Achievements against local priorities for 2021/22
The following provides information on achievements against local priorities set for 2021/22
Priority One: Patient Safety
Developing a learning from deaths programme to benefit patients.
Our aim within the year was to further develop the Learning from deaths programme through a number of actions including;
- Finalise standard operating procedure to identify cases that meet the learning from deaths criteria.
- Finalise training for Trust clinicians to begin undertaking SJRs.
- Deliver training to Trust clinicians.
- Design learning and feedback mechanisms to fully embed the learning from deaths programme.
Due to operational system pressures and the need to focus on contractual and statutory duties, the programme has not progressed as far as initially planned in the 2021/22 financial year and not all actions have been completed however, the Trust now has a robust identification system in place, to ensure that patients who meet the inclusion criteria are known and a dashboard is set up which is monitored through the Trust’s Patient Safety and Experience Group.
The next step is to train a group of clinicians to undertake the structured judgement review process and embed the learning identified. The Trust has recruited a Safety Improvement Specialist to lead on the improvement work who works closely with the Patient Experience Improvement Lead to ensure triangulation of themes is identified and actions are set for improvements to be made.
This important piece of work will continue in 2022/23 as a priority.
Development and Implementation of the Patient Safety Incident Response Framework.
Our priority for 2021/22 was to complete the development of and start to embed the Patient Safety Incident Response Framework (PSIRF) into the organisation to enable us to improve our ability to learn from incidents using the methodology principles of the Framework.
This piece of work, led by the NHS and not specific to EEAST, was also affected by the ongoing pandemic and the NHS has not been able to progress migration to the PSIRF as planned in the 2021/22 financial year. The early adopter sites have now evaluated the new framework for investigating when things don’t go to plan and EEAST has worked with local and national partners to have a plan in place for when the full migration occurs (expected June 2022. Patient safety specialists are also in post in order to progress this work at pace once the final documents are received and this will continue to be a priority within 2022/23.
Following a rise in the number of incidents reported by staff and other health care providers seen during 2020/21 for patients who were not conveyed to hospital following assessment and treatment by our staff, and a commitment to treat more patients in the community, a priority was set to ensure that appropriate safe decision making was applied for these patients.
This included the introduction of a non-conveyance care bundle which was designed to improve the safety of patients who are discharged from EEAST’s care to another part of the healthcare system and provides staff with a standard of care to deliver to patients, the indicators of which are listed below.
- Establishing the reason for contacting EEAST
- Undertake at least one set of observations, including an ECG if appropriate
- Use of a risk stratification tool, such as NEWS2
- Shared decision making with another Health Care Professional (HCP)
- Adequate safety netting documented
- Adequate worsening advice given
- Detailed documentation of all of the above We also developed an electronic auditing tool to sit alongside the care bundle which allows
for continuous monitoring of its use and to identify focused areas of improvement to further improve the safety and experience of patients not needing hospital treatment. The number of SIs relating to patients left at home for 2021/22 was 17 compared to 18 in the previous year, and the Trust is committed to great improvements in these cases.
This audit is in its infancy and to date 280 audits have been completed of which 52% were fully compliant. Indicators of lower levels of compliance identified for improvement relate to the documentation of the se of a risk stratification tool such as NEWS2, shared decision making with another Health Care Professional (HCP) and documentation of adequate safety netting.
In 2022/23 we will undertake a series of focus groups to understand staff perception of the tool, what can be done to improve the safety of discharges, and to set the appropriate actions. Safety engagement events have also now started with one of the main points on the agenda being to ask about the use of the non-conveyance care bundle.
Priority Two: Clinical effectiveness
Implementation of clinical supervision
As an organisation, we are committed to placing the patient at the centre. This also means we need to focus on our clinicians to enable them to care for others safely and effectively. Our plan is to commit to clinical supervision in our patient-facing workforce. Clinical supervision is a formal provision, by approved supervisors, in a relationship-based education and training system that is work- focused and which manages, supports, develops and evaluates the work.
The objectives of which are:
- To embed a culture that values and achieves effective clinical supervision.
- To ensure clinical supervision is educational and supportive, enabling professional development and growth.
- To ensure clinical supervision is available to all patient-facing-staff.
- To establish a system of clinical supervision that is inclusive, accessible, flexible, built on trust and meets the needs of supervisers.
- To create a shared understanding of the purpose of clinical supervision. • -To ensure that our patient facing workforce are competent and skilled in the role they undertake.
Clinical supervision will be undertaken by members of staff who have completed their consolidation phase of clinical practice, are experienced as a Practice Educator (PEd) and who have undertaken further training in supervision of the wider workforce, including those not on a learner journey.
Clinical supervision is an ongoing process and as a minimum each patient-facing member of staff should have at least eight hours protected time to undertake supervision each year, over at least two periods of supervision.
Core emergency operations staff will be allocated to a practice supervision group. Where not working on a mentorship and Support Vehicle Team (MST), each clinical supervisor will provide supervision to a group of approximately 20 staff. For other specialist groups, which will be provided on a sector basis.
In 2021/22 we began to build on the work that we had started in the previous year, unfortunately this was limited due to the ongoing COVID19 pandemic and the impact this had on the organisation. However, we did complete some actions including;
- Approval and publication of our Clinical Supervision Policy
- Development and agreement of the role and associated job and person specification.
- Initial round of the posts being advertised within two sectors of which we received more than 25 applications.
The high importance of this plan is recognised within the organisation with a commitment to continue this going forward, therefore this will continue as a priority for 2022/23.
Mobile Stroke Unit – trial within Norwich and Ipswich areas
Since the publication of the last years Quality Account the Trust has continued to operate the Mobile Stroke Unit (MSU) within our East Suffolk Locality. After the initial feasibility trial that was discussed in the last Quality Account the Trust has submitted and received ethical approval from the Health Research Authority to undertake a clinical trial of the mobile stroke unit concept. This is a randomised control trial where patients are allocated to the MSU arm of the trial when it is available on randomly allocated weekly blocks. Recruitment to this trial commenced in March 2021 and aims to recruit over 800 patients. Recruitment is due to continue throughout 2022 and in to 2023. This is the first and only trial of its kind in the United Kingdom.
The MSU, since it has been with EEAST has assessed and managed hundreds of patients, in doing delivering the highest quality of care alongside interventions normally only delivered in a hospital setting. The team responsible for the MSU have published one paper in a scientific journal, ‘Mobile Stroke Unit in the UK Healthcare System: Avoidance of unnecessary accident and emergency admissions’ which was an initial feasibility study and a second paper is currently undergoing peer review for publication. As recruitment to the randomised control trial is still underway there is no data currently available to present beyond what has been published via open source. However, the trial team are k een to engage with anyone who is interested and can be contacted through EEAST by emailing QualityAccount@eastamb.nhs.uk
Launch of the Trust’s Clinical Strategy
With the extended period of Covid 19 as well as development of the new ICS Boards the Trust has been working in collaborative approach on its Urgent and Emergency Care Strategy. This document will incorporate the clinical priorities as well so will provide a single integrated direction for the Trust in how it will deliver high quality, safe and effective clinical care.
At the core of the strategy will be the need to work in collaboration with all providers to ensure the patient receives the appropriate care for their presenting condition. This could include a single 999/111 call system where patients are sign posted and managed by the appropriate part of the healthcare system. Over the last year several pieces of work have been occurring across the region which will influenc e the work and the direction of the strategy. The Trust will launch this integrated strategy over the forthcoming year and this will remain a priority for 2022/23.
Produce a Public Health Strategy in collaboration with Public Health England
EEAST has continued to work in collaboration with the public health network, Association of Ambulance Chief Executives (AACE) and NHSE in establishing the role that ambulance services will play in the system wide approach to tackling public health issues and will ensure that public health is embedded within the trusts urgent and emergency care strategy.
The role of the ambulance service as part of the public health strategy is still in an evolution stage with the continuation of identification and data gathering and EEAST continues to work closely with a designated Public Health (PH) registrar from Public Health England (PHE) to develop and align the developing strategy with the wider system goals and priorities.
The COVID-19 pandemic has sadly continued to put a hold on the timelines, primarily due to workforce priorities and capacity, but also the implications the pandemic would have on our approach to public health. It was felt that a revised deadline would be better to allow time to reflect, adapt and integrate the learning found from the COVID-19 pandemic into the PH strategy and as such, this will be an ongoing priority into 2021/22.
Enhancement of our Annual Clinical Audit Plan
Clinical audit is a crucial part of the Trust’s strategy to improve health care to service users. The evaluation of clinical performance against standards or through comparative analysis, with the aim of informing the management of services, is an essential component of modern healthcare provision. It forms part of the Trust’s clinical governance arrangements helping to ensure safe and effective clinical practices.
Unfortunately, the increased volume of cases for cardiac arrests, stroke and STEMI patients within the mandated national audits and the increase in records completed on paper whilst the Trust moved to a new ePCR platform, greatly impacted our own availability to undertake any local defined audits within 2020/21. To ensure that a focus was in place to complete this important annual piece of work, a priority was set within last year’s Quality Account.
In line with our aim, the revised plan considered several drivers including patient feedback, themes from incidents and serious incidents, NICE guidance, NHS Long Term Plan as well as the nationally mandated audits as directed by NHSE&I through the ACQI programme.
Our Clinical Audit Policy was also updated to ensure it aligned to the latest best practice advocated by the Healthcare Quality Improvement Partnership (HQIP).
Despite our best endeavours, the ongoing pandemic meant that not all audit topics defined within the plan were completed, however this was significant progress on the previous two years when only the ACQI topics had PCR submission audit were undertaken.
A proposal was made to our Quality Governance Committee that the plan for 2021/22 is repeated in 2022/23 which will enable all topics to be completed. Those that were not completed during the year will be prioritised, although it should be noted that for audits relating to mental health patients, this will be moving to a national audit and the Trust is still waiting for notification as to when this will begin.
The Trust will also be celebrating Clinical Audit Awareness Week in June, a national campaign hosted by HQIP to promote and celebrate the benefits and impact of clinical audit and quality improvement work in healthcare.
For information relating to audit outcomes, please see the clinical audit page.
Priority Three: Patient Experience
Within this priority, in 2021/22 we attempted to continue with the three main objectives set in 2019/20 in relation to improving the experience and quality of care for people with learning disabilities and obtaining feedback from these patients and other harder to reach groups, such as younger people or patients with dementia, however our planned engagement events, including that related to our Learning Disability and Autism Strategy, were cancelled in response to government’s social restrictions.
Despite our aspirations in the delivery of this strategy, we were thwarted by the global pandemic and its impact on both our service and our patients.
Part of our year 1 milestones were to host a number of events at which patients and their carers could participate, however due to the nationally invoked actions and legislation severely restricting engagement, these events had to be postponed which has impacted on the construction of feedback processes for this patient group.
During the next few months we will be re-invigorating and re-launching the strategy, contacting patients’ representatives and advocacy groups and working with the patient experience team to engage with other groups and system partners to support us in achieving the s trategic aims which are to;
- Deliver compassionate person-centred care and recognise the uniqueness of all those living with a learning disability, autism or both.
- Develop a skilled and effective workforce able to champion compassionate person-centred care.
- Develop the ‘Easyread’ option within all Trust communications workstreams and patient care documentation.
- Seek and action feedback from people living with a learning disability, autism or both and their carers to improve the quality of service we provide.
- Develop internal systems that allow the patient living with a learning disability, autism or both to be placed at the centre of joint care planning whilst ensuring that their rights are protected and respected in all aspects of Trust business.
- Develop effective partnerships with local agencies (health, social care, third sector) to improve care and outcomes.
Experiences of emergency services patients with learning disabilities
As previously state, the planned focus groups for these patients were not able to take place in 2021/22 due to the COVID-19 restrictions and we were reluctant to develop a bespoke survey form without this valuable feedback.
However we reviewed the equality and diversity monitoring questions within the emergency service/emergency clinical assessment triage responses and determined the following.
• 84.6% rated the service received from EEAST as ‘good’ or ‘very good.’ Over three quarters of respondents (76.9%) rated the 999 call handling as ‘good’ or ‘very good,’ and 72.7% of respondents were satisfied with the length of wait for an emergency response. Ambulance service staff were mostly rated as ‘good’ or ‘excellent’ (84.6%), with all respondents advising that they were treated with dignity and respect to at least ‘some extent.’ Overall, 90.9% of respondents understood the explanation of their treatment and care and felt involved to at least ‘some extent’ (91.7%) in the decisions made regarding their care. The majority of additional comments received were positive in relation to the service and staff, however, the main area of dissatisfaction was in relation to staff attitude.
• The co-produced Patient and Public Involvement (PPI) Strategy was led by patients, the public and stakeholders, including Experts by Experience who have a lived experience of a learning disability. The strategy will ensure that the key domains as identified by our patients and public directly lead the direction for patient engagement and involvement, for the patient voice to be heard and to directly influence service improvement and service delivery. An easy read version of this strategy (produced by ACE Anglia) is now available on the Trust’s public website.
- During 2022/23, the patient experience department has begun to work with external providers to improve accessibility to the complaints process, patient surveys have been reviewed to become more streamlined and user friendly, with patient survey reports now published on the Trust website using the accessible template format. The continuous surveys are available online and can be completed using the ReachDeck Toolbar Everything function, with alterative survey formats also available as options (e.g., large print, Braille or in a different language).
- The Trust has recently been in liaison with the Norfolk and Norwich SEND Association in relation to the co-production of an easy read survey, which is planned to take place during 2022/23. The Patient Survey Programme for 2022/23 also includes a planned survey project in relation to patients with a learning disability who have contacted our emergency service. Due to the pandemic, the digital platform has been used as the main method for patient engagement and involvement. This has been of great value, particularly during the pandemic, however, going forward face to face engagement, where possible, may allow for a more inclusive input from patients and carers where verbal communication is not necessary the primary communication tool.
The Patient Survey Team has worked closely with the Clinical Lead in relation to the Trust’s Dementia Strategy. Two Dementia survey projects have taken place over the past few years, however, a specific survey for our social care partners and their experiences following contact with the Trust had not previously been undertaken.
The Trust is always keen to engage with social care partners and identified an opportunity to engage with care home staff, given that many patients with Dementia in care settings had been isolated from their family members during the COVID-19 pandemic. During 2021/22, a pilot survey for care home staff was designed and posted to 32 Norse Care Homes within the Norfolk and Suffolk area, inviting staff to provide feedback on their experiences. The survey project was also discussed and shared with the Registered Care Home Managers Network.
Despite the signposting, only a small number of survey responses were received. Given the current pressures due to the pandemic (for EEAST and our social care partners), this survey project has been postponed to 2023/24.
During 2021/22, a pilot young patient mental health Instagram survey was designed in collaboration with Experts by Experience from the Youth in Mind Group. Trust patient surveys are regularly signposted via social media; however, Instagram had not previously been used a method for obtaining patient feedback method.
The survey went live on the Trust’s Instagram stories in January 2022 and received 1,825 views, highlighting the need to trail new methods to ensure the feedback is received across different patient groups.
Overall, 73 respondents had previously contacted 999 in relation to a mental health crisis. 27 respondents (22.9%) advised that a mental health service had been accessed prior to the call, however, 91 respondents (77.1%) had either not accessed a mental health service (52.5%) or had not been aware as to what mental health services were available (24.6%).
Positively, overall satisfaction and the attitude of ambulance service staff were rated as ‘good’ or ‘excellent’ on average on the sliding scale, with positive comments also received to this regard. 81 respondents (69.8%) felt that that the call handler listened and understood their needs at the time of their 999 call, however, 35 respondents (30.2%) did not feel that their needs were understood or that they were listened to.
The results of this survey have been discussed with the Trust’s mental health team and Experts by Experience.
Further call handling engagement sessions are planned for 2022/23 and communications will also be publicised in relation to the call handling process and what a patient should expect if they need to call 999. The Instagram survey has been included on the Trust’s social media plan for 2022/23. The continuation of this survey will ensure the patient voice is heard to highlight areas of good practice but to also identify areas for learning and service improvement.
Experiences of emergency services patients who are of an ethnic minority group
During 2021/22, 38 respondents who completed the ES/ECAT equality and diversity monitoring section of the survey advised that they were of an ethnic minority group. Of these respondents, 86.8% rated the service received from EEAST as ‘good’ or ‘very good.’ 82.9% of the respondents were satisfied with the handling of their emergency call, and 70.3% rated the length of wait for an emergency response as ‘good’ or ‘very good.’ However, 21.6% of the respondents rated the length of wait as ‘poor’ or ‘very poor.’
Ambulance service staff were generally rated highly as ‘good’ or ‘excellent’ (94.1%), with the same proportion of respondents recalling that they were treated with dignity and respect. Overall, 94.1% of respondents understood the explanation of their treatment and care, with all respondents advising that they felt involved to at least ‘some extent’ in decisions made regarding their care.
A number of additional comments were received, which were mostly positive and highlighted the professionalism, kindness and care provided by staff. The main theme to arise from the additional comments was in relation to ambulance delays/non-attendance, followed by staff attitude.
The demographical information received through surveys will continue to be monitored alongside the patient experience feedback received.
Over the past year, a Patient and Public Involvement (PPI) Strategy has been co-produced with members of the public, patients and stakeholders. This was the first entirely co-produced strategy undertaken by the Trust, and was led by patients, the public and stakeholders through a series of 16 co-production workshops, with 70 attendances by patients, community representatives, volunteers and patient groups, which included patients of an ethnic minority and those in harder to reach groups. This strategy will provide clear direction in relation to patient and public engagement and involvement over the next three years and ensure the patient voice is heard across different patient groups.
New Patient Transport Service Vehicle Specification
In last year’s document we set out a priority to involve dementia patients and their cares in the new PTS vehicle specification for future procurement, unfortunately we have not progressed the level of engagement that had originally been planned due to the restrictions of the pandemic and to protect these groups of vulnerable patients.
However now that restrictions have lifted, some actions have already taken place, this includes; liaising with the North East Ambulance Service NHS Trust, who undertook a similar project during 2019, to learn from their processes, discussions with a care home in Bedfordshire who are keen to support this work and links with carers in Cambridgeshire are also being explored.
We have been in liaison with North East Ambulance Service NHS Trust, who have already undertaken a similar project during 2019, and we will be replicating the processes they developed. Now that COVID requirements have reduced, we are in discussion with a Care Home in Bedfordshire who are keen to support this work. Links with other carers in Cambridgeshire are also being explored.
We have also worked with staff and union representatives from across the organisation, to harness the expertise of a large staff group.
There has been good engagement, and a range of ideas have been explored. Small adaptations can be made, particularly to colour schemes, to enhance the environment for patients. Whilst dark colours offer a contrast, some patients have difficulties with dark areas. We are looking at the colour schemes for seats and grab rails.
The length of grab rails is also under review. The next phase of the project will ensure engagement with patient and carer representatives to formulate these ideas further.
Alongside this work, the NHS Executive have produced a national vehicle specification, which includes elements of dementia friendly design. This states that flooring should be matte rather than shiny, and steps should have a contrasting step along the front edge. These elements are already included in the most recent fleet specification.
A number of steps have been planned to build on the work undertaken as outlined above, these include;
Working with the Trust’s clinical lead who holds the dementia portfolio to harness useful information gathered during the specification design of our emergency vehicles.
Inviting and working with the Royal National Institute for the Blind (RNIB) to gain essential understanding on things to consider for the design
To continue this as a priority for 2022/23.