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North Cumbria University Hospitals NHS Trust - 70 years of the NHS

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Continuing our journey of improvement

Posted on Monday 9th December 2013
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West Cumberland Hospital, Whitehaven

North Cumbria University Hospitals NHS Trust is continuing its journey of improvement to patient safety and care at its two hospitals – the Cumberland Infirmary in Carlisle and West Cumberland Hospital in Whitehaven – since it was identified as an outlier in the annual Dr Foster Good Hospital Guide 2011/12.

In the latest Dr Foster Good Hospital Guide published on Friday 6 December, the Trust’s Hospital Standardised Mortality Ratio (HMSR)* used by Dr Foster Intelligence is 112 with the Trust moving from its 4th position to 10th demonstrating reasonable progress. There has been some improvement to our HMSR at weekends however, overall we remain an outlier.

The Trust has also improved its ‘standardised hospital mortality indicator’ (SHMI) - which covers 100% of deaths which occur both in hospital and those which happen in the community up to 30 days after discharge – with Dr Foster stating this has improved from 118 to 108.

It is important to note that analysing hospital mortality ratios is a very complex process – this is illustrated by the fact that the two different mortality measures (HSMR and SHMI) generate two different pictures of ‘outlier’ trusts.

The Trust was one of 14 hospital trusts identified as having higher than expected mortality ratios and became part of the Keogh Review in May 2013.

The Keogh team clearly recognised that alongside the changes that had been made, or were in development, they would positively impact on patient care. Improvements are taking place all the time and our Keogh action plan is monitored each month at our public Trust Board meeting and placed online.

A safety panel meets weekly with the aim of eliminating harm from the hospitals and we are continuing to develop and refine our care systems to meet the needs of our patients.

Some of the things we have already done include:

  • Acute care physicians are now working seven days a week 8am to 10pm to assess patients quickly
  • Over 10,000 patients have participated in our new patient experience programme and feedback is providing the Trust with a wealth of knowledge about what patients are experiencing within the hospitals, as well as showing where wards can improve further.  The latest results show:
  • 98.7% patients state being treated with respect and dignity
  • 89 % of inpatients rate the Trust as excellent, very good or good
  • 93% of outpatients rate the Trust as excellent, very good or good
  • A new nursing structure has been put in place on all wards with dedicated ward managers and matrons are providing clear leadership and accountability to frontline nursing teams 
  • An increase in the number of serious incidents being openly reported with Trust wide improvements identified and changes implemented to improve patient safety and embed learning
  • Focussing all emergency high-risk trauma and orthopaedic patients at the Cumberland Infirmary in Carlisle to improve patient safety
  • Recruitment to 20 consultant posts, with the aim of reducing dependency on locum cover, and to over 100 nursing posts
  • An organisational development programme and leadership programme entitled ‘high performing clinical leaders’ is underway with around 100 senior leaders across the organisation
  • A comprehensive review of estates and facilities, with all theatres now fully compliant in relation to issues picked up in the Keogh Review 

Dr Jeremy Rushmer, Interim Medical Director, said: “The improvements we are putting in place to ensure that we are providing the optimum levels of safe care is beginning to take effect. We are, however, on a long journey and we are continuing to meet our challenges head on to improve our care. Our patients deserve nothing less from us.”