Council of Governors January 2019 - PowerPoint Presentation

1. Council of GovernorsJanuary 2019

2. www.dbth.nhs.ukOur core themes

3. www.dbth.nhs.ukFiona LittlewoodSenior Programme ManagerEffective Patient Pathways for prisonersA South Yorkshire Collaborative

4. www.dbth.nhs.ukEffective Patient PathwaysThe prisonerPrisonsCare UKOur TrustEscort and bed watchOther trusts

5. What prisons and prisoner categoryCare UK / FCMSDBTH on site deliveryDBTH off site deliveryOther trustsSocial care.www.dbth.nhs.ukPrisons and site healthcare delivery

6. Health when starting custodySubstance misuseViolence and self harmLong term conditionsAging in prisonPrimary, secondary and long term needsBehaviours.www.dbth.nhs.ukPrisons issues

7. Prisoner attendance:DRI emergencies – 1,000 in the last year from five prisonsPercent of not treated patientsEscort impact on elective/ planned careUse of DBTH ’by default’Admissions/ dischargeOnsite risk and managementBusiness risk – clinical, appointments lost/ DNA, re- booking.www.dbth.nhs.ukKey issues for DBTH

8. Build relationships with prisons and Care UKUnderstand THEIR issuesBe clear about what needs to changeFacilitate changeReduce risk for organisationsEncourage communication and Feedback between organisations.www.dbth.nhs.ukWhat’s the plan?

9. Thank you, any questions?

10. www.dbth.nhs.ukSimon MarshChief Information OfficerTelephony at DBTHAn update on challenges and developments

11. New Voice Over Internet Protocol (VOIP) system in place at DRI and MH, almost complete at BHSwitchboards joined since October 2018. Overflow calls now handled by a virtual switchboard across DRI and BHNo priority on internal or external calls but GPs retain priority calling number. Direct Dial Inwards (DDI) now available for most extensions and communicated in patient letters and other correspondence – 75% of calls initially via this routeChallenges exist in overall volume of calls and call answering www.dbth.nhs.ukA summary in 2018/19:

12. www.dbth.nhs.uk3,591 VOIPExtensions 6912,604691Total VOIP extensions:

13. www.dbth.nhs.uk3,591 VOIP 509614Total fax lines

14. www.dbth.nhs.ukStatistics Jan to Dec 185.65mTotal number of calls handled by DBTH Telephony in 2018.69.5% external callers, of which 70% answered.30.5% internal callers, of which 78% answered.4.6m5.65mOverall, Switchboard has handled 22.8% of all calls, or 1.05m.Direct Dial Inward (DDI) calls, not involving Switchboard.

15. www.dbth.nhs.ukStatistics Jan to Dec 1815,479Average calls per day via DDI and Switchboard – external to internal and internal to internal.Bassetlaw Hospital average time to answer:17 secondsDoncaster Royal InfirmaryAverage time to answer:34 seconds

16. www.dbth.nhs.ukStatistics Jan to Dec 18Bassetlaw internal to Switchboard:91.9% answeredBassetlaw external to Switchboard:92.9% answeredDRI/MH internal to Switchboard:72.4% answeredDRI/MH external to Switchboard:65.5% answered

17. www.dbth.nhs.ukCalling patterns Oct 18 - DRILocation and abandonment rateED Reception 42.91%Clinical Therapy Reception 78.29%Orthotics Reception 45.8%Eye Centre Reception 80.02%Fracture Clinic 35.23%Urology Reception 63.39%AMU Reception 29.74%Maternity Reception 26.04%Orthotics 36.54%

18. www.dbth.nhs.ukCalling patterns Oct 18 - BHOur appointment bookersBooking Team Admin 81.87%Booking Team Admin 77.85%Booking Team Admin 74.6%Booking Team Admin 32.32%Location and abandonment rateA&E Reception 20.56%ATC Nurse Station 9.47%A&E Nurse Station 5.53%Ward B5 Nurse Station 16.1%

19. www.dbth.nhs.ukFaxes at DBTH27,000 per month324,000 per year17% external, 25% internal58% outgoing to ‘others’Replacement planned with Electronic Patient Record

20. www.dbth.nhs.uk(Call handling now across both sites for incoming calls)Monday to Friday8am to 5pm: Four whole time equivalents, max five seats availableMonday to Friday5pm to 10pm: Two whole time equivalents.Monday to Friday10pm to 8am: One whole time equivalent.Switchboard Rota – 572 hours per weekSaturday and Sunday8am to 10pm: Two whole time equivalents.Saturday and Sunday10pm to 8am: One whole time equivalents.

21. www.dbth.nhs.uk(Call handling now across both sites for incoming calls)Monday to Sunday6am to 2pm: Two whole time equivalents.Monday to Sunday2pm to 10pm: Two whole time equivalents.Monday to Sunday10pm to 6am: One whole time equivalent.Switchboard Rota – 572 hours per week

22. Training for call forwarding to avoid the ‘merry-go-round’Review of staffing and potential merger of booking/reception staff. New working patterns to cope with peak demand Awareness training at ward and reception areasSeek to alter switchboard rotas at DRI to have maximum operators 8-12 Monday to Friday Better use of communication and messaging - both from external comms and at extension level to inform callers of ward busy times and call queue messagesRollout of clinical data (via portal) to GP and community staff to avoid calls to discuss/find out about patients whose ongoing care has been transferred from the Trust. www.dbth.nhs.ukMeeting our challenges(1/2)

23. Dr Doctor: Implementation of Dr Doctor for patient communications includes ability to change/cancel appointments From February - one way text message pilot for respiratory and ophthalmologyFrom March – two way text messaging (select from a choice of appointment) for gastroReview pilot end of March Intelligent AI-based appointment bookings to avoid high DNA rates and calls to reception areas – longer termIncoming call analysis to identify frequent callers, repeat callerswww.dbth.nhs.ukMeeting our challenges(2/2)

24. Communication of DDI numbers for reception centres and booking office via appointment letters Virtual switchboard will start to improve call answeringBooking office is often overwhelmed an unable to cope with volume of calls Staffing and working patterns across the Trust, particularly at busy times, prevent calls being answeredCall back services are not necessarily the answer and technology is not the problemDr Doctor will improve patient choice and be a long term optionFurther analysis is needed on incoming call patterns.www.dbth.nhs.ukConclusion

25. Thank you, any questions?

26. www.dbth.nhs.ukDavid PurdueChief Operating Officer and Deputy Chief ExecutiveCall centre performanceAn update on challenges and developments

27. High rate of abandoned and calls waitingWorking environmentStaffing levels for call rate volumesMoving staff between roles and areas has been problematic.www.dbth.nhs.ukIssues within the service

28. Patient dissatisfaction Poor reputationService user complaintsLow staff morale – and further impact upon sickness levelsHigh patient ’Did not attend’ levelsLoss of income. www.dbth.nhs.ukImpact on the service

29. Improve the environment:Change office layout, soundproofing booth type desk spaceAdditional screens for use when scrolling through CAMIS screens as this is time consumingVisual display screen to show calls waiting, average call time and staff buy-in Introduction of ‘Visual Management Board’ and team briefing at the start of the daywww.dbth.nhs.ukPotential solutions(1/4)

30. Workforce review:Establish , based on an agreed average call length that the current establishment is correct – business case if notFollowing completion of the admin review start consultation with Booking and Call centre staff about shift pattern changes and rotation through both areas. This will help with managing peaks and troughs in activity. www.dbth.nhs.ukPotential solutions(2/4)

31. IT improvements:Creation of a ’Hunt Group’ with bespoke messages with Call Centre to allow staff in Booking to pick-up calls waiting when team is busy. The bespoke message would be repeated every 30 secondsImplementation of Dr Dr project and enhanced patient communication. The service also allow us (via a portal) to send along with the text , instructions on travel and site services. A third screen where we can upload Trust speciality specific information for patients on what to expect form the service they are visiting.Piloting in three specialities commencing in February: Ophthalmology, Respiratory and Gastro. www.dbth.nhs.ukPotential solutions(3/4)

32. Further technology:We are also working with Doncaster Health Watch and Doncaster college to produce videos which we will upload onto the portal:This will help patients visualise an attendance at the outpatient appointment they will be attendingThe responses to the text messages form an IT worklist for the Booking staff to work throughIt is expected that this project will reduce DNAs and reduce calls into the call centre.www.dbth.nhs.ukPotential solutions(4/4)

33. Thank you, any questions?

34. www.dbth.nhs.ukDr Kirsty Edmondson-JonesDirector of Estates and FacilitiesManaging violence and aggressionAn update on approach at DBTH

35. Secretary of State for Health Directions – each NHS body must nominate one of its Executive Team as Security Management Director (SMD) to take responsibility for security management matters, including responsibility for measures to deal with violence against NHS staff. Nominated SMD - Kirsty Edmondson-Jones, who in turn nominated Kerry Williams as the Accredited Security Management Specialist (ASMS) who will work within a clear legal framework as set out in the Secretary of State Directions www.dbth.nhs.ukDirections to deal with violence

36. At a RCN’s stakeholder event about the Assaults against Emergency Workers (Offences) Act 2018, Matt Hancock - Health Secretary, launched the new NHS Violence Reduction Strategy which will include new Security Standards. NHS Improvement with NHS England with engagement across NHS Reinforces Government commitment to NHS staff safety and welfare Legally security management function remains with Health and Social Care Secretary until it is designated by directions to another NHS bodyThe Department of Health and Social Care’s legal team have begun this process which should be complete within four to six months. www.dbth.nhs.ukNHS Violence Reduction Strategy

37. Violence towards staff is increasing, particularly from younger patients, often through alcohol or drug related admissionsSouth Yorkshire Police recognise there is an increasing number of gang related crimes and increasing violence with a direct impact on our staffDoncaster Council’s ‘Public Spaces Protection Order’ (PSPO) displacing rough sleepers, drug/alcohol users to DRI site, and their suppliers.www.dbth.nhs.ukCurrent challenges(1/2)

38. Organised Crime – relating to patients from local prisonsIncreases in break-ins and property damageIncreased anti-social behaviourShould be noted that a high percentage of violence as a result of medication or condition of patientswww.dbth.nhs.ukCurrent challenges(2/2)

39. www.dbth.nhs.ukDrugs found on site - January

40. www.dbth.nhs.ukRough sleepers on site - January

41. www.dbth.nhs.ukStatistics: Assaults YearAssaults involving Medical FactorsAssaults not involving medical factorsTotal2012/13181481662013/14138662042014/152501393892015/161041412452016/172721133852017/18199129328

42. www.dbth.nhs.ukWe have remained within control figure.Statistics: Violence and aggression (two years)

43. www.dbth.nhs.ukTypes of violence and aggressionNovember to December 2018

44. All staff receive a minimum of three hour face-to-face training.Course Aims:Describe common causes of conflict.Describe two forms of communication.Give examples of communication breakdown.Discuss communication models when dealing with conflict.Describe different patterns of behaviour that they may encounter during different interactions.Explain different warning and danger signs.Give examples of impact factors.Describe the use of distance when dealing with conflict.Explain the use of “Reasonable Force” as it applies to conflict resolution.Describe the different methods for dealing with conflict resolution.www.dbth.nhs.ukConflict resolution training

45. The LSMS has undertaken an evaluation of breakaway training and its delivery by the team at RDASH, with a view to a collaborative working arrangement including conflict resolution training provision by DBTH to RDASH staff in return for breakaway training to DBTH staff. If successful this will enable the Trust to provide enhanced breakaway training to Care Groups with a higher incidence of violence and aggression and other outlying wards on request, for example ED.All divisions have been sent example risk assessments and a TNA for the proposed 3 levels of conflict resolution training, and a request that risk assessments are completed and returned for evaluation, to ensure staff receive the correct level of training to the needs of the Departments.Encouragement required to increase uptake.www.dbth.nhs.ukBreakaway training

46. South Yorkshire Police have requested a meeting with Richard Parker to discuss demand reduction:Doncaster Royal Infirmary has the highest number of calls to the Police requesting assistanceA local Officer has been tasked with reducing the demand to our siteLocal Police Community Support Officers visiting DRI a minimum of a twice a week Bassetlaw a procedure in place with Nottinghamshire Police Force where bi-monthly meetings are held with the Beat managerX-ray Arch to be used ad-hoc ED DRI Sniffer Dogs to visit ad-hoc DRI.www.dbth.nhs.ukPolice engagement

47. Following a meeting with South Yorkshire Police 24th Jan, the following has been agreed:South Yorkshire Police will issue Community Protection Notices (CPN) whilst evidence is collected for a Criminal Behaviour Order (CBO), for persistent offenders.New Security Officers to wear Body Cameras and record any individuals found sleeping on site and download the footage for evidence file.Police will increase presence on site – Single Point of Contact is based on local Neighbourhood team Government legislation for tougher sanctions for those who abuse Health Care Workers – Police will be encouraged to investigate acts of intentional violence towards staff, and promote convictionsTo review local Concordat for Care of Prisoners - to include searching from Prison Guards.www.dbth.nhs.ukNewly-agreed measures

48. Thank you, any questions?

49. www.dbth.nhs.ukJonathan SargeantDirector of Finance

50. www.dbth.nhs.ukFinance at DBTHOur month nine position was a a small surplus of £59k with the year-to-date position at £11.5m deficitThe Trust has made small surpluses for the past three months, something which has not been achieved since 2015. In order to reach our overall target for the year we must achieve a better than break-even position every month until March 2019As ever, we must make the most of every penny spent!We continue to work with staff on their cost-saving ideas.

51. David PurdueDeputy Chief Executive & Chief Operating Officer www.dbth.nhs.uk

52. 4 hour access – This quarter we achieved 92.12%, year-to-date we are at 92.9%. The national average is 86.4%RTT – At 86.6%, slightly behind our commissioner target of 89.1%Cancer targets – 62 day performance achieved at 86.9% against the 85% standard. Two Week Wait performance was 91.9% against the 93% targetStroke – Performance against one hour scan standard decreased to 55.4% and direct admissions at 57.1%.www.dbth.nhs.ukPerformance at DBTH

53. C.Diff – Below trajectory for the yearHSMR – The Trust’s rolling 12 month position remains better than the expected level of 100 at 93.43Serious incidents – Decrease overallFalls – Performance is slightly higher year-to-date than 2018Pressure ulcers – Higher than last year but reducingFriends and Family – Response rates slightly behind national average but positive feedback higher than national average.www.dbth.nhs.ukQuality at DBTH

54. Nursing workforce – The Trust’s overall planned versus actual hours worked was 98% in DecemberAppraisal rate – The Trust’s appraisal completion rate has risen to 78.85%, the ‘Appraisal Season’ will begins in April. SET Training – There has been a slight increase in compliance with Statutory and Essential Training (SET) to 81.78%.www.dbth.nhs.ukWorkforce at DBTH

55. www.dbth.nhs.ukRichard Parker OBEChief Executive

56. In November we achieved an entire year (and counting) without any hospital-acquired MRSA at the TrustThe NHS Long-term Plan was published in early January – we are currently exploring how this fits with our five year strategyIn-line with national guidance we are working towards the removal of fax machines by 2020 at the Trust, moving to secure emailIn early January, we implemented a small charge of 50p for use of the Park and RideOur Chequer Road Clinic will be moving shortly.www.dbth.nhs.ukUpdate from the CE

57. NHS England and NHS Improvement have announced their new joint senior leadership team as they work more closelyIn early December, we opened the Macmillan ‘Pod’ in our outpatient department at DRIWe began the search for three new staff governors and ten new public governors. We are currently encouraging members of Team DBTH to come forward to stand, as well as casting our net far and wide in Doncaster and Bassetlaw for our public seats.www.dbth.nhs.ukUpdate from the CE

58. www.dbth.nhs.ukUpdate from the CEThe Trust’s library service received top marks in the library assurance process undertaken by Health Education England for the third year runningOur Pathology Service was granted full accreditation by the United Kingdom Accreditation ServiceWe appointed Dr Mike Whiteside as our new Chief Clinical Information Officer to help to spearhead a lot of our upcoming work such as introducing an electronic patient record.

59. Mr Muhammad Shahed Quraishi was appointed President of the Royal Society of Medicine for ENT and Laryngology in early NovemberIn preparation for Brexit, in December we signposted members of staff who are EU citizens (non-UK nationals) to the EU Settlement Scheme to help ensure residency after the UK leaves the European UnionWe signed the ‘Armed Forces Covenant’ in mid-January, ensuring that those serving are catered for by the Trust. www.dbth.nhs.ukUpdate from the CE

60. www.dbth.nhs.ukSuzy Brain England OBEChair of the Board

61. In late 2018, I had the privilege of presenting an award to Hannah Pendergast, our monthly Star – and would encourage you all to nominate members of Team DBTH who go above and beyond in their roleSince the Trust moved to its new structure, I have met with all of the Divisional Directors to offer support and Non-Executive Directors will also be working closely with themIn December 2018, I had the pleasure of hosting the Volunteer’s Christmas Brunch – a wonderful opportunity to say ‘thank you’ to those who give their time to help the hospital freely.www.dbth.nhs.ukUpdate from the Chair

62. Stay in touchKeep up-to-date with the Trust by following our social media accounts and checking our website (link in the bottom right corner).www.dbth.nhs.ukFacebook@DBHNHSTwitter@DBH_NHSFTInstagram@DBTH_NHSFB Staff groupDBTH Staff

63. Thank you, any questions?