances and admissions rising by 5% and 6.5% respectively. The high attendances and admissions have inevitably had an effect on the quality of care provided for patients and in particular this has impacted on ambulance handover times. This has been recognised as a very serious concern by both Leicester’s Hospitals and East Midlands Ambulance Service NHS Trust; the handover delays are the subject of a joint action plan, which is being monitored closely by the Executive Team.
On Monday 30th November inspectors from the Care Quality Commission (CQC) visited the Emergency Department (during a major internal incident). It was a very challenging day and the inspectors witnessed over 100 patients in the department. Inspectors noted a number of concerns which they subsequently followed up by applying conditions to Leicester’s Hospitals' registration with the CQC. Since then, progress has been made against these conditions, which has been recognised by our external partners. The new Emergency Floor, which is due to open in February 2017, will give the Emergency Department the space it needs and enhance patient and staff experience considerably.
During 2015-16 the Urgent Care Centre transferred back to Leicester’s Hospitals management from George Eliot Hospital NHS Trust; since then the service has been delivered in partnership with Lakeside Plus, an innovative GP partnership. This gives us more flexibility in terms of its delivery, and in better supporting the main emergency department; plans are developing to this effect, including the introduction of a GP based at reception to assess all admissions from the Urgent Care Centre in January 2016.
We continue to work with partners across Leicester, Leicestershire and Rutland to improve our emergency performance and the quality of care provided on the emergency care pathway. Next year will be the first full year of the Vanguard plans and we are optimistic that this coupled with our pre-existing plans will result in further improvements. Ensuring that we deliver capacity in line with our activity plans for next year is a key focus both for our hospitals and the wider health system.
For the year 2015/16 we have seen one patient with an MRSA bacteraemia against a national target of zero. We did however go for over a year without a case of MRSA bacteraemia, which is a significant achievement for a trust of this size.
For the year 2015/16 we have recorded 60 cases of CDI against a trajectory of 61. We are the most successful trust within the Midlands and East in terms of delivery of the CDI objective and one of the most successful trusts of comparable size in England.
Post Infection Reviews (PIR) are carried out by the CMGs with support from the Infection Prevention Team in accordance with the NHS Commissioning Board ‘Guidance on the reporting and monitoring arrangements and post infection review process for MRSA bloodstream infection from April 2013’.
The PIR reviews and any identified action plans that have resulted from the investigation have been presented to the CMG Infection Prevention Groups and CMG Quality and Safety Boards to ensure that lessons learnt can be disseminated within the CMG.
During 2015/16, the national rules around referral to treatment changed to focus wholly on patients with an incomplete pathway (i.e. those actively waiting for treatment). The Trust was compliant with the incomplete standard for every month of 2015/16, meaning that at least 92% of patients had to be waiting fewer than 18 weeks for treatment. This is an important achievement in light of rising referrals, increasing emergency pressures over the winter period, and capacity constraints in key services. However, we recognise the need for continuing improvements to waiting times in a small number of key specialties, such as gastroenterology, adult and paediatric ear nose and throat and orthopaedics.
Significant efforts were also made to raise the profile of the importance of good waiting list management across our hospitals. Leicester’s Hospitals are the first to design and host its own e-learning module for RTT, which has so far been accessed by over 600 members of staff. Alongside this, the central RTT team provide face-to-face training sessions across all three hospital sites every six weeks. While a lot has been achieved this year, there is always more to do and this work will continue into 2016/17.
As in the previous year, Leicester’s Hospitals have struggled with cancer performance during 2015-16 and this area remains one of our highest priorities. One of the reasons behind this is increasing demand; this growth is in the order of 11% in 2 week wait urgent cancer referrals and a growth of 9% in patients requiring treatment for cancer. Therefore, Leicester’s Hospitals continue to work closely with GPs to ensure the suitability of cancer referrals and is planning for continued growth in the coming year.
In the past year we have invested in more staff to help support cancer patients, including a new cancer surgeon in urology and clinical nurse specialists in a number of services. Additionally, we have invested in administrative and management resources to help pull cancer patients through the hospital systems as quickly as possible, including expanding the number of cancer navigators who track patients on a cancer day pathway, as well as appointing three cancer service managers to support the most pressured tumour sites: urology, lung and gastrointestinal (GI).
In November we held a Listening into Action event focused on improvements to cancer services. This was well attended by both staff and patient representatives and the outcome of this is a programme of work which aims to ensure that patients leave every appointment knowing what is going to happen next and with that appointment booked. This will be implemented by three pilot tumour sites in late 2015/16 with the intent to roll this out across our hospitals.
A sustainable recovery of the 2 week waiting time standard of 14 days from GP referral will be in place in 2015/16. Recovery of the more complex 62 day standard, from referral to treatment for cancer patients is anticipated by June 2016 and is the subject of a detailed hospital wide plan.
Diagnostics performance at Leicester’s Hospitals has been a challenge in 2015/16. A large number of patients were found to be overdue their diagnostic endoscopy test. This led to a breach of the diagnostic standard at our hospital level. This has required a fundamental restructuring of the endoscopy process with input from the national Intensive Support Team. A significant amount of additional endoscopy activity has been carried out at weekends to ensure that patients care is not compromised. By the end of April 2016 Leicester’s Hospitals will have recovered this waiting time standard. Demand and capacity modelling has indicated that the service is short of 8-10 lists per week. Plans will be in place for the coming year to maintain adequate capacity.
The Imaging department has also experienced rising referrals, which continually stretch the service’s capacity. In order to meet demand during this year, the department has been running an extended service into the evenings and at weekends.
Click here to view a table of our Performance Indicators
Click here to read the full 2015-16 Quality & Performance Report
For more information about what the Care Quality Commission do, visit www.cqc.org.uk/
For more information about what Monitor do, visit www.monitor-nhsft.gov.uk/