Looking back and looking ahead:
2012 will be remembered as a remarkable year for this country, and it has been a great year for the Trust too.
Our performance has dramatically improved. We have made investments around the hospital in extra beds, new facilities and extra doctors, and all this hard work has paid off. The Trust is now rated as ‘performing’, putting us among some of the best healthcare providers in the country.
In September the Care Quality Commission (CQC) published their report on their recent visit to the services we provide at Crawley Hospital. Overall we met all the standards the CQC inspected and the report includes some glowing commendations of staff and our services. The report said: ‘People spoken with during our visit were very pleased with the quality of care they received from the trust at Crawley Hospital. One person told us that they felt lucky to have such a local facility, because the care provided there was, “excellent in all respects”.’ The full report can be found on the CQC website.
In 2012 we made significant strides in improving the facilities at East Surrey Hospital. The new Main Entrance has a fully staffed reception to help guide people to where they want to go, a WHSmith, Costa Coffee and Boots that is dispensing outpatient prescriptions. The new entrance was the final phase in the £35 million refurbishment programme that has seen the opening of two new wards and the renovation of our Endoscopy department.
We were privileged to have HRH Princess Alexandra visit the hospital in June to take a tour of the new facilities and unveil a plaque honouring her visit. It was the first time in the hospital’s 25-year history that a member of the royal family had visited East Surrey Hospital.
The building work continues. The Postgraduate Education Centre (PGEC) refurbishment is well underway. This year the Trust was made an Associated University Hospital of Brighton and Sussex Medical School, and the PGEC needed to expand to facilitate the additional training and development opportunities.
Also, a £10M development has been agreed between the Royal Surrey County Hospital NHS Foundation Trust and Surrey and Sussex Healthcare NHS Trust to provide radiotherapy from the East Surrey Hospital site. This development will place two state of the art radiotherapy linear accelerators (Linacs) at East Surrey Hospital, and will mean that patients from East Surrey and north-east West Sussex currently travelling to Guildford for radiotherapy, will be able to receive treatment much closer to home. The radiotherapy unit is expected to be open by the beginning of 2014.
We still have a month left of 2012 and winter is upon us, so we must remained focussed on the present. But at a glance, 2013 is promising to be a very exciting year with CCG’s officially taking control in April, and our journey towards Foundation Trust gathering momentum. It will be tricky at times as the NHS gets to grips with the new way of working, but if we work together and keep in mind the Trust’s vision of ‘putting people first and delivering excellent and accessible healthcare’, then our patient care and their experience will only get better.
For October 2012 the Trust is expected to be rated as “Performing” for Quality of Services. This average rating is based on CQC registration, Integrated Measures, Patient Experience, and Overall Quality of Services.
• The Emergency Department continued to achieve the 95% standard in October 2012 for the sixth consecutive month, and with performance in October of 98%.
• There was one incidence of MRSA and two incidences of C-Diff during October resulting in C-Diff being 11 cases below the straight line YTD trajectory and MRSA on the YTD trajectory.
• RTT performance continued as expected with the 90% Admitted, 95% non-admitted and 92% incompletes measures all being achieved in aggregate.
• The percentage of patients waiting 6 weeks or more for a diagnostic returned to normal levels in October. Performance in month is 0.2%, putting this measure in the performing category.
• Delayed Transfers of Care continued to be below the 3.5% standard.
• Following achievement of no mixed sex breaches for the first time in July, this performance was sustained into October.
The Trust’s overall ‘performing’ score means, among other things, our overall patient experience has improved. However, the Trust expects to be rated as ‘Performance Under Review’ for this particular domain in October 2012, so we still need to do more to improve our patients’ experience.
Following the agreement with the Department of Health to accept the revised inpatient survey results that have been collected, the Trust has begun its three month ‘Your Care Matters’ inpatient survey. This is a new approach to collecting feedback from our patients. The aim is to increase the robustness of patient feedback data and hence its reliability. Results will be available at ward level and can be aggregated to directorate level and tracked over time. Data from the survey will be turned around faster, allowing the Trust to respond to the needs of patients in a timelier manner.
The use of the Patient Opinion website has continued to increase as a result of the publicity actions the Trust has taken. Although the number of respondents on NHS choices remains lower than hoped, the percentage of NHS Choices users who would recommend SASH has been increasing month on month since August. For the month of October 60% of respondents would recommend the Trust. This result is based on feedback since the start of the NHS Choices system. Looking at the feedback during this financial year, in excess of 79% of patients would recommend the Trust to their friends and family.
One area where our patient experience has drastically improved is in ED. Patients no longer have to endure long waits in ED and we go into winter 2012 with ED in the best shape it’s ever been.
We have made huge levels of investment in both front line staff and the building itself. ED has increased in size by 30%, and includes two new rooms designed for rapid assessment and triage to promote a more efficient and speedy journey for patients. We also now have a separate resuscitation area and a completely separate state-of-the-art paediatric emergency department – specifically designed with children in mind.
This month ED was officially designated as a ‘Trauma Unit’. This means it can provide high quality initial care and stabilize patients with a traumatic injury, and where necessary arrange for their safe transfer to a trauma centre. Being awarded Trauma Unit status is not the end point – we have plans to make our service even better by recruiting even more consultants and building four new theatres.
As you will be aware the Trust has made significant improvements in managing our demand since last winter, however with demand exceeding the number of patients we are able to discharge, we are seeing a severe pressure on patient flow and therefore our ability to manage our medical and surgical take. Recently, we have undertaken a number of actions internally and these include the cancellation of elective in-patient surgery. Your help in managing patients in the community is much appreciated.
• We ask GPs to visit patients before requesting an ambulance or admission (unless immediately life threatening) and consider alternative pathways before referring to the hospital
• Before referring into the acute services or to support the management of patients in the community, please utilise the speciality advice line, where you are able to speak to a senior specialty physician or surgeon, this can be accessed via the switchboard on 01737 768511
• Please ensure the community facilities, such as Caterham and Crawley assessment units are utilised, as well as the Rapid Response (Surrey) and One Call Admission Avoidance (Sussex) Teams
The Trust has a bigger and better ED now and we want to ensure it’s only used by patients who need urgent care.
The Trust has a robust plan in place to deal with the additional demands that winter brings and we have never been better prepared to ensure we maintain our current high performance on quality. But with the forecast for a particularly cold winter, we need your help to ensure patients know where to go for the most appropriate care – especially over the Christmas holidays and Out Of Hours.
25 per cent of people who go to our ED could have been treated elsewhere in the community.
NHS services in this area:
Surrey – Minor Injuries Unit
Caterham Dene Community Hospital Minor Injuries Unit -patients ages 18 and over Church Road, Caterham, CR3 5RA 01883 837500 Over 16’s only
Open 9am to 5pm (last patient will be seen at 4.30), Monday to Friday, excluding bank holidays.
Sussex – NHS Walk-in Centres
Crawley Health Centre (GP-led health centre) 14 Haslett Avenue West, Crawley, RH10 1HS Open 8am–8pm, including weekends and bank holidays 0300 999 3000
Caterham Dene Community Hospital NHS Walk-in Centre Church Road, Caterham, CR3 5RA Open 9am-5pm, Monday to Friday, excluding bank holidays 01883 837512 Over 16’s only
Minor Injuries Units and Urgent Treatment Centres
Horsham Hospital Minor Injury Unit Hurst Road, Horsham, West Sussex, RH12 2DR Open 9am to 5pm, Monday to Friday, except bank holidays 01293 600300 ext 7202
Queen Victoria Hospital Minor Injury Unit Holtye Road, East Grinstead, West Sussex, RH19 3DZ Open 8am to 10pm, seven days a week, including bank holidays 01342 414375
Crawley Hospital Urgent Treatment Centre West Green Drive, Crawley, West Sussex, RH11 7DH Open 24 hours a day, seven days a week, including bank holidays 01293 600300 ext 4141
Self-care and pharmacies:
High-street pharmacists are one alternative for:
– easily accessible, confidential care and treatment for minor ailments - advice on self-care
Winter illness – Make sure your medicine cabinet is stocked up with:
• Paracetamol or aspirin
• Rehydration mixture
• Thermometer (a high temperature is usually above 38C)
In preparation for winter it is important you urge our patients who are at risk of becoming dangerously ill from flu, to get their free flu jab ASAP.
Norovirus season has started early this year and it is essential that all healthcare workers are alert to the possibility of this diagnosis. Norovirus is highly infectious. Aside from the effect this illness may have on vulnerable hospitalised patients, the infection control measures employed to contain spread within the hospital environment frequently include partial or full ward closures. This in turn can have a very significant effect on the operational running of the hospital.
You may be aware that we have already seen cases at ESH, with patients and staff on several wards being affected. A proportion of these cases have come in from the community either with symptoms or incubating the illness. Although norovirus can be a very unpleasant illness, it is self limiting and in the vast majority of cases hospital admission is not required. In order to reduce the risk of introducing new cases into the acute hospital setting where risk of cross transmission to vulnerable patients and staff is high, suspected cases should be managed in the community where possible and practical.
Please consider the following when assessing patients:
• Has your patient had diarrhoea and/or vomiting within the last 48h? If so is an infectious cause likely?
• Can your patient be safely managed with supportive/symptomatic care in the community: oral rehydration (or IV/sub-cutaneous if appropriate) and anti-emetics?
• Has your patient been in contact with a suspected or confirmed case of viral gastroenteritis within the last 48h?
If hospital admission for suspected cases or contacts is unavoidable then please ensure that symptom and exposure history is clearly communicated to the triage/admitting team.
For more information
Detailed information on Norovirus symptoms and management plus useful information for patients can be found on the HPA
http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/Norovirus and NHS Choices http://www.nhs.uk/Conditions/Norovirus/Pages/Introduction.aspx websites.
Deep Vein Thrombosis
The DVT (deep vein thrombosis) pathway. Please do not send patients with suspected DVT to the emergency department at East Surrey Hospital during working hours.
All Surrey suspected DVT patients who are mobile should be referred to Caterham Dene rapid assessment clinic Monday to Friday 09:00-17:00. For unwell patients, who are immobile, they need to be referred directly to the medical registrar on call. The Out of Hours arrangement is the same.
East Surrey Hospital’s Emergency Department will see suspected DVT referral via the Out of Hours GP service.
All Sussex suspected DVT patients who are mobile, should be referred to Comet ward, Crawley Hospital Monday to Friday 08:00-18:00. Out of hours can be referred to Crawley urgent treatment centre. The unwell and immobile patients need to be discussed with Comet ward. If the patient cannot be dealt with by Comet ward, they need to be referred to the medical registrar on call.
Your care matters
The Trust is ahead of the game when it comes to listening to patients. We already publish a live feed on our website from the Patient Opinion site. All of the comments about our services and care are openly available to read on our website. We have been praised in the press for embracing the Patient Opinion conversations in such an open and honest way.
In our pursuit of excellence and to continue to improve our patients’ experience, we launched a new survey called ‘Your care matters’ for a three month trial on 12 November. All adult inpatients in medical and surgical wards are asked to participate either by phone or on-line, and the aim of the survey is to help us better understand our patients’ experience and how we can improve our services. By actively listening to our patients we can co-design improvements to the hospital and our services.
As well as answering questions about the ward on which they spent the longest time, patients will also have the opportunity to mention a staff member who they believe has gone above and beyond their call of duty and these staff members will get commended for their effort. In the first week of the survey launching, we celebrated nearly 10 staff commendations.
Patients completing the survey will be asked if they would like to leave a comment on Patient Opinion and will be automatically linked to this site. These comments will appear on our website as usual, and the survey results will be fed back to the relevant ward.
Update following Crawley fire
A fire incident happened at Crawley Hospital in August and disrupted all of the services that run out of Comet ward, which include the hospital’s medical day unit and some outpatient chemotherapy.
Comet ward is now open again and we are working closely with NHS Sussex to move back in a safe and planned way.
The new patients with suspected DVT’s continue to be assessed by AMU at ESH and this arrangement will continue at present.
The haematology clinic has been moved to Outpatients 2 at Crawley hospital, and will remain there until the New Year.
SASH paediatric outpatient service that has clinics on Thursdays and Fridays has temporarily relocated to the paediatric outpatients department at East Surrey Hospital.
Health Tourism Fraud
The recent media coverage of “Health Tourism” is timely and welcome publicity on an important type of NHS fraud. “Health Tourism” covers a multitude of activities but the outcome they share in common is that people receive non-emergency hospital healthcare in the UK that they are not entitled to, unless they pay for it.
Panorama reported that some GP practice staff were taking payments to ensure registration applications are successful. Registration with a GP is perfectly legal for anybody visiting or temporarily staying in the UK. Anybody in the UK regardless of their immigration or residency status has the right to free primary and emergency healthcare services. A practice should process and decide upon such applications as with any others, by reference to their policy, and that process should absolutely not include payment or a “signing on” fee, to the GP, the practice or its staff. All such payments are illegal.
The registration with a GP is a key first step for a would-be fraudster, because a registered patient, regardless of their entitlement, might be referred by their GP to a secondary care provider (such as this Trust) for non-emergency elective care.
Under the Bribery Act it is now illegal not only to make / take such a payment (to ensure the registration application is successful) but the organisation suffering the loss may also be prosecuted for not having taken reasonable measures to prevent / detect such payments. It remains unclear as yet whether the “organisation” in such a case would be the PCT/CCG (whose commissioning funds had been defrauded) or the practice as the employer of the bribed employee.
If you have any concerns about fraud and/or bribery, please do not hesitate to contact the Trusts fraud expert on 01732 424147 or 07824307370, or by email at email@example.com or firstname.lastname@example.org